Moral Dilemmas and Moral Injury

2017 ◽  
Vol 31 (2) ◽  
pp. 189-205
Author(s):  
Jennifer Mei Sze Ang ◽  
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Moral Dilemmas ◽  
War Trauma ◽  
Moral Injury ◽  
Post Traumatic Stress ◽  
Dirty Hands ◽  
Personal Morality ◽  
Shame And Guilt ◽  
Post Traumatic

Psychiatrists working with war veterans have, in recent years, constructed ‘moral injury’ as a separate manifestation of war trauma that is distinct from Post-Traumatic Stress Disorder (PTSD). This paper argues that for moral degradation to occur, it necessarily involves one’s commissions or omissions that transgresses one’s personal morality, and hence, distinguishes sufferers of moral injury from PTSD sufferers who were witnesses to traumatic and morally abhorrent events. To this end, it clarifies how some of the situations surrounding moral injury are misunderstood, by discussing the process of moral reasoning in the context of moral dilemmas, dirty hands, and moral blind alleys. Finally, it concludes that when we conceptualise moral injury as being caused by one’s commissions and omissions in moral dilemmas, we find that shame and guilt are situation-appropriate responses with a role to play in what ethics mean.

scholarly journals Resilience in the aftermath of war trauma: a critical review and commentary

2014 ◽  
Vol 4 (5) ◽  
pp. 20140008 ◽  
Author(s):  
Brett T. Litz
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
War Trauma ◽  
Service Members ◽  
Post Traumatic Stress ◽  
Traumatic Life Events ◽  
Military Trauma ◽  
The Face ◽  
Post Traumatic

The resilience construct has received a great deal of attention as a result of the long wars in Iraq and Afghanistan. The discourse about resilience, especially the promise of promoting it and mitigating risk for serious post-traumatic negative outcomes among service members and veterans, is hopeful and encouraging. Remarkably, most service members exposed to horrific war trauma are not incapacitated by the experience. Yet, resilience is elusive and fleeting for many veterans of war. In this paper, I address some of the complexities about resilience in the context of exposure to war stressors and I offer some assumptions and heuristics that stem from my involvement in the dialogue about resilience and from experiences helping prevent post-traumatic stress disorder among active-duty service members with military trauma. My goal is to use my observations and applied experiences as an instructive context to raise critical questions for the field about resilience in the face of traumatic life-events.

scholarly journals The psychosocial impact of the COVID-19 pandemic on 4,378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic

2021 ◽  
Author(s):  
Danielle Lamb ◽  
Sam Gnanapragasam ◽  
Neil Greenberg ◽  
Rupa Bhundia ◽  
Ewan Carr ◽  
...  
Keyword(s):  
Mental Health ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Healthcare Workers ◽  
Alcohol Misuse ◽  
Common Mental Disorders ◽  
Moral Injury ◽  
List Type ◽  
Post Traumatic Stress ◽  
Post Traumatic

AbstractObjectivesThis study reports preliminary findings on the prevalence of, and factors associated with, mental health and wellbeing outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK.MethodsPreliminary cross-sectional data were analysed from a cohort study (n=4,378). Clinical and non-clinical staff of three London-based NHS Trusts (UK), including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire (GHQ-12). Secondary outcomes are probable anxiety (GAD-7), depression (PHQ-9), Post-Traumatic Stress Disorder (PTSD) (PCL-6), suicidal ideation (CIS-R), and alcohol use (AUDIT). Moral injury is measured using the Moray Injury Event Scale (MIES).ResultsAnalyses showed substantial levels of CMDs (58.9%, 95%CI 58.1 to 60.8), and of PTSD (30.2%, 95%CI 28.1 to 32.5) with lower levels of depression (27.3%, 95%CI 25.3 to 29.4), anxiety (23.2%, 95%CI 21.3 to 25.3), and alcohol misuse (10.5%, 95%CI, 9.2 to 11.9). Women, younger staff, and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one’s moral code) was strongly associated with increased levels of CMDs, anxiety, depression, PTSD symptoms, and alcohol misuse.ConclusionsOur findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.HighlightsWhat is already known about this subject?Large-scale population studies report increased prevalence of depression, anxiety, and psychological distress during the COVID-19 pandemic.Evidence from previous epidemics indicates a high and persistent burden of adverse mental health outcomes among healthcare workers.What are the new findings?Substantial levels of probable common mental disorders and post-traumatic stress disorder were found among healthcare workers.Groups at increased risk of adverse mental health outcomes included women, nurses, and younger staff, as well as those who reported higher levels of moral injury.How might this impact on policy or clinical practice in the foreseeable future?The mental health offering to healthcare workers must consider the interplay of demographic, social, and occupational factors.Additional longitudinal research that emphasises methodological rigor, namely with use of standardised diagnostic interviews to establish mental health diagnoses, is necessary to better understand the mental health burden, identify those most at risk, and provide appropriate support without pathologizing ordinary distress responses.

scholarly journals To Understand and Support Contemporary Veterans Utilizing Biblical Combat Veteran Types

2018 ◽  
Vol 72 (4) ◽  
pp. 232-240 ◽  
Author(s):  
Jan Grimell
Keyword(s):  
Pastoral Care ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Combat Veterans ◽  
Stress Disorder ◽  
Real Life ◽  
Moral Injury ◽  
Post Traumatic Stress ◽  
Combat Veteran ◽  
Post Traumatic

This article continues to build on the biblical combat veteran types (BCVTs) which were recently presented as a tool to describe and understand biblical combat veterans through the lenses of post-traumatic stress disorder and moral injury. The purpose of this article is to connect the BCVTs with real-life cases so as to show the potential usefulness of the biblical types. This article further develops a model for pastoral care which integrates this tool.

scholarly journals Severe war trauma and post-traumatic stress disorder in adolescents with sensory impairments: a cross-sectional study

2013 ◽  
Vol 1 (2) ◽  
pp. 16 ◽  
Author(s):  
Khuzama Hijal Shaar
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Study Groups ◽  
Severe Trauma ◽  
Cross Sectional Study ◽  
War Trauma ◽  
Post Traumatic Stress ◽  
Cross Sectional ◽  
Sensory Impairments ◽  
Post Traumatic

A paucity of studies of the psychological status of adolescents with sensory impairments in political conflict areas is noted. This study was set up to examine the exposure of adolescents with sensory impairments (ASIs) to severe war trauma and development of post-traumatic stress disorder (PTSD) as compared to their able-bodied peers (ABPs). It also answers the question whether their impairments have made them more resilient in facing traumatic events. A cross-sectional study of all ASIs attending special schools in three administrative districts in Lebanon (n=166) as well as a group of 166 age and sex-matched ABPs from neighboring schools was conducted. The Post Traumatic Stress Reaction Checklist for children (PTSRC) was used to assess exposure to severe trauma, PTSD and their determinants. ASIs reported a lower exposure to severe traumatic events (24.1%) as compared to their ABPs (69.9%), and risk factors for their exposure were an older age group, a fatherless family, and severe visual impairment. Prevalence rates for PTSD were similar in the two study groups (17.5% and 16.4%). Younger ASIs were at a significantly higher risk of developing PTSD. Lower exposure to trauma among ASIs points to the more sheltered life that they lead. Given the same exposure as ABPs, similar rates of PTSD are noted among the two study groups. This may indicate that having a sensory impairment may protect from PTSD due to decreased exposure to severe trauma and not due to increased resilience of subjects.

scholarly journals Moral injury in a context of trauma

2020 ◽  
Vol 216 (3) ◽  
pp. 127-128 ◽  
Author(s):  
Edgar Jones
Keyword(s):  
Moral Philosophy ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Rating Scales ◽  
Stress Disorder ◽  
Moral Injury ◽  
Ethical Behaviour ◽  
Post Traumatic Stress ◽  
Effective Interventions ◽  
Post Traumatic

SummaryMoral injury, characterised by guilt, shame and self-condemnation, is conceptualised either as an adjunct to post-traumatic stress disorder or as a new syndrome. Studies of symptoms and potentially morally injurious events have produced a possible definition and informed the design of rating scales. The current challenge remains the design of effective interventions. Because moral injury relates to ethical behaviour, the meaning attached to events and perceptions of the self, moral philosophy and spirituality could contribute to the design of treatments.

Post-traumatic stress disorder and depression

1997 ◽  
Vol 170 (5) ◽  
pp. 479-482 ◽  
Author(s):  
Avi Bleich ◽  
Meni Koslowsky ◽  
Aliza Dolev ◽  
Bernard Lerer
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Affective Disorders ◽  
Stress Disorder ◽  
Psychiatric Morbidity ◽  
War Trauma ◽  
Drug Misuse ◽  
Special Focus ◽  
Post Traumatic Stress ◽  
Post Traumatic

BackgroundWe examined psychiatric morbidity following war-related psychic trauma, with a special focus on the depressive comorbidity of post-traumatic stress disorder (PTSD).MethodSubjects consisted of 60 Israeli veterans who sought psychiatric treatment 4–6 years after having been exposed to war trauma. PTSD and psychiatric comorbidity were diagnosed using the Structured Interview for PTSD and the Schedule for Affective Disorders and Schizophrenia.ResultsBoth lifetime (100%) and current (87%) PTSD were the most prevalent disorders. Comorbidity was extensive, with major depressive disorder (MDD) most prevalent (95% lifetime, 50% current), followed by anxiety disorders, minor affective disorders, and alcoholism or drug misuse.ConclusionsWithin post-traumatic psychiatric morbidity of combat origin, PTSD and MDD are the most prevalent disorders. In addition it appears that PTSD, although related to post-traumatic MDD beyond a mere sharing of common symptoms, is of the same time differentiated from it as an independent diagnostic category.

scholarly journals Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic

2021 ◽  
pp. oemed-2020-107276
Author(s):  
Danielle Lamb ◽  
Sam Gnanapragasam ◽  
Neil Greenberg ◽  
Rupa Bhundia ◽  
Ewan Carr ◽  
...  
Keyword(s):  
Mental Health ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Healthcare Workers ◽  
Alcohol Misuse ◽  
Stress Disorder ◽  
Moral Injury ◽  
Health Questionnaire ◽  
Post Traumatic Stress ◽  
Post Traumatic

ObjectivesThis study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April–June) of the COVID-19 pandemic in the UK.MethodsPreliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale.ResultsAnalyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one’s moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse.ConclusionsOur findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

scholarly journals Spiritually Integrated Cognitive Processing Therapy: A New Treatment for Post-traumatic Stress Disorder That Targets Moral Injury

2018 ◽  
Vol 7 ◽  
pp. 216495611875993 ◽  
Author(s):  
Michelle Pearce ◽  
Kerry Haynes ◽  
Natalia R Rivera ◽  
Harold G. Koenig
Keyword(s):  
Cognitive Processing ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Moral Injury ◽  
Cognitive Processing Therapy ◽  
Post Traumatic Stress ◽  
Spiritual Beliefs ◽  
Post Traumatic ◽  
Spiritual Resources

Background Post-traumatic stress disorder (PTSD) is a debilitating disorder, and current treatments leave the majority of patients with unresolved symptoms. Moral injury (MI) may be one of the barriers that interfere with recovery from PTSD, particularly among current or former military service members. Objective Given the psychological and spiritual aspects of MI, an intervention that addresses MI using spiritual resources in addition to psychological resources may be particularly effective in treating PTSD. To date, there are no existing empirically based individual treatments for PTSD and MI that make explicit use of a patient’s spiritual resources, despite the evidence that spiritual beliefs/activities predict faster recovery from PTSD. Method To address this gap, we adapted Cognitive Processing Therapy (CPT), an empirically validated treatment for PTSD, to integrate clients’ spiritual beliefs, practices, values, and motivations. We call this treatment Spiritually Integrated CPT (SICPT). Results This article describes this novel manualized therapeutic approach for treating MI in the setting of PTSD for spiritual/religious clients. We provide a description of SICPT and a brief summary of the 12 sessions. Then, we describe a case study in which the therapist helps a client use his spiritual resources to resolve MI and assist in the recovery from PTSD. Conclusion SICPT may be a helpful way to reduce PTSD by targeting MI, addressing spiritual distress, and using a client’s spiritual resources. In addition to the spiritual version (applicable for those of any religion and those who do not identify as religious), we have also developed 5 religion-specific manuals (Christianity, Judaism, Islam, Buddhism, and Hinduism) for clients who desire a more religion-specific approach.

scholarly journals Culinary Nostalgia and Post-Traumatic Stress Disorder: Addenda to Kinga Király's Az újrakezdés receptjei (2019) / Recipes for a New Beginning (2020)

2021 ◽  
Vol 14 ◽  
pp. 186-204
Author(s):  
Louise O. Vasvári
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
War Trauma ◽  
Food Culture ◽  
Jewish Tradition ◽  
Post Traumatic Stress ◽  
Social Death ◽  
New Beginning ◽  
Post Traumatic ◽  
Historical Sketch

Kinga Király conducted interviews with ten North Transylvanian survivors who represent the last witnesses of a generation that is about to disappear and leave us with the question of what to remember and how. On reading the testimonies catalogued in the volume Király produced from those interviews, I realized that I felt compelled to make further connections with my own research on foodways and war trauma and on the ecologies of survival witnessing. In a section on the mass genocide of Transylvanian Jewry I provide a brief historical sketch to help the understanding of the historical complexity and tragedy of the lives of pre- and postwar Transylvanian Jewry. I then contrast the stories of some of Király's subjects with the postwar memoirs of other Transylvanian survivors who emigrated either right after the war or under the Ceausescu dictatorship. I discuss prewar Transylvanian Jewish food culture, and subsequently locate Király's collection as a continuation of the tradition of the memorial or yizkor [‘remembrance’] books. Finally, I discuss Jewish cemeteries and the virtual social death of Jewish tradition in Transylvania, to ask: what is it that remains today from the shattered culture of Transylvanian Jewry?

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