On Moral Injury

I just re-read a post full of sound and fury that I wrote last year at this time, detailing my initial shock at our unsafe and unprecedentedly intense working conditions at the time. The only policy improvements since then is that students don't have to be in the building during lunch and that we flip two courses every week so we only work five days without prep instead of seven months. What's worse is that there are twice as many in the building, and kids know they can take off their masks all the time to eat or drink. Teachers are finally allowed to wear their own masks openly (I've been hiding mine the whole time) while kids are getting lax about theirs (some teachers too due to vaccine-provoked complacency), and we have no recourse to stop them - excepting being that bitch of a teacher who won't let her kids take a sip of water in class! I realized how many rules at school I've ignored over the years to students' delight, and it sucks to suddenly be seen as a hard ass. The rules still don't make sense. We still err on the side of privacy instead of saving lives by stopping the spread. We still provide businesses with free rapid tests (paid for with our taxes) and leave the $40 option for unvaccinated children. The world feels crazy in its callousness.  

Then Dr. Hishram Ziauddeen's twitter post on moral injury really hit it home for me. Here it is in full with just minor punctuation adjusted for clarity: 

"This is about the recurrent feelings of horror, disbelief, sadness, helplessness and anger in response to the callousness and cruelty we continue to see during the pandemic. The majority of us (I'd like to think) share important ethical values & standards that we believe should guide how we & our leaders handle a disaster like the pandemic. These include: We should prioritize life & health for everyone. We should protect our kids We should protect our most vulnerable (CEV, the disabled, the elderly, the poor, etc). We should try to look after and help all our fellow humans, everywhere. These are all 'as much as possible' values and standards i.e. you aim to do the most you can. 

Moral outrage is the justifiable anger, disgust, or frustration directed toward those (govt, media, advisors, fellow citizens, etc) who violate these values and standards. 'How could they do this?' 'How could they deliberately devise a policy that meant so many would die?' 'How could they plan to let kids be infected?' 'How can they refuse to accept responsibility?' 'How can they refuse to change track after seeing what their mistakes have wrought?' 'How could they use this to enrich themselves & their friends and push through their agenda?' 'How can they care so little for others?' 'How did this become normal and acceptable? Especially in a country and a media that is so readily outraged by nonsense and still is? (anti-trans, anti-refugee outrage going as strong as ever)' 'How can they be so corrupt?  'How can they lie so blatantly?' 'How can they keep gaslighting us?' 'They are doctors! They are scientists! How can then argue for or support something so heinous? 'HOW CAN THEY FEEL NO SHAME, NO TWINGE OF CONSCIENCE? My conscience could not bear even a sliver of the wilful cruelty they are inflicting! Surely there must a red line even for them?' This last point is one of the core issues. More sickening than seeing what is being done, is trying to imagine the mind that could do these things. It's something we do automatically, and it makes you feel sickened in your own mind.

Which brings us to moral injury. Moral injury is the damage done to one’s conscience when one perpetrates, witnesses, or fails to prevent acts that violate one's moral code and ethical standards. This has been studied a lot in the military and it includes the betrayal of what is right by one's leaders. Some of us who have carried out acts that violated our moral codes e.g. healthcare workers who have had to give suboptimal care and/or fail patients because of various failures higher up in the system. There are many of us who have witnessed so many violations. 

There are also many who tried very hard to prevent this, doing the research, challenging the government, fighting the case for controlling transmission. The vast majority of them did not do it for any personal gain but at considerable personal cost. Many of them (scientists, doctors, teachers, parents, lawyers, etc) are still fighting, to stop things getting even worse, to still try and protect people. To my mind, the vilification and abuse they receive is an active violation. But here's the thing, despite their best efforts, they've lost. The people who were working to help everyone & save as many as possible, lost. For them, they failed to prevent these egregious violations. For the rest of us, the good guys lost. 

Moral injury rocks your sense of the world, it can rock your sense of you (especially if you are a perpetrator). It leads to anger, frustration and rage (at the world, at the perpetrators, at those who don't seem to see the terrible violations). It can disconnect you from other people and parts of the world, 'how can people just carry on like normal when this has happened, when this is still happening?' It can make you feel suffocated, like you're almost choking on disbelief and injustice. Like you're stuck. Like the world does not make sense anymore. Like you don't know what else you can do. 

And you still have to carry on like at least some things are normal. For your kids, for your family, for your patients, for the stability of your own mind. Also moral injury can also contribute to depression, PTSD and other mental illnesses. I wrote this thread because I have felt overwhelmed like this several times in the last 19 months but this thread from today was a bit too much. Is there anything that helps? Find the other people who feel the same. The empathy, kindness and support of people on Twitter has been amazing & heartening."

I am so grateful to the people who feel the same. People willing to listen to my regular rants have been an absolute life-saver. Collective rage against this moral injustice, even if we're unable to satisfactorily amend the situation, is a starting point. If we can keep it up, we might inadvertently manage to take down the capitalist structure!