The Disease Talking

There’s a phrase in the mental health community: “that’s the disease talking.” The implication is that the disease is wrong, and it’s best not give it a platform. Probably true of depression, which, for me, is a crude (if powerfully persuasive) liar. PTSD is not like depression. It doesn’t bubble up like hot tar to suck you into the earth. It is rational; it is protective. It’s much harder to discredit.

Jonathan Shay, a doctor and clinical psychiatrist, describes PTSD in veterans as “the persistence into civilian life, after danger, of the valid adaptations you made to stay alive when other people were trying to kill you.” With tweaks, it’s a pretty good definition even for civilians. PTSD is insidious not because it is irrational or invalid—very much the opposite! Another interesting element in this definition: there are two halves to the problem. There is the person who was in danger, and there’s the world which put him in danger. Both are part of the disease. I’d say the dangerous world has a lot to say about PTSD and to PTSD (variations on “hush”). But maybe PTSD shouldn’t just be looked at from the outside in. Maybe there are things to be learned by talking about it from the inside out.


The veteran community has an alternative framework for PTSD that better accounts for things like why drone pilots get PTSD at similar rates as people in combat. It’s called moral injury. It’s defined as when someone, voluntarily or through coercion, does something contrary to their personal moral code and experiences an injury to their sense of self. The reported feeling is as if their soul died.

I’m a leftist. Out of all the political persuasions, we’re the… shall we say “least enthused” about the troops. I can absolutely think of comrades I know who would hear my request to listen to a veteran’s account of trauma as “alas, poor perp.” They’d prefer non-combatant victims of war be centered.

But troops aren’t even close to the only category of people who must do things contrary to their personal moral code to survive. Among ourselves, we all agree capitalism is a brutal, coercive system. What do we imagine coercion entails? Are we being coerced to do things we think are always good and right? Of course not. There’s massive trauma in the working class, the collective trauma of “what we had to do to survive.” And I wonder if it doesn’t serve a function in preserving capitalism. “This thing is my fault,” is a hell of a trap. Guilt has, built in, a feeling of ownership and control, and that feeling of control, contrary to fact, may make the working class feel as if they have more of a stake in the economy than is actually the case. And forced complicity, the terrible things we did to avoid violence, curls a person back on themselves. Makes it difficult to talk about the problem without self-implication, without facing our own lack of control and what has been done to us.

I wonder how our approach to politics might change if we take it as a given most people in the working class, one way or another, are dealing with moral injury. Would we be more gentle? Would we be less?


In my observation, the response to talk about moral injury is often horror that we are blaming ourselves for things that aren’t our fault. But just listen a minute: part of why some traumas are so ingrained is not that somehow, we feel delusionally at fault. It is that we had a choice– something bad, or something worse. And no matter which we chose, we did choose. And you can tell me that’s not my fault, but you can’t tell me having chosen didn’t change me. That I am not a different person after.

That is trauma.

I watched, recently, the movie of Annihilation. It is a meditation on grief and trauma. Trauma is personified as a shimmer that, without malice, without blame, turns you into something else.

And yeah. That’s about right.


Moral injury, as a model of trauma feels incomplete. As a materialist, “I feel as if my soul has died” is evocative nonsense. As a trauma victim, it’s perfect. There’s no better way of describing the experience of it. I think we can all agree feelings exist. We don’t need to cut open a brain to decide they exist. Evocative language describing emotions can describe a real thing. Whether it does in this instance is beyond the scope of what I can do here.

But more importantly than it being insufficiently materialist, not all trauma involves an act that’s violation of a personal moral code.


I’ve heard before that trust isn’t about believing nobody will harm you, but believing that if you are harmed, you will cope with it. This often gets boiled down to sheer grit. But that calculation, “can I survive this?” is pragmatic.. It’s a function of cash, number of sick days, how many friends lost.

A bad event is more expensive for someone without a safety net. Grief over a parent turns into grief over the realization none of your friends have texted you in six months because you’re too sad. Multiple losses, multiple times hoping people will be there and find they’re not, can fester into trauma.

In this example, there’s no “wrongdoing” (coerced or otherwise) on the part of the traumatized person, even as they feel something has been changed about them. So, while I found moral injury interesting and useful idea, I shelved as a specific kind of long-lasting trauma rather than an all-encompassing definition of it.


The dark triad is a set of three characteristics that predict someone will seriously mistreat others: Machiavellianism, narcissism, and psychopathy. There is also a recent variation called the light triad, the characteristics of people who treat one another well, are Kantianism (treating people as ends unto themselves), Humanism (belief in the dignity and worth of each individual) and faith in humanity (believe people, as both a species and individuals, are generally good).

Uh oh. Uh, two out of three ain’t bad, right?

This might all be pop psychology bullshit, but when I think back to my trauma, it is absolutely the source of my lack of faith in humanity. I am vigilant, not of friends, but of friends’ friends out of a belief they might seriously harm me. And the problem is, I’m not always wrong. If I went years between being wrong, I’d be cured! My hypervigilance makes me actually pretty good at spotting fraud in organization, at finding predators in friend groups. It’s not so much that I am wildly accusing anyone of wrongdoing. It’s that the same cues I use to find predators—minor inconsistencies, gut feelings, word choices—  flag me to others as suspicions of them.

Socially, it’s a problem. In my work, sometimes we investigate fraud. A fraudster in the workplace is an invaluable employee, almost universally beloved, never takes a sick day. These people are beloved. And they don’t have to lie to trick people! Their co-workers make excuses for them. Being the person who identifies a problem is a social disaster. That’s not an embezzler, that’s Cindy. Cindy’s been with the company for 20 years. She’s an admin assistant. She buys everyone lunch every Friday. She does a yearly charity drive for Ronald McDonald House. She arrives at 6am and leaves at 5. That’s our friend. Fuck you for accusing Cindy.

They’re not looking for evidence Cindy is bad and will not find it. If you are looking for evidence people are bad, you will find it. Often. Sometimes, the proposed solution is to simply stop looking.  I’ve had boyfriends and co-workers tell me I need to be a little less hard on people.

But for the marginalized, that’s not an option. People really are out to get marginalized folks, so they’ll be vigilant. Not that vigilance prevents anything, prevention requires cooperation. But their co-workers, well—they have faith in humanity. Wouldn’t want to be unfair. So they’ll be immensely kind to victim and your right up until the offense happens, and then there’ll be a post-mortem, and that post-mortem will, inevitably, cite the suspicion on the part of the victim as one of the causes. Ain’t that a bitch?

It would be very easy for me to stop here and say “suspicious people good, naive bad.” But I don’t believe society works if we all get exactly what we deserve. Maybe this is a regressive holdover from my early Christian education. Grace is the divine giving us each better than we deserve, and Christ the recognition that the cost of doing that is blood. In the book, Killing from the Inside Out, the author mentions moral injury maps almost 1:1 with the Christian idea of sin. Sin, in the original Greek, simply meant “error.” There’s no implication it’s avoidable. It’s a contaminant. It’s what you had to do to survive and can’t be undone.

I don’t want to venture into apologetics. But I do want to propose that, perhaps, Christianity is appealing because it identifies an inherent contradiction in our daily lives— that what we must do to survive kills a part of us— and sets out to do something about it. The most radical idea in Christianity isn’t that there’s life after death. It’s that there’s life after trauma. And before we on the materialist left sneer at that, we probably should think about offering the same or better.


PTSD remains a valid and useful set of habits in my life. I nevertheless do feel like my loss of faith in humanity is a moral injury. Faith in humanity isn’t itself a moral tenant, but a precursor to a morality of daily life. It governs very small daily interactions. Where do I keep my wallet? Do I thread my keys between my fingers while walking to my car? Do I take that comment as an  innocent social boo boo, or an insult? Do I trust your wife, and is that mistrust mistreatment of her? Does that mean we never talk about her, then never talk about your friends, then never talk about your pets, then never talk?  And then I’ve lost another person, and the disease adds that loss to the running total.

Trust isn’t built over a series of big moments, but over the smallest ones. Friendships are built or lost in micro interactions, so slowly, so subtly, that by the time someone is gone, you’re not close enough to ask them what happened.

I’m tempted to end there. It’s a good line, right? Despair talks very well. The more difficult thing to make pretty: that gradual building can work in the other direction. It has for me. I am not better, and I still, from time to time, lose more than I feel I can bear. I don’t think I’ve felt hope in years. But hope is just the thing we do that makes all other things possible. You get out of bed, you do the work, you win just a little more on average than you lose. By the accretion of time, things get better. Not all better! Never normal. But it will be enough. It has to be.

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