Moral injury is a devastating experience that can have a lasting impact on those who experience it, with the potential to affect people across organisations, including those who witness it in others.
Although moral injury is a relatively new concept from an academic perspective, it has likely existed ever since humans have been engaged in conflict or working under stressful conditions.
Prior to the pandemic, the majority of research focussed on military cases before spreading into the healthcare sector and it is now gathering more interest across wider society, where it is often known as “moral burnout”. Both terms will be used interchangeably throughout this article.
In this article we’ll look at what causes moral injury, how it can be avoided and how it should be addressed.
Moral injury – what is it?
Moral injury is a state of profound emotional and psychological distress resulting from the violation of a person’s core moral values.
It often occurs when an individual perpetrates, fails to prevent, bears witness to or learns about acts that transgresses deeply held moral beliefs. What often follows is an extreme sense of guilt and shame around the circumstances in question.
It can also result from what might be termed “institutional betrayal” where an individual believes they have been let down by their organisation, particularly after a traumatic event.
It is an emerging issue that can permeate every level of an organisation, from senior leaders who have to make tough decisions, down to frontline staff who are responsible for carrying these decisions out.
As such, it’s essential for employers to be aware of the causes and signs of moral injury so that measures to help prevent it can be put in place.
What are the causes of moral injury?
As previously described, moral injury is caused by a number of things including:
When someone engages in, fails to prevent, or witnesses acts that conflict with their values or beliefs.
When an individual experiences betrayal by people they trust.
Examples of this include:
- An individual comes to believe that their actions have been harmful to others despite being well intentioned (e.g., in good faith).
- A person can’t change or influence the moral conundrum they are faced with (e.g. helplessness).
- Lack of psychological safety in the workplace – not feeling safe to speak up about wrongdoing; a belief that speaking up will result in retaliation from management.
Who can be affected by moral injury?
Moral injury can affect anyone and everyone.
In fact, we all have our own moral calling that can be questioned at any time. Some everyday examples include:
- Whether it’s the decision to give up your seat on public transport when an elderly person boards;
- Whether it’s deciding whether or not you should tell your boss about their unethical behaviour;
- Whether it’s weighing the pros and cons of skipping work…
One of the explanations of moral injury becoming more prevalent in the wake of the pandemic is that a greater part of the population than usual has been faced with more extreme ethical dilemmas and situations that cause them to contravene their morals.
These may include:
- Being told to break the law to keep a business going
- Not permitting relatives to see a dying patient
- Being sacked because you chose to highlight restrictions being ignored
These are all moments where we make moral choices about how we want our lives to look and feel, and we may come to judge ourselves harshly or even unfairly in hindsight.
Screening and assessment – how do we identify it?
The signs and symptoms of moral injury are similar to those experienced by post-traumatic stress disorder (PTSD) but differ in some respects such as guilt and shame at failing to uphold high standards rather than reliving traumatic memory of events.
Moral injury can also lead to cognitive and emotional impairment as the result of a traumatic or toxic environment that violates a person’s moral or ethical code.
It may present as:
- Feeling ashamed or embarrassed by event that have happened in the workplace
- Feeling more fatigued
- Constantly procrastinating
- Feeling fearful or anxious during the day
- Unable to switch off from work, unwind or relax
- Having intrusive thoughts about work or worries
- Thinking of worst-case scenarios
- Feeling disinterested and disengaged in work/your day-to-day life.
- Emotional, mental and physical exhaustion
These symptoms can lead to brain fog, forgetfulness, slower reaction time and general inability to be engaged in present actions.
The impact of moral injury on organisations and workplaces.
This increasingly apparent moral dimension appears to be causing a more intense type of burnout in people across many business sectors, which is far more challenging to overcome than traditional manifestation of “standard” burnout.
This, in turn, has an impact on organisational culture, output and performance.
At its most disruptive, moral injury can contribute to an outflow of people, possibly where they feel they have no other option but to resign from their jobs because of it.
This highlights that it is not just the original transgression that causes the injury but also that the lack of validation and support from their workplace leaders or peers exacerbates it.
How do we address moral injury?
Organisations can help to create strong cultures of psychological safety by implementing and reinforcing policies that support employees.
For example, organisations should have a clear policy around reporting harassment and sexual misconduct; they should make sure this policy is visible and easy to find, promote it so that all employees are aware of it, and ensure that anyone can easily report concerns about misconduct without fear of retaliation.
Organisations should also provide confidential channels for reporting these types of concerns as well as training on how to respond appropriately when an employee reports harassment or misconduct.
If you’re an individual experiencing moral injury yourself, or if you know someone who might be experiencing moral injury, there are resources out there that may be helpful.
This can all be reinforced by giving teams the opportunity, resources, structure and confidence to regularly explore topics that may contribute to, or counter against, moral injury.
You can do this by using Genesis in just 15 minutes per week – book your demo here.
If you see these signs in your colleagues or employees:
- Encourage them to speak up if they feel they have been given an order which goes against their values.
- Help them get support if it seems like they are struggling with the consequences of moral injury.
Moral injury is a real and serious problem that can have a long-term impact on individuals and organisations.
If you know how to identify it and treat it, though, you can minimise the effects and help your employees recover from its symptoms.
What’s more, strong, authentic and compassionate leadership throughout an organisation is the real key to preventing it in the first place.
Written by: Olly Church, Co-Founder