For years, we've heard phrases similar to "We keep it in house" and "It's not something that is talked about".  We heard you.  We get it.  We understand.  That's why ART works for service men and women and their families.  You DON'T have to talk about it. 

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The phrase PTSD has become stigmatized and has a negative connotation attached to it, and may for good reason.  Consider the idea of Moral Injury rather than a disorder...

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Moral injury is the damage done to one’s conscience or moral compass when that person commits, witnesses, or fails to prevent acts that violate their own moral and ethical values or codes of conduct.

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One of the thing we hear often is that individuals followed orders, did their job, and did it well.  They didn't question themselves or others because they knew they were doing the right thing in that moment.  Yet days, months, or years later... removed from the situation... they aren't as comfortable with those choices and often replay those scenes or ruminate on what happened.

In the opposite situation, a person may know what they WANT to do but they are unable to do so due to political limitations, specific orders, fear of judgement or repercussion, or lack of resources.  In either situation, a person may experience moral injury. 

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Moral Injury among the helping profession and First Responders

Moral Injury has been called many things such as burn out, compassion fatigue, vicarious trauma, and so on.  First Responders and those in the helping profession are often present for and expected to remain calm in high stress, emotionally intense situations. 

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Events that may lead to Moral Injury include death-related situations, killings, handling/uncovering human remains, severely wounded victims that the person was not able to help, rape disclosures, discovery of ongoing abuse, witnessing events that go against one's moral code without intervening, and many more.  In the helping profession, someone may know how the right thing to do, however due to red tape, time limitations, insurance constraints, internal politics, or funding issues, they are forced to make less than optimal choices. 

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Signs of Moral Injury are similar to PTSD and can include intrusive thoughts, negative self-concept or question the self, questioning decisions, replaying or reliving past events, avoiding certain situations, substance abuse or other attempts to "numb" or turn off the mind, or having feelings of regret, shame, or guilt.