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Together we are stronger

An overlooked public safety crisis: Moral injury

06 Jul 2020 12:41 PM | International Public Safety Association (Administrator)

By Jennifer Leftwich, Graduate Clinical Social Work Student, IPSA Mental Health, Fitness & Wellness Committee Member

“Be strong, my heart. You’ve survived worse and kept your nerve.” Odysseus

With the evolving pandemic, recent civil unrest, natural disasters, continued violence, economic uncertainty, and the lack of uniformed leadership, we are arguably living in a perfect storm of uncharted waters. There is no map to guide us. There are no search and rescue teams coming to save us. We cannot send a distress signal, but there is a survival kit: moral identity and moral expectations, or also known as, the moral compass.

Moral compass

While chaos and danger continue to threaten us, the moral compass protects and guides public safety officials through hardship. The moral compass is a shield of the human condition. It grounds a person. It cultivates courage. It contains values and beliefs about what is treasured and what is to be protected. It aids humans by informing their experience in and assumptions about the world to create purpose and mission to withstand adversity. During these ongoing events and emergencies, the public safety and health officials who have dedicated their lives to protecting citizens’ safety and wellbeing, are possibly vulnerable to questioning their sense of direction in their mission.

What happens when these emergency responders who work under intensifying pressure for a society that wavers between hero-worship and devaluing, despite their unwavering commitment to society’s protection?

The answer is a different crisis occurs: moral injury.

Emergency responders may begin to question their roles in societal suffering and possibly question the validity of their chosen vocations or lives themselves. When pre-existing daily stressors and occupational hazards inherent in public safety work are coupled with the current crises, the risk for moral injury is high, despite the protective factors of adaptability and fluidity.

Moral injury explained

Historically, moral injury has been studied and discussed in the context of military servicemembers and veterans. Because moral injury overlaps and co-occurs with symptoms of PTS on a continuum, and because public safety shares spheres of connection with military service like mortal danger, studying moral injury in the public safety population is indicated.

Distinguishing between the overlaps helps identify the originating problem (the true north) and is critical to assessment and intervention. The more specific and holistic understanding of the person in his or her environment, in relationship to the origin of the problem, the better chance for competent supports.

From there, other co-occurring disruptions can be assessed and worked through as they relate to the origin. Frankl said, “we cannot infer from a shadow what casts it” that environmental circumstances must be incorporated to create a holistic picture.

In this overlap, it is possible that moral injury as a multidimensional problem (not a psychiatric diagnosis) may be the precursor to other maladies or vice versa.

Identifying moral injury

How does someone sustain moral injury? It is not a broken bone that a person can point at and say, “that’s what hurts.”

Moral injury is a soul wound that occurs when an authority figure or person with the responsibility of power (either themselves or someone else) commits, witnesses, or fails to prevent a violation of their moral code, in a high-stakes situation where mortal danger is present. Put another way, when “psychological trauma” is disassembled into its Greek origin, it translates to “spirit wound” or “soul wound.”

It is a normal human reaction to tragedies that occur beyond the reach of human control.

Mechanism of injury 

Moral injury is being out at sea in a dangerous storm and the navigation system becomes damaged. The person’s internal compass is broken. This makes it increasingly difficult for a person to know if they are headed in the right direction, let alone where they are; to trust themselves and those around them; to believe their identity, purpose or mission is even justified at all.

When public safety officials experience this betrayal it misaligns their moral compass; the very part of being human that called them to a life of service. That is when pain and anguish begin.

The assumptions of control have been breached. Regardless that public safety officials are trained to manage crises, they are still human and there are forces beyond their control. This prompts questions like:

  • Did I do everything I could?
  • Did I make the right decision?
  • Why did I do that?
  • What have I done?
  • How could you make me do that?

Moral injury symptoms

Moral injury reveals itself through a continuum of the human condition’s dimensions. Emotionally, feelings of guilt, shame, grief, anger, sadness and despair can be present.

Common behaviors are self-loathing, loss of faith, loss of meaning, self-sabotaging, substance abuse and self-isolating. Because the spiraling nature of moral injury creates internal dissonance and produces diminished ability and capacity to trust, there is an increased risk for suicide or suicidal ideation.

Repairing and recalibrating the moral compass

Public safety professionals are helpers, fixers and protectors. They are brave. Their baseline stress level is the crisis point for most civilians. They demonstrate psychological elasticity and adaptability daily. This is who they are at their core. It lends itself to drive and determination. Their careers are journeys to put their gifts of being clutch under pressure to meaningful use.

Because public safety officials are still human, damage may happen to their moral compasses. However, this damage can be repaired and recalibrated. This requires accurate input to get back to alignment. Since isolation and a loss of capacity for trust are primary markers of moral injury, it stands to reason that social support through meaningful relationships is tantamount to repair. This manifests through a variety of methods.

As part of a multi-level integrated triage approach, proactive and well-developed formal peer support is a critical asset to public safety agencies as a first-line support. Peers provide a safe, empathic and normalized relationship and can help refer for additional supports. On the more holistic side, individuals with a moral injury are encouraged to return to old or develop new hobbies and recreational activities and seek spiritual care.

Clinically, strengths-based therapeutic modalities that focus on fortifying forgiveness, life narratives, acceptance and commitment, family systems, and cognitive-behavioral aspects have been shown to be helpful. Addressing any substance use barriers to wellness is also imperative. These methods of re-forging meaningful relationships and activities can re-ignite the soul and aid in realigning the moral compass. They can spark hope, faith and moral courage. They can bring joy and healing. They direct a person to reconnect with their primary role. They remind a person that despite their vocation, they are a multifaceted living human.

Going forward

The concept of moral injury is not new, though it has had many names and faces. That is meant to offer comfort, not to minimize or devalue pain. Humans have historically grappled with the internal anguish of a transgressed conscience. Maybe it is too vast to encapsulate it into one term. No matter what fits best, a broken spirit and rupture in basic trust can have lasting detrimental effects.

As long as there have been humans with large hearts and deep minds, there has been existential tension and anguish. They survived. They learned they are more than a vocation and that level of assigned meaning to roles is malleable. They used adversity to strengthen their moral courage. They shared their messages so others would find solace. People forget this, get distracted or blissfully hide. Fortunately, even while wounded, the soul knows and will speak through whatever pangs demand the most attention for its moral compass to be repaired. The storm does not become less treacherous. You just become more courageous. You trust your moral compass again.


About the Author

Jennie Leftwich is a former Emergency Communications Officer for Powhatan County Public Safety Communications and Powhatan Sheriff’s Office where she formed the agency’s CISM/Peer Support team. She is certified CISM through UMBC and the ICISF, CIT certified, earned an M.A. in Trauma and Crisis Counseling, a Forensic Social work certificate, and will complete her Clinical M.S.W. at Virginia Commonwealth University in May 2021. She plans to practice clinically and independently with public safety and military veterans’ populations, while also advocating for better collaborative partnerships between social work and public safety. She is a proud LE/Fire/Rescue/Military granddaughter, daughter, sibling, spouse, and advocate who grew up in San Diego.

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