On Becoming De-Centered in Health Care: Learning from the Military’s Experience of Moral Injury and Formulating Recommendations for Health Care Professionals
Numerous reports from health professionals in the United States who treat warriors returned from combat in the Middle East describe a phenomenon now called “moral injury.” This condition occurs in addition to post‐traumatic stress disorder and is characterized as intensely unpleasant feelings of worthlessness and shame in having witnessed or in being complicitous with moral atrocities during the Middle East crisis. The psychological architecture of moral injury is constituted by feelings of 1) profoundly deflated and injured self‐esteem, 2) unnerving lack of control over one’s life, and 3) persistent feelings of endangerment. If a “centered life” is one admitting enjoyment of and satisfaction with one’s life situation along with feeling able to realize it, then moral injury connotes the opposite. As such, de‐centered lives that admit significant moral injury spin out of control and often become either personally or interpersonally destructive.
This presentation will theorize that health professionals witness a less devastating but nevertheless extremely serious variant of this by way of a variety of situations involving working with disruptive and defiant family members, experiencing workplace bullying, encountering allegations of harm‐causing medical error, and facing impossible production pressures and quotas. We will examine each of these at some length and discuss their effects on health professionals. The talk will conclude with strategies whereby the intensity of these threats might be lessened and managed in healthy ways that restore some sense of centeredness to health care professionals.