A Startling example of “Immoral Injury”

Jul 22, 2023

The op-ed by Garry Trudeau (the link: https://www.washingtonpost.com/opinions/2023/07/10/ptsd-treatment-veterans-medicine-mental-health/ ) recently published by the Washington Post is a very sad commentary on ethics challenges in glaring evidence from leaders of organizations, federal and otherwise, whose livelihoods depend on maintaining current treatments of PTSD to the exclusion of at least one new one — dubbed ‘the best PTSD treatment you’ve never heard of.’  Trudeau describes the active efforts for well over a decade by leaders in the PTSD research field to suppress an evidence-based neurological intervention for PTSD known as the Reconsolidation of Traumatic Memories (RTM) — as DoD’s Chief PTSD Research lead communicated directly to Dr. Frank Bourke, support for RTM would jeopardize all of their careers.

That’s right…The Reconsolidation of Traumatic Memories (RTM) Protocol is a brief (3-5 sessions, conducted virtually), and effective treatment (dramatically more so than the existing “gold standard” treatments) which, importantly, requires no medication and does not retraumatize clients or therapists, a major problem for Prolonged Exposure and Cognitive Processing Therapy.  RTM is a breakthrough that so many, including our nation’s active military and vets, have needed after years, even decades of suffering from PTSD. And, what about the billions of dollars have been spent on PTSD treatments that either don’t work over the long term or have high (50% and higher) drop-out rates?

We have a term, “moral injury,” that is used to describe people who are suffering because they are riddled with guilt from  having done things that violate their moral ethic. War fighters can be an example of suffering “moral injury.” We are taught not to kill…and in war times killing is required when deployed in war zones. Military service members can be plagued by the “moral injury” of actively causing the death of others as well as witnessing atrocities that they are helpless to change.

But what happens to leaders like the ones cited in Trudeau’s article? These highly-placed individuals that head various national PTSD organizations put the security of their own careers and status, a status that is, in part, derived from what had once been earlier innovative PTSD treatments (albeit with very high drop-out rates), above the well-being and healing that an exciting innovative, evidence-based treatment like RTM offers.

I propose that we use the term “immoral injury” for people like these. Maybe they are in too much denial to experience the truth of what they have done, maybe they repressed the guilt, the shame for what they have done. But if they ever suffer, it will be from the injury to the psyche that comes from immoral actions like the suppression of a proven treatment that actually cures PTSD.

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