A discussion about moral injury and its impact on first responders and members of the military.
Prior to going to work in the field of first responder wellness, I had never even heard of the term of moral injury. If someone had spoken it in my presence, I’m certain I would have taken an educated guess at what it meant, consulted Google and moved on with my life with little thought given to the deeper meaning of what I was hearing. After all, this squishy wellness stuff was for other people anyhow. Now I find myself having finished an objectively aggressive policing career with three tours on SWAT/TAC, a focus on training and narcotics enforcement and thirty years of bad stuff of all shapes and sizes. First responder wellness has a whole new meaning to me now and I approach it with passion hoping that younger generations do not have to experience what I did in the way that I did. I approach it much as we parents teach our children and hope for better lives for them. To that end, it’s time to briefly discuss moral injury.
Because I’m not an expert on this topic, I plan on citing articles and web sites for the curious minds who frequent my blog to investigate. There is a lot of information out there on the topic. I don’t plan on writing a doctoral thesis, just illuminating some dark corners of our world.
Before I go too much further, let’s define what exactly moral injury is. One of the best definitions I found came from a study on health care workers from https://ptsd.va.gov and says:Moral Injury in Health Care Workers and said:
By: Patricia Watson, PhD, Sonya B. Norman, PhD, Shira Maguen, PhD, Jessica Hamblen, PhD
Moral injury can occur when someone engages in, fails to prevent, or witnesses acts that conflict with their values or beliefs. Examples of events that may lead to moral injury include:
- Having to make decisions that affect the survival of others or where all options will lead to a negative outcome
- Doing something that goes against your beliefs (referred to as an act of commission)
- Failing to do something in line with your beliefs (referred to as an act of omission)
- Witnessing or learning about such an act
- Experiencing betrayal by one’s organization or by trusted others
Such potentially morally injurious experiences may lead to distressing feelings such as guilt, shame, anger, or a sense of betrayal. Moral injury is the lasting psychological, spiritual, behavioral or social impact that may result from these experiences.
It seems that in the first responder and military world about a third of moral injuries are attributed to leadership failings. In my experience this seems about right. Leaders making amoral decisions, decisions based on factors that are outside of our moral compasses or the moral compass of anyone in our orbit. Leaders who seem more concerned with their own personal survival than public safety, the team they are responsible for or just what is actually right in any given situation. Situational ethics…
Another broad group of moral injuries happens when those we are sworn to protect are harmed and we are helpless. Children killed on the battlefield. Innocent people cut down by gunfire between drug dealers in a mall parking lot. You get the picture. It is made especially worse if you identify with an innocent victim. If a child killed is the same age as your child at home for example.
Members of the military and first responders are, quite obviously exposed to moral injury on a regular basis. What is the possible fallout from it? The outlook from repeated moral injury is not good. It includes: intense guilt, shame, social isolation, depression, PTSD, burnout, and suicidal ideation. Moral injury is not PTSD but can be a contributing factor. None of this sounds like a picnic to me.https://maralinjuryproject.syr.edu
The key here is to recognize what we are dealing with and talk about it openly. There are answers. Peer support, spiritual care, and psychotherapy are all part of the solution to this problem. The biggest leap is for leaders in the professions to openly discuss this topic and admit that this is dangerous and can lead to the loss of our friends and coworkers by burnout or worse. I fear that my former profession is lagging the furthest behind here and is the most exposed.
I hope this has been just enough to raise awareness while not overwhelming and shutting folks down. Pray for and support your first responder and military brothers and sisters. They bear a heavy burden.
If you or someone you know is struggling, there is help. Call 988 or if you are in the Big Bend of Florida call 211. The 2nd Alarm Project has many resources available as well (2ndalarmproject.org). If you are interested in getting notified when a new blog is posted and are not subscribed, please consider subscribing by entering your email in the “subscribe” icon on the home page. Then you’ll get an email each time a new blog is posted. If you appreciate what you have read here, please feel free to share as you are led across your social media or via email. There just might be someone out there who needs to see this content. Thank you all and stay safe.
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