Introducing Moral Injury

Two years ago the world was hit by the global pandemic. It was considered a devastating catastrophic event in the recent history of mankind. Within the time 2020 to today, based on WHO data there are 615.310.890 confirmed cases and 6.524.568 confirmed death globally. In our country, Indonesia there are 6.434.585 confirmed cases and 158.132 confirmed death. This event not only impacts physically but is also soul-crushing.

Medical personnel on the frontline are affected by the most severe impact of the pandemic. When the first wave hit, these brave people shield up and give their best shot to save many. But as the pandemic rages on and the unstoppable surge of patients keeps coming in, medical personnel must have to make a tough call. Frontline medical personnel get to decide which ones get the treatment and which don’t. of course, these are made by professional assessment and the principle of priority. Yet this kind of decision takes a toll rooted deep in their psyche causing a moral injury.

What is Moral Injury?

Moral injury is a specific type of trauma that occurs to a person who faces situations that deeply violate their conscience or threaten their core values. It is the distressing psychological, behavioral, social, and sometimes spiritual aftermath of exposure to such events (Pandemic, War, Injustice, etc). Those who suffer from moral injury constantly battle with guilt, anger, and a consuming sense that they can’t forgive themselves or others.

The term moral injury was first introduced to the public by psychiatrist Jonathan Shay in the 1990s. The trail of the moral injury itself can be traced way millennia back such as in the literature The Iliad by Homer when Patroclus died, Achilles was consumed by guilt and self-blaming that tortures himself because he failed to shield Patroclus from harm. Emile Zola depicted moral injury as further and more self-destructive in His book Therese Raquin (1867). Therese, the protagonist was trapped in her unhappy life and marriage, when She and Laurent killed Her husband. The guilt and self-blaming manifest into something physical, disturbing, and destructive and end up in tragedy at the climax of the book.

Symptoms of Moral Injury

Even though symptoms of Moral Injury are almost similar and can be overlapping with PTSD (Post-Traumatic Stress Disorder) it’s completely different and disassociative. One of the distinctive symptoms is hyperarousal which is a severe symptom of PTSD that makes the sufferer live in a state of constant tension, a sense of suspicion, panic, paranoia, and irritability as well as an inability to go to sleep which is not central to moral injury.

Based on the findings of research and study at Salisbury VA Healthcare System in North Carolina in 2019 moral injury has different brain signatures than PTSD alone: People with moral injury have more activity in the brain’s precuneus area, which helps govern moral judgments, than those who only have PTSD.

a deeper study of moral injury is still being carried out to this day. it is very difficult for someone to admit and be diagnosed with moral injury because of the feelings of guilt and shame associated with them. Until now, researchers and scientists continue to study the best treatment for dealing with moral injury.