Page 266 - Total War on PTSD

this experience. Indeed, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013), “Feelings of detachment or estrangement from others” are examples of this symptom cluster (p. 272). Trauma undermines and disrupts global schemas, such as our view of the world as a safe place, of people being mostly benevolent and ourselves being generally competent, lovable and good (Janoff-Bulman, 1992). Trauma survivors, Veterans included, may lose trust in people and generate a negative view of themselves as part of the meaning-making process that ensues participation in war and the emergence of PTSD. This may exacerbate in cases of moral injury (Litz et al., 2009). Moral injury may be defined as follows:
Disruption in an individual’s confidence and expectations about one’s own or others’ motivation or capacity to behave in a just and ethical manner. This injury is brought about by bearing witness to perceived immoral acts, failure to stop such actions, or perpetration of immoral acts, in particular actions that are inhumane, cruel, depraved, or violent, bringing about pain, suffering, or death of others. (Drescher et al., 2011, p. 9)
The conviction that one is not good is an isolating one, and one that in due course results in more loneliness (J. T. Cacioppo & Hawkley, 2009). Indeed, moral injuries are a source of immense shame but also anger and a sense of betrayal. Veterans often feel that their commanders have stranded them to preform missions that, as Shay (1994) notes, “betray what is right.” Such violations of moral values haunt the Veteran long after the deed is done and manifest as psychopathological symptoms similar to those of PTSD (Litz et al., 2009). Thus, anger wells inside. Moreover, as these domains of experience are often those that no one wants to hear about, they are shrouded in a conspiracy of silence that is the sources of immense loneliness. For some Veterans, the burden is so great that even the civilian gesture of thanking Veterans for their service feels alienating rather than embracing (Sherman, 2015). As one Veteran of Iraq notes:
“I. . .resented the strangers who thanked me. I suspected that they were just trying to ease their guilt for not serving. Instead of thanking me, I wanted
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