As we continue to see 17.5 Veterans die daily by suicide, a little-known truth is that moral injury, not PTSD is the culprit. Within the last few months, two more combat Veteran friends of mine have died early deaths. Both were around 50 years of age, and let me clear, they did not take their own lives by willfully shooting, hanging, or overdosing themselves. I also know nothing about their lifestyles. Both had PTSD diagnoses, as do most of us, and because they were where I was, I am almost certain there was some level of moral injury present.
Simply put, PTSD is a psychiatric condition caused by exposure to life threatening events, is a normal fear-based response. We all know the symptoms. By contrast, moral injury is not a formal psychiatric diagnosis, but an emotional/moral/spiritual wound and arises from a sense of betrayal (by others or self) in relation to deeply held beliefs. It is a psychological injury, resulting in a loss of trust of self and/or others, and a pervasive sense of shame and condemnation. Of course, this overlaps with PTSD in Veterans.
In my personal experience, killing myself, not outrightly, but slowly and systematically became a basic theme within my distorted thinking. I had never put my 12-gauge shotgun or .380 to my head, and pull the trigger, but my guilt, and its insidious “cousin” shame was slowly taking me out. Fostered by a sense of loss (of comrades, my marriage, etc.), fear, anxiety and depression led me to use alcohol as a means for reprieve. Self-medication with this substance became, for the first time in my life (I had never really drunk until I was 41), a way of navigating life. Alcohol is not a problem for many people, but for us problematic drinkers, it creates more problems for ourselves and those closest to us. My slow suicide could be measured by my blood work and other symptomatology. Combat Veteran friends, hear me when I say that I am not minimizing our trauma events, but I am here to tell you that my own behaviors were the cause of the lion’s share of my psychological distress. So, what to do with this moral injury stuff? Humans have a plethora of maladaptive coping strategies, worsening our own lives, and which lead to some kind of “death.” Let us acknowledge our pain Veterans, by talking with one another, exercise, therapy, diet, meditation, prayer/spiritual growth, etc. (fill in the blank), and quit killing ourselves and others in these subtle and destructive ways.