Moral Injury - Healing Invisible Wounds

Have you ever made a split-second decision that went against your values or witnessed something that left you feeling deeply conflicted? What about witnessing a tragedy you couldn’t prevent? If you’re in the people-helping profession, chances are you’ve faced situations like these. In this episode, we’ll explore what moral injury is and its impact on your mental health and provide practical strategies to cope. Join us as we dive into understanding and addressing the emotional toll of moral injury. You won’t want to miss what I’ll be talking about today.

Show Intro

During one of my most recent peer support trainings for the Coast Guard, the subject of moral injury came up. It became a subject of much discussion, to say the least. Even though moral injury isn’t currently included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), it’s becoming more widely recognized and discussed.

I’ve had my share of calls that I’ve made that I later questioned. And the weight of those decisions haunted me for quite some time. I began to process these feelings and start healing by talking with a trusted colleague. This experience taught me the importance of addressing moral injury head-on and getting help when you realize it’s bothering you.

Moral injury happens when you do something, or see something, that goes against your deeply held beliefs and values. It’s different from physical injury or even PTSD. It’s that gut-wrenching feeling of guilt, shame, or betrayal that lingers because you feel like you did something wrong or didn’t do enough.

For first responders, this can mean making a tough call during an emergency that haunts you, or witnessing suffering you couldn’t prevent. It’s like a wound to your soul that doesn’t heal easily. The emotional and psychological pain can be overwhelming, leading to anxiety, depression, and even self-destructive behaviors.

Imagine having to make a split-second decision that might lead to the loss of someone’s life but would allow many more to live or witnessing a tragic accident where you felt helpless. These moments can leave a mark on your conscience, making you question your actions and your role. It’s important to recognize that moral injury is real, and it can deeply affect your mental health and well-being.

Understanding moral injury is the first step in dealing with it. Acknowledge the pain, and know that it’s okay to feel this way. You’re not alone, and there are ways to heal and move forward.

Moral injury can sneak up on you. It’s not just about the intense emotions you feel; it digs deep into every part of your life. You might feel like you’re in a constant battle with yourself because your actions or what you witnessed on the job clash with your core beliefs. It’s a unique kind of pain, different from physical injuries or even PTSD

First, there’s the emotional weight. You might find yourself feeling overwhelming guilt. You might find yourself falling down the rabbit hole of the “could’ve, should’ve, would’ves” Thinking, “I could have done more to save them”; “If only I had been more alert, I would have been able to prevent it.” This guilt isn’t about doing something illegal; it’s about feeling like you let someone down or didn’t live up to your own moral standards. Shame is another heavy hitter. You might start seeing yourself as a bad person because of these experiences, thinking, “I’m not who I thought I was.”

These feelings can spiral into anxiety and depression. You might be on edge, replaying the situation over and over in your mind, unable to shake the “what ifs.” This stress can make it hard to function at work and at home, leading to sleepless nights and a constant feeling of unease.

Moral injury also impacts your relationships. You might start pulling away from family and friends because talking about what happened feels too painful or embarrassing. This isolation can make you feel even more alone and misunderstood.

Sometimes, the pain of moral injury pushes people towards harmful coping mechanisms. You might turn to alcohol or drugs to numb the pain, or throw yourself into work to avoid dealing with your feelings. These behaviors might offer temporary relief, but they often lead to more problems in the long run.

Maybe you’ve already recognized the signs. If you’ve been feeling this way, it’s not because you’re weak or broken. Moral injury is a natural response to an incredibly difficult situation. Understanding its impact is the first step toward finding ways to heal and move forward. You’re not alone, and there are ways to get through this.

Here are some practical steps to begin healing from moral injury.

The first step is Acknowledge Your Feelings.

Acknowledging what you’re experiencing is the first step toward healing from moral injury. It’s important to recognize and accept the emotions you’re experiencing instead of suppressing or ignoring them.

What can you do?

• Write in a Journal

Start a Daily Routine: Set aside a few minutes each day to write about your thoughts and feelings. This can help you process and understand your emotions better.

Be Honest: Write openly and honestly about what you’re experiencing. Don’t censor yourself; let your feelings flow onto the page.

Reflect on Specific Events: Write about specific incidents that are troubling you. Describe what happened, how you felt, and why it bothers you.

• Allow Yourself to Feel

Embrace Your Emotions: Permit yourself to feel whatever comes up—whether it’s anger, sadness, guilt, or fear. These feelings are valid and a natural response to your experiences.

Avoid Judgment: Don’t judge yourself for feeling a certain way. Understand that these emotions are a part of your healing process.

Mindful Acknowledgment: Practice mindfulness by sitting quietly and observing your emotions. Acknowledge them without trying to change or suppress them.

Some of you may be blowing me off right now, thinking, “This is just a bunch of woo woo psychology. But hear me out.

I know what it’s like to be afraid of Appearing Weak: Many in the helping professions worry that acknowledging their emotions makes them look weak. But you need to understand that recognizing your feelings is a sign of strength and courage, not weakness.

We have the Habit of Suppressing Emotions: In high-stress professions, there’s often a culture of pushing emotions aside to get the job done. This is necessary while you’re operational. But, over time, this can lead to more significant issues. Acknowledging your feelings helps prevent emotional buildup. Because sooner or later, it will erupt.

By beginning to acknowledge your feelings, you’re taking a critical step toward healing from moral injury. It’s about giving yourself the space and permission to feel, which is the way to begin moving forward.

Another thing is to reflect and reframe.

This will help you understand the context of your actions and changing your perspective on the events that can bring on moral injury. This will help you see the bigger picture and be kind to yourself.

• Reflect on Factors Beyond Your Control

Identify External Influences: Consider the factors that were beyond your control during the event. This might include limited resources, time constraints, or the chaotic nature of emergencies.

Acknowledge Your  Limitations: Understand that you did the best you could with the information and resources available at the time. Reflecting on these limitations can help you see the situation more objectively.

• And then, Be kind to yourself.

That’s right. Don’t be too hard on yourself. You’re not Superman or Superwoman. You’re not all-knowing and all-powerful.

Tell yourself the stuff you would offer a friend in a similar situation. Remind yourself that making tough decisions under pressure is no picnic.

Focus on Positive Actions: Reflect on the positive actions you took, no matter how small they may seem. Recognize the efforts you made to help and the intention behind your actions.

• Reframe Your Perspective

Shift the Narrative: Instead of focusing on what went wrong, try to reframe the situation by looking at what you learned and how you can grow from the experience. This shift can help reduce feelings of guilt and shame.

Recognize Growth: Acknowledge how the experience has contributed to your personal and professional growth. Reflecting on how you may have become more resilient and skilled can help you see the positive aspects of challenging situations.

• Reflective Writing Exercises

Revisit the Event: Write about the event in detail, including what happened, how you felt, and why it bothers you. Then, write a second account focusing on what you did well and what you learned.

Perspective-Taking: Write from the perspective of a supportive friend or colleague. How would they view your actions? This exercise can help you see your actions in a more positive light.

Ditch the Self-Blame: Many first responders struggle with self-blame, constantly thinking about what they could have done differently. It’s in our nature. Admit that there were factors beyond your control. This can be super helpful in giving self-blame the boot.

And Don’t Focus on the Negative: It’s so easy to get stuck on negative aspects of a situation. Reframing helps shift the focus to learning and how you can grow from the experience, making it easier to move forward. As the saying goes, “We can grow bitter, or we can grow better.”

You may not like this next one, but…

Reach Out for Support

You’ll never make it by trying to be the Lone Ranger. Reaching out to others can provide a ton of relief, new perspectives, and the sense that you’re not alone in your struggles.

• Talk to a Trusted Friend or Colleague

But You Need to Choose the Right Person: Identify someone who is empathetic, trustworthy, and understands the challenges of your job. This could be a colleague who has been through similar experiences or a close friend who listens without judgment. If you’re concerned about someone too close to your situation, reach out to a peer from a few miles away in another agency, city, or even another state.

Start the Conversation: Begin by sharing a little about what you’re going through. You might say, “I’ve been having a hard time with something that happened at work. Can we talk?”

Be Honest and Open: Don’t hold back your feelings. Sharing openly about your guilt, shame, or confusion can help you process these emotions and feel less burdened.

• Join a Peer Support Group

Find a Group: Look for peer support groups within your organization or community. These groups are often made up of individuals who understand the unique challenges of being a first responder.

Participate Actively: Attend meetings regularly and share your experiences. Listening to others can also provide comfort and new coping strategies.

Build Connections: Use these groups to build a network of supportive peers who can offer advice and companionship.

• Seek Professional Mental Health Support

Contact a Therapist or Counselor: Find a mental health professional who specializes in trauma and moral injury. Make sure they’re culturally competant. Ask how many in your line of work that they regularly deal with. They can offer specialized techniques and therapies to help you heal.

Employee Assistance Programs (EAPs): Many workplaces offer EAPs that provide confidential counseling services. Take advantage of these resources to get professional support.

Consider Trauma-Informed Therapy: Look into therapies specifically designed for trauma and moral injury, such as Cognitive Behavioral Therapy (CBT) or Trauma-Informed Guilt Reduction Therapy (TriGR).

• Leverage Online Resources and Hotlines

Crisis Hotlines: Use crisis hotlines for immediate support when you’re feeling overwhelmed. These services can provide a listening ear and direct you to further resources.

Online Forums and Peer Support Groups: Take part in online communities and forums where you can share your experiences anonymously and receive support from others who understand your situation.

I know there’s still a Stigma Around Seeking Help, especially in high-stress professions. It’s important to recognize that seeking support is a sign of strength, not weakness.

And then there’s the Fear of Being Judged: Many worry about being judged or misunderstood when they share their struggles. Finding the right people to talk to can help alleviate this fear.

The fourth big step is to Practice Some Self-Care

Taking care of yourself is essential for maintaining your physical, emotional, and mental well-being, especially when dealing with moral injury. Regular self-care practices can help you build resilience, reduce stress, and improve your overall quality of life.

• Incorporate Regular Exercise

Find an Activity You Enjoy: Choose physical activities that you like, whether it’s jogging, swimming, biking, or even just walking. Enjoyable activities are more likely to become a regular part of your routine.

Set Realistic Goals: Shoot for at least 30 minutes of exercise most days of the week. Start with small, achievable goals and gradually increase the duration and intensity.

Regular exercise can reduce stress, improve mood, and increase energy levels, helping you cope better with emotional challenges.

• Practice Mindfulness and Relaxation Techniques

Mindfulness Meditation: Spend a few minutes each day practicing mindfulness. Focus on your breathing and being present in the moment. Apps like Headspace or Calm can guide you through the process.

Deep Breathing Exercises: Use deep breathing exercises to calm your mind and body. Try inhaling deeply for four seconds, holding for four seconds, and exhaling for four seconds.

Relaxation Techniques: Explore other relaxation techniques like progressive muscle relaxation, yoga, or tai chi to help reduce tension and stress.

• Pursue Hobbies and Interests

Engage in Activities You Love: Make time for hobbies and activities that bring you joy, whether it’s reading, painting, gardening, or playing a musical instrument.

Creative Outlets: Use creative outlets like writing, drawing, or crafting to express your feelings and unwind from the stress of your job.

Social Activities: Participate in social activities that connect you with others. Things like joining a club, taking a class, or volunteering.

• Make Sure You Get Adequate Rest and Relaxation

Establish a Sleep Routine: Create a consistent sleep routine. This can help signal your mind and body that it’s time to transition to sleep. Make sure your sleep environment is comfortable and free of distractions.

Take Breaks: Schedule regular breaks throughout your day to relax and recharge. Even short breaks can help reduce stress and improve focus.

Unplug: Take time to disconnect from electronic devices and social media to give your mind a break from constant stimulation.

• Nourish Your Body with Healthy Foods

Balanced Diet: Eat a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Proper nutrition can improve your mood and energy levels.

Hydration: Drink plenty of water throughout the day to stay hydrated. Avoid excessive caffeine and sugary drinks. And by all means, please stay away from energy drinks. Whether you believe it or not, consistent use and overuse will do more harm than good.

Mindful Eating: Practice mindful eating by paying attention to your food and savoring each bite. This can help you enjoy your meals and improve digestion.

Taking care of yourself is really important.

Because we usually have a Difficult Time Prioritizing Self-Care: In high-stress professions, it can be challenging to find time for self-care. Recognize that taking care of yourself is essential for being able to help others effectively.

Don’t Feel Guilty About Taking Time for Yourself: Many first responders feel guilty about taking time for themselves. Self-care is not selfish but necessary for maintaining one's well-being and ability to perform one's job.

And lastly, Step 5: Set Boundaries

Setting boundaries is essential to separate work stress from personal life. This helps ensure that your job doesn’t overwhelm your personal time, allowing you to recharge and maintain a healthy work-life balance.

• Create a Physical Separation

Leave Work at Work: Incorporate some kind of Transition Ritual. Make the transition from work to home a clear-cut one. Avoid bringing work home unless absolutely necessary.

• Use Technology Wisely

Set Boundaries with Devices: Turn off work-related notifications on your phone and computer after work hours if you’re able to. This helps prevent work from intruding into your personal time.

Limit After-Hours Communication: Don’t check work emails or messages once you’re off duty. Encourage your colleagues to respect this boundary.

• Schedule Personal Time

Prioritize Personal Activities: Schedule regular activities that are important to you, things like hobbies, exercise, or family time. Treat these appointments with the same importance as work meetings.

• And back to Self-Care

Make Time: Make sure that you schedule regular self-care activities, such as exercise, relaxation, and hobbies, into your daily routine.

Protect Your Downtime: Guard your free time and use it to do things that help you relax and unwind. This is essential for recharging and maintaining mental health.

Many first responders feel a strong sense of duty and may struggle with the guilt of setting boundaries. Remember, taking care of yourself allows you to be more effective in your role.

We’ve covered a lot today about moral injury and how to begin healing from it. Remember, it’s okay to feel the way you do. Moral injury is a heavy burden, but it’s something you can work through. By acknowledging your feelings, reflecting and reframing your experiences, seeking support, engaging in self-care, and setting boundaries, you can start to heal.

You are not alone. Many have already faced these challenges, and there are resources and people ready to help you. Take small steps each day towards recovery and know that healing is possible. Reach out, take care of yourself, and remember, there’s hope and support available for you. Keep moving forward, and know that brighter days are ahead.

Thanks so much for joining me today for another episode of Surviving Your Shift. Are you wondering if you’re experiencing some of the signs of Post Traumatic Stress? Or know someone who is? Grab a lifeline by going to survivingyourshift.com and on the right sidebar click to download your copy of Understanding PTSD: It's History, Causes, Symptoms and Treatment.

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