How to Support a Peer Who's Struggling with Moral Injury
Discover the invisible wounds of moral injury and learn how to support peers struggling with it. This episode of Surviving Your Shift explores the differences between moral injury and PTSD, common scenarios in public safety, and practical steps for listening, validating, and referring.
Discover the invisible wounds of moral injury and learn how to support peers struggling with it. This episode of Surviving Your Shift explores the differences between moral injury and PTSD, common scenarios in public safety, and practical steps for listening, validating, and referring.
Are you supporting a peer who's struggling with moral injury, but you're not sure what it is or how to help?
Moral injury is a hidden wound that affects many first responders and healthcare workers. It's different from PTSD, and it requires a unique approach to support.
BY THE TIME YOU FINISH LISTENING, YOU'LL LEARN:
- What moral injury is and how it differs from PTSD
- Common moral injury scenarios in public safety
- How to listen and validate without judgment or fixing
- When to suggest professional help or spiritual support
- How to support yourself when you're the one struggling with moral injury
Use this episode to enhance your peer support skills, improve your team's well-being, and create a safer, more compassionate work environment. Share it with your colleagues, and start conversations about moral injury in your department.
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Let's learn to thrive, not just survive!
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Have you ever had a coworker who seemed fine on the
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surface, but something was clearly eating at them from the
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inside? Maybe they become cynical when they used to care.
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Maybe they pull away from the team or stop talking about calls
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they used to process out loud. Maybe they've made comments like,
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"I don't know if I'm a good person anymore," or, "I can't
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believe I did that," or, "The system is broken and I'm part of
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the problem." If that sounds familiar, you might be looking
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at Moral Injury. And here's the thing: Moral injury is not the
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same as PTSD, even though they can overlap. A lot of peer
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supporters are trained to recognize signs of trauma and
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acute stress, but Moral Injury often flies under the radar.
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Welcome to Surviving Your Shift, your go-to resource
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for building strong, peer support teams in high-stress
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professions. I'm your host, Bart Leger, board-certified in
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traumatic stress with over 25 years of experience supporting
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and training professionals in frontline and emergency roles.
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Whether you're looking to start a peer support team, learn new
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skills, or bring training to your organization, this show
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will equip you with practical tools to save lives and careers.
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this episode of Surviving Your Shift, we're going to talk
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about supporting your peers who are suffering from Moral Injury.
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And there are so many years in this episode that we are dealing
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with before, you know, "I just can't live with what I did," or,
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"The job made me do something I'll never forgive myself for,"
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this episode will give you a roadmap for that conversation.
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I've sat with a lot of people over the years who were dealing
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with something they couldn't name. They knew they felt bad
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and they knew something was wrong inside, but they didn't
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have the word for it. "I've had conversations with veterans and
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first responders who made judgment calls that have haunted
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them; medics who couldn't save someone they felt they should
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have saved; nurses who had to follow protocols that felt
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dispatchers who gave instructions and then heard the
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worst outcome on the other end of the line." "The common thread
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they didn't just feel scared or traumatized; they felt
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like they had violated their own values or had been forced to
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participate in something that crossed a moral line. And that's
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a different kind of wound. I've had my own brushes with this
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also, times when the job put me in a position where I had to
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choose between bad and worse; times when I wondered if I was
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still the person I thought I was." It's not comfortable to
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admit that. But if we're going to support peers with moral
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injury, we have to understand it from the inside, not just from a
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textbook. Let me walk you through this in a few sections:
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First, what moral injury is and how it's different from PTSD;
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Second, the common scenarios in public safety that can cause
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moral injury; Third, how to listen and validate without
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judgment or fixing; Fourth, when to suggest professional help or
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spiritual support; And fifth, how to support yourself when
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you're the one struggling.
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The first question is: What is moral injury and how
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does it differ from PTSD? Mental injury is a wound to the soul or
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the conscience. It happens when someone does something, fails to
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do something, or witnesses something that violates their
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deeply held moral beliefs or values. The term originally came
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from military research, but it applies directly to first
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responders and health care workers as well. You don't have
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to be in combat to experience it. You just have to be in a
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situation where your sense of right and wrong gets crushed.
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All right. PTSD is a fear-based response. It's about threat,
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danger, helplessness, and horror. The symptoms are things like
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flashbacks, nightmares, hypervigilance, avoidance
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reminders, and a jacked up nervous system. It's your brain
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stuck in survival mode. How could you become aware of that?
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But moral injury is different. It's not primarily about fear.
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It's about guilt, shame, betrayal, and a sense that
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you've crossed a line you can't uncross. The symptoms are more
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like deep self-condemnation; loss of trust in yourself or
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others; anger at institutions or leaders; withdrawal from
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relationships; questioning your identity; and sometimes, a
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spiritual crisis. Here's the tricky part. You can have both
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at the same time. Someone can be traumatized by a call and also
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feel morally injured by what they did or didn't do during
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that call. But some people have moral injury without PTSD.
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They're not reliving the event in nightmares. They're just
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carrying a weight of shame or guilt that they can't shake. So,
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why does this matter for peer support? Because if you only
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look for PTSD symptoms, you'll miss the moral injury. And the
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interventions are a bit different. Trauma processing and
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nervous system regulation help PTSD. But moral injury often
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needs something more: acknowledgement, meaning-making,
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sometimes forgiveness, and sometimes spiritual or
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philosophical work.
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examples so you can recognize these situations when
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they show up. In law enforcement, moral injury can come from the
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use of force that felt justified in the moment but haunts you
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later. It can come from enforcing laws you don't believe
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in, arresting someone you know is a victim of circumstance, or
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watching a system fail the people you're supposed to
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protect. It can come from staying silent when you see
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misconduct, or feeling complicit in a culture you're not proud of.
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In fire and EMS, moral injury often shows up around triage and
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resource decisions. Who do you treat first? What happens when
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you have to leave someone?
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It can come from being forced by policy or time to cut corners,
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or, so it would seem, in a way that bothers your conscience. In
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dispatch, moral injury can happen when you give
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instructions and the outcome is bad. When you hear someone die
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on the line and wonder if you could have said something
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different, when you're blamed for things outside your control.
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In hospitals and health care, moral injury became massive
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during the pandemic. Being forced to ration care, deny
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family access, and follow protocols that conflicted with
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compassion sometimes. But it was there before COVID, too. Anytime
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you feel you can't give the care you know you should or you're
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complicit in a system that harms patients, that's moral injury
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territory. Across all these jobs, moral injury can also come from
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leadership failures, being ordered to do something you
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thought was wrong, watching your organization cover up mistakes
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or blame the wrong people, feeling like you sold out your
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integrity to keep your job. You don't need to diagnose moral
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injury. You don't need to diagnose moral injury. You're
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not a clinician,
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helps you respond better.
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When you're not a person who opens up about moral injury,
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your instincts might push you toward fixing. You might want to
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say, "You did the best you could," or, "It wasn't your
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fault," or, "Don't beat yourself up." Those responses come from a
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good place, but they often backfire. Why? Because the
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person doesn't feel like they did their best. They feel like
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they failed their own values. Telling them not to feel guilty
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can sound like you're dismissing what they're saying or like you
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don't understand the weight of it. Instead, lead with
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validation. Validation means acknowledging their experience
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and their feelings without arguing with them, or rushing to
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make them feel better. Validation means it makes sense
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that you're carrying this. Validation means "What you went
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through put you in an impossible spot," or "I can hear how much
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this weighs on you. You're not crazy for feeling this way." Or,
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"That sounds like a wound that goes deep. I'm glad you're
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telling me about it." Validation means that you're not agreeing
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that they're a bad person. You're not saying they should
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feel guilty forever. You're saying, "I see this, and I'm not
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going to minimize it." Then, listen. Ask open questions like,
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"What's the part that stays with you the most?" or, "What do you
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wish had been different?" Then let them talk. Resist the urge
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to jump in with solutions or platitudes, or oftentimes your
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own story. If they express guilt or shame, you can gently explore
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it. Something like, "You said you can't forgive yourself. Can
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you tell me more about what that looks like?" You're not playing
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therapist. You're just making space for them to put words to
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the wound. And be careful not to pile on spiritual or moral
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advice too quickly. If someone says, "I feel like God can't
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forgive me for this," don't rush in with, "Of course he can!
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You're forgiven!" That might be theologically true, but it can
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feel dismissive if they haven't had a chance to unpack the pain
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first. Let them talk before you offer any perspective. One of
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the most powerful things you can say is simply, "Thank you for
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trusting me with this!" That tells them they're not a burden
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and that you respect the courage it took to open up.
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Peer support is valuable for moral injury, but it has
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limits. Sometimes the wound is too deep, too stuck, ... or too
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tangled with other issues for peer support alone. Here are
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some signs for: Here are some signs that you should encourage
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"If the person is stuck in a loop of
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self-condemnation that never gets better despite your
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conversations If they're making statements about not deserving
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to live or hinting at suicidal thinking, If their functioning
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is falling apart, relationships, work performance, or health, If
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they're numbing with substances in a way that's getting worse,
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or if they're becoming increasingly isolated or
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detached from reality." being here for you!" But I also think
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this might be something a counselor could help you with.
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Someone who specializes in this kind of thing. Would you be open
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to that? You're not abandoning them. What you're doing is
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you're widening the circle of support.
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Now, let's talk about spiritual care. Moral injury
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often touches on spiritual or existential questions. Questions
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about meaning, forgiveness, identity, and whether they can
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ever be okay again. For many people, these aren't just
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psychological issues. They're spiritual ones. If the person
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has any kind of faith background, or even if they're just
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wrestling with questions about meaning and forgiveness, a
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chaplain or spiritual care provider might be a good
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referral—not to preach at them, but to sit with them in those
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hard questions. You might say, "It sounds like some of this
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goes beyond just how you're feeling. But I'm not sure." It's
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about who you are and what you believe. Have you ever talked to
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a chaplain or someone in that space? If they resist, don't
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push, but you can plant the seed.
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but it might also include therapies specifically designed
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for moral injury, like adaptive disclosure or some of the newer
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moral injury treatment models. A good clinician will know the
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difference between treating fear-based trauma and treating
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shame and guilt-based moral wounds. Peer support and
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spiritual work well together here. You're providing ongoing
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presence and connection. A chaplain or counselor provides
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deeper work. Neither replace the other.
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Everything I've said so far assumes you're the peer
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supporter helping someone else. But what if you're the one
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carrying the moral injury? First, recognize it for what it is. If
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you've been telling yourself, "I just need to get over this," or,
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"I shouldn't still be bothered by this," pause and ask yourself,
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"Is this about fear or is it about guilt and shame?" If it's
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the latter, you might be dealing with moral injury. Second, find
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someone safe to talk to. That might be another peer supporter,
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a chaplain, a counselor, or a trusted friend who can listen
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without judging. Moral injury thrives in isolation. When you
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keep it locked inside, it grows. When you put words to it with
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someone who cares, it starts to lose some of its power. Third,
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resist the urge to self-condemn endlessly. Acknowledging that
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you did something that violated your values is important, but
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staying stuck in self-punishment doesn't heal anything. At some
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point, the work of moral injury recovery moves toward making
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meaning, accepting responsibility where appropriate,
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seeking or granting forgiveness, and figuring out how to live
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with what happened. That doesn't mean pretending it didn't happen
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or excusing it. It means finding a way to carry it without being
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crushed by it. Fourth, consider professional or spiritual
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support for yourself. If you've been trying to process this on
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your own or with peers and you're still stuck, that's not
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failure; that's a sign you need a different kind of help. A good
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trauma therapist or chaplain trained in moral injury can walk
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you through the harder work. Take care of your body and your
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basics. Moral injury can mess with your sleep, your appetite,
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your relationships, and your motivation. Don't neglect the
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basics like sleep, keeping moving, time with people
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you care about, and activities that remind you who you are
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outside of the things that have wounded you. And finally, be
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patient with yourself. Moral injury doesn't heal on a
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timetable. Some of it you'll carry for the rest of your life,
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but carrying it well with support and meaning is very
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different from being crushed by it alone.
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One more thing I want to address: sometimes moral injury
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isn't just about what you did. It's about what your
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organization did or made you do. In those cases, the wound is
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partly relational. You feel betrayed by leadership. You've
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lost trust in the system. You're angry at policies, cover-ups, or
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the way your agency treats people. That's harder to heal
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because it's not just internal. And peer support has limits when
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the problem is structural. You can't fix the organization. But
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you can do a few things: You can acknowledge the betrayal. Say,
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yeah, they put you in an impossible situation. That
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wasn't right. You can help the person separate their own
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integrity from the failures of the system. And you can support
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them in figuring out what they can control. Whether they're
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setting boundaries, advocating for change, or deciding whether
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to stay. Sometimes, the healthiest thing someone can do
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is to leave a toxic organization. Other times, they find ways to
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make peace with the imperfection and keep doing good work anyway.
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That's a personal decision. Your role is to support them in
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figuring it out, not to tell them what to do. Here's what I
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want you to take from this episode. If you're a peer
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supporter, start paying attention to moral injury as a
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distinct category. profile, ask yourself: Could this be about
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guilt, shame, or a violated conscience? Practice the
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language of validation. Get comfortable seeing things like
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"It makes sense that you're carrying this," or "That sounds
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like a wound that goes deep" instead of jumping to "You did
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the right thing," or "Don't beat yourself up." And know your
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referral options. Do you have counselors who understand moral
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injury, not just trauma? If not, start building that list now.
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And if you're the one struggling with moral injury, don't carry
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it alone. Find one person you trust and start talking. That
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might be another peer, a chaplain, or a counselor.
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Isolation makes it worse. Connection is where healing
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starts. Share this episode with your peer support team or your
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crew. Moral injury is something we need to talk about more
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openly in public safety. The more people who understand it,
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the more likely we are to catch it and support each other
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through it.
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on surviving your shift. Moral injury is one of the quieter
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wounds in our line of work, but it's no less real. When we learn
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to see it and support each other through it, we give our people a
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better chance at not just surviving, but actually healing.
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Take care of yourself, take care of your crew, and I'll see you
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next time on Surviving Your Shift. you
