Joe Biel

National PTSD Awareness Day & Moral Injury – Make the Connection

Wednesday, June 27th was officially recognized as the >3rd annual National PTSD Awareness Day.  PTSD Awareness Day was first established by Congress in 2010 after Sen. Kent Conrad of North Dakota proposed honoring North Dakota Army National Guard Staff Sgt. Joe Biel, who was a suicide casualty following two tours in Iraq. Biel’s birthday was June 27. Tragically and stunningly, in the first 155 days in calendar year 2012, the active duty armed forces endured 154 suicide casualties – as sure a cry for help as there is.

It took a decade of war in Iraq and Afghanistan, and millions of words, and thousands of shattered lives, for our nation to finally recognize the legitimate and true nature of post-traumatic stress and the effect it has on survivors of trauma. Trauma comes in many many shapes and sizes – I call them species of trauma. Combat, certainly. Accidents, whether vehicular or otherwise. Domestic abuse. Sexual abuse. Bullying. Racism. Crime victimization.

The link above includes 12 ways to increase awareness of PTSD in the community. PTSD does not affect just returning veterans. It affects every community, and all ages. It is, in effect, a 12-Step program for community members to learn about living with trauma.

But soldiers and veterans experience something else – a different species of trauma. Because they are volunteers. Every single one of us volunteered to don the uniform, to strap on the boots, and to take up arms to support and defend the Constitution of the United States against all enemies foreign and domestic. That is a good thing. Its a morally right and defensible action. Love of country is part of the natural order. So what happens?

My friend Nan Levinson of Tufts University is a writer and PTSD researcher. She has written an incredibly insightful essay about “moral injury” crossed posted at Tom Dispatch and the Huffington Post. Entitled Mad, Bad, Sad: What’s Really Happened to America’s Soldiers, she calls these moral injuries “sacred wounds.” Here she tells the story of a soldier:

“Andy had assumed that his role would be to protect his country when it was threatened. Instead, he now considers  himself part of “something evil.” So at a point when his therapy stalled and his therapist suggested that his spiritual pain was exacerbating his psychological pain, it suddenly clicked. The spiritual part he now calls his sacred wound. Others call it “moral injury.”

Nan goes on to explain:

“While the symptoms and causes may overlap with PTSD, moral injury arises from what you did or failed to do, rather than from what was done to you.  It’s a sickness of the heart more than the head. Or, possibly, moral injury is what comes first and, if left unattended, can congeal into PTSD.”

She gives credit for the term “moral injury” to Dr Jonathan Shays, the MacArthur Genius Grant recipient and Boston VA Psychiatrist who wrote Achilles in Viet Nam: Combat Trauma and the Undoing of Moral Character and Odysseus in America: Combat Trauma and the Trials of Coming Home There is an important academic paper on the phenomenon of moral injury entitled Moral Injury and Moral Repair in War Veterans published by in 2009.

It is no accident that the first National PTSD Awareness Day happened in 2010.

Awareness is not enough. Reaching out. As in combat, creating bonds under extreme conditions of stress and trauma. The VA has a new campaign called Make the Connection. Veterans share a common bond of duty, honor, and service. Some military Veterans served in combat overseas. We experienced things – life – that most people can’t fathom. We know. We get it. That’s why we have to reach out.