The Pain of Moral Injury

 

In simple terms, Moral Injury means acting in a way (witnessing, participating, or failing to prevent something) that goes against a person’s moral beliefs. These “transgressive acts” violate an individual’s acceptable boundaries of behavior.

As professionals in bureaucratic systems, first responders must follow strict codes of conduct, adhere to standards of practice, and follow the law when making decisions. The unpredictable and potentially traumatic nature of first responders’ work often requires them to make split-second decisions in high-stress situations where their safety and that of others are on the line. And those decisions may go against their personal morals. 

Scenarios that could lead to moral injury:

• A firefighter being unable to save a victim or having to choose between victims to save.
• A law enforcement officer having to use physical or lethal force to resolve a criminal incident.
• Being forced to make difficult decisions about how to allocate resources during a crisis

Even if a first responder's actions don’t violate their morals at the time, an unfavorable outcome such as the death of a victim or serious injury to a team member can reveal the injury in later feelings of deep remorse, guilt, and shame.

Morally injurious events are significantly associated with Post-Traumatic Stress Disorder, depression, and suicidality. The pain of Moral Injury is a sign of a working conscience and the loss of deeply held beliefs and/or trust. It challenges our fundamental core values and eats away at us, undermining the trust we had in ourselves, in others, and the world we live in.

Signs of Moral Injury:

• Feeling demoralized
• Feeling guilt/ shame or Persistent self-blame or blaming others
• Feeling “haunted” by decisions, actions or inactions that have been made
• Anger in particular following betrayal
• Sense of loss of identify and role
• Questioning our sense of self and a loss of trust in oneself and in others
• Self-isolation, avoidance and withdrawal from others
• Increase in substance use
• Loss of spirituality or religious beliefs (if previously held).
• Suicidal ideation 

With Moral Injury, the trauma and its meaning need to be processed. If you feel you are suffering from some of the symptoms above, please seek social support and professional help. Seeking help is not a sign of weakness, it's a necessary step towards healing.

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“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

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