From our Moral Injury and Veterans Symposium in September 2015. Presented by Elizabeth Stinson.

1. M
oral Injury
Inner Conflict:
Trauma Assessment Project
www.traumaassessment.org

2. Moral Injury & Veterans
Symposium
The Torture of a bad conscience is the hell
of a living soul………….John Calvin

3. Moral Injury is not a diagnosis
Moral Injury can occur when someone,
witnesses, perpetrates, fails to prevent
or learns about acts that transgress
deeply held moral beliefs and
expectations.

4. Moral Injury occurs as a response of deeply felt
Empathy
The injury occurs when an empathetic person
experiences a trauma and has a deep emotional
response to a significant event.
Moral Injury is a normal and empathetic response
to a very abnormal traumatic event.ssi

5. Witnessing or participation in an act of
serious transgression that leads to
inner conflict can result in the
development of a number of serious
psychological symptoms.

6. Know That Moral Injury Is
NOT a Diagnosis
Moral Injury Is Not A Mental
Health Disorder
The event can however lead to the development
Of a number of psychological symptoms

7. Symptoms Moral Injury Can Lead To
Psychological Impact

8. Depression
Anxiety
Dissociation
Hyper-vigilance
Agoraphobia or social withdrawal
Self Medication

9. Symptoms that May Lead to Suicide
Increased hopelessness
Denial of impact of trauma
Feelings of helplessness
Depression
Isolation/avoidance
Lack of support
Numbing
Intrusive thoughts

10. Failure to Recognize Moral Injury
Existing PTSD treatment modalities may
fail to address moral injury.

11. Sense of Betrayal May Lead to
Development of Moral Injury
A moral construct that contains
contributing factors in research on
vulnerability to suicide can include:
Betrayal
Violence against civilians,
Failures in Leadership
Adverse outcomes resulting in killing or
abuse

12. Goals in Healing Moral Injury
Empathy with oneself
The same strength that results in
moral injury can be used in
building a healing narrative for
those who suffer.
Forgiveness of self
Forgiveness of others
Recognition of Somatic Symptoms
Increase in self-regulation

13. Many of the symptoms from suffering moral
injury
Are also co-morbid with mental health
diagnosis.
Knowing your clients capacity for empathy is your
key to
supporting their capacity to heal.

14. Explore with your client abilities for
spiritually directed, socially directed
and personally directed interventions
that
“ help normalize their
response to an abnormal
event”.

15. According to Dr. Bessel Van der Kolk
“The challenge of trauma treatment is not only dealing
with the past...when one does not feel fully here, one
goes to the places where they did feel alive
...even if those places are filled with horror and misery.”
The challenge in healing is enhancing the day to day
experience, Learning to live in the present.

16. Community Goals
Recognition
&
Support
Without the mental health community support to
recognize and address the symptoms of inner
dissonance, the response that contributes to
moral injury cannot be normalized and cognitive
disconnect may continue to interrupt client
function.

17. According to the National Center for PTSD
Current Theory about Moral Injury fits well with
factors associated with suicide
such as:
Feelings that one does not fit well with other people
Feelings that one is a burden on others or society
as well as an acquired capability to overcome the fear
and pain associated with suicide
...Volume 23

18. Suffering from PTSD and Moral Injury can result in
the manifestation of many of the same
symptoms
More Research is needed to more clearly define
and recognize moral injury, as belief systems vary
as do individuals responses to stress.
Traumatization can lead to moral injury when
there is deep conflict with ones belief system.

19. As clinicians committed to working with veterans
We have the opportunity to support their recovery.
Family members and friends may also suffer from
secondary moral injury and secondary trauma from
the sharing of the veterans story and within their
own capacity for empathy
The Torture of a bad conscience is the hell of a
living soul………….John Calvin