Moral Injury Part One: Are You Experiencing Burnout or Moral Injury?

Your mental and emotional health directly affects your ability to provide quality care to your clients. Healthcare professionals in various industries—and mostly due to factors of the coronavirus pandemic—are feeling guilt, shame and exhaustion, all symptoms of burnout. But are you experiencing something more complicated?

What is Burnout?

First, let’s discuss what burnout is. Burnout is a non-medical diagnosis characterized as a specific type of work-related stress. Burnout causes physical or emotional exhaustion (or both) that typically includes a feeling that you’ve lost your personal identity and sense of accomplishment.
Experts don’t know the cause of burnout, but some believe that depression and other individual factors may be involved.

Signs of Burnout

One person may experience burnout entirely differently from another. Take a few moments to consider these work scenarios to see if you’re experiencing burnout:

  • You feel pessimistic, critical and/or irritable
  • You feel unmotivated, easily distracted, and less productive
  • You don’t feel satisfied by your achievements or your work
  • Your sleep habits have changed (extreme fatigue, insomnia, sleep disturbances)
  • You’re experiencing headaches, stomach aches or other physical ailments
  • You’re using food, drugs or alcohol to feel better or to not feel at all
  • You no longer have energy for the people or things you enjoy

Possible Reasons You May Experience Burnout

Again, reasons of burnout will be different for each individual. Common factors include:

  • Lack of support
  • Unclear job expectations
  • Toxic or dysfunctional workplace environment
  • Lack of work/life balance

You may also be experiencing a heavy workload, excessive or long hours, or having little control over your work or schedule. Unfortunately, if you work in a helping profession, you may be more susceptible to burnout. If you suspect burnout, discuss your feelings and possible options with your supervisor or an HR resource.

You can also seek the advice of a healthcare professional to help address and alleviate any physical or emotional effects that are troubling you. Without intervention, burnout could lead to excessive stress, sleep issues, substance misuse, high blood pressure and higher risk of other health-related conditions.

Identifying with typical job burnout may not be sufficient for those in the helping professions, particularly in the years of the COVID-19 pandemic. This is where moral injury is increasingly getting brought into the conversation.

What is Moral Injury?

Moral injury involves the stressful social, psychological, and/or spiritual effects of having witnessed or participated in behaviors that go against a person’s core beliefs and values.

The term was developed in the 1990s to describe the moral conflicts military professionals were feeling after returning from war zones. Later, it was used to describe healthcare professionals facing similar distressing environments.

In a healthcare setting, burnout is described as a type of “chronic work stress” while moral injury is explained as the “suffering that occurs in response to moral adversity.” Having our beliefs or ethics repeatedly dishonored at our workplace can create undue psychological injury including disrupting how we feel about our individual selves and how we show up in the world.

What does moral injury look like in the helping professions?

Moral injury can occur in any profession but is on the rise in the healthcare industry. Here are some examples of what that may look like:

Feeling a sense of responsibility to make decisions that entail conflicting morals, ethics and values. For example, taking on more clients to meet the needs of your community, despite the caseload size exceeding your typical self-care standard.

Doing something that goes against your beliefs (referred to as an act of commission). Behavioral health care workers may be faced with situations where they need to decide how best to prioritize clients in need of a session (e.g., which clients receive less/more frequent sessions and how to best use limited time when multiple clients need help or when many are waiting for services).

Failing to do something in line with your beliefs (referred to as an act of omission). Moral injury can also develop in behavioral health care workers when they feel unable to provide the type of care requested by the client (e.g., in person session) for sake of their own safety or their families.

Witnessing or learning about an act that goes against your ethics and beliefs.Some may feel guilt and shame because they felt numb in the face of suffering and death. Behavioral health care workers may also witness what they perceive to be unjustifiable or unfair acts or policies that they feel powerless to confront.

Experiencing betrayal by someone you trust. A person who experiences betrayal may also feel anger, resentment, and/or diminished confidence in peers, leaders or organizations.

In behavioral health and mental health professions specifically, moral injury is a common occurrence. However, neither moral injury nor burnout is the fault of an individual, and self-care alone will not eliminate them. If you’re experiencing or have experienced moral injury, consider the following:

  • If you don’t already, attend therapy sessions regularly
  • Connect with colleagues who feel or have felt similarly
  • Take the time to self-reflect often (journal, prayer, meditation, etc.)
  • Stay connected to your true self, beliefs and values
  • Align your personal values with your business’ values
  • If you’re not self-employed, look for a workplace that prioritizes care over quotas and encourages a work/life balance

Clinicians, therapists, and other behavioral health workers are in their line of work because they truly want to help others—but remember that being an impactful, successful, and respected healthcare professional doesn’t need to come at a personal cost.

Self-care for moral injury can be particularly challenging for people working in behavioral health care given that those in the field strongly value caring for others and may prioritize the needs of others over their own. It is often only in conversations with others that we can hear a different, more helpful way to think about or make meaning from morally distressing situations.

On the positive side, there is also evidence that indicates after potentially morally injurious experiences some people develop a redefined meaning in life and, with time and support, begin to incorporate the experience into growth or helping others. Further, some develop new insights about how to help the systems in which they work or that can help them grow in their own work or lives.

Behavioral health care workers, their colleagues, and leaders can use strategies to take care of themselves and each other both during and after potential morally injurious situations, to support recovery and growth.

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