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ARMED FORCES PENSIONERS
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/ANNUITANTS
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ASSOCIATION OF CANADA
As we continue to learn just how
deeply Post-Traumatic Stress Disorder
(PTSD) can get rooted in a soldier’s
mind, psychiatrists are also discovering
that many veterans suffer from moral
injury — this is now being researched
as a separate battle-related disorder.
There have been several publica-
tions about “moral injury” and what it
really is. Moral injury arises when a
soldier’s on-duty actions lead to seri-
ous inner conflict because the experi-
ence is at odds with the soldier’s
ethical and moral beliefs. Moral injury
is defined as “perpetrating, failing to
prevent, bearing witness to, or learning
about acts that transgress deeply held
moral beliefs and expectations” (Brett
Litz, 2009). It is a term used in the
mental health community and is de-
scribed as the psychological damage
armed forces member’s and others face
when an act of war transgresses or con-
tradicts their moral beliefs. Moral in-
jury is not yet accepted as a psychiatric
diagnosis. Canadian doctors and veter-
ans continue to look for ways to ad-
dress the issue of CF members who
have experienced this dimensional
problem. Several Canadian veterans
are starting to believe that “moral in-
jury” finally puts a name to their con-
dition and explains symptoms.
Moral injury should not be con-
fused with Post Traumatic Stress Dis-
order. PTSD is a fear or trauma
triggered reaction to danger and can af-
fect just about anyone. Moral injury is
an inner conflict a person struggles
with when placed in a situation. It may
be a greater factor in suicides than any
other physiological wound of war, in-
cluding PTSD. While there are ap-
proximately twenty three million
veterans around the world (8 % of the
population), veterans account for 20%
of all suicides.
Transitioning to civilian life can be
a tough process for some people. Sta-
tistics taken from “Survey on Transi-
tion to Civilian Life” (January 4, 2011)
state that over 40% still have difficulty
adjusting up to ten years after returning
home and one in two feel an emotional
disconnect from their loved ones, fam-
ilies and friends they had before serv-
ice.
The trauma of combat can leave
profound psychological scars, damag-
ing their sense of right and wrong and
often leaving them with guilt, shame
and grief. So far, therapists have de-
vised two different types of treatments.
Brett Litz, PhD., and his colleagues
represent a traditional approach that re-
volves around the use of talk therapy
as a patient interacts with a therapist in
an office. Psychiatrist Edward Tick be-
lieves in a different approach and uses
groups where veterans share experi-
ences, but he also turns to ritual, char-
ity work, visits to former battlefields
and even a redefinition of what it
means to be a soldier. Although we
have yet to get a definitive answer as
to which treatment works best, both
sides agree that moral injury is a very
real condition and yet another cross our
veterans must bear.
The Veterans Transition Program
(VTP) is the first group-based program
for veterans returning home and tran-
sitioning to civilian life. Treatment
takes place in a completely confiden-
tial environment with skilled clinicians
and paraprofessionals helping with the
transition process and the effects of
trauma. This program has helped al-
most 300 Canadian veterans success-
fully transition into civilian life since
its inception in 1999.
As many of our returning military
personnel struggle to adapt to previous
lives, we hope that one day as veterans,
they will see the light at the end of the
tunnel and that greater awareness of
this problem will lead to earlier diag-
nosis and treatment.
For more information on transi-
tion to civilian life and the privately
run Veterans Transition Program
(VTP), visit
.
Post-Traumatic Stress Disorder and
Moral Injury
All photos courtesy of DND
