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Moral Injury and Moral Repair . Brett Litz National Center for PTSD VA Boston Healthcare System Boston University. Why is Unique About Modern Military / Long Wars?. Resilience resources: Pride, purposefulness, leadership, training, peer-support… Roles are motivating and reinforcing

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moral injury and moral repair

Moral Injury and Moral Repair

Brett Litz

National Center for PTSD

VA Boston Healthcare System

Boston University

why is unique about modern military long wars
Why is Unique About Modern Military / Long Wars?
  • Resilience resources: Pride, purposefulness, leadership, training, peer-support…
    • Roles are motivating and reinforcing
    • Societal support for warriors / military
  • Combat and operational experiences are complex:
    • Deployment adversities, stressors, sacrifices take toll
    • Non-combat roles entail unprecedented exposure
    • Traumas are complex, repeated, and enduring
    • Loss is profound
    • Bearing witness to mass destruction, human depravity and evil
    • Destruction, killing, maiming
  • Military trauma has been conceptualized narrowly
current conceptualization of ptsd
Current Conceptualization of PTSD
  • Neo-Classical Conditioning Model
  • Heuristic model has been useful
  • Excellent evidence in non-veterans
  • Evidence is weak for more complicated, interpersonal traumas
  • Trials with veterans are weak
  • Stress disorder and PTSD-thinking have hampered progress
assumptions
Assumptions
  • Resilience to fear-based traumatic stress
  • Traumatic loss and moral injury cause the most lasting scars
  • Loss and moral injury require different thinking
  • Shame and guilt thwarts motivation
  • Guilt, shame, sorrow, anguish are not extinguishable via repeated exposure
  • Reengagement, reattachment, and corrective action are pivotal (not all intrapsychic)
  • Societal, community, cultural, and family responses matters a great deal
  • Most outcomes will be delayed
most valid open ended definition
Most Valid Open-Ended Definition
  • The lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations
  • We do not know what “the syndrome” is
  • We do not know its prevalence
  • Betrayal has emerged as an important theme
why has it taken so long to get serious about moral injury
Why Has It Taken So Long To Get Serious About Moral Injury?
  • We have not asked the right questions
  • Fear-based models of care
    • Shame and guilt not targeted in CBT
  • Shame may prevent disclosure
  • Clinicians may feel helpless or unprepared
  • Clinicians may be too frightened of their own reactions
  • Clinicians may be judgmental