Standing out amongst other living things is something we humans do rather well.  We are at the top of the food chain, after all, our brains so far advanced that our technology actually blows the mind!  Just take a look at the title character in the famous 80s television show “MacGyver”.  Now he had some mad skills:  Give the man a quarter, a jar of peanut butter and a fence post, and he could make a hover craft, for crying out loud!  Yes, the limits of the human mind and imagination are endless.  Through our study and technology, we are able to understand so much about our world and about ourselves.  Yet, we still maintain individuality amongst our millions, no two people being exactly alike – anywhere!  That’s pretty impressive!

But there is one thing that we conceptually struggle with as a race – morality.  The conflicts that arise from the concepts of moral ethos are centuries old.  They exist on individual and international levels.  And they never stop.  We see this in so many people just struggling to get from one day to the next.  People doing battle with the world on the outside, and wreaking havoc on themselves from the inside.  It’s no surprise to me, therefore, that millions of people suffer from major depression.  Post-traumatic stress disorder (PTSD), while most commonly associated with those who have experienced wartime combat, can affect anyone:  civilian or service member.  It is defined as “a psychological reaction occurring after experiencing a highly stressing event…that is usually characterized by depression, anxiety, flashbacks, recurrent nightmares, and avoidance of reminders of the event”.  Obviously, it can be expected that many of our service men and women returning from Iraq and Afghanistan will have higher odds of developing this syndrome.  I would imagine this would be a modern term for what we called “shell shock” after the wars of the 20th century, as we were still not ready to recognize these as disorders worthy of attention back then.  People wondered why men returned from WW!!, for example, and had a difficult time fitting back in.  Well, to that I say just look at the horror of war back then!  Of course they were haunted by their experiences!  With weaponry being so much more barbaric, and the technology lacking to transport and save countless lives, I would image that even the toughest man alive at that war would have had a terrible time getting those memories to subside.  How could one not be affected?

Now I am not a trained professional in the field, admittedly.   While not to understate anything that our veterans have experienced, I can state that you do not have to go to war to experience PTSD.  A child who is neglected from the moment they are born grows up fighting every day, for sustenance, confidence and survival.  The young man who is beaten by his father time and time again, as he becomes the target of the person who was supposed to protect him.  The girl who is teased endlessly by classmates for years just because she has no money to buy the right clothes during her adolescence.  The man that takes a vow to care for and save the lives of animals, who one afternoon, finds himself putting bullets in the family dog because it killed another animal, something that is instinctual to the dog by its very nature.  The woman who turns the corner into a neighborhood at the exact same time a young child runs into the pathway of her vehicle.  These are also examples of tragic events that can trigger PTSD in our culture.

There is a new term that is being used today to describe a type of psychological affliction that is affecting more and more people, mostly because of our several years of active wartime in the US.  The term is “moral injury”, and psychologists are having a much more difficult time understanding and treating this dilemma because of the wide scope of morality we entertain as a society, and even as a race.  Moral injury is defined as “the pain that results from damage to a person’s moral foundation”.  It “is a violation of what each of us considers right or wrong”.  Our morality is based in not only what is taught to us from our parents, preachers and peers, but is also based in our cultural:  What may be okay here in the US may not be okay in a third world country, for example, and vice versa.

I first stumbled across reports of moral injury just recently, as I was studying the effects of major depression on people and their families.  As someone who is very familiar with major depression, I wanted to learn all I could about it, assuming that the more I know, the better equipped I am to handle the consequences of the disease.  But then I came across this term, and as I researched it, the less I found regarding the existence of it in the civilian world.  Do you have to go to war to experience moral injury?  This is a question to which I do not have the answer.  But my guess would be no.  I base this in the definition of the injury:  a rattling of one’s morality to a serious extent.

But what separates us from other living things?  After all, a lion will kill to survive.  A snake is armed with lethal venom in order to preserve itself on the planet.  Do these animals suffer the mental and/or moral consequences of killing?  No, they don’t.  But we do.  Why?  Because we are taught as a society and a race that killing is wrong, that it is immoral.  Yet, in times of war, it is necessary.  Which is right?  What is ethical?  Civilians also experience times of moral conflict.  Eventually that little boy who was beaten over and over again by his father will cower in fear at the very sight of the man who should have cared for him, blaming himself for the beatings.  If only he wasn’t so naughty all the time, his father would love and protect him.  The girl who is teased for years on end will suffer the feelings of inadequacy and self-loathing, thinking herself unworthy of acceptance and love from anyone.  People are supposed to be kind to each other, after all, so she must be wrong.  The man who shoots his own dog will be haunted in his dreams every night by the dog, as it crawls to his feet to die, wounded by the bullets slowly robbing its four-legged body of life.  This is the dog he swore to care for by merely integrating it into his family.  The woman whose car struck the child will relive the moment time and time again, thinking if only she’d not made the turn, or been driving slower, or had seen the child, the child would not have died as a result of her actions.  People in situations like these are living a nightmare every single day.  It is no wonder that major depression and chemical abuse is a common thread amongst them.

If only…

What if…

Two very small words, yet very capable of wreaking havoc on our moral self judgement.

Until we learn how to treat the soul, we will suffer from effects of moral injury.  Unlike PTSD, we can’t prescribe drugs to treat our ethical wounds.  The soldier who accidentally killed noncombatants in the heat of battle lives with the outcomes of wartime decisions, for example.  He/she may be ashamed of what they have done.  They may isolate themselves, often afraid to speak of the events to the world for fear of being judged.  Then they may have to field the “thanks for their service” comments, well-intended, but stabbing in their wounded soul.  “If only they knew what I did, what I had to do…”.  They may sequester themselves, thinking they cannot possibly fit in or be understood.  They, too, may look to self-medicate through drugs and alcohol to soothe their injured psyche.  Often, it can become completely unbearable to the individual, and the idea of ending the pain can grow more and more appealing.  Some will eventually pop the pills or pull the trigger, and the pain will stop.  It is truly sad.  How do we treat that as a nation? A culture?  A race?

Many join the military as very young men and women.  The things that they are asked to do at such a tender age are appalling – things we couldn’t imagine asking our own children to do.  But they do it, in the name of the flag, the family and their friends who are often standing right next to them in combat.

With so many levels of morality out there, there is no one answer.  And people in the field of behavioral health certainly have their work cut out for them.  But I would suggest that in addition to the mind, we begin to assess the very condition of the human soul, a part of our anatomy that we cannot physically find.  But it is there, and it plays an integral role in our thoughts, our choices and our human condition.  It is what alone separates us from other animals.  Yet with all the technology that abounds in the world, we have no clue how to care for it or how to mend it after it suffers a serious blow.  Until we begin to figure it out, we will have rises in physical abuse, chemical abuse and suicide, especially in our service men and women.

I write this with no answer in mind.  Just thoughts that needed to come out today.  I hope that maybe it will help some to be aware of or to understand the problems of major depression, PTSD and moral injury, as well as the things that result from those to include chemical abuse and suicide.  These are growing epidemics.  There is no one solution.  But we must raise awareness of them amongst ourselves.  They are very real, dangerous and debilitating afflictions.  Please keep that in mind when you think of those suffering in the world.  After all, you cannot choose to just tough it out sometimes.  Often, we really do need help, but we don’t know how to, or simply cannot ask for help.  Let’s learn to recognize the warning signs, and stop judging people for being treated for these afflictions.  They are not crazy!  They are not just down!  They are truly suffering, and they need help! Your help!