I once knew a man who had served in Viet Nam who believed that he deserved to suffer for the things he did there. He refused all pain medication to treat his terminal cancer. I believe he suffered more from the guilt over what happened there than he did the disease he was currently experiencing. It was painful to watch, knowing his pain could be eased, but that he wouldn’t allow it.
As a society, we teach our children that violence is wrong, killing someone is abhorrent, and that we have an obligation to step forward to prevent others from causing injury. And then we send them off to war where they have to resort to the very behaviors they’ve had a lifetime of learning not to do. It’s no wonder they come back with PTSD!
When we are forced to engage in behaviors that cause a conflict of interest, such as believing in the sanctity of life and then having to kill another person in combat, we violate our moral code. At least in some instances, this is part of the basis of PTSD. We don’t even have to be the instrument of death itself; we may witness others, and by not stopping their actions feel we are responsible.
Once someone experiences moral injury, s/he may become overwhelmed by shame, guilt, and anxiety over the possible consequences or anger over feeling betrayed. Moral injury is tied to PTSD. More research is needed to learn why some people develop PTSD while others go through similar circumstances without the same response. Perhaps if treatment focused more on responding to the moral issues involved, it would prevent the development of PTSD, at least in some individuals.