Moral Injury, Trauma, and the Pandemic: Here's One Thing I Want You to Know
Happy New Year! It’s a joy to be back in my practice after taking some time off for the holidays. As I’ve returned to work in the past couple of weeks, I’m saddened by how so many are affected by illness amidst this devastating wave of the COVID-19 pandemic. It brought to mind a message that I wanted to share with you.
I was at a Christmas party over the break with my girlfriend and met a physician who has her finger on the pulse of the healthcare system in our country amidst the pandemic. She told me that healthcare workers everywhere are feeling guilty, ashamed, and angry at themselves for the choices that they have had to make in the midst of a reduced workforce, flooded hospitals, and limited resources.
She had a term for what healthcare workers are experiencing: moral injury.
What is Moral Injury?
In traumatic situations, people may do something or fail to prevent something that goes against their deeply held moral beliefs. Moral injury refers to the guilt, shame, anger, and even disgust that people experience after a morally injurious event. As the US Department of Veterans Affairs explains on its website, “In order for moral injury to occur, the individual must feel like a transgression occurred and that they or someone else crossed a line with respect to their moral beliefs.”
As I spoke with my new friend at the party, she explained that she’s been hearing about how healthcare providers are experiencing moral injury during the pandemic. They’re flooded with patients and short-staffed, she said, so that nurses, for example, might have to make a choice between changing a patient’s sheets or helping another patient to the bathroom. One choice might save one patient from getting bedsores, while the other might save a patient from embarrassment and unsanitary conditions. Faced with impossible choices, they feel guilty and ashamed no matter what they do. They feel like they’re never doing enough or the right thing, a violation of their commitment to patient care.
Sounds like what therapists are going through, I replied. The pandemic has created a mental health crisis in this country that has been utterly devastating. Therapists everywhere are exhausted trying to do right by their patients, fighting the mental health crisis on the front lines, and going home battle-weary, only to get up and do it all over again the next day.
Moral Injury and Trauma
Moral injury can be traumatic. After all, most simply, trauma is any experience that creates an emotional wound. Moral injury and trauma both begin with an event that is in some way threatening or harmful to oneself or others.
Guilt and shame are core features of moral injury and can also be responses to traumatic events.
The betrayal and loss of trust that can occur with moral injury can also be present in posttraumatic stress disorder (PTSD) (ibid.).
Even though moral injury and PTSD are not the same, there is a great deal of overlap, and sufficient moral injury can lead to or exacerbate existing PTSD.
“I’m struggling with moral injury. What should I do?”
If you think you might be experiencing moral injury, finding a therapist to support you is a very loving thing to do for yourself. It’s critical to connect with a therapist who is warm, caring, accepting, non-judgmental, and empathetic, which is what we’re all about at the Center for Integrative Change.
Regardless of whether you choose to seek support, I—and my new friend from the party—want you to know one thing.
You’re doing your best. And that’s all we can ever do.
So please, I invite you to show yourself compassion and care, to extend to yourself the same love that you pour out to others on the job each and every day. Keep fighting the good fight, and know how grateful we are to you.
About the Author
Jeremy Mast is a licensed marriage and family therapist, a Certified Sex Addiction Therapist, and the founder and director of the Center for Integrative Change. He is passionate about helping those struggling with substance use and problematic sexual behaviors and their loved ones find lasting healing. In his spare time, he enjoys reading, rock climbing, health and fitness, and trying out new recipes while cooking at home.