Road to Recovery: Healing from Moral Injury
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1 Road to Recovery: Healing from Moral Injury Sheila Frankfurt, PhD, LP Investigator & Counseling Psychologist VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX USA Deputy Director, Clinical Investigation Research Office Fort Hood, TX
2 Acknowledgements This work is supported by the Department of Veterans Affairs Office of Academic Affiliations, Rehabilitation Research and Development Office, Career Development Award-1 (IK1RX002427), the Central Texas Veterans Health Care System, and the VISN 17 Center of Excellence for Research on Returning War Veterans. Disclaimers: The views expressed in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
3 Overview What is moral injury? Does moral injury differ from PTSD? How to promote healing from moral injury?
4 What is Moral Injury? When bad things happen in war.
5 Caveats Old wine in new bottles. Developed in U.S. Veteran context. Emerging concept... AND YET
6 CONTEXTUAL BACKGROUND OF MORAL INJURY
7 DEFINITION: Commonly accepted standards of proper and improper behavior, such as is mutually expected or is an interpersonal demand Context and role dependent Working definition of morals Strawson, 1962
8 Military trains character values and moral law Moral Worldview of Military Sherman, 2015
9 Veteran in Context: Situational Determinants on Behavior REUTERS/Ceerwan Aziz Baron, 1997; Darley & Batson 1973; Haney et al., 1972; Mathews & Canon, 1975; Milgram, 1963
10 PTSD Transgressive Acts Moral Injury Cause Unresolvable Inner Conflict Guilt Shame Rage Moral Injury Mechanism Moral Injury Isolation & Withdrawal Despair Anomie Compulsive Bx. Suicide Litz et al., 2009; Stein et al., 2012
11 PTSD Transgressive Acts Moral Injury Cause Unresolvable Inner Conflict Guilt Shame Rage Moral Injury Mechanism Moral Injury Isolation & Withdrawal Despair Anomie Compulsive Bx. Suicide Henning & Frueh, 1007; Kubany, 1994; Opp & Samson, 1998
12 PTSD Transgressive Acts Moral Injury Cause Unresolvable Inner Conflict Guilt Shame Rage Moral Injury Mechanism Moral Injury Isolation & Withdrawal Despair Anomie Compulsive Bx. Suicide Frankfurt & Frazier, 2016; Frankfurt et al., 2017; Jordan et al., 2017; Hendin & Haas, 1991
13 Moral Injury PTSD What is the Difference between Moral Injury and Posttraumatic Stress Disorder?
14 How to Treat Moral Injury? Reconnect with Others & Communalize Wounds Reconnect with Self-Worthiness and Goodness
15 Principles of Healing Guilt/Self-recrimination > Amends Shame/Isolation > Connection Rage/Despair > Meaning-Making Moral Dumbfounding > Grace COMPASSION FORGIVENESSS VITALITY Boulanger, 2007; Gilbert, 2010; Sherman, 2015; Singer, 2004
16 Talking about Moral Injury Prepare yourself to hear combat stories involving gruesome, troubling violence or failings WITHOUT comforting or repulsing Look for opportunities to build genuine self-empathy, selfcompassion, and trust Finlay, 2015; Haley, 1974; Singer, 2004
17 Talking Points Contextualizing Transgressive Acts Mindfulness Prophetic Wisdom Antal, 2017; Gilbert, 2010; Sherman, 2015
18 Reconnection through Giving Back Volunteering Active, present-centered coping > Passive coping Helping behaviors improve wellbeing Community Building Veterans organizations Peace groups Politics Religious or spiritual institutions Frazier, 2003; Post, 2005
19 Intervention Elements Elements of military culture that can be included in the development of treatments and with therapy providers: Cohesion building rapport in groups Leadership identifying opportunities for veterans to engage their leadership skills Training engaging veterans to utilize their skills to train others (e.g., peer support)
20 Next Steps in the Moral Injury Field Develop moral injury theory Military history & theory + philosophy + psychology Create measures of moral injury Develop treatments for moral injury
21 Thank You! Please be in touch!
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