I’d never heard the term “moral injury” until I read about it last week in a New York Times article about a crisis among doctors precipitated by the accelerating treatment of healthcare as a privilege rather than a right, a profit center rather than a social good. (This phenomenon rhymes with much I’ve written about education in my new book, In The Camp of Angels of Freedom: What Does It Mean to Be Educated?)
The Times piece links to a 2018 essay by Simon G. Talbot and Wendy Dean that defines moral injury:
The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”
I’m calling it an epidemic. Moral injury definitely explains the shell-shocked look on the faces of people I know at the egregious headlines greeting them upon awakening. Hearing the latest outrage, some people like to say, “I’m not surprised, but I’m shocked,” an expression that has always annoyed me, since it indicates how low our expectations have fallen concerning the conduct of the privileged and powerful, how many of us protect ourselves with cynicism. Truly, I’d rather be surprised, but of course I know what they mean. Your or I may think we know right from wrong, at least in obvious cases, but then a vicious criminal like Trump raises millions off the assertion that he’s being politically persecuted, and politicians rush to kiss his ring.
Now at least I have a name for the kind of headache this gives me: moral injury.
I used to be considered an optimist. I rejected the title when I thought it described one who holds the belief that everything will work out fine. But when I understood it instead as holding to possibility rather than predicting a happy ending, I embraced it. Nowadays I encounter quite a few optimists, including those who’ve had popular success bringing a message of hope wrapped in the undeniable truth that none of us can know the future with certainty. I applaud them. If we are reality-based, we have to be open to possibility. And if we believe in human agency—whether or not we believe it, we live it everyday—then we must see the wisdom of living into that possibility.
But now a bad case of moral injury is tarnishing my optimism, and I’m pretty sure I’m not the only one. What to do?
One thing I really like about both the Times piece and the Talbot and Dean piece is that they pierce the myth of burnout to point out what’s really happening with people whose jobs come under the heading of medical care. The doctors and nurses and aides who quit because they can’t take it any longer—inadvertently compounding the problem of understaffing, compounding the communication gaps and unanswered anxieties that proliferate when you can’t have the conversations with your doctor that could assuage them—cannot be fully explained by overwork and over-stress.
Indeed, the word “burnout” can be taken to subtly connote some type of weakness or lack on the part of the person who’s experiencing it. I’ve heard it said that conditions are tough, yes, but the burnt-out person just couldn’t take it while someone with more fortitude or dedication could have. This way of seeing misdirects attention from true culpability, which lies with social institutions that are structured to maximize speed or profit or both at the expense of human beings, thus treating ethical and moral considerations as insignificant, as understandable collateral damage if the trains are to run on time.
Reading about this reminded me of something that happened 30 years ago. My then-partner and I were hired by the state arts agency in South Carolina to work with local groups, mostly in rural counties. Our brief was to help them with what was described as “burnout.” The state had given small grants and technical assistance to people who would coordinate and promote cultural events in their towns. Why were so many of these local arts organizers feeling demoralized and giving up?
When we visited, we found out. The powers-that-be in most counties had responded to federal desegregation mandates with delaying tactics. When they could no longer hold out—that was 1971 or so—they shut down public facilities rather than integrate them. We saw a lot of public pools that had been drained and closed. Where there were once black schools and white schools, we found the people and infrastructure of formerly black schools had been cast aside. There would be a single public school with mostly white teachers and almost all black students, while white kids went to what their parents called “Christian academies,” shoestring operations with no sports, no arts classes, just the three Rs in an environment created to keep black and white from mixing.
The arts organizers who were supposedly burnt-out weren’t suffering from overwork. It was the impossibility of nurturing creativity, conviviality, and communication under ambient conditions.
We learned a lot from this experience. I could tell you stories all day. One of the deepest learnings was about the impact of racism. The damage it does to those it is directed against is evident and appalling. We also saw firsthand how racism impairs its perpetrators, stunting their imaginations of the possible, blinding them not only to the suffering of others, but to the beauty and meaning all around them, to what it is to live in truth. Two types of moral injury: one inflicted by those in power, the other self-inflicted.
Moving toward the cure for both requires the same first step: demolishing the excuses that rationalize systems meting out “deep soul wound[s] that pierce a person’s identity, sense of morality, and relationship to society” on grounds of profit or so-called efficiency. I have vowed never again to nod agreement when someone tells me that soldiers or nurses or teachers are simply burnt-out. I have vowed to call out the epidemic of moral injury for what it is. Join me?
“Hard to be a Human,” Bettye Lavette.