Moral Injury in Canada

This article is interesting as the mention of moral injury in the article implies that at least in Canada, moral injury is an accepted descriptor, rather than something radical or outside the norm. That, and their quoted definition:

Moral injury is distressing feelings of shame and guilt felt by individuals who have done, witnessed or not intervened in things they believe are morally wrong and against their personal ethics.

is much closer to Dr. Shay and others original definition than the current one operating definition within the US Veteran Administration mental health community led by Dr. Litz and Dr. Maguen which has drifted towards molding moral injury to fit into the VA’s evidence based therapies. As I wrote in my dissertation in 2019:

The differences between moral injury and PTSD had implications for treatment modalities. When I first started exploring this topic in 2009, Litz et al. (2009) had just written their first paper proposing moral injury as a possibility. At that time, the general consensus was that moral injury could not be treated by conventional, VA approved therapies such as prolonged exposure (PE) and cognitive processing therapy (CPT). Instead they averred that moral injury was something that only the veteran on her or his own, or preferably in conjunction with other veterans, had to work on outside of the typical evidenced based therapies. This comports with the alchemists who cautioned that only by working alone could the lapis philosophorum be achieved. However, Litz et al. did believe that PE and CPT were effective for treating the symptopms of co-morbid PTSD. Since that time, Litz and Maguen (n.d.) have tempered that initial belief by combining some components of PE into a treatment framework. However, one must take into account that both work for VA at the National Center for PTSD. In this context, it is not inconceivable that they are proposing this type of treatment in order to reach a wider constituency of suffering veterans while operating under a VA that accepts only evidence-based therapies.

Perhaps the Canadians have taken to heart Romeo Dallaire’s experience in trying to prevent the Rwandan massacre from occurring.

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