The June 2019 issue of the Journal of Traumatic Stress (JTS) was devoted to Moral Injury (MI). As a clinical psychologist working at a military training hospital where nearly all patients are Warfighters, I was curious about current recommendations regarding the accepted definition of MI, what measure to use, and how to treat it.
When addressing moral injury, there is a need to help patients learn to compartmentalize their experiences. But it doesn’t stop there. Patients then need to be able to step back and see all the pieces of themselves in order to move forward.
Post-Traumatic Stress Disorder (PTSD) among Service members and Veterans receives a lot of well-deserved attention. That said, it was not until 1992, that the term Moral Injury was coined by Dr. Jonathan Shay to describe the devastating impacts of an event or experience that violates one’s personal ideals, ethics, moral expectations, conscience, or attachments. Since moral expectations are at the core of who we are as humans, moral injury describes a fracture to one’s deepest sense of being. The result of this moral violation can lead to guilt, existential crisis, and loss of trust (Jinkerson, 2016).
In the U.S., awareness of mental health problems as a common public health challenge has grown. An important example of societal support and awareness of the need for access to mental health services is reflected in the Mental Health Parity Act (MHPA) of 1996 and the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
Yoga, meditation, weighted blankets, herbal remedies....while interest in complementary and alternative interventions has grown, the science behind them is still cloudy. Rather than try to formulate a one-size-fits-all recommendation, I find it more helpful to consider the ways that the complementary intervention augments or contradicts the evidence-based psychotherapy for that condition. There are four questions that help me critically evaluate the suitability of these interventions for patients.