Psychiatrist to Explain Difference Between Moral Injury and PTSD

On Monday, Chautauquans heard about moral injury from the Rev. Rita Nakashima Brock. Now they will hear from Jonathan Shay, the clinical psychiatrist who first coined that term.

At 2 p.m. August 16 in the Hall of Philosophy, Shay will give a lecture titled “Moral Injury in War” where he will explain moral injury and its differences from post-traumatic stress disorder.

Shay said he fell into working with veterans “through sheer, dumb luck.” At the time, Shay was hired as a staff psychiatrist at the U.S. Department of Veterans Affairs Outpatient Clinic in Boston where he was only interested in the job as a way to keep doing his neuroscience research.

But after a short time working with the veterans, Shay said it wasn’t even a decision for him. He felt he couldn’t do anything else.

“The veterans saw something in me that I didn’t see in myself, and they kidnapped me,” Shay said. “I never went back to the laboratory. They just utterly redirected my life and did it in ways that have been incredibly rich and satisfying for me.”

After 20 years as a staff psychiatrist, Shay retired from working at the U.S. Veterans Affairs Outpatient Clinic in 2008 to focus on his “missionary work”: studying moral injury. He has also held various positions at other U.S. military institutions.

According to Shay, moral injury occurs when three main factors are present: the betrayal of what’s right, by someone who has legitimate authority, in a high-stakes situation.

“I will not be talking about moral injury in any specific religious context. I will be talking about it as part of a picture of the whole human being,” Shay said. “The usual riff on the way people get wrecked by going to war is to talk about PTSD, and the public, the press [and] Congress tend to use this term PTSD very loosely for everything that goes bad in the mind and spirit.”

Shay has a lot of criticisms of the way the American Psychiatric Association views PTSD, arguing its approach is too narrow and limited to the brain and mind.

Shay thinks the institution ignores the social impacts culture has on a human’s sense of right and wrong, especially regarding situations where people of legitimate, or illegitimate, authority are found. After his lecture, Shay hopes Chautauquans will have a better understanding of moral injury and its correlation to misuses of power.

But although Shay criticizes the APA, he said his clinical team is an important part of the work he does.

Shay is the author of multiple high-profile books on moral injury, but the work he’s most proud of is a clinical chapter in the book called Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, which he wrote with his colleague James F. Munroe.

The chapter addresses the struggles faced by people who treat those with PTSD and moral injury, and explains how to do this work safely “in a way that none of the clinicians become casualties.”

“Nobody can do this kind of work alone,” Shay said. “The characteristics and the functioning of the clinical team as a community in the workplace is absolutely critical to keeping everybody healthy.”

Madison Rossi

The author Madison Rossi

Hailing from Chicago, Madison Rossi is the 2016 Interfaith Lecture preview reporter. She is a class of 2018 journalism major at Northwestern University with minors in marketing and religious studies.