Moral injury was a term created in the 1990s to explain symptoms observed in war veterans. It has since been expanded to include symptoms and experiences in a wider variety of environments, including healthcare and education. When I discuss moral injury with my clients, I still use the original framing of war because I think there are similarities in the experiences of idealistic individuals in high stakes, high pressure environments that exist within distressing systems that sometimes present no good choices.
Who does society send to fight in wars? Who joins the miliary voluntarily? Typically, people in their late-teens/early-20s who want the opportunity to do “good” in the world, to protect their country, to promote the values and beliefs they grew up with. Young adults with a desire to help and a belief they will make themselves and their families/friends proud through their actions.
Then what happens? Soldiers are faced with the messy, horrific, brutal reality of conflict. They realize sometimes there are no “good” choices and they may even act in ways that are contrary to their own values. They may receive instructions to act so, or they may encounter a situation in which survival or success depends on acting against their own beliefs. Each time a soldier does this it creates a psychological cut. Over the course of a deployment a soldier could experience hundreds of these cuts and they may add up to significant mental wounds that create a deep moral injury to the self.
Ok, so idealistic and caring people who want to help and don’t mind making sacrifices for the good of others. Who else does that sound like? To me that sounds like anyone in the United States who has worked in healthcare. The individuals who choose these careers are generally intelligent, capable, and compassionate. They know their path will be difficult, and they are eager to reach the end goal of being able to work as a fully licensed healthcare professional.
They complete their education and are launched into the realities of the American healthcare system. A system that is full of roadblocks like insurance denials, lack of resources for indigent patients, and unrealistic expectations about productivity to meet organizational metrics. They face a healthcare system in which it’s not always possible to provide the type of care a patient needs. Each time they are unable to provide the type of care they believe a patient needs it creates a small psychological cut. They witness suffering and feel powerless to change it, even though they have the medical knowledge to help. Over time these experiences can build into anxiety, depression, addiction, burnout, and compassion fatigue.
Sounds pretty bleak, huh? The good news is that working in healthcare doesn’t HAVE to lead to mental distress, burnout, or moral injury. It is possible to care for others, take care of us, and have enough energy to advocate for a better system for all. That is what I help my clients accomplish – creating a life that feels sustainable so that they have the internal resources to care for others without losing themselves.
Need support navigating burnout, compassion fatigue, or moral injury? Send me a message or schedule a consultation to learn more about my services!