Washington Post

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.



Memorial Day 2012 – Do Veterans Really Need a Welcome Home Gift? Or Just a Chance?

Recently, on May 6th, 2012, Admiral Mike Mullen co-authored a well-received editorial in the Washington Post entitled A Welcome Home Gift for Veterans: Jobs. Hard to argue with that sentiment…or is it?

Jobs are not a gift. A gift is a freebie. Something given, gratis. Free of any recompense or obligation to return the favor (supposedly, but we know how regifting works). But I am not so sure that “gift” is the right language or the right image we want Americans to have when it comes to the issue of veteran employment and re-entry into a post-combat, post-military civilian workforce.

In my eyes, veterans not only have earned the right to compete for a place in the workplace in the global free market, but are eminently qualified to perform and contribute as value creators. For those of you who have read the book Moneyball or seen the movie by the same name starring Brad Pitt, the central theme is that Billy Beane created value (both by winning a championship and by making money!) by finding and extracting performance from assets in a labor market that were overlooked by traditional baseball metrics. I submit that this is the fundamental dynamic that is at work as veterans of the wars in Iraq and Afghanistan enter the civilian labor market today, and will continue to do so for the next decade.

From a hiring manager or employer’s point of view, hiring a veteran is no gift. It’s not a give-away. Its making a shrewd business judgement based on an evaluation of what that veteran can bring to the workforce. Its not an act of charity, but an act of self-interest. Its about finding and extracting value from a traditionally and currently overlooked asset in the labor market, where other employers are not making that same judgement. In that sense, it gives the hiring manager or employer a competitive advantage, in an economic environment where capital is scarce and fiercely contested, and everyone needs every edge and advantage one can get.

With all due respect to Admiral Mullen, and I appreciate his message, but jobs do not equal gifts. An article entitled Record Suicide Rates Highest Among Jobless detailed a study that found suicidal ideation far more prevalent among the unemployed. Another recent article The Best Medicine Might Just be a Job cites “Study after study correlates unemployment with suicidality” and a “two-fold to three-fold increased relative risk of death by suicide.”

Two thousand five hundred years ago, Thucydides observed in his History of the Peloponnesian War, that the Athenian politicians found it was easier to honor the dead than care for the living. What was true then remains true today. This Memorial Day, as we remember more than 6,000 dead in Iraq and Afghanistan, more than 50,000 wounded, and several hundred thousand permanently disabled – lets remember the approximately million veterans who are unemployed and looking for work.

Jobs equal a chance for veterans to re-enter the civilian workforce and re-integrate into American civilian society, having earned the hard way – through blood and sacrifice and suffering – a shot at making their American dream a reality.