Feeling Broken by Your Job? It Could Be Moral Injury

Dr Marianne Trent (: 00:00

Have you ever done something at work or maybe even being asked to do something at work that just didn't sit right with you? Something that made you feel like you'd betrayed your own values, even if you were just doing what you've been told or working within the system? That feeling might be more than just discomfort. It could be moral injury, and it's something that more and more of us are experiencing in education, in healthcare, in policing, and in other public service roles too. Stay tuned to get the low down on what moral injury is and what you can do about it. Hope you find it really useful.

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Welcome along to the Aspiring Psychologist Podcast. I am Dr. Marianne, a qualified clinical psychologist. Thank you so much for being here. I first became aware of the term moral injury in 2020. At this time, I was being trained able to support the COVID situation that was unfolding. At that point, we didn't really know what it was going to be like, but we were planning for the worst, whilst hoping for the best. And as part of that, I was trained to kind of do debrief situations for people who had been through very challenging work situations, and that is where the term moral injury first came onto my radar. It's definitely been around before that. It's definitely been around since that. I just didn't know the term, and so I thought four years later, why not tell you about it? Because I think it's something we should all be more aware of, both for the impact for ourselves in our roles, but for those around us as well.

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It might be our friends, it might be our colleagues. Other people might be experiencing this. Our family members may be even in their work situations, and I think it's big. It's important it should get airtime. So let's take a little bit of a look to some examples in a variety of different roles for how moral injury might show up. During the pandemic, frontline healthcare workers were asked to decide who would get access to ventilators. Imagine the psychological toll of being forced to deny someone life-saving treatment simply because there weren't enough resources available. Mental health professionals working in overstretched services are sometimes, or in my experience, often asked to add people to waiting lists, knowing full well they might not be seen for two or even three years. When someone is clearly in distress and in need of immediate support that can feel unbearable in policing.

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Officers might be instructed to respond in ways that go against their own judgement or values. For example, they might firmly believe that someone ought to be arrested or prosecuted for something that's happened, but they might be told that there wouldn't be enough chance of prosecution or that there aren't enough resources to follow that through. That can sit very unhappily. Indeed, in education or safeguarding, it can be very difficult when you're having to address specific needs for certain individuals in your class when actually you know that that is a detriment to others in the class and in the school. That can be a very bitter pill to swallow. So none of these situations are easy, but actually when we are asked to consistently do things that go against our values, they stack up and can lead to emotional friction. And over time, that can look like guilt, shame, blame, withdrawal, anxiety, depression, even trauma symptoms, hypervigilance feeling like you are not worthy of anything.

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Perhaps you get kind of intrusive thoughts or memories or maybe sometimes even flashbacks to some of the people that you feel have been not having the experience they deserved along the way. And you might notice that they just feel like little jagged bits that you keep tripping over, that you keep coming back to. That's an indication that that's not sitting right and that this might be a moral injury or even a bigger traumatic presentation. So how does moral injury show up emotionally? People experiencing moral injury might be feeling like they've let others down or betrayed themselves. They might be feeling powerless and like they're in a broken system. They might be feeling anxious or ashamed. They might also be feeling isolated from their colleagues, especially if no one else is talking about it. That can be incredibly invalidating as it makes us think it's just me.

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I'm the problem. Everyone else seems to be okay with this. Moral injury also can make it really hard to trust ourselves. You might start to wonder, am I even a good person? How can I continue doing this job with integrity whilst also feeling like I am living authentically to myself and my own values? Like I said, it might well affect your sleep. It might well affect your wellbeing. It might feel like you've got a lot of problems weighing down on you. It may even interfere with your functioning, your ability to get through the day to do the things that you would usually do, like shower, prepare meals, eat, sleep, pick up your children, do your own homework or your own work or the things you'd usually be interested in like going for a run or to the gym. It's really impacting on your functioning and when this becomes really problematic, this might also impact on your risk to yourself and others.

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So practical steps. What can we do about moral injury? The first step is actually recognising that it's happening, giving it the name. I'm experiencing moral injury. That was definitely something that I felt was problematic for me when I was working in the NHS. The long waiting lists felt very complicated. I was often doing the majority of the psychology assessments. So for me, the people on waiting lists were real people with names and that was really hard, really hard to manage that waiting list. Knowing that those people were out there and they were waiting and really wanting this service and that I'd had that connection with them, I began to feel like I was letting them down. So the second step is seeking support, speaking out about it. Moral injury thrives in silence. Finding spaces where you can process and reflect is key and actually moral injury can be indicated in burnout.

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If you would find learning more about burnout, please do check out the very special series, which was created for the Aspiring Psychologist by Dr. Claire Plumley, which is called Burnout Bites. You will find a playlist for that on YouTube if you want to catch all the episodes together. So options to find that support. So I think supervision can be so powerful and so important, but this can be indicated contraindicated if your supervisor or your person who's managing you is actually part of this moral injury problem. So finding supervision with someone where you can freely explore that without judgement , without shame can be really, really important. It might even be immediately that you do some peer supervision so that you can get a sounding board so you can get some validation. You can kind of try and work out whether this is really what you think it might be.

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Finding some sort of supervision or conversation that is values based that really helps you think about your values, your integrity, and what operating within those values would look like for you can be really important too. There are also peer communities. There might well be Facebook groups for people working in your organisation or similar organisations. There might be people that you know already who do a similar job that you can talk to. Certainly the Aspiring Psychologist membership is a really lovely place to be able to have safe and supportive conversations and to be able to test the limits of what is normal. You need somewhere where you can feel safe to be vulnerable and seen and that your values are seen as an asset. Part of this process in naming it and externalising it and talking it through might help you realise that actually where you are working is the problem.

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And in terms of the culture and the change that I spoke about with Kelly loves C in our recent episode about starting a job and hating it. So you may decide that actually what you are choosing to do is to leave to find yourself a new job where you are being appreciated and supported where you are. Being able to work towards your values, within your integrity and free of moral injury. Of course, union or HR representation might also be helpful for you to feel supported and to help have someone advocate for you. Being a mental health professional myself, I'm of course going to suggest mental health treatment. I think that this is definitely strongly indicated and strongly in the trauma family. So therefore you might want to access A-P-T-S-D type treatment such as eye movement desensitisation and reprocessing, which is all about the eye movements or the tapping to help you to process that so that it lays flat and so that it's assimilated, blended into your life.

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That could be trickier to do if you are still in the same environment and you're still being asked to make the same decisions and live in the same way that is layering more moral injuries on top of each other. But yes, it's not impossible. We can help you to feel better even if you are still in that situation. I guess accessing some curious reflection and some compassion around grief, what you've lost out on what you've been through, what you've endured as part of those experiences can be powerful too. Compassion focused therapy can be life changing and I think and liberal sprinkling of that can do so much in whatever therapy you are receiving. So we've had a quick look at what moral injury is, how it might show up for us and what we can do about it. I think it's lovely that you have integrity and that you want to do the work you do, but you deserve to thrive as well.

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You shouldn't be having to compromise your values. Your values are what makes you you. I think as humans we have these fantastically tricky brains, which do help warn us about things that aren't sitting right, but over time, if we continue to ignore that, we can struggle with our mental health. We do experience burnout. It can be detrimental to our life, to our career, and to those around us that have to kind of watch us shrink to be able to anaesthetise ourselves enough to carry on going into work and doing these things every day. You don't deserve to suffer. You deserve to thrive, and I believe you can find a work situation in future that feels more validating, that feels more like a bit of you, and that maybe you can even adapt the situation you are in at the moment to help that be true.

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To help that be the case, if you are an aspiring psych and you would find some more support helpful, please do check out the Aspiring Psychologist membership and also the brand new Ready to Rise programme, which is more intensive and involves one-to-one with me and runs for a whole year. What is not to like? There'll be details in the show notes. If you found this helpful, please do like, please do subscribe, please do drop a comment, share this with your networks. And if you're listening on Apple Podcasts, please do rate and review the show And on Spotify you can drop questions and answers and you can rate the show too. Please do come along to the free Facebook group, the Aspiring Psychologist community with Dr. Marianne Trent, which is the unique home of Marianne's motivation and mindset sessions, which happen on Friday mornings.

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