# Moral Injury, Beyond PTSD.



## pardus (Mar 26, 2014)

I think this is long overdue. There is an institutionalized culture of fucking people in the US Army (can't speak for other branches). Missed your promotion because we wouldn't do our part? Pay didn't go through? You're homeless because we didn't arrange housing for you? Suck it up, you're in the Army now!
That mentality is poisonous to the moral and welfare of the Military and is simply wrong. It's an excuse that incompetent leaders use to cover their mistakes instead of going the extra mile to ensure things are done correctly. It needs to change and I'd like to think this will be part of the start of that change.













http://www.ptsd.va.gov/professional/newsletters/research-quarterly/v23n1.pdf


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## Gunz (Jul 1, 2014)

Very grateful for this. Wow, a guy who gets it. A guy who _listens _and _learns _from combat vets.  Pardus, I think there's an _institutionalized culture of fucking people _in any big bureaucracy, but the services are more prone to do it with the least amount of human sensitivity because SOP is founded upon the principles of cattle herding.  Combat vets have a very low boiling point when it comes to petty bullshit. And petty bullshit is everywhere in the military and the VA and the civilian workplace, _everywhere you freaking go post combat_. 

You have a brotherhood with your squad/teammates, with your medic/corpsman, a spiritual connection, an incredibly strong bond of understanding that outsiders--and by that I mean anybody, even military personnel--who didn't experience that unique relationship, will never be able to comprehend unless, like this man, they actually _listen _and _learn. _

The military's never wanted to hear about your personal problems even if you've gotten your arm blown off at the military's behest and upon its behalf. They just want to process your problem out the freakin door in the most efficient manner. And then you get to the VA and they throw drugs at you--the magic bullet--or put you into some counselling session with some civilian non-hack who talks to you like you're a three-year-old in a room with a group of wannabes working claims.

I had a very difficult time assimilating. For years. When I first went to the VA in the mid-70's, it was staffed by a lot of WW2 veteran mid-level REMFs who dismissed what Jonathan Shay defines as "moral injury" as chickenshit.  The shrinks were all quacks who couldn't make it in civilian practice and the MDs just wanted an excuse to cut you open.  And this is the way it was until the late 90's, at least in my experience. Things are better at the VA, no question. But you can't diagnose and treat "moral injury" from a manual. I remember once, during a bad spell, I really needed to connect, to talk. They set me up with some 20-something girl who'd just gotten her psychology degree. I talked to her for maybe five minutes and realized it was a waste of her time and mine.

War becomes part of your character. You can't forget about it so don't even try. It's going to be with you until the day you drop your ruck, the day you meet your fallen brothers. There is hope and help. Recovery can happen in the company of your peers. What eventually helped me was a Vet Center counsellor, who'd been grieviously wounded with 1st Cav in the Central Highlands. He put me in a small group with other men who shared similar experiences. All combat vets, some Army, some Marines, three of us had gotten hit.  It was amazing.

Your Brothers will always be there for you. The military may fuck you, the VA may fuck you, your civilian boss will most likely fuck you...but never leave the Brotherhood. Always stay in touch.


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## TLDR20 (Jul 1, 2014)

Your brothers will always be there, but there needs to be a bottom up feeling that a guy is not a pussy for seeking help, that is beginning/was beginning when I got out. Part of the problem with hardcore mofo's, is that they are just that, and don't trust anyone who isn't the same. Maybe we need to be pushing 18D's into the Psych arena instead of the PA world. Maybe I will think about going that route... I will say I saw an ex 18A who became a psych. We had very positive results from a few meetings. I recommended him to a few buddies, he is local to Bragg and almost exclusively treats guys with PTSD and other service related problems.


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## Gunz (Jul 1, 2014)

Absolutely. And please don't think I was trying to come across as some big war dude because my shit pales in comparison to what you guys have done, multiple deployments, multiple theatres, 4-5 Purple Hearts...I'm just a lightweight. But I'm old...and I've had a lot of time to be fucked up in the head and to think about it.  Physical injuries, depending on severity, heal as far as they'll go...the moral injury part is like a big painful-ass tattoo drilled right into your brain. Lots of color, lots of needlework, hurts like hell, never goes away...fades a bit, gets a little less painful with time, but it aint going nowhere.  Some the artwork may be cool, but it comes at a price.

TLDR, I can see where a professional would be reluctant to seek help for a number or reasons. It could come back and bite you in the career. I'm sure it would. My company CO who retired an O-5 still can't talk about it. I can talk to him easily about most anything, we hunt together, drink beer together at least once a year...but when war comes up the comm doesn't last long, the wall comes down. From his point of view, a retired LtCol, there's no way he's gonna walk into the VA and ask for help, and he could use it. He shouldered every injury and death suffered by his boys. 

Me, I'm different. I tossed a coworker over a desk in 1979  I didn't get fired because he was an asshole and everybody hated him. But that's what I mean about low threshold.  To paraphrase Sam Kinison, ther've been times I've wanted to drive my car into a fuckin brick wall.


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## Evans (Jul 1, 2014)

TLDR, I've wondered the same thing, about why there isn't any kind of specialized team of Mental Health providers or techs within career fields like that. You could make them 18D’s just with a psych specialty. That way they can be used for more than psych needs and could be utilized as a medic if needed. Or integrate a small portion of psych into courses like that, same thing I guess.

It’s hard for us to do anything to help people like that though. I know plenty of Mental Health techs that would love to be a part of something like that, but it’s never seen as a big issue. We can never build enough report with patients like that, because we cannot prove ourselves to them, and that’s the mindset of most patients from that side of the military. It doesn’t help that we have the stigmas that we do like “it will end your career” or “it shows weakness”. I am by no means a feelings person, but some people have no shit problems that they need help getting through and never get that help because of it.


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## pardus (Jul 1, 2014)

I know several guys that are currently serving that won't go to the Army or VA and seek help, because they know that it will be held against them and they could very well be looking at being separated from the Military. 
So they continue to suffer without professional help...


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## Evans (Jul 1, 2014)

Which pisses me off more than anything. That's basically someone taking the easy way and not doing they're fuckin job. It's our job to help the individual and keep them in the fight, not get rid of them and pass them off. I hate people.


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## Ranger Psych (Jul 1, 2014)

Even better is when you do seek help and what psych staff the military does have is probably the stupidest portion OF the military.

Nothing better than trying to explain a situation using military jargon while being in the military and having to explain for 30 minutes out of your hour session what a ruck, poncho liner, taking a knee and facing out, etc mean because the major you're talking to doesn't even know a fucking THING about the military she's a member of.


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## pardus (Jul 1, 2014)

Evans said:


> Which pisses me off more than anything. That's basically someone taking the easy way and not doing they're fuckin job. It's our job to help the individual and keep them in the fight, not get rid of them and pass them off. I hate people.



While I agree with your sentiment, it's not people per se that are the problem, it's the system. Insomnia is a mental disorder report it and you're flagged just like someone who says they want to kill themselves and others. The system is fucked.


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## pardus (Jul 1, 2014)

Ranger Psych said:


> Even better is when you do seek help and what psych staff the military does have is probably the stupidest portion OF the military.
> 
> Nothing better than trying to explain a situation using military jargon while being in the military and having to explain for 30 minutes out of your hour session what a ruck, poncho liner, taking a knee and facing out, etc mean because the major you're talking to doesn't even know a fucking THING about the military she's a member of.



That's one reason why "we" get fucked.

E.G. I got yelled at when I was at the VA because during a PT session for my shoulder I asked if I could do a few pushups to see how things were progressing, the PT said sure so I dropped and did some, I was yelled at by half a dozen staff members, I was like WTF? They bombarded me with "the hospital floor that is mopped and buffed once a day is DISGUSTING!!!!1!!"
I just looked at them speechless and didn't say a word, civilians have NO idea what we do.

I often find civilians more surprised and shocked, at the stories of no sleep and no food more so than bombs and blood stuff.


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## Ooh-Rah (Jul 1, 2014)

pardus said:


> <snip>I often find civilians more surprised and shocked, at the stories of no sleep and no food more so than bombs and blood stuff.



This is such a true observation, and I think it is because they can actually relate to the idea of no sleep/food.  All the other stuff, they have no point of reference.


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## pardus (Jul 1, 2014)

Ooh-Rah1069 said:


> This is such a true observation, and I think it is because they can actually relate to the idea of no sleep/food.  All the other stuff, they have no point of reference.



Yeah, and the whole generic ""war is hell" now lets gets brunch and discuss it mentality", did you see the people dying? Oh yes terrible!, pass the wine would you dear?"" mentality.

I appreciate the 'support our troops' stickers etc... but fuck off, what are you really doing for the people that allow you the freedom to drive that car?


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## Grunt (Jul 1, 2014)

Ooh-Rah1069 said:


> ...All the other stuff, they have no point of reference.



I agree with your observation here. I also think that they don't believe that you can see the things you have seen and do the things you have done and not be a mental marshmallow afterwards. It is beyond their comprehension since most people walking these streets have never even been hit in anger.


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## Evans (Jul 1, 2014)

My apologies Pardus, I misunderstood and ran with it. I'll just got back to reading and learning for now.


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## pardus (Jul 1, 2014)

Agoge said:


> I agree with your observation here. I also think that they don't believe that you can see the things you have seen and do the things you have done and not be a mental marshmallow afterwards. It is beyond their comprehension since most people walking these streets have never even been hit in anger.


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## Grunt (Jul 1, 2014)

Very well said. I couldn't have said it better myself.


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## pardus (Jul 1, 2014)

Evans said:


> My apologies Pardus, I misunderstood and ran with it. I'll just got back to reading and learning for now.



Bullshit, what are you apologizing for? You have an opinion and we want to hear it. 
Trust me, if I or any other member of staff think you're a full of shit cunt, we'll tell you. Differences of opinion are welcomed, that's how we sometimes learn to expound our thoughts.


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## AWP (Jul 2, 2014)

pardus said:


> Bullshit, what are you apologizing for? You have an opinion and we want to hear it.
> Trust me, if I or any other member of staff think you're a full of shit cunt, we'll tell you. Differences of opinion are welcomed, that's how we sometimes learn to expound our thoughts.


 
This.

@Evans if you have something to add, someone may benefit from it. A member or maybe a lurker.  I battled my own issues (not PTSD, I should be clear about that) years and years ago and I can tell you the worst thing is to think that it is only happening to you and that you're alone. When isolation sets in you've gone down a hole that is difficult to leave. So, if you have something to share, please do so. Maybe someone won't fall into that hole.


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## Ranger Psych (Jul 2, 2014)

Evans said:


> My apologies Pardus, I misunderstood and ran with it. I'll just got back to reading and learning for now.



You were right, partially.  The system is fucked up in a huge way (seek help, seek other employment because you're on the fast track for an ETS you probably didn't plan for) but the people that are part of the system ARE ALSO THE SYSTEM.... and they're fucked. Even better with the new mix of shared medical care cross-service. 

I had to fix USAF medical care done to my wife, the USAF plus USA is why I'm not in the military anymore arguably moreso than anything that was going on with me at the time... funny thing is, I was golden while I was undergoing care from a specific shrink (and had no negative connotations or service effects from seeking help)... except that former AFSOC command shrink went back to Hawaii, and the guy that took over for him was an absolute asshat with no effort towards anything remotely considerable as patient care.

I mean, I was a fucking Ranger, combat deployed, with an ongoing war. Especially in a unit that's ill trained and set to deploy within a year. I'm going to be pretty spooled up because I'm used to being with some locked on highspeeds and now I'm in a unit best equated as a pinto with a burnt out clutch and supposed to compete in LeMans here shortly. YES I AM GOING TO BE SPOOLED UP.


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## Gunz (Jul 2, 2014)

So many misconceptions on the part of the public, the military "system" and even care-givers. There's nothing wrong or weak or pussified about having moral injury. Maybe you can't sleep at night, maybe you're drinking too much, maybe you're hyper-vigilant or you get pissed too easily, sometimes you want to put your fist through a wall. _There's all kinds of things working on you that you can't shoot your way out of..._  Nobody wants sympathy,  you just want somebody to get it and give you some useful input to help you channel it so you can make your life better.  It took me years to get hooked up with the right people and that was just luck. I'm glad to hear at least that some steps are being taken by the military...maybe after a few more wars they'll get it right.


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## Evans (Jul 2, 2014)

pardus said:


> Bullshit, what are you apologizing for? You have an opinion and we want to hear it.
> Trust me, if I or any other member of staff think you're a full of shit cunt, we'll tell you. Differences of opinion are welcomed, that's how we sometimes learn to expound our thoughts.


 Understood, then my opinion is that yes the system is fucked, but the system is still people. It may be the persons command or it may be shitty docs, but it comes back to people and them being lazy. I can be a doc, have a patient come in, and have two options...Help them to the best of my ability or find a way to Med Board them because its easier. I've seen that happen to many times, and it pisses me off when it does.

The military is all about meeting numbers anymore. If they can get rid of you and still meet numbers they will. It's "easier that way", but by no means is it right. And that kind of thing doesn't help destigmatize Mental Health, it makes it worse. Our job isn't to weed out those with problems, it's to help those who need it. What sucks is success stories don't get out to the public, but if shit hits the fan it's our fault. It's a losing battle and will be until we have all squared away docs that won't try to easy way out of seeing an individual by Med Boarding them, and once we can get over the whole "You're a pussy if you get help, just keep it to yourself and press on."


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## AWP (Jul 2, 2014)

[QUOTE="Evans, post: 343993, member: 6856] What sucks is success stories don't get out to the public, but if shit hits the fan it's our fault.[/QUOTE]

In your experience, what percentage of success stories do you see? Or better, success stories vs. failure vs. Med Boarding (I try to differentiate between the last two. Who sees a Med Board and who doesn't)?


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## Evans (Jul 2, 2014)

Freefalling said:


> In your experience, what percentage of success stories do you see? Or better, success stories vs. failure vs. Med Boarding (I try to differentiate between the last two. Who sees a Med Board and who doesn't)?



Thats kind of a tough one to answer from my limited experience (1 year in career field and only one duty station so far), but I will say that it also depends on the motovation of the patient. It is also hard to give you an accurate number for this because alot of our PTSD patients aren't actually deployment related, but more from abuse during childhood.

That being said, I do recall a few cases of deployment related diagnosed PTSD that the patient actually did the homework (desensitization at different public locations and tracking their SUDS in this case) and noticed the improvements, became motivated by this to share more during sessions, and was actually cleared of all profiles. We have a few docs here that are trained for PTSD patients, and I think thats why sometimes places like the VA or other installations fall short or don't take as good care of these patients as they could.

To actually answer your question though, I would say, for our clinic here, atleast 75% -80% (estimate) carry on with their career with no negitive impact. Those that don't are usually Med Boarded, and that is only because they are legitimately unable to continue the mission. And even with those patients, we continue to see them until the day they separate to make sure they have some sort of set up afterward. But I can only speak for our clinic on that. I can do some research on that though to get a more accurate number for you.


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## AWP (Jul 2, 2014)

Evans said:


> I can do some research on that though to get a more accurate number for you.


 
No need unless you want to. I was simply curious, not calling you out. I'm a little surprised at your estimate, not because I doubt you, but I honestly wonder if your location is not the norm or maybe if the AF is doing a better job than the other services or some other factor.  

The reality is that we'll probably never know exact numbers. I'm cynical, but if the VA or DoD ever released any numbers I'd immediately shave 10-20% off of those figures. I think the problem is bigger than the gov't would like to admit and I think there's a certain amount of "ostriching" going on (head in sand)  in the hopes that the problem will go away. One case in point: Lariam/ mefloquin.


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