Morally Injured
I was on the phone with a representative of my insurance company. The phone call was recorded. The man on the phone told me that the blood tests the doctor ordered might not be covered. They probably were, but the last word has to come from their board of doctors.
I told him, “this might may cost me thousands of dollars—is there a way to know the impact of this ‘might’ on my finances?”
He kept his tone neutral. I felt guilty pressing him that much, but I continued, “What if I was seriously injured and I could not use my brain to make these choices?” “What do I do with insurance that cannot assure my well-being when I need to be reassured?”
“‘Ma’am, they will most probably cover your tests, but I cannot give you a final answer.” That was the best I could get.
I left the call with a sense of injury inflicted and received.
Change of scenario.
I have a friend who started working in marketing for a little but promising university. This university targeted students who needed a second chance to complete their studies and receive a specialization in their work. My friend poured heart and soul into this job to slowly discover that they were trying to squeeze as much money out of the students as possible, with promises that they could not live up to quite often.
This system resonated with the same scholastic system she received in her native country. She thought she was working to redeem herself and the people who went through the same issue; she discovered, instead, to be working for the enemy.
In both scenarios, people are just doing their job. We all need a job to survive.
Yet, how often does it happen that our job leaves us morally injured? How often do we have to endure a moral injury to gain enough to get through the day? This strange feeling we have when we have to go through this experience is called moral injury.
The Moral Injury
The notion of moral injury showed up for the first time in military language to describe those veterans who found themselves doing moral harm to other human beings. It is a different phenomenon from PTSD or burnout, even if the effects might seem the same.
The journalist Diane Silver described it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.” We incur a moral injury when we do something that does not resonate with our set of values and often goes against our moral beliefs and personal expectations.
As Boudreau wrote, “Researchers from the VA describe ‘moral injury’ as ‘involving an act of transgression that creates dissonance and conflict because it violates assumptions and beliefs about right and wrong and personal goodness.’”
Moral injury involves a sense of guilt stemming from the wounds we inflict upon ourselves in doing something against ourselves or others. Despite this concept being coined in relation to morally challenging actions that veterans might have taken in war zones or during campaigns, I believe it is possible to recognize this form of injury in different expressions of our daily routine. Boudreau continued: “moral injury resonates with the notion that killing hurts the killer, too, even in self-defense or in the line of duty and that no justification, legal, political, religious, or otherwise, can heal those wounds.”
The Daily Moral Injury
Coming back to the stories I presented at the beginning. The insurance representative had to face several phone calls of this kind every day, often worse than the one we had; yet, there was nothing this person could do. This is their job, and they have to stick to very specific guidelines no matter how inefficient they might be for the client they are trying to help.
On the other hand, I have to make phone calls of that kind, not only to my insurer but also to other people working for companies who have to protect themselves legally before thinking of their clients’ interests.
A structural problem sets up the condition for invisible injuries that a person might bring home every day to obtain a salary, be healthy, or be loyal to their original vocation.
My friend eventually left her job—but recovering from the sense of moral confusion that such an experience leaves on you is hard. What are the psychological tools that we can provide for those who want to do better? How do we repair our moral fiber after these kinds of injuries?
Considerations
As any wound does, it takes time to heal. It might happen that after a morally challenging job, one would need time to recover. This required time should not be thought of with a sense of failure or inadequacy. It should be taken as a cleansing time to review what has been done and where the injuries might be.
During this time, we need to learn how to pledge a new loyalty to the burgeoning set of values that stem from such experiences.
Ignoring the injury—and the sense of discomfort—is human, but it might take an ongoing invisible toll on our energy and later might flow into feelings of burnout.
That is why I think that being able to see our values and somehow remain loyal to them, even when they are mutable or when they have been betrayed, is important to repair our moral fiber.
It is not praiseworthy to get frustrated on the phone with the insurance representative from my moral standards. Maybe it feels morally wrong, as well, for an employee to work for a place that feels morally challenging to them. This does not mean that we are not human. We can do better with each opportunity.
From that sense of loyalty, we should take one step at a time to compassionately acknowledge how we can do better at each step of the way and how much space we objectively can gain to improve alignment with our moral fiber.
Wherever possible, we can apologize to ourselves and others if we act out of character because of external necessity.