Maybe you’ve had an influx of new hires from The Great Reshuffle. Or maybe you’re at a company going through a rough time. Or maybe you’re just trying to maintain a healthy status quo. For all these situations and more, it’s important for leaders to understand moral injury: a form of trauma that can occur in both intense occupational settings, like an emergency room, or seemingly more placid environments, such as in an accounting office. This cognitive affliction can occur at work, because of work, or have an impact on work, in every setting imaginable. 

THE ORIGINS OF MORAL INJURY

Sometimes misdiagnosed as post traumatic stress disorder (PTSD), which often results from the trauma of a threat to life, moral injury describes an affliction resulting from witnessing, perpetuating, or participating in a transgression that goes against a person’s belief system or core values. Rigid moral compasses are built over a person’s upbringing and can guide our behavior paths. These sacred values can develop from strong spiritual or cultural influences and are so powerful that evidence of a person’s beliefs are found all over the brain–from lower processing areas, to higher order reward and anticipatory areas.  

This moral compass can lead a person to become vegan, or send them into a career choice that helps others. And because values are so varied, they can steer one person to stick with people like themselves, and another person to dedicate their lives to embracing differences in others. Moreover, when faced with a value breach, the brain’s engagement differs if the transgression occurs from someone close to us versus a ‘distant other.’ In other words, our brains maintain beliefs based partly on those around us, or who is with us versus who is against us.  

In the context of military or first responders, it’s easy to see how moral injury could emerge if, for example, a commanding officer orders a mission that results in loss of innocent life. And as seen in the COVID-19 pandemic, many healthcare providers experienced moral trauma by treating people or unable to save patients who refused vaccination. It could also appear as a bystander effect in occupations like photojournalism, or news reporting, where the nature of the work requires witnessing and relaying horrific events to others in a manner designed to appeal to a paying audience. 

In a corporate setting, moral injury can come from working for an organization that recruits with promises of inclusive and transparent values, but has leaders who practice exclusion or secrecy. Or an anti-racist being asked to participate in a project that tokenizes marginalized people, or a pacifist working with people who are verbally aggressive to others on the team. It can also occur after observing or experiencing a breach of trust by leaders who violated a promise of confidentiality or care.  

Nearly anyone who believes the world is generally a safe place and that people—including themselves—are good, can experience moral injury. According to Noël Lipana, a violence prevention professional for the U.S. Department of Homeland Security, if you have the ability to empathize, evaluate behavior, understand moral reasoning, and create stories of memories, you have the necessary baseline criteria. When a person has all those attributes, and a behavior or action around them challenges their core belief of safety and goodness in the world, moral trauma can occur.  

The outcome of morally-traumatic events could present symptomatically as employees with lower motivation, altered cognition or mood, avoidance, or isolation. As a result, it can be the cause or crux of disengagement, reducing an employee’s willingness to collaborate or speak up in meetings. And it’s worth noting that moral injury, though an individual affliction, can become a collective traumatic experience among groups of people who share common values. 

Moral injury results in a powerful emotional and cognitive response that can cause people to feel shame, guilt, a lack of compassion from their coworkers, or like they have failed. This type of trauma specifically points to greater brain activity within areas involved in guilt, moral cognition, and how we think about how we fit into our external world. The overarching self-blame or shame associated with a moral injury event is reflected in activity of areas like the inferior parietal lobule, which helps to process our emotional external environment, like facial expressions, and helps us make decisions in uncertain conditions. It also activates the precuneus, which is critical for retrieving our memories and integrating them with new information, as well as our emotional responses to pain.  

NEUROSCIENCE CAN HELP US UNDERSTAND AND PROCESS MORAL INJURY

Given the specific neural underpinnings of moral injury, we can now target strategies for becoming resilient after it happens.  

One way is via storytelling, which connects people by allowing them to share in an experience. In fact, it can synchronize the storyteller and story listener on a neural level and boost their feeling of connection. In the case of moral injury, storytelling is a way to make someone feel heard and understood, which–when ideally combined with other professional forms of treatment–can be effective in their journey to recovery. But it isn’t as simple as just relaying and hearing information. There are specific actions leaders must take. 

Role-model a safe environment where all stories are encouraged. Leaders can demonstrate psychological safety by being authentic and sharing bite-sized stories during check-ins that demonstrate their willingness to be seen, and see others, in our truest form. This creates a feeling of assurance by creating relatedness, or the sense that we belong among others. That feeling can create enough certainty to reduce fear of a negative response to sharing something difficult, especially when the plot involves both teller and listener. 

Dedicate space for the injured person to talk, or communicate in whatever way that person needs. For example, this can look like an uninterrupted meeting, a team get-together, or a listening circle, so long as distractions are removed and any concern over power differential is addressed. When providing space, it’s perfectly acceptable to announce that’s what you’re doing. It can be an impactful, quality connection moment when a leader says: “I’m here to provide the space you need to talk about it” to their direct report. And giving space leaves room for insights, which may also be needed as part of the process. 

Provide validation, using skills that let the storyteller know you’re being attentive, such as nonverbal cues like head nods, reflecting the speaker’s behavior, periodically asking questions if they get stuck, or paraphrasing your understanding. Feeling understood makes individuals feel valued, respected, and validated, increases a sense of interpersonal closeness, and activates the neural regions associated with reward. And if upon listening to the story you discover you’re part of the transgression, be authentic in your discovery. Have the self-compassion that comes with a growth mindset – accept that all may fail or feel inadequate, then work out a plan for the process and value progress over time.  

Regardless of whether moral injury came from a past employer, or a current situation, leaders have a responsibility to understand it as a significant wellness and wellbeing issue that can have a profound, long-term, negative impact on their organization. Keep an eye out for who this may be happening to, or when it may have happened, and be proactive in helping people process what happened. For some, all they need to get back on the path to resilience is to be heard.