Moral Injury in the Pandemic: A Double-Edged Sword
Moral injury is referred to as damage to an individual's conscience, when the individual perpetrates, witnesses, or fails to prevent acts that transgress their moral values, beliefs, and ethical code of conduct (The Moral Injury Project). It occurs when an individual believes that they have acted in ways or witnessed an act, that goes against their moral values. Moral Injury has only been studied amongst veterans and off late by frontline workers of the pandemic. But almost every individual today is experiencing moral injury as they try adapting to the new normal. I would like to shift the focus here from militants to civilians. Yes! Civilians in the times of COVID-19 are experiencing moral injury in dreadful intensities. By acknowledging how it is playing out in individuals of our society, it is important to address its dire consequences.
The Dilemma: A Double-Edged Sword
Humans are driven by evolutionary forces of kinship, kin altruism, where one is concerned about their near and dear ones and tries to protect them. Driven by such strong evolutionary mechanisms, civilians today face a dilemma. A dilemma that involves two contradicting forces of alarming magnitudes. Should they step out of their house, to provide for their kin in terms of food, water, and money for basic survival, versus, should they stay at home, to protect their kin from the novel coronavirus. Based on kin altruism, one’s moral beliefs and values include the idea of protecting and caring for their families. These moral beliefs face transgressions, when an individual under ‘choice’ or ‘compulsion’, has to step out of the house, at the same time, risk the health of their family members which might include those from the vulnerable population.
COVID-19 has posed at us many difficult questions like, ‘Should I continue my family's COVID-19 treatment at home, or should I admit them to a hospital’, ‘Should I get myself tested’. The answers to these questions are deeply integrated in one’s conscience. The results of such questions hence can trigger moral injury. Both, an act of commission (doing something against one’s moral belief- like putting one’s family into danger), as well as an act of omission (unable to act as per one’s values- unable to prevent risk to family members), can lead to serious experiences of moral injury and trauma. The reason these contradicting forces act so strongly can be attributed to the powerful underlying need for kin altruism and protection, which is deeply tied to one’s value system of caring for their close ones. Hence both these forces act in opposite directions. I call this dilemma a double-edged sword.
Effects of this Dilemma
Stepping out of the house on one hand, and sitting inside on the other, is perceived by some as transgressing their moral values of protecting their families from COVID-19 and being unable to provide for their families respectively. Not only one’s act of venturing outside in times like these but also witnessing other family members do so, can trigger moral injury and thoughts like, ‘What if I/they catch COVID-19, and become a carrier, spreading it to my family members, ‘What if I am asymptomatic and unaware of the risk I am posing to my family’. Other cognitive distortions might include, ‘I am bad, because I could not help my family or prevent them from getting infected’, or ‘I killed my family’ or ‘I could not provide for my family’. Witnessing other friends or family members acting recklessly too can cause feelings of betrayal. Such thoughts and actions can accompany a large amount of shame and anxiety. It can also cause survivor guilt in an individual who has survived COVID-19 but has put into risk other family members or friends. Such effects of moral injury can cause severe trauma. It can lead an individual to lose trust in oneself. For example, an individual dealing with the dilemma here might experience a drop in his self-confidence and his ability to stay true to his conscience. Such feelings can reduce their motivation of acting by their moral values, inviting unwanted consequences, like either excessively venturing out, or causing prolonged periods of isolation in the house.
The need of the hour!
It is important for all health professionals, to identify, acknowledge moral injury, and address this dilemma amongst society. It is important for all health professionals to situate their patient’s problem in the context of the pandemic, and adopt a trauma-informed approach in helping them. Advocating for healthier and adaptive ways of dealing with uncertainties and insecurities in such unprecedented times can prove helpful. It is important to understand and psycho educate individuals regarding the dichotomy of control-how much control one can possess on their actions and its results. Individuals facing the moral burden of acting against their values can be helped through therapies and other intervention strategies that can target the symptoms of the injury first, and later go on to resolve it from its roots.
Lastly, I urge individuals experiencing such dilemmas to seek help. I request our community to extend their helping hands to one another, in dealing with such involving times!