Dr. Shay has his own name for the thing the clinical definition of PTSD leaves out. He calls it “moral injury” — and the term is catching on with both the VA and the Department of Defense.
“Whether it breaks the bone or not,” he says, “that wound is the uncomplicated — or primary — injury. That doesn’t kill the soldier; what kills him are the complications — infection or hemorrhage.”
Post-traumatic stress disorder, Dr. Shay explains, is the primary injury, the “uncomplicated injury.” Moral injury is the infection; it’s the hemorrhaging.And a parallel quote from Abe Verghese's The Tennis Partner:
It's important that you realize that every illness, whether a broken bone, or a bad pneumonia, comes with a spiritual violation that parallels the physical ailment.As I was commenting on the Facebook page of On Being, I started to think about our constant pursuit of precision medicine, which just misleads us into a delusion of certainty, and how far we have drifted from the humanistic goals of medicine -- healing the soul along with the body.
Yesterday I listened to a podcast of Krista Tippett's conversation with Natalie Batalha, an astronomer who discovered the first rock planet outside of our solar system. Dr. Batalha, the ultimate scientist, reminded me that poetry and imagination are essential ingredients of science. She said something like "I am the universe looking at myself through the eyes of this sentient being." This is poetry and spirituality, and every component of this statement is grounded in scientific fact.
The science of medicine needs to regain its soul. It can do this only through the admission of our great uncertainties at the intersection of the "uncomplicated injury" and "moral injury." And even more than admit, we need to embrace and revel in these uncertainties -- this is where poetry and imagination reside. If we fail to do this, we risk compounding this "spiritual violation" instead of easing it. I know this isn't anywhere in the PPACA, and it is not a quality metric that anyone will monitor so as to reward/punish. And it's uncharted territory to boot. Yet this is precisely what is needed to heal medicine.
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