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Post Traumatic Stress
& Moral Injury

A closer look

Numerous definitions and descriptions can be found about what PTS and Moral Injury are. PTS is so broad, manifests itself in so many different ways and symptoms and are so comprehensive that it is not always straightforward. It is approached from a medical basis.

We are not about making a diagnosis, a medical approach.

We look at this from a holistic view and human side. We are concerned with and dedicated to what you can do as a human being to be able to live your life to the fullest despite trauma.

We think it is important to describe some basic elements of PTS and Moral Injury. Trauma is stored in the body and much is stored in the brain.

What is PTSD (post-traumatic stress disorder)?

PTSD, or post-traumatic stress disorder, is a mental illness that can occur after experiencing or witnessing a life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual violence and abuse in adults or children. Most survivors of a trauma can recover from it.

However, some people have stress reactions that don't go away on their own or even get worse over time. These individuals can develop PTS. People who suffer from PTS often relive the experience through nightmares and flashbacks, have sleep problems, and feel disconnected or alienated, and these symptoms can be severe enough and last long enough to significantly harm the person's daily life.

People with PTS experience three different types of symptoms. The first set of symptoms involves somehow reliving the trauma, such as getting upset when faced with a traumatic memory or thinking about the trauma when trying to do something else. The second set of symptoms involves staying away from places or people who recall the trauma, isolating from other people, or feeling numb. The third set of symptoms includes things like being wary, irritable, or easily startled.

PTS is characterized by clear biological changes and psychological symptoms. PTS is complicated by the fact that people with PTS can often develop additional disorders, such as depression, alcohol and drug abuse, memory and cognitive problems, and other physical and mental health problems. PTS is also associated with a deterioration in the person's ability to function in social or family life, including work instability, marital problems and divorces, family disagreement, and parenting difficulties.


How Trauma Affects the Brain

It is essential to understand that only part of PTS is a medical problem: the damage to the brain's limbic system. Our limbic system has a few parts that change when we are affected by trauma, including the amygdala and the hippocampus. The amygdala is the 'general' of the brain, and one of the main tasks is to ensure that you are prepared to respond to threats. Our brain's 'fight or flight' function is rooted in the amygdala, which is designed to respond to threats such as lions, tigers and bears.

Historically, we have not been apex predators. We've been prey before, and our brains have been developed to ensure that we could survive when faced with threats. Our central nervous system believes that we are prey because we were that until recently in our ancient history. The amygdala also controls functions such as your heart rate and lung function. It always works even when you are sleeping.

When people experience various traumatic events and long-term exposure to threats, the amygdala becomes sensitive and changes. The average person has an amygdala the size of an almond, while someone with PTS can have an amygdala the size of a golf ball or even a tennis ball. After the amygdala has become accustomed to regularly responding to threats, it does not simply return to its normal state. It remains convinced of constant threats and begins to respond to anything it may consider a threat.
When the amygdala activates the 'fight or flight' function, it sends a signal to the hippocampus, which releases chemicals to our body so that we can respond to the threat. However, the hippocampus cannot release chemicals and store memory at the same time, which is why many have a hard time remembering things. For those who know what it is like to experience anxiety or panic attacks, the chemical release caused by being 'activated' gives those awful feelings that arise when they experience anxiety. Also, the perceived hyper-vigilance is rooted in the changes of the amygdala, which is one reason why people with PTS have trouble sleeping. They are always on guard. Their amygdala believes that they are always in danger, even though they rationally know they are not.

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Finding the right balance

It is important to understand that our brains must work in a balanced way to stay healthy. Normally, the prefrontal cortex, which controls logic, reason, decision-making and compassion, is the most active part of the brain. However, when someone is in a war situation, the limbic system (which controls the fight or flight response) is constantly under stress and becomes hyperactive. When the activity of the limbic system increases, the balance is disrupted and the prefrontal cortex cannot function as needed. Increased activity of the limbic system and decreased activity of the prefrontal cortex cause a person to experience anxiety, panic attacks, tantrums, irritability, and difficulty sleeping. The effects can be debilitating if left untreated.
The only way to cure post-traumatic stress is to restore balance in the brain by strengthening the prefrontal cortex, releasing control from the limbic system. In other words, we need to train our Prefrontal Cortex, which is possible by practicing meditation or yoga regularly and finding a new balance in life. Lowering from the head to the heart and hands and rediscovering and allowing connection, authenticity, vulnerability in strength. Opening the heart.


Moral Injury

Unlike PTS, Moral Injury is not approached from a medical basis.

A description of Moral Injury by Rita Brock: 'Moral injury is a response to trauma when a person or group's existing core moral foundations are unable to justify, process, and integrate trauma into a reliable identity and meaning system that sustains relationships and human flourishing.

Moral Injury stems from:
A. Being betrayed by people and /
or institutions that should have been trusted to do the right thing morally
B. Doing, recording, witnessing, imagining or not preventing acts or events that can be judged to be harmful or bad and
that basic social and
violate ethical rules
C. Being involved in events or situations where taboo violations or abusive actions occur that give one a sense of being contaminated with "dirt," being contaminated with "evil."
D. Surviving circumstances of
oppression and extremity.


Moral feelings include guilt, shame, despair, remorse, indignation, sadness, aversion. Self-condemnation results in suffering with basically broken confidence,
alienation, a sense of betrayal, and
social withdrawal.

Grief as a Dimension of Moral Injury
• Loss of best friends
• Loss of innocence or feeling of
• Loss of profession, work
• Loss of mission, purpose
• Loss of role / purpose for others
• Loss of family or capacity for
intimacy - conflict / divorce
• Loss of confidence and meaning
• Loss of self - changed forever
• Living with a broken heart

More information can also be found at:

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Rituals, storytelling and bodywork

It is our experience in both the US and the Netherlands that Moral Injury can turn into Moral Growth and you can learn how to reduce stress. Rituals and ceremonies have an important place in our programs. They bring meaning to values and norms and provide content and meaning. Storytelling is essential to let go of shame and guilt. We all carry shame with us, but until we can discuss it, it grows like an all-devouring monster inside. Body work - such as yoga and tai chi easy, nature walks and working with horses - connects our head with heart and hands. It has a positive effect on our brain and allows the release of trauma that has accumulated in the body.

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