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Trauma and moral injury

It’s helpful for non-specialists to understand a bit more about trauma. Trauma can be defined as the experience and effects of overwhelming stress. Trauma overwhelms a person’s ability to cope when faced with threat, or when they believe there is a serious threat confronting them. 

Moral injury is defined as “the psychological distress which results from actions, or the lack of them, which violate someone’s moral or ethical code”.  Unlike formal mental health conditions such as depression or PTSD, moral injury is not classified as a mental illness. However, those who develop moral injuries are likely to experience negative thoughts, often about themselves and others involved in the traumatic incidents which have triggered their distress.  These can range from guilt and shame, through blame and disgust towards others, to fear and loss of self-confidence. Read more on moral distress in Health Education England – NHS Staff and Learners’ Mental Wellbeing Commission Report (2019)

Trauma, and the distress it causes, is determined from the perception of threat rather than by the magnitude of the event/s. This means that it can arise from what may appear to the outside observer to be relatively minor triggers. 

The role of perception reveals why contrasting experiences can be traumatic, and why some experiences may be traumatic for some people and not for others. Differences between people and context, such as a person’s, prior experience/s, and the extent and duration of the stress affect a person’s capacity to respond. So, too, do their resources, including their internal resources.

This point is very significant and underlines the importance of hearing accounts of trauma and moral injury in a non-judgemental way, respecting the staff member’s experience and narrative.   In addition, it relates to the complexity of some experiences of trauma which will require patient listening and a degree of skill in structuring conversations.   To give two possible examples related to the current pandemic:

  • A black staff member who had suffered discrimination in their life before Covid-19, may be struggling to cope with their experience of working through the crisis – in other words, suffering trauma on top of trauma
  • A staff member required to “shield” a family member, therefore confined at home in self-isolation, may suffer acute guilt at not having “played their part”.

Such experiences are already coming to light.

Remember, as managers and leaders we are often not privy to the experiences that our staff have been subject to in their personal and work lives to date. We are all at risk of trauma and moral distress. This does not make one person stronger/weaker than another.