As the omicron surge–tsunami–hits the United States I am grateful for the protection of vaccination and yet I am braced against less deadly, but still deep impact. The impact of a form of trauma called “moral injury” or “moral distress”. I’m worried for all of us.
“Moral injury” was first described by Jonathan Shay to describe the impacts on military and veteran patients. It includes the traumas caused when we act against our morals, fail to act for our morals, witness others betray our morals, and in particular, when those in power betray what’s right. It’s similar, but somewhat different to the idea of “moral distress” first described among health care workers: when we know what’s ethically right, but are not allowed or cannot do what’s right whether caused by inadequate staffing, two conflicting values, or conflicts on the team.
At first glance this level of trauma may seem inconsequential. But the mental health impacts can be profound: depression, alienation from others, alcoholism, even suicidal thoughts or actions.
Even before the pandemic, many in fields like nursing and teaching struggled with moral injury or distress: for-profit health care with persistent understaffing, doctors unable to fully help patients because patients couldn’t afford medication, teachers with too many students told to implement programs they knew wouldn’t help, social workers and more.
And then came this pandemic: Nurses witnessing families unable to be at the bedsides of dying patients; doctors needing to decide who got the available ventilators; teachers trying to support students across zoom; school administrators trying to balance way too many needs including trying to keep their staff safe. The stories are heart-breaking. So I think many of us have shut them out. Tried to forget the idea of rationing care. Tried to forget hearing the teacher coach a kindergartener over zoom through fetching their own snack wondering if we should be doing more, something, but what?
But more, all of us have some impact: Watching a relative not understand when or how to use a COVID test and putting our vulnerable loved ones at risk. Or stopping a family gathering and listening to the emotional impact on isolated elders. Or even realizing we accidentally put loved ones at risk. Watching others refuse to wear a mask or get vaccinated. Parents having to decide between the physical risks of a virus and activities vital to our children’s mental well-being. Or just feeling like we should be doing something more to help, but feeling like the little things we’ve been able to do like sew cloth masks early on or donate meals to hospital staff are never enough.
Congregational leaders too: we wish we could meet all our people’s needs, but we can’t. Balancing the need to slow the spread in our communities, keep vulnerable people safe, keep our staff staff safe, but also knowing the very real impact of so much isolation. It often feels like everything is the wrong decision. I know you’re all exhausted and part of this exhaustion is this never being able to meet everyone’s needs.
The moral injury is deepened by the betrayal of the systems: By hospitals laying off staff during the pandemic; By the chronic underfunding of schools; By the CDC “safety” guidelines for schools lacking evidence of effectiveness with delta or omicron; By the lack of testing; By the lack of readily available cheap rapid testing as is nearly ubiquitous in Europe; By every municipality who will not consider proven methods like masking to slow the spread.
I believe the moral injury is worsened by our collective failure this winter to remember that even if omicron is mild for healthy people who are vaccinated, there are many among us whose immune systems cannot fully protect them even if vaccinated. And those with kids still have to decide if they’re going to send their kids to school or not.
This coming month, as we all live through this wave, may we have compassion for each other. Every sector will struggle with not enough healthy staff. Already understaffed schools will do their best to function. Already exhausted teachers will struggle with not being able to be the teachers they want to be and watching the impacts on their students. Already traumatized and burned out health care workers will do their best, but will witness yet more impacts including their emotions about those unvaccinated patients filling the ICU beds. Parents will try to make the best decisions they can. Parents of unvaccinated young children are already making hard decisions and risk calculations daily. Parents of school age children are wondering if school will be cancelled and worrying about the impact of not enough staff. Some children really need their paraprofessional and really won’t do well with a sub for even a week, much less two. Service workers will continue to work short-staffed and yet face abusive customers who refuse to wear masks.
The only way out is through. We have to be willing to notice our feelings and tell our stories. We have to listen to each other’s stories. We have to tell the full complex story how, when the systems that could have supported us all did not, we did the best we could even knowing it was never enough.