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Moral Injury_Perspectives Panel
Moral injury, defined as the lasting psychological and social effects of witnessing or perpetrating acts that violate moral beliefs, is linked to higher rates of suicide among veterans. Witnessing extreme human suffering during war can undermine beliefs about the world being safe and people being good. Upon returning home, moral injury can cause profound guilt, shame, and self-condemnation in veterans as they reflect on their experiences, leaving them socially isolated and at increased risk for suicide. While PTSD is also linked to higher suicide rates in veterans, the presence of moral injury, guilt, and shame may be an especially strong predictor. Resources for veterans like the Veterans Crisis Line aim to address these issues and prevent suicide.
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Moral Injury_Perspectives Panel
- 1. Moral Injury andVeteran Suicides University of San Francisco September 15, 2015 Kathleen S. Pierce, PsyD kathleen.pierce@va.gov 510-495-4450
- 2. Moral Injury: Definition “Thelasting psychological, biological, spiritual, behavioral and social impact of perpetuating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.” Litz, Stein, Delany, Lebowitz, Nash, Silva & Maguen 2009
- 3. A Military Definitionof Moral Injury “A profound sense of alienation and abject shame.” Source: Battleland, Military Mental Health Ritchie, 2013
- 4. Pre-War Belief Systems Theworld is benevolent The world is safe People are generally good Bad things happen to bad people People get what they deserve If someone behaves badly, they should be punished Witnessing of extreme human suffering can call into question all of these beliefs
- 5. Coming Home Moral injuryfeeds on despair. When the narcotic emotional intensity and tight camaraderie of war are gone, withdrawal can be intense. As memory and reflection deepen, negative self-judgments can torment a soul for a lifetime. Moral injury destroys meaning and forsakes noble cause. It sinks warriors into state of silent, solitary suffering, where bonds of intimacy and care seem impossible. Its torments to the soul can make death a mercy. Soul Repair, Nakashima & Lettini, 2012
- 6. Readjustment Challenges No longerhave daily support of Military culture, peers Concerns about being judged by others Resumption of civilian life, larger social values Exposure to loved ones (spouse, children, elders)
- 7. Internal Consequences of MoralInjury Feeling “broken” or “weak” Concept of self as a monster Extreme Guilt and Shame Fundamental Mistrust – Belief that the world is a dangerous place People cannot be trusted or counted on Belief that “I” cannot be trusted – a fundamental shift in self perception
- 8. Guilt, Shame andSelf Condemnation are the Hallmarks of Moral Injury Guilt, Shame and Self Condemnation are also precipitating factors for Suicide
- 9. Losing the Battle TheChallenge of Military Suicide Center for New American Security October, 2011, p3
- 10. Rates by Gender Per100,000 Men Women Military 32.1 28.7 Civilian 20.9 5.2
- 11. PTSD & Suicide Veteranswith PTSD have a 6-10x greater chance of committing suicide than U.S. pop. Panagioti , Gooding & Tarrier, 2009
- 12. PTSD & Suicide Panagioti, Gooding & Tarrier, 2009 • VA reports 22 suicides per day among the entire veteran population and 1,000 suicide attempts per month. • Female veterans are 2-3x more likely to commit suicide than nonveteran women.
- 13. PTSD & Suicide AStrong Relationship Exits: PTSD alone = 6x risk of suicide compared with US pop. PTSD + Co-occurring disorder = 10x suicide rate Combat (or MST) PTSD Substance Use Depression Available Weapons Highe r Suicid e Risk Panagioti , Gooding & Tarrier, 2009
- 14. Facts about Veteran suicide 20percent of U.S. deaths from suicide are Veterans (National Violent Death Reporting System) Veterans are more likely than the general population to use firearms as a means for suicide (National Violent Death Reporting System) Decreased suicide rates in Veterans aged 18-29 who use VA health care services (National Violent Death Reporting System and VA Serious Mental Illness Treatment Resource and Evaluation Center) 33 percent of recent Veteran suicides have a history of previous attempts (VA National Suicide Prevention Coordinator reports, October 1, 2008 – December 31, 2010 )
- 15. Resources Veterans Crisis Line/Chat/Text 1-800-273-8255and Press 1 http://www.veteranscrisisline.net/ Text to 838255 VA Suicide Prevention Coordinators Each VA Medical Center has a suicide prevention coordinator to make sure Veterans receive needed counseling and services Resource locator - http://www.veteranscrisisline.net/