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THE REAL BLUE

Who have I become?

I will never be the same.

I don’t give a shit.

I’m so tired.

I can’t feel anything.

People say I’m cold blooded.

People are so stupid, incompetent, ungrateful.

No one gives a fuck about us.

I hate people.

I don’t trust anyone.

I can’t relax.

I can’t sleep.

If they knew me/what I think/what I have done they would not love me.

I’m an asshole.

I feel guilty for doing or not doing…X.

I used to be a good person.

I have done some terrible things.

I wish I could just get in my car and drive away, live in a cave, and not have to deal with people or anything.

Nobody understands what I’m saying or who I am.

Why can’t they hear me?

We are expendable.

Why are we under attack? Why are people looking to hurt us?

No one has my back.

Things would be better for everyone if I were dead.

Why are you so angry?

Why are you so controlling and overprotective?

Why don’t you ever want to go anywhere?

Why won’t you talk to me?

Why won’t you listen to me?

Why are you so distant?

Why don’t you tell me you love me or hug me?

Why do you always see the bad in people or situations?

First, know you are NOT alone! You are perfectly normal for a person of service. Your feelings and behaviors make sense in the context under which you operate.

The information contained in this application is the culmination of 20 years of treating traumatized veterans and first responders. Unlike many psychotherapeutic approaches which were conceptualized by researchers or theorists, our program is an integration of what veterans have taught us about the emotional wounds they carry and how best to treat these injuries.

 

Specifically, many people of service experience unresolved loss, guilt, and shame caused by losses and traumatic experiences suffered in the line of duty. Our program specifically targets these three areas of distress and aims to resolve these feelings. The VA reports that over 20 veterans per day are committing suicide (VA Study 2018). Research links suicidal ideations and traumatic guilt and shame (Maguen S, Madden E, Cohen BE, Bertenthal D, Neylan TC, Seal KH.

 

Our clients have taught us that leaving the deeper core issues of Moral Injury (unresolved loss, guilt and shame) untreated leaves them with lasting emotional wounds which interfere with all aspects of their lives and put them at risk for suicide.

In the policing population, Moral Injury, like Post Traumatic Stress Disorder needs to be recognized as a workplace injury related to exposure to both traumatic content, and threat not only to one’s personal safety, but also, to one’s integrity” (OPA member, personal communication, June, 2020)

We have finally come to understand that individuals who have been exposed to trauma often exhibit symptoms beyond anxiety and hyperarousal. At its core, Post Traumatic Stress (PTS) is more than anxiety and hyperarousal. We have repeatedly observed that deeper core issues exist and are typically the most distressing to traumatized individuals. These are unresolved loss, guilt and shame now termed Moral Injury (Shay 1994, Litz, et al. 2009).

Moral Injury is NOT a disorder, it is a soul wound that occurs when one bears witness to harm or believes they have perpetrated harm to others.

 Moral Injury is something that happens frequently to people of service who choose professions that repeatedly expose them to the Suffering & Evil in the world.

 Such repeated exposure can end up shattering one’s view of the world, one’s belief and trust in others and sometimes one’s trust in oneself.

Question? Have you experienced a change in your view of the world and others since you started your service? 

Moral Inury develops when highly competent and principled individuals (people of service) are repeatedly exposed to events which violate their deeply held moral values and expectations. It is the most competent, compassionate, and principled people that are the most vulnerable to these kinds of wounds, as these very qualities that help them excel, are also what makes them more vulnerable to being morally injured. Populations whose “professions take them into the burning building [or into the line of fire] not away from it” (Briere, 2003, training). One of our veterans expressed his internal experience of moral injury this way​, ”I feel like I have forfeited my membership card in humanity.”​ Moral Injury creates a sense of alienation from others and the rest of humanity because they believe  they have violated the basic tenets of human conduct regarding how we are to treat one another. ​In short, moral injury stems from broken relationships between people; the severing of human connection through traumatic loss or perceived transgression against others. 

Early in my career my veterans diagnosed with Post Traumatic Stress Disorder (PTSD) taught me the issues that bothering them were the loss of buddies, Survivor Guilt and shame for having participated in acts of commission or omission that violated their beliefs about how humans are supposed to treat one another. Based on this we developed a treatment that targeted the unresolved loss, guilt and shame that result from broken relationships between people that these veterans were describing. The mental health field has now termed these problems Moral Injuries (MI). So in essence we have been treating Post Traumatic Stress (PTS) and MI in conjunction for two decades. MI is a problem of the human condition and therefore applies to many people of service. MI creates spiritual and emotional suffering, but is not pathological.

People of service with Moral Injury often conclude that they are bad people because they may have done bad things. Good people can do bad things, but this does NOT mean they are a bad people. What someone does or dosen’t do under cirtsin circumstances in no way means they are irretrievably bad or always good.

There are two kinds of people in the world: regular people and sociopaths. Regular people have a conscience, sociopaths do not. People of service typically have an especially developed sense of right and wrong and empathy, that’s why they are drawn to service professions. They want to help! This makes them especially vulnerable to moral injury when they are forced to breach their morals.

In addition to moral injury, people of Service may also become injured by the systems in which they work.

A system or institution that is supposed to respect and protect you betrays you. Your family, your command, those in power, those you serve those you serve with. Shay, 1996: “a betrayal of what’s right, by someone who holds legitimate authority, in a high-stakes situation.”

Interpersonal Betrayal and Institutional Betrayal also result in moral injury in people of service. Often these issues are factors that compound the unresolved loss, guilt and shame suffered when they have breached their own moral values.

For example when your command

Second guesses your decision-making during a critical incident, blames you or fails to have your back.
Fails to give you the resources necessary or blocks your ability to accomplish the mission.
Provides incompetent or dishonest leadership resulting in harm to yourself and others
The people you are serving (command, citizens) are openly hostile and hateful toward you.

Institutional Betrayal can create a Moral Injury all its own. Freyd (2009) defines Institutional Betrayal as, “wrongdoings perpetrated by an institution upon individuals dependent on that institution, including failure to prevent or respond supportively to wrongdoings by individuals committed within the context of the institution.”

Remember

There is hope

You can find some measure of peace

You can love again

You can find a community of people who do understand

Interpersonal betrayal by those who are expected to respect and protect you. This leads to intense often unrelenting anger and deep shame.

Why can’t they just forget, get over it, focus on the good things?

If they could forget, or only think of good things, they would have done that years ago. It is simply not possible to forget trauma. Trauma changes brain functioning. Trauma memory is held in the amygdala and the hippocampus two structures in the limbic system. The limbic system is the survival part of our brain, it is where instinct lives. Trauma memory is not processed through the cortex, the part of our brain where we make language and meaning of things like other memories. The prefrontal cortex is shut down when trauma occurs and the memory gets “branded” into the brain as an intensely detailed and terrifying experience. It is important to note that trauma memories are branded without a “date stamp”. So, when trauma gets triggered by something around us, the amygdala starts firing and we are flooded with all of the images, thoughts, feelings, sounds, and smells, and our body and brain do not know that the trauma is not happening right now. It feels as though it is happening all over again. These images, thoughts, feelings, smells and sounds are with people for life. We can work with the memory so they learn to carry it differently so it is less intense, triggered episodes are less frequent and of shorter duration, but they do not go away.

Why won’t they socialize or go to crowded places?

Once you have been traumatized you become hyper-aware of your surroundings at all times. This is a survival skill that becomes automatic. You must learn to sleep so lightly you can react to any strange sound, immediately. The body gets biologically reset, and because it was life or death survival, they can’t just turn it off. You cannot “un-ring” a bell. Once traumatized it becomes hard to trust ANYONE or any place. To your body you are never not in danger. Crowds of people in and of themselves are dangerous because you cannot escape quickly if you need to and you are packed in with people you do not know, of whom you cannot keep track, or keep them all in front of you. So, in crowds traumatized people feel very anxious, hyper-aroused and exposed to danger in crowds.  That is why people of service often have to sit with their backs to the wall with a straight sight line to doors and windows. Most folks with a trauma history have a maximum social time of around two hours, if they are forced to stay much longer than that, often they will either have a major panic attack or get angry and blow up and leave. Both are fear-based responses.

Why do they isolate and withdraw from the family?

Because traumatized individuals’ brains are hyper-alert at all times, their brains and bodies become exhausted, and they physically need solitude, total quiet, and sometimes darkness. This is the way their brains recuperate. Social situations are very taxing on traumatized people’s brains due to the overstimulation and hyperarousal. It is not that they don’t want to be around you. Sometimes, they simply can’t. They can also become dependent on the adrenaline (stress hormones) which can make you feel alive and present at work and then at home they feel bored and flat.

Why can’t they be close or tell me he/she loves me?

Emotional numbing and the survival necessity to convert soft emotions into hard emotions becomes a way of life (Schneider, 2016). It is the only way they survived following moral and post traumatic stress injuries. People learn to survive traumatic situations by not getting too close to those around them because those they love may be hurt or killed at any time. Also, individuals with moral injury may fear that if you really knew who they are deep inside, or what they have done, you will judge or reject them. Most of our people tell us over and over, without their spouse they would be dead. They love you dearly.

 Why are they so angry or irritable all the time?

Anger is an emotion of physical and emotional survival when under threat. Anger keeps you moving forward, focused and motivated. It becomes the emotion of survival, and it also buffers you from the feelings that will get you, and those around you, hurt or killed. This makes it very difficult to let go of anger. Anger covers up all of the emotions that make people feel vulnerable or weak. Traumatized people are sometimes afraid of their anger, they are afraid they will “lose it” or “crack” and hurt somebody. On the other hand, they also worry that they might “lose their edge” and they won’t be able to protect themselves and you. Their edge is what keeps them and those they love alive. Some particular issues are especially triggering to traumatized people: (perceived and real)stupidity, incompetence, and disrespect are among the top interpersonal triggers. All of these are things they saw got others or themselves hurt or killed. This is why traumatized people may seem to over-react when confronted with these situations.

Why do they have so many problems with traffic?

Driving is probably one of the most dangerous things we do day to day. Everyone has a lethal weapon, and you can’t control the crazy things they do.  Traumatized people of service often feel trapped, out of control and often overwhelmed. They become exceedingly hypervigilant in traffic because they feel vulnerable and helpless to control others. They are waiting for something terrible to happen.

Why are they so controlling and overprotective?

Then a person of service has experienced traumatic events, he or she has been subjected to something unimaginably horrifying such as witnessing another be killed or maimed. When one has experienced such events, their body remembers that and stays vigilant to it happening again at any time. Remember, trauma memory has no “date stamp”, so the body and brain, when triggered, react as if the original event(s) is happening again. Therefore, the traumatized person cannot say to him or herself…”that happened 10 years ago, and it is not happening again.” So, they become hypervigilant to danger and controlling and overprotective as a countermeasure to losing their loved ones…again.  One person of service said: “I’m an asshole to my family because I want them alive”.

 I can’t sleep with my spouse because he/she does not sleep or yells and thrashes. What can we do about that?

Some couples have found “work arounds” for common problems. For example, some couples sleep in separate beds because of the thrashing around by their traumatized partner. Some couples will share some close time together in bed and once the significant other falls asleep the traumatized person leaves to the other room…since they are usually the one not sleeping. Traumatized people very often feel guilty about hitting, kicking, or hurting you while they are dreaming. Staying together, for a time, when you go to bed, preserves some of the intimacy. Sleeping separately relieves them from worrying about hurting you or keeping you awake.

 What is an Anniversary Date? Why are they such scrooges during the Holidays?

An Anniversary Date is simply the date or time of year that an individual experienced a traumatic event. The date of the traumatic event is not necessarily conscious. The heart, mind and body know when that event took place even if the person is not consciously aware of it. Inevitably, symptoms increase around these times and may even begin increasing a month or so ahead of the anniversary date and may take another month to dissipate. When one of our people comes to us and says, “I’m having more symptoms and I don’t know why”, we ask them two questions. First, “What is going on in your life now?” As stress increases, so do PTS symptoms. If the person’s current life is relatively stress free, we ask them, “Was this a time you experienced a traumatic event?” Many times, the person will then be able to identify if this is an anniversary time. Unfortunately, recognizing the anniversary date does not take away the reaction or the symptom, but it does provide the person with some sense of control since they can identify when the anniversary reaction will occur so you both can prepare for them.

Weather can be a strong trigger as well. Similar weather to traumatic events or Ike’s of year.

Most traumatized people of service that we have worked with over the years dread the holidays for several reasons. First, is the practical stuff like, more crowds of people out shopping, a significant increase in social activities (which as noted above, are the most difficult things for them to endure), the expectations of “good cheer”and gift giving. Many of them are grieving their losses and remembering those who don’t get holidays. There are some “workarounds” to make the holidays more manageable, such as picking a few important events you want to attend; don’t overwhelm them with all the holiday parties, take 2 cars so they can leave when they are ready, freeing you to stay longer at social events. Remember, about two hours is their maximum. We encourage traumatized people of service to take breaks at parties, go outside and breathe, or go to a back room, recoup and then rejoin the party.

 They drive me crazy with their focus on home security and all his/her weapons, cameras, and flashlights. Why is he/she like that?

Nighttime can feel particularly dangerous because they were more vulnerable to danger so traumatized people of service become especially vigilant at night. Traumatized people become danger-detection machines and when a person has experienced a traumatic event, he or she has been subjected to something unimaginably horrifying. Not only do they want to protect themselves, but they won’t let you be hurt on “their watch”.

How do I help?

First, it is important to remember that the traumatized person of service is responsible for his or her healing journey; you cannot do it for them, or have them do it on your time frame. Be supportive, but don’t push. Let them know you are interested in listening if they want to talk.

 What do I do when they are in a rage, flashback or panic attack?

 Ask what they need when they are in one of these emotional states. During a flashback or panic attack, they need grounding, in the here and now, a gentle voice, or a gentle touch, sometimes helps. When people are in a rage, touch might escalate them. Some couples use a code word to cue them and help them de-escalate, because they may be unaware they are escalating. This can vary for each couple, so it is best for the two of you to sit down and make a plan when everyone is calm and agree on some strategies to try out in these situations. Become a team.

 Why won’t they open up and share their experiences?

Many times, people of service have tried to talk to others with bad outcomes. They may have received judgment, misunderstanding, fear, or have had their disclosure used against them by others. So, they often do not trust others with their experiences. They fear your judgment. They fear their trauma is toxic and will harm you, as it has harmed them, so they protect you from it. They also fear that if you know the truth about them, you will no longer love them. Ask yourself: Do I really want to know the gory details? Will it change how I feel about them? If you ask, be ready to listen and hear some horrific things. You cannot truly understand their experiences unless you have been there. Most people who have come through therapy will come to you when they are ready. Let them know you will listen when they are ready to tell you what they want you to hear.

Also, trauma memory is stored in the brain very differently from other memory. Memories of traumatic events are stored in the limbic system because it is a survival memory. Trauma memories are branded into the brain like a movie, or may be just fragmented images, feelings, sights, sounds, smells, and tastes. We have found that people have to “tell” the story to themselves first to make meaning of the story before they can tell it to others.

Information People of Service have Shared with their Families

What We Want Our Loved Ones to Know:

When I get triggered, it will take me a long time to cool down. Any further arguing will only prolong that period of time. Please give me my space to wind down.
When we’re arguing and I need to walk away for a while, you need to let me.
Because I’m quiet sometimes doesn’t mean I don’t love you.
When I get deep in my thoughts, I’m not ignoring you – I’m just zoned out.
You ask me to explain or describe things that I can’t even explain or describe to myself.
There are things I just can’t let out and put into words.
You don’t understand that I can be 2 different people.
If you take me into a crowd and I act like a dick, it’s not your fault, and it’s not my fault. Just let me stay home next time!
If we go somewhere, at least one of us has to be on guard.
If you ask me to tell you what’s on my mind, and I do – don’t stop me. If it’s about my experiences, don’t ask unless you really want to know.
Let’s attack the problem, not each other.
I have a unique bond with my police buddies, a special love. I don’t mean to exclude you.
I’m hard on you because I love you.
I’ve learned that a lot of the hurtful things I’ve done, I wasn’t aware of.
I thought I was doing the right thing for my family, but I somehow missed it.
I’m not in treatment just for me; I’m here for us.
Thank you for tolerating 22 years of working the night shift and being absent to you.
Indecision drives me up a fucking wall.
Please forgive me for making you the ass end of my attitude.
I didn’t know that I was making you walk on eggshells.
I have a hard time having fun.
I have a hard time feeling love.
I have a hard time expressing any emotion, but that doesn’t mean I love you less.
I love you, but it’s detached. I can only show it through sacrifice and doing things.
I don’t feel adequate to be around anyone; I have too much shame.
I don’t know how I can ever talk about things until I can forgive myself.
When my daughter cries, I have trouble holding her. I can’t deal with high-pitched screaming. I don’t want bad things to go from me to her.
Don’t feel bad if I don’t ask you for help right now.
As I learn, I’ll tell you. Until then, don’t badger me.
My symptoms may get worse before they get better.
You are my rock.
No matter what happens, know that I have your back.
I don’t want you to be afraid of me when I get tense and agitated.
No matter how angry I get, know that I will never harm you physically.
When I get angry and snappy, it doesn’t mean you’ve done something wrong.

There is light at the end of the tunnel – for me, for us, and for you.

Why Moral Injury?

How do we know the letters work?

Applications for Other Populations

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