The term moral injury is a recent one, and, as coined by psychiatrist Jonathan Shay, has a pretty specific definition when used in conjunction with military vets suffering a PTS injury. You won’t find it in the Big Book shrinks use like writers use a dictionary, though (DSM-V). Not yet, anyway. He used it to describe “an injury to an individual’s moral conscience resulting from an act of perceived moral transgression which produces profound emotional shame”. In simple terms, that is making a decision to do something you find almost unconscionable and the difficulty you have later reconciling that with your own morality. I am not going to co-opt the phrase for my own purposes, though. Rather, I am going to talk about another part of it that specifies how a moral injury can happen to those on the pointy end of these decisions; The ones being transgressed against as opposed to those doing the transgressing.
The stigma surrounding mental health injuries is a real thing, and though for many, comfortably insulated in their own worldviews, it’s an abstract concept, for many others it has a tangible effect on their daily lives. In this new age of information we live in, this is changing, albeit slowly. Specifically with first responder PTS injuries, where once it was something not even whispered about, now there’s almost an advocacy industry shooting up like weeds through a crack in a concrete sidewalk, there have been legislative changes in some jurisdictions (mine, for one) to make it easier for those of us suffering to get the help they need, and far more workers feel comfortable coming forward than they ever did before. The warrior culture still exists, though. Worse than that, and perhaps even more damaging, are the individual attitudes of regular people who, through a simple lack of understanding or just simple compassion, shoot arrows at us perhaps without even realising that’s what they’re doing.
I’ve posted this story before on Facebook, but then it was because of self-pity (if you’ve read The Myth of the Pity Parade you’ll know this is an unhealthy expression of a valid human emotion). I’ve told it in group sessions in an effort to commiserate and before you ask, no, I have not told it to anyone who had the power to do anything about it, at the time or afterwards. I am telling it again here to make a point.
Very early after I received my initial diagnosis, I approached my shift supervisor and told him I thought I had a drinking problem. My thought at the time, all good-hearted, naive and innocent, was that a city the size of Toronto must have helpful programs in place for its employees and that as a good employee, my first point of contact should be my immediate superior. He couldn’t think of any, however. He didn’t offer to look into it, he didn’t take me into a private room to discuss what he might be able to do to help, and though he said I should try contacting the city’s employee assistance office myself, he never even looked up the number for me. I could very well have been asking for a spare pen. That’s certainly off-putting, but it’s not an injury. The injury came later when someone who was still a friend told me that he had given out details of this short chat with my colleagues, people I worked with every day, like a knitting circle of old women gossiping about the new neighbours.
Let that sink in for a few moments.
It’s pretty horrible, isn’t it? An outrageous breach of trust that only furthered what had already become a hostile workplace, and made a very deep wound I had already suffered so much worse. It’s easy to raise the angry banners at a bludgeoning attack like this, but what about the thousand cuts not so blatant or obvious?
I had a part time job not long ago, with a boss who I thought of as a friend. I’d been to his house for dinner, and I’d played with his children. He’d known me for a few years and knew about my history. One night I booked off because I’d had a particularly bad anxiety episode, but the next time I saw him he said to me, “You can’t just call in sick because you want a day off.”
Just yesterday someone I’ve known for almost thirty years made a remark that suggested life is as simple as just getting up off your ass and doing something.
Another time, when I was trying to describe what PTSD was like, another friend looked me in the eye and said, “But everyone has stress at work.”
These, unintentional as they may be, can be more than salt thrown carelessly into a wound but salt mixed with just enough fresh shit to infect it. Sometimes they cause new wounds we have to care for, too, with an already over-taxed ability to do so.
It would be easy to talk in-depth about a lack of bureaucratic concern, the poor or even harmful individual leadership and leadership structures in both the workplace and the communities we live in, and the deep-seated cultural attitudes that can be so hard to change. People do talk about these things, and they do it much better than I can and with a much greater gravitas than I could bring to it. We can work to change laws and raise awareness all we want, however, and succeed at it, but without striving for something much more basic and individual – simple compassion, it can often seem like digging through a brick wall with a teaspoon.
Normally healthy people will never understand the injuries, and that’s not meant to be a disparaging remark but simply an honest truth. They may have an abstract, or academic grasp of the effects, but even then they’re splashing around in a wave pool while we’re offshore trying to hold our heads above water in 15-foot breaking swells. Understanding what someone is feeling, though, especially since they’ll never truly get it, is not nearly so important as understanding that they’re feeling something, and that right there my friend is empathy.
Legislation can be passed, policy statements can be written, and these can be pretty effective at reducing the great hammer blows like the one I took to the head when my supervisor told people I was a drunk. The more insidious paper cuts, the moral injuries that can be much more damaging because they happen so often, and are just as often dismissed because they seem so petty, need a big dose of individual compassion to relieve. We all have it, we just don’t all use it.
Unless you’re like Dexter, in which case you’re more fucked up than I am.