" The consequences of violating one ' s conscience can be devastating . Responses include overwhelming depression , guilt , and self-medication through alcohol or drugs . Moral injury can lead veterans to feelings of worthlessness , remorse , and despair ; they may feel as if they lost their souls in combat and are no longer who they were ."
Since the Gulf War Gavin had gone through periods of abusing drugs and alcohol and engaging in criminal and reckless behaviour . When he came to see me he was a little more straightened out as far as his behaviour went , but still he felt that no one could ever love him , that he was damned , that he was worthless . He looked at me despairingly and said , " Why am I even alive ?!"
So how can we help the morally injured client ?
Step one : As always , deal with the worst first
At the risk of committing ' concept creep ', I ' ve found that some survivors of sexual abuse may feel a terrible sense of not just betrayal , but also shame and guilt at having been coerced by a person in a position of authority and trust to do something which was , of course , terribly wrong . They know it wasn ' t their fault , but somehow it doesn ' t feel that way .
In such cases , once we treat the trauma it ' s much easier to reframe any sense of moral injury and help the client re-establish a strong and positive sense of identity .
It ' s hard to have a sense of coherent identity when we ' re plagued with flashbacks and nightmares . Use
the Rewind Technique to help your client over any
PTSD , and treating any moral injury will become a lot easier .
But we need to do more .
Step two : Help your client contextualise
Unless we ' re cruel
psychopaths ( in which case moral injury would never be an issue !), we have moral scruples . What ' s more , we behave as we do in context . This isn ' t to excuse so much as to explain .