Moral Injury and PTSD

By Chief Joel F. Shults, Ed.D

Moral injury is a relatively newly recognized distress that can affect first responders and combat veterans. It is short of Post Traumatic Stress Disorder (PTSD) but can have long-term effects on emotional well-being. PTSD has entered the common vernacular so much that it is often self-diagnosed or labeled by others without a full understanding.

An important aspect of PTSD is that the condition is a distinctly biological process. This is why many prefer the term Psychological Traumatic Stress Injury, to emphasize the biochemical changes that result from the sensory processing of a traumatic event or cumulative trauma. When PTSD is considered to be a merely emotional reaction by someone who can’t “handle” it, treatment and support are stymied. People don’t choose PTSD nor suffer due to some character flaw. Trauma can create changes to the brain that just having a strong attitude does not repair.

A PTSD diagnosis is made based on standardized criteria after assessment by a qualified and licensed mental health practitioner. Not every trauma results in PTSD and lesser levels of impairment from anxiety disorders can be serious but not rise to the level of a PTSD diagnosis.

A recent poll of top concerns of police officers revealed that mental and physical wellness is in the top five, alongside surviving ambushes! Research indicates that a police officer will be exposed to an average of 178 critical incidents over a career (a conservative number), compared to the average person’s experience of two to three such incidents in a lifetime. Law enforcement leaders and citizen supporters need to understand the range of services that our officers should have non-judgmental access to manage a career filled with threatening experiences.

While some cynics might say if a person can’t handle the job, then they shouldn’t be doing it, smart leadership recognizes that better health, better job performance, and better retention of good officers make building and restoring resilience an economic necessity aside from the human decency of such efforts.

One of the mysteries of PTSD is that several officers can be at the same incident and not have the same negative effects. Each individual’s background and experience determine how their brain processes the threat and stores it. While anywhere from 5-20% of police officers could qualify for a PTSD diagnosis, there are many more who don’t consider themselves impaired by stress-related conditions. There are also many, and perhaps most, who experience an uneasiness or distress that has been less easily defined.

Their distress may be what is being recognized as moral injury. This can occur when the moral guides of an individual come into conflict with the reality of what they experience and even in some of the actions and decisions they are called upon to make. Loosely defined, moral injury can occur when one’s experiences conflict with expectations and ethics. Examples might be seeing an injustice done during the criminal justice process, exposure to innocent victims, having to make an unpleasant decision like arresting someone for whom there is great compassion, and especially being unable to achieve an outcome like reducing crime or failing in a rescue or resuscitation attempt. Being bothered by what one sees, what one had to do, or what one didn’t do can be unsettling to one’s identity.

The sense of helplessness, guilt, frustration, or failure can torment first responders and other helping professions where idealism and sense of purpose are high. Sometimes guilt or self-doubt can come when one seems to be unaffected by senseless tragedy and violence that should disturb an ordinary person. The idea that stuff just happens and you can only do what you can do is not sustainable protection against moral injury.

Especially in this era of hypercritical cynics, negative media narratives, and political cowardice, providing support and encouragement for our law enforcement officers has never been more critical to efficient policing and public safety.

This article originally appeared at the National Police Association and was reprinted with permission. 

Source: www.lawofficer.com