I’ve written before about Dr. Jonathan Shay, a pioneer in using the term moral injury to describe what he was seeing in veterans he was counseling. He was one of the first to move away from using the term PTSD. And, he wrote two important books looking through a veterans lens: Odysseus in America and Achilles in Vietnam. His work sets up this quote from a recent article in Quillete:
[Achilles speaking to Odysseus] “I would rather be alive and toiling as serf to another man, one with no land and nothing much to live on, than be a king over all the perished dead.” These words shatter the illusion that the wounds of heroes ever mend—one of the earliest commentaries on the lingering trauma of war for its combatants.
https://quillette.com/2020/04/14/moral-injury-and-the-battle-against-covid-19/
Though I do not agree with this quote for the mere fact that it is written with Veterans Administration (VA) constrained ‘evidence based’ bias:
Far less diagnosed and understood, though, are moral injuries, sometimes described as a “wound to the soul.”
I think that many people treating veterans all too often understand what they are dealing with is a wound to the soul–they just do not know how to deal with the type of psychological wounds veterans present with or they are simply constrained by the strait jacket of the VA environs.
I find this very true, however:
Guilt has been identified as the crucial factor that distinguishes a moral injury, even as other symptoms—anxiety and despair, flashbacks, social isolation, and suicidal thoughts—overlap with PTSD.
This mutually exclusive difference between interiority (moral injury) and exteriority (PTSD) causal correlations is one of the main points I made in my doctoral dissertation: that there is co-morbidity and they are very different things. Unfortunately, until this becomes accepted, the veteran is the one who suffers as ‘soul’ is not in the lexicon of clinicians who toil within the constraints of the VA and its focus on evidence based outcomes.