You’re a soldier or law enforcement officer and, in the line of duty, you are forced to kill someone.
Your head understands, but your heart hurts.
Or maybe you find yourself having to parent your parent, scolding them as you would a child. Maybe they have dementia and you simply can’t safely care for them anymore. You have to make tough decisions — take away the car keys or move them from their home filled with family memories.
Or it's your child. You promised you would always be there for them, but their addiction has made that difficult. To save yourself, your marriage, the rest of the family, you have to cut that child out of your life.
These are all gut-wrenching decisions that can leave you with moral injury — wounds to the conscience.
Moral injury is a relatively new term used to describe the internal suffering that results from someone doing something that goes against their moral code.
The Rev. Carrie Doehring is an expert on dealing with moral injury.
Doehring, who is also a licensed psychologist, directs the masters of arts in pastoral and spiritual care and the military ministry course provider program at Iliff School of Theology and the University of Denver. She recently spoke about moral injury to local clergy through a grant from Bristol-Meyers to Volunteers of America.
Doehring said nurses in hospital emergency rooms who were unable to spend what they felt was enough time with their patients were the first to identify moral stress as a professional and organizational challenge. They experienced anger, guilt and shame about potentially causing harm or being part of a system or organization that causes harm or compromises care, she said. Over time, Doehring said, this feeling results in post-traumatic stress disorder.
“Moral injury arises from a traumatic event that causes us harm,” said Doehring. “The shame and guilt can make you withdraw, and then it takes on a life of its own.”
You never completely get over a trauma, she said, adding it simply becomes a part of who you are. It can be lessened by sharing and spiritual practices, which can include something as simple as prayer, yoga or quiet contemplative time.
“Organized religion can, however, make moral injury worse,” Doehring said. “It can make us feel like we’re being judged. When religion harms us, one struggle leads to another."
Some of that “spiritual pollution” includes family or cultural beliefs that we suffer because we’re bad or there’s something wrong with us, she said, or that God is punishing us for our wrongdoing, and, that if we worked harder or took better care of ourselves, we or those we love wouldn’t suffer.
“We need to hold ourselves in love,” she continued. “When we care for ourselves, we can care for others. … If we can share it, we can bear it. But you need to find a safe place to share it so as not to be judged.”
The most common types of stress and conflict are between work and family.
“We deal with stress at work because the biggest stressor in this country is financial. So, by the time we come home, we’re exhausted,” said Doehring. “When we become overwhelmed, we lose our ability to cope and understand.”
So, how do you deal with moral injury?
Doehring said to begin by finding the spiritual practices that help you. You accept whatever feelings — fear, guilt, anger, shame — that arise with physiological stress. In the process of embracing this stress and these feelings, experience goodness and compassion for self and others.
“People with strong core values of responsibility and concern for others will be more susceptible to moral stress,” concluded Doehring. “It results from a heightened sensitivity to the possibilities of causing harm, which can be life-giving if people don’t isolate themselves and are able to reach out to others in order to share responsibility and realistically assess harm."