" I swear he wasn ' t more than 16 ," Gavin told me , the horror already evident in his voice .
" He was out scouting too - for us , for his enemy . We guessed his unit was close by . My superior officer whispered to me to kill him . Without thinking , I went for my gun ... but he stopped me . " No , they ' ll hear ! We can ' t alert his whole unit . Use your knife ." I hesitated , so my officer punched me in the arm and sort of shout-whispered , " Kill him !"
Gavin looked infinitely sad . " So I did . And I ' ll never forget the look on his face .” Shame , powerlessness , betrayal , guilt
Gavin was suffering from
post-traumatic stress disorder . He still had flashbacks and suffered nightmares . Even though this had all happened years before , it still felt " like yesterday ."
But even after we ' d
treated the trauma , Gavin still displayed a sense of devastating damage to his sense of self . Yes , he felt more able to get on with his life now that the past felt more ... past . But he still struggled with a sense of who he was . A
sense of shame about himself , betrayal by his commanding officer , and terrible guilt about the boy he ' d killed .
None of that is unnatural , of course , given the extreme circumstances . But it was making his life unbearably hard .
" I must be a terrible person !"
We often hear about PTSD in association with returning veterans , but there ' s a danger of conflating PTSD with the less talked-about phenomenon of
moral injury .
Sure , often there ' s an overlap , as there was with Gavin . Sometimes , too , we see
survivor guilt in clients if they made it through some terrible event while others didn ' t . But it ' s important to understand the difference . It ' s also important to recognise that many conditions aren ' t clear cut , but bleed into one another . Emotional issues don ' t usually have distinct edges . But moral injury can certainly exist outside of PTSD and survivor guilt .
So what is moral injury ?