By On August 19th, 2014

Pain Beyond Injury

American Soldier Saluting Lost FriendsLast Thursday, August 14, 2014, Michael Bruns spoke about moral injuries at Brookhaven Hospital’s RENEWAL Pastoral Seminar series. Mike is a Brain Injury Case Manager for the Neurologic Rehabilitation Institute with a background in working with people with brain injuries including: military veterans, the homeless, incarcerated people and individuals who have survived disasters like the Joplin tornado. He is an Army veteran having served on the DMZ in Korea. Mike’s presentation dealt with the subject of moral injury which. as he described, is a reaction experienced by “individuals who struggle with the transgressions of moral, spiritual and religious beliefs and are haunted by dissonance and internal conflict”.  In Mike’s definition, moral injury includes what we think of with Post Traumatic Stress Disorder (PTSD): flashbacks, hyper vigilance, and nightmares, re-experiencing the event, irritability, insomnia, depression, fatigue, cognitive deficits, anxiety and self-medication via prescription or illegal drugs and alcohol. He described moral injury as “the infection” and PTSD as the underlying disease. A study involving Vietnam veterans with PTSD examined the relationship of combat experiences to the occurrence of PTSD. In that study, veterans who killed or thought they killed women, children and the elderly experienced a higher rate of PTSD than those who killed enemy combatants. In the conflicts in Iraq and Afghanistan it can be hard for the soldier to determine who the enemy is and the killing of non-soldiers can occur. With that in mind, are PTSD and the related moral injury more of threat?

CNN recently featured the psychological issues faced by returning veterans from Iraq and Afghanistan and the high rates of suicide, PTSD, substance abuse and other psychological problems. The treatment program that was offered to some veterans included exercises to develop trust in others and themselves and to learn to free themselves of pain through Mindfulness meditation. The program’s facilitators were veterans who had faced similar problems. Mike Bruns referred to the veterans needing to heal themselves and in the CNN piece that is exactly what happened.

There is much to be learned about moral injury as part of PTSD and as a separate entity. As an “infection” it occurs in returning veterans, police officers, firefighters, emergency medical personnel, physicians and disaster relief workers, anyone who encounters the aftermath of violence, by their hand or that of another, and experiences suffering at a spiritual level in which they question themselves, society and how God could let that happen. It is an injury of enormous depth which may leave no physical mark. The process of healing is complex and involves bringing the spiritual and religious components into the treatment process.

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