Post-traumatic Stress Disorder (PTSD) has become a familiar and frequently used concept in recent years. Although PTSD is a major issue faced by our returning troops, it has become somewhat of an umbrella term we often jump to when considering psychological injuries in the military and veteran population. This article discusses the lesser-known forms of trauma affecting returning military personnel and veterans.
In the DSM-5, PTSD is conceptualized as, “exposure to actual or threatened death, serious injury or sexual violation.” This exposure then produces prolonged distressing symptoms in the individual such as nightmares, flashbacks, or hyper-vigilance. The key distinguishing factor is that PTSD is closely related to a fear response tied to the fight or flight instincts.
Expanding on PTSD, moral injury focuses on trauma to the moral conscience. Two major definitions have emerged:
1) Brett Litz defines moral injury as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
2) Jonathan Shay, in Odysseus in America, defines moral injury as stemming from the “betrayal of ‘what’s right’ in a high-stakes situation by someone who holds power.”
Here is a comparison between PTSD and moral injury symptoms as presented in a recent series on moral injury in the Huffington Post:
This is a concept I’ve developed to depict the unique challenges many veterans face upon reintegrating into civilian life. In my research, I’ve found that beyond PTSD and moral injury, as described above, veterans often experience a traumatic transition to civilian life due to the cultural differences they encounter.
Canadian psychologists with the Veterans Transition Program have referred to the problem as a “reverse culture shock” (Westwood, Black, and McLean 2002). Veterans speak of losing their closely bonded “military family” upon leaving the forces and experience a sense of identity disorientation as they attempt to navigate within an unfamiliar civilian world.
From a sociological perspective, transitional trauma is a form of ‘anomie’. Anomie is a concept used by Sociologist Émile Durkheim to describe a society lacking moral regulation. An anomic society lacks the moral signposts that guide individuals throughout their life-course, leaving them without direction to pursue collective goals. In this sense, it is closely tied to moral injury. Rather than alienation resulting from an individual committing a moral offence resulting in self-blame, alienation results when the individual cannot reintegrate into a relatively loosely regulated society that doesn’t provide the same clear sense of purpose and boundaries found in the military.
A concept developed by Dr. Steven Silver, sanctuary trauma “occurs when an individual who suffered a severe stressor next encounters what was expected to be a supportive and protective environment’ and discovers only more trauma.” Although this concept is under-recognized, a Canadian veteran has been advocating for its current relevance.
Bruce Moncur wrote a recent article in the Huffington Post expressing that fighting veteran affairs is like fighting the Taliban. He attributes at least half of his trauma to navigating the vicissitudes of veteran affairs. Sanctuary trauma comes from a feeling of abandonment, the feeling that one was merely used and thrown away when becoming injured. As stated in my post on Canada’s ‘sacred obligation’ to veterans, this was reinforced by the meeting with Veteran Affairs Minister, Julian Fantino, that went “off the rails.”
Veterans experience forms of trauma beyond PTSD. New labels allow researchers and mental health practitioners to more accurately pinpoint the source of the issue. By knowing the source of the issue, better solutions can be provided.
Treatments for PTSD may include forms of cognitive behavioral therapy. Treatments for moral injury may include existential/ spiritual counseling. Solutions for transitional trauma may be sought in group therapy, programs that teach entrepreneurial skills, or occupational groups that provide individuals with a new sense of mission. As for sanctuary trauma, the solution is ensuring returning veterans feel they are cared for upon their return.