Moral Injury

I am attending a conference this week for my continuing education credits for my counselor’s license for substance abuse. I have been in the field for about five years now. You may have been able to sense from my other blog entries that there are times that I feel as though I may a bit of a hasty choice in pursing this career, especially making the decision to go this route with less than two years of recovery under my belt. When I attend a training like the one I am at this week, I do get a little sense of being re-energize about my passion to look at addiction and the ways it can be treated.
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One of my recovery heroes is C.C. Nuckols. He has done amazing work in the field with regards to the brain, attachment, addiction science and most of all spirituality. I have not had the opportunity to see him present in person. When I saw my options for this training, I took his track. He is extremely knowledgeable about the brain and how addiction works on the most intricate levels. All these various experiences we have from the minute we join the earth contribute to development. Our development in addition to our genetics can create all sorts of fascinating outcomes – good, bad or otherwise. It is an honor to listen to him. The amount of information is almost overwhelming but I would never ask him to slow down or stop. It’s a rare opportunity to learn every last bit of information I can.

When I arrived on Sunday, the topic he was discussing was “moral injury” and effective treatment interventions. I hadn’t previously heard the term “moral injury”. Even before he started speaking, this term made complete sense to me. I talk with my clients regularly (mainly based on my personal experience with addiction) that there are to Me(s). There is me – sober. The sober me has a value system. I know what is important to me. I know who and what is of value to me in my life. I know that hard work makes me feel proud. My family’s relationship to me is of the utmost importance. I want to have connection with others and feel accepted. I value volunteering and offering help to my fellow brothers and sisters whether this be professionally or personally. I feel that giving back is something I have to do.

Then…..there is me – drunk/high. Everything that I listed above is thrown right out the window. This me knows how to use those relationships most important to me to get what I need to stay sick. This me exhibits impulsive, poorly thought out ideas to keep secrets or to manipulate others. Drunk me has a whole bunch of ideas about how the world owes me something and I am tired of working so hard for so little. Using me is just looking for the next high, the next relationship, the next “thing” that will make me whole. I will chase the wrong goals, I will cast my family and friends aside for a quick fix to meet my immediate needs.

There are many times that two contradictory things can so-exist. In fact, this concept is the whole idea behind Dialectical Behavioral Therapy. I can be right AND you can be right while thinking different things. I can be having a tough time AND still be doing OK. I had to learn this concept when I first got sober. Black and white thinking is notorious among those with addiction issues. It’s all or nothing; living in the gray just does not happen. To this day, the time in my life in which these two “me”(s) are fighting, they cannot co-exist peacefully for me. My value and moral system just cannot tolerate what the using me considers appropriate. What I participated in when using caused me “moral injury”.

The following are some of the quotes from his presentation regarding moral injury: “What we cannot acknowledge, we cannot process. What we cannot process, we cannot transform. What we cannot transform, haunts us. ” Moral injury, he described, has a long acting effect on a person (spiritually, behaviorally, emotionally and/or socially) who has taken actions which are against the individual’s own moral code or outside of what a person’s expectations of oneself. We talked about various populations of people who could experience moral injury (with his main focus for our educational session being those with military backgrounds). At any point, I can experience a moral injury by betraying a strongly held belief which, in turn, will create an internal conflict. When I have betrayed this value/belief, I may have also altered my perception of what is right and wrong. I may have caused confusion with my own boundaries. And depending on the type of injury I engaged in, I can feel the weight of betraying societal expectations as well.

When he was presenting about all of these concepts, I couldn’t help but think about my two me(s). I created a lot of moral injury to myself. My value and moral system are partially based on societal expectations (go to work, be a good neighbor, follow the law) while the other part in based in personal expectations (contribute, be generous, be accepting, honor your family and friends). Although I am often accused of keeping my expectations too high for myself, I have a strong pull to be of help to others. The drunk me knew of no such thing. People were to be used and discarded if not helpful. I help others, not for the betterment of the world, but to fill some empty void in my soul. “Maybe if I help this lady across the street, I won’t feel like such a disgusting human being…..now that I did that, let me tell the world so the world can tell me how great I am!”

Moral injury describes so much to me. What I have felt in the past few years in terms of my recovery are my moral injuries coming to the surface. I am trying to reconcile some of my past behaviors with the current me. It has not been the smoothest of processes. When I think about doing spiritual work, I am seeking a deeper connection and understanding of the world I live in. There is a lot of bad out there, but I believe that there is more good. I want to be a part of the good and make a difference. While that has been a core value of mine before alcohol got its hands around my neck, I feel like some of my intentions to contribute have become unclear and misdirected. As I learned more about moral injury, I could see the characteristics of my recent journey starting to surface. There is some existential sorrow for all the things I lost because of addiction. I carry strong regret about what I missed out on, what I put my family and friends through and all that could have been had I not made some of the decisions I did.

My therapist works with me a lot on being a “shame-based” individual. If you tell me that I am in trouble, watch me flip out. It’s for real. I absolutely despise being in trouble. If I did something wrong, I will immediately become defensive and try to blurt out 14 different reasons why I am not wrong. I am working hard to not be so defensive because everything related to my response is about me. I am shaming myself for not being perfect so I will try to make the issue about the other person’s misunderstanding of my intentions so that I am not in trouble. Because, you know, if this person didn’t UNDERSTAND my intentions, then I did nothing wrong, this person just misunderstood. Let me tell you, it can take a lot of energy to think of all the different ways to explain myself when I could have just taken the situation at face value: “Oops. I did that wrong. Thanks for letting me know. I will know for next time.”

Because I lived outside of my value system for so long (give or take 15 years), I have yet to resolve a lot of my past conflict. From time to time, my addictive personality shows up in the present and I can feel the pull to do something out of my value system again because there will be some immediate gain. I have had to watch myself because I know I can persuade people easily. When I find myself doing that, I feel uncomfortable now. I think that starts to bring up the hurts of my past behavior I haven’t yet been able to resolve. Instead of facing that head on, I do what a lot of people with moral injury do – avoid. I keep a distance from others. I will isolate more. I may have a shorter fuse. All of this in a misguided attempt to avoid situations that might result in seeing my moral injury. If I am unwilling to see it, I can tell you that I am even more unwilling to address it.

I know that continuing education is suppose to be an opportunity to learn about information to help me with my practice and not necessarily to help me with my own stuff. However, I couldn’t help but sense that maybe this is the universe offering me a little bit of direction. This session was an elective session and I had signed up for it because of who was presenting, not necessarily the topic. Honestly, when I sat down on Sunday, I didn’t even know what I was sitting down to listen to. I was too busy going all “fan-girl” about the presenter. I am, however, so grateful that I did. Although the concepts around moral injury and the treatment thereof has been around for a while, I hadn’t heard the discussion presented in this way before. It was tremendously meaningful to me and gave me so very much to think about.