Article archive / November 1, 2015
Originally published: . Volume 6, No. 11. Source pages: 10.
During 1947, approximately 50 percent of hospitalizations of Veterans into VA hospitals were for psychological issues in returning combat Veterans from World War II. A suppressed documentary by film director John Huston from 1946 estimated that as many as 20 percent of casualties in World War II were psychological.
Historically, symptoms of PTSD have been noted in written form for over 2,000 years, dating back to 490 B.C., when Greeks described behaviors of soldiers returning from war. Over the years, various terms have been used in describing PTSD-type symptoms, including nostalgia, railway spine, railway brain, spinal concussion, traumatic neurosis, functional nervous disorder, and neurasthenia; and then “Soldier’s Heart” and “Irritable Heart Syndrome” (also known as Da Costa’s Syndrome) during the American Civil War.
In the 20th century, there were another series of terms used to describe the debilitating symptoms often seen in combat Veterans returning home, including shell shock (World War I), exhaustion, battle fatigue, battle neurosis, traumatic war neurosis, and even “attitudinal psychosis” (World War II).
In 1980 “PTSD” was formalized as a diagnosis which has been attributed by many to the effects of Vietnam War Veterans who had lobbied for recognition of their psychological problems.
But in spite of the recognition of the sequelae of PTSD, numerous mental health professionals who treat individuals with PTSD feel that the formally recognized symptoms of PTSD by DSM have been too limited. As a result, the concept of “Moral Injury” was introduced.
Most attribute the introduction of the concept of moral injury to Dr. J. Shay, recipient of a 2007 MacArthur “Genius Grant” Fellowship, and a psychiatrist at the VA in Boston from 1987 to 2008. Shay sees three components to moral injury: A betrayal of what is viewed as morally correct; Done by someone who holds legitimate authority (which Dr. Shay calls “leadership malpractice”); Occurring in a “high stakes” situation.
The definition would include those who are witnesses to events or the consequences of moral injury to others, such as those involved in the liberation of concentration camps, first responders (fire, police, military), etc.
Dr. Shay argues that moral injury is an actual “injury,” but not a disorder or sign of pathology, and he describes treatment as a healing process that must involve “the whole social process.”
He has described his concepts in two seminal books, Achilles in Vietnam: Combat Trauma and the Undoing of Character (1995), and Odysseus in America: Combat Trauma and the Trials of Homecoming (2002). In these books, Dr. Shay describes the far- reaching psychological, cultural, and spiritual effects from trauma.
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