By Lauren Phillips | The Coast
What is moral injury, and who experiences it?
Moral injury describes “the persistent suffering, including shame or guilt, experienced by those who witness, perpetrate, or fail to stop acts of grievous harm,” write the co-organizers of two upcoming events on moral injury in frontline workers, Catherine Baillie Abidi and Ardath Whynacht.
The injury is experienced as a violation of one’s deepest-held beliefs and expectations. It can lead to a sense of moral confusion, feelings of grief, shame, guilt, despair, self-isolation and a loss of trust in oneself and others due to a sense of betrayal.
Through their work and research, Baillie and Whynacht see how many people experience moral injury on the job. This is particularly true for professions that involve helping or protecting others, including first responders, people in the military, healthcare workers, community service workers, educators, and people who work with children.
‘The bad news about moral injury is that so many vital workers are feeling it’
“The bad news about moral injury is that so many vital workers are feeling it,” Whynacht tells The Coast. “But that’s also the good news about moral injury, because when we can collectively organize around these occupational mental health injuries—the more numbers, the better so that we have a stronger voice.”
The term moral injury gained recognition by public health experts in the ‘90s based on numerous discussions with Vietnam veterans who returned home with injuries that didn’t fit into understandings of other psychological injuries like post-traumatic stress disorder, says Baillie Abidi, an assistant professor with the Department of Child and Youth Study at MSVU. Baille Abidi has been working in the humanitarian sector for over 25 years and her research draws on international humanitarian law, veteran care, critical childhood and youth studies and peacebuilding.
“The concept of moral injury started to evolve to describe an injury to the soul,” she tells The Coast. “There was something about a violation of your norms or values that was very different from other kinds of injury experiences being amplified in that context.”
Learning from veterans, moral injury came to be connected with experiencing “things that they did, observed or couldn’t stop, which they felt deeply violated their personal values and ethics and caused internal struggles between right and wrong; conflicts by their behaviour, someone else’s behaviour, their institution’s behaviour; and feelings of guilt, shame and betrayal.”
Moral injury and its overlapping term, moral distress, gained renewed recognition during the COVID-19 pandemic, says Whynacht, an associate professor and director of the Health Studies Program at Mount Allison University who works closely with non-profit sector organizations, including the AIDS Coalition of NS and the Avalon Sexual Assault Centre. During that period, “we started to see high levels of burnout, demoralization, increased rates of suicide of healthcare workers and healthcare workers quitting en masse.”
She says moral injury is often discussed under different names, including demoralization, vicarious trauma or burnout.
“What I’ve seen in my work in the nonprofit sector is that—similar in the ways that a lot of veterans are forced to witness or participate in atrocious acts or things that are deeply wrong, violent and traumatizing—so too is the experience of being a worker in a domestic violence crisis shelter and constantly having to turn away women who are in danger because there aren’t enough beds, and then hearing someone in the government say, ‘Oh, domestic violence isn’t an epidemic in Nova Scotia.’”Moral injuries appear as multi-sectoral “huge feelings of betrayal,” says Whynacht, and they need to be discussed now, as public sectors and places of care are overstretched and understaffed.
“The huge network of folks who do the work to help us be safe in our everyday lives—they’re struggling, and they’re falling apart.”
Building cross-sector support and work-based strategies for prevention
The other side to this, says Whynacht, is that “if we’re collectively experiencing this, and if it’s preventable, then we need to have these conversations more openly and invite more folks to the table,” in the hope of providing “a framework for us to collectively organize around occupational mental health injuries and look at the causes—which we don’t talk about enough.”
Baillie Abidi and Whynacht want to broaden the conversation of moral injury to include workers from many different workplaces who share one thing in common: their responsibilities include helping or protecting communities. In connecting workers, clinicians and public health and policy experts, they aim to build cross-sector support and work-based strategies for prevention and treatment beyond clinical mental health disciplines. And they are bringing two days of events to MSVU to do just that. On Thursday, Feb 13, from 7-8:30pm in the Seton Auditorium at MSVU, located at 166 Bedford Highway, they will be moderating a panel discussion, “This is Not Burnout or PTSD: Moral Distress and Occupational Injury.”
These panelists will offer their perspectives across several sectors:
- Dr. Manal Azzi, team lead on Occupational Safety and Health Policy in the International Labour Organization
- Dr. Lisa Barrett, clinician-scientist and assistant professor in Dalhousie University’s Faculty of Medicine
- Jodie Boyle, humanitarian and Canadian Armed Forces veteran
- A speaker(s) from No More Silence and Hummingbird Healing Lodge, honouring the lives of missing and murdered Indigenous women
Register for Thursday’s panel here. All are welcome, and childcare is available.
On Friday, Feb 14, Whynacht and Baille Abidi will lead, with others, a full-day symposium, “Confronting Workplace Harm: Moral Injury in Frontline Work.” This will continue unpacking moral injury from different lenses, including through clinical psychology, the crisis of domestic violence and supporting women in communities and, through social work training to examine how race and colonialism influence inequalities in policy-making and conceptions of care, says Baillie Abidi.
Workshops will focus on sectors engaging with children and youth and those working in the nonprofit sector, including volunteer community support workers responding to the opioid and housing crises.
“One of the things that we’re seeing with the twin crises of the opioid crisis, the drug poisoning crisis and the housing crisis is that a lot of folks are doing frontline care and support,” says Whynacht. “For example, saving lives with naloxone. Staff are often doing that on shift and not able to access time off the day after to decompress and process what it means to literally be doing hands-on work, saving lives with your job.”
Whynacht says it is important for those who fund nonprofit organizations to understand that these positions need to be well-paid and include benefits, employee assistance programs, and mandatory time off.
“Even within our healthcare system, we have healthcare workers who save lives and go through tremendously stressful experiences on shift, and they don’t get time off the next day to just process and hea.,” she says. “So, we see them swallowing the impacts of, say, an attack in the ER [where three workers were injured at the Halifax Infirmary on Jan 29].
“It makes me wonder, ‘how many of the folks who witnessed that were given time off to process and make sure that they’re coming back to work healthy and feeling ready to engage and support others?’”
She says the hope of broadening their conversation about moral injury is three-fold: prevention, support for those experiencing it now and building a critical mass to resist further experiences. “To talk about the cost of the harms of injustice, we’ll be developing a critical mass of folks to name and quantify and resist those harms in the future while also paying attention to the pragmatic aspect of healing and support for those who are currently feeling it and are maybe feeling so burnt out, they can’t return to previous employment, or they need to leave.
“Having workers have happy, healthy lives and making sure that there isn’t a permanent cost to that work that’s going to impact their mental health for the rest of their life is something we’re concerned with.”
Response to the symposium has been strong—it’s already full. “When people start to understand what we mean by a moral injury and the context in which it can happen,” says Baillie Abidi, “this is something that touches all of us.”
However, at least one seat is being held. If the minister of education, Brendan Maguire, wants to come to Friday’s sold-out symposium, “we will certainly make space for him,” says Whynacht, so that the Department of Education and Early Childhood Development can get involved in this conversation, too–“because educators are facing many of these harms at work trying to support youth and children and it’s not being recognized.”
