Navigating Moral Injury
In our increasingly complicated world, we are not only grappling with ethical dilemmas specific to our own field, but also facing broader societal issues that weigh heavily on our moral compass.
The referendum in Australia and the international events of recent weeks have been harrowing for many in our world in ways that challenge our morals, ethics and values and the type of world we wish to live in.
It’s essential to broaden our understanding of moral injury to include the impacts of external events such as the ones we are experiencing, as these too can contribute significantly to our mental and emotional strain.
What is Moral Injury?
Moral injury describes the emotional, psychological, or spiritual distress or wounding that can arise when one’s core ethical beliefs are compromised or violated. Traditionally examined within the scope of professions like healthcare, the concept is now being extended to acknowledge that societal issues can also be significant stressors.
Dr. Jonathan Shay, a clinical psychiatrist, has played an instrumental role in advancing our understanding of moral injury. Initially conducting his research with war veterans, Shay coined the term to describe the profound psychological distress that arises when one’s deeply held ethical or moral beliefs are betrayed or compromised, especially by a person in authority or by the systems that influence how we live and work.
Shay’s research shifted the focus from merely diagnosing post-traumatic stress disorder (PTSD) to exploring the nuanced complexities of moral injury. He laid the groundwork for understanding that moral injury originates from an ethical dilemma or a violation of one’s moral code.
His contributions have not only opened new avenues for treating military veterans but also have had far-reaching implications in professions, like healthcare, where ethical dilemmas are a frequent occurrence. Shay’s work has been pivotal in reframing the discourse around trauma to include ethical dimensions, and his findings continue to influence both clinical practice and organisational policies aimed at mitigating the impact of moral injury.
Vulnerabilities Beyond the Healthcare Setting
While healthcare professionals are accustomed to facing ethically challenging situations within our work environment, today’s local and global landscape presents additional trials. Issues dividing public opinion, conflicts and humanitarian crises can all contribute to moral injury. These circumstances often exacerbate the internal challenges we face, leading to a compounded emotional burden.
Identifying the Signs
Recognising moral injury can be challenging, particularly when it coexists with or is exacerbated by other forms of stress. Signs that may indicate the presence of moral injury include:
Emotional exhaustion or numbness
Cynicism or increased pessimism
Sleep difficulties or recurring nightmares
Social withdrawal
Overwhelming feelings of guilt or shame
Steps for Addressing Moral Injury
Acknowledge the Complexity: Realise that the moral distress you’re feeling may be influenced by a blend of professional and societal factors. Understanding this complexity is the first step towards addressing it.
Foster Open Dialogue: Encourage conversations within your team or family about the emotional and ethical challenges you’re facing, including those stemming from broader societal issues.
Seek Professional Guidance: There may be times when expert intervention is required. Psychologists and counsellors trained in exploring moral injury can provide tailored coping strategies.
Advocate for Institutional Change: Push for organisational policies that acknowledge the impact of societal stressors on healthcare professionals and offer resources for managing this added layer of complexity.
Self-Care and Resilience: Engage in self-care activities that help restore emotional and psychological balance. We offer professional and workplace resilience training as an additional tool.
Conclusion
Moral injury is an emerging area, that we are just now recognising and acknowledging. There are no easy answers, but I do hope that bringing this concept and research to your attention creates a language and framework that helps you make sense of your experience, as well as the challenges we are witnessing in our community.
Moral injury is increasingly important, compounded by both the inherent challenges of healthcare and the broader societal events that influence our moral landscape.
Identifying multiple sources of ethical stress is essential for us as healthcare leaders and supervisors. By doing so, we can work towards creating a supportive environment that addresses the multi-dimensional nature of moral injury and fosters a more resilient healthcare community.