COVID-19 and the Threat of Moral Injury

[MUSIC PLAYING] Welcome, everyone. You're watching "Coronavirus in Context." I'm Dr. John White, chief medical officer at WebMD. Today I want to talk about this concept of moral injury and the role it's playing in the COVID pandemic. To help provide some insights, I've asked Dr. Rita Nakashima Brock, senior vice president of Volunteers of America. Dr. Brock, thanks for joining me.

It's a pleasure to be with you.

Let's start off with help explain to our viewers, what exactly is moral injury?

RITA NAKASHIMA BROCK: So moral injury happens when we violate core moral beliefs in high-stakes situations and harm happens. And we may cause the harm, fail to prevent it, or witness it. Um, and ev-- it can even be harm that's been inflicted on us by someone, um, in authority or in power who should have protected us or done the right thing, and they didn't.

OK. Now we've been talking about COVID.

Right.

How does it affect frontline workers?

Well, even the most competent, seasoned professionals, in a crisis like this pandemic, are facing situations that are really out of control. So-- so-- so decisions are having to be made in-- in very quick ways when, often, you get more time to think about them.

There are things going on that, uh, in-- on a battlefield would be called triage, where you have to decide very quickly who will get a ventilator and who won't, and how you're going to try to save someone. And those are the kinds of conditions that can lead to people, uh, making mistakes or making the wrong choice, e-- even with the best intentions, or just feeling completely overwhelmed by, uh, the moral chaos of the whole situation.

So what does it look like? Help our viewers understand.

It looks like--

Maybe they've experienced moral injury and don't even know it. Because it's not a term we've often used.

That's right. And it's-- and it's important to note that it's not a mental health disorder. It isn't that something's wrong with you, it's actually that your conscience is still working. But it's become unmoored from your normal ways of operating and your moral system.

And so you may feel very discouraged and-- and like everything is futile. There's nothing you can do. You may feel extremely guilty. You may feel ashamed we may feel outraged that you didn't get more PPE. And so people in your center got sick. There are all kinds of things [INAUDIBLE] stir up what we call moral emotions. And moral emotions are emotions that aren't based in fear, they're based in moral judgments.

So how do we manage that? What-- what do we do about it?

Y-- well, rest and a vacation won't help. They can make you better able to cope with those feelings, but those feelings will continue to haunt you until you begin to process them. And that means get-- finding people to talk to.

And you have an approach at Volunteers of America as to how to help address this. Walk us through.

Yeah. We-- we did a-- we did a program with veterans with moral injury, which is where the-- where the original research was done, was with veterans. Um, and we've taken some of the strategies that-- out of that program that worked. Um, and we've applied them to a one-hour, online, peer-facilitated program for people who need to unload those feelings with other peers and with peer facilitators. There's not a mental health expert in the group. It's just peers who are trying to facilitate the groups.

And it's a chance to, um, talk to other people who aren't going to judge you, uh, who are going to understand what you're feeling, uh, and validate the truth of those feelings. And once you begin to express them then you can begin to mull them over, process, and think about them.

So this could be frontline responders, not just health care workers, but police officers, fire personnel. But it could also be, you know, bus drivers as well, right, and people that, you know, are at increased risk, maybe, because of their jobs, or even caregivers, correct?

That's right, that's right. And our program's open pretty much to anybody who thinks they need it. Um, and, uh, it-- it can-- you know, you can, uh, start to feel like you're not a very good person because you actually caught the COVID from your job and then spread it to your family.

So how do people find out about, uh, these different programs? How do we raise awareness?

RITA NAKASHIMA BROCK: The program is called REST. It stands for Resilience Strength Time, REST. And you just go to VOA.org/rest, and there is a website with information about it. And you can sign up to register to attend sessions. Um, and we offer, right now, sessions three days a week. We're going to begin to expand that.

You have to acknowledge our feelings, right, and talk about it, even in simple terms. Is-- is that correct?

That's right. And it's easy if you are a-- a high-competent professional to set those feelings aside and to sort of compartmentalize that emotional pain so that you can do your job and focus directly on what's in front of you, and get the job done all day. But often that kind of working to avoid the feelings can lead you to, um, getting too exhausted, that you keep working not to feel those things. And so to stop and just be with them, uh, and, uh, and share them with someone else-- it's sort of like once you share it, it's like popping a blister. It's like, OK, now the healing can begin.

Yeah. But Dr. Brock, what about if it's not you that maybe sustained the moral injury, but it's a coworker, a friend, a loved one. How do you broach that conversation with them?

I would ask, you know, how-- how are you doing? What's-- how's your day been? Sort of specific questions about experiences rather than what-- I wouldn't say, what's wrong with you?

OK.

That is, like, the worst thing you could do?

Right, exactly.

Right? You could just say, I-- you know, I've noticed you've been feeling a little down. Is there something going on? Uh, or just, how is it with you? Those-- those are sort of neutral questions.

But I have to say, if you ask that question, you have to be prepared. You may hear things that are upsetting, um, because of what we're looking at right now in the pandemic. Th-- awful things are happening.

So it can't be these rhetorical questions. We really have to wait for the answer. Some people have said we should say, how are you doing really? And then pause to-- to truly take time to listen. Or-- or maybe what about even saying, to folks, tell me about your day. Because that could be an opening as well.

RITA NAKASHIMA BROCK: [INAUDIBLE]. And-- and as long as I think-- and I think most of us can sense this. If the person is genuinely interested in hearing, and isn't looking for, um, a way to ask a question or-- or voice an opinion, but is really empathetically and compassionately listening, um, that can be a miraculous thing, that gift of listening.

Well, Dr. Brock, I want to thank you for helping raise awareness of moral injury and really offering solutions, uh, to address it.

Thank you for having me.

And thank you all for watching "Coronavirus in Context." I'm Dr. John Whyte.

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