Staff Perspective: Recovery from Moral Injury – Compartmentalizing the Whole

Staff Perspective: Recovery from Moral Injury – Compartmentalizing the Whole

Compartmentalization - Google it, I dare ya! You will quickly find that it is far from an easy concept. However, what seems to be agreed upon is that it can be both really good… and really bad. It can lead to problematic suppressed emotions and addictive behaviors, but is a must in order to interact with a complex world and ever-present things that create conflict and confusion between what is and what we want to be. When it comes to moral injury, I believe it is absolutely essential in helping people move forward with their lives, but ONLY if the person is able to follow compartmentalizating their life or a situation with then stepping back and bringing all of the pieces together to view the whole.

So, you have to compartmentalize in order to be okay with the whole and move forward? Sounds like that sentence doesn’t add up when you first look at it. But allow me to make my case. Let us first consider what compartmentalization is. By general definition, it is making divisions where some ideas, behaviors, or emotions are held separate from others. From a psychological perspective, it is a defense mechanism a person may use to avoid mental discomfort caused when they have conflicting values, beliefs, emotions, etc. within themselves. By placing walls between these concepts and subsequent emotions, the person can let these divergent ideas co-exist within themselves. In general, this ability allows us to transition between different roles with relative ease, allowing us to interact with a variety of different life circumstances. However, if people do this with too much rigidity, these different aspects of themselves can lead to confusion regarding their self-concept, wondering "Who am I really?" People need a consistent sense of self that crosses various roles. I see this as a process of walling off aspects of ‘who I am’ but being able to step back and see all of these compartments, or rooms, for what they are – one complete house. The rooms look different and serve different functions, but there is definitely design cross-over that the person owns.

When it comes to moral injury, a big part of the problem, in my opinion, is that people are not able to create walls around their deeply held beliefs about the traumatic event that occurred. They overgeneralize the situation to the point that it is the only room left in the house. It overshadows everything else, and patients are no longer able to see the nuances that made the traumatic event different from other situations or aspects in their lives. For example, you may think, “because I violated or was violated in a way that clashes with my truth, I must throw everything else around that truth out and only see the entire thing as a failure.”

Many Service members have sat in my office after experiencing a moral injury. Because they have been violated by another Service member (e.g., sexual assault) and this so strongly crushes the military belief of looking out for each other, they generalize their understandable angst against the entire military system and their whole military life. “I can’t trust any of them… it was all a lie!” It isn’t hard to see where compartmentalization here can be of significant help. I recall a patient once telling me that his turning point was when I was yelling (forcefully stating, I’d say) that he has to learn how to compartmentalize! It isn’t all leaders and everyone in the military that failed, after all! He has had some great moments!! Okay, perhaps I was raising my voice, but this was someone who I’d been working with for a long time, after all, and had a good rapport with. But the point stands – you have to wall off the situation and see it for what it is – an example of when we and/or others do not measure up to what we think is right. And in the process of putting these walls up and contextualizing the situation, you can start to see that the moral still stands. Whatever happened was bad and you will never feel good about it, but it doesn’t have to mean that the situation is hopeless and you are doomed to never make progress toward that person you want to be.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Deb Nofziger, Psy.D., is a Senior Military Internship Behavioral Health Psychogist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Nofziger is currently located at Brooke Army Medical Center in San Antonio, Texas.