Post-Traumatic Stress Disorder (PTSD)/Moral Injury Amongst Frontline Staff


Post-Traumatic Stress Disorder (PTSD)/Moral Injury Amongst Frontline Staff

It seems impossible to avoid anxiety in an anxious world. The Covid19 virus has engulfed the world in troubling times that not only challenge our healthcare and incidental systems but also the psychological resilience of every individual. These challenges pose imminent risks of psychological injury. The frontline staff, especially first responders and healthcare workers, face such challenges every day.

The Risks Befalling Frontline Staff

Escalating numbers of patients, casualties and days of lockdown, unforeseeable causes of anxiety, long hours of work and continuous state of anxiety and fears of an impending physical and psychological crisis amongst other citizens can all mount up and cause tremendous pressure on frontline staff. Eventually, a traumatic incident harnesses this pressure to cause Post-Traumatic Stress Disorder (PTSD).

At this very moment, frontline staff are responsible for the rest of us and despite the best efforts and the most acceptable numbers on paper, every single failure may be deemed as a wrong choice in retrospect and burden an individual with unbearable guilt or regret.

Understanding Moral Injury

The pandemic continues to impose countless situations where healthcare workers are put in a situation of moral conflict. When failure is not an option and doing the right thing results in a wrong outcome, the choice can injure your morality. As someone suffering from moral injury, you may get riddled by any, many or all of the following questions again and again:

1. You might wonder if you are a good person. Retrospectively, you may feel you gave preferential treatment to certain patients while ignoring those in need.

2. Whether you are someone who causes pain and suffering to others, your intended or unintended lapses cause someone else to suffer.

3. Whether you are responsible enough to help others. Your judgment call puts your patients and/or staff in peril.

4. Whether you have the right set of values and beliefs? For example, you may regret choosing integrity over empathy or vice-versa and find both set of values inadequate.

5. Whether you lack the courage to uphold your values? You surrender to authority, peer pressure or patient demands and believe that you failed to live your values.

6. Whether you can trust yourself. You question your memory, facts, interpretations and perceptions and you may end up in an endless cycle of seeking validation from others while doubting yourself.

7. Whether you are the reason for the failure of your colleagues i.e. your actions cause them to suffer trauma, injury, financial loss, legal actions or even death. For example, you may be concerned about the lack of protective gear or its access to paramedical staff and may blame yourself for not demanding it and putting your colleagues at risk.

8. Whether you can exist as a part of society.

In this psychological state, your morality has been compromised and your Post Traumatic Stress Disorder (PTSD) can be extremely damaging. It is highly likely that your ability to distinguish things beyond your control is compromised.

Due to the detrimental impact on life, Moral Injuries are often used synonymously with PTSD, but in clinical terms, it is seen differently and attributed to Potentially Morally Injurious Events (PMIES).

People who undergo PMIEs show a much wider variation of distress and they suffer from more acute stages of shame, depression, anger, guilt, anger, and social isolation. While a PTSD patient may wish to avoid fear, those who suffer from Moral Injury cannot stand situations and occurrences that trigger shame in them.

The Right Choices for Prevention and Recovery

Moral Injuries have been subject to comprehensive studies and discussions in the USA, but the UK has only begun discussions on it since 2019. Furthermore, online coverage of the subject has focused on the “moral injury” vs. “burnout” debate and provided no actionable insights to a worrying citizen that could guide them to a qualified therapist. Instead:

1. Seek Therapeutic Help: Few psychologists specialize in PTSD, fewer specialize in Moral Injury and only a handful can get PMIE victims to set aside their guilt and self-isolation to open up. The lockdown may hinder access to the right therapist and make the choice to avoid therapy look easier, but it may not be the right choice.

2. Grieve: Acknowledge the loss and the pain. When you do not grieve, you do not revisit the traumatic incident from the point of view of loss and damage. Instead, you foster denial that cannot suppress unmanageable emotions or center it on your decisions, your shame and guilt. This doesn’t make you a self-centered bad person or someone who is sick. In fact, it makes you human enough to feel sadness, helplessness, hopelessness and terror. It was a situation of duress, the choices of that time were impossible and world cannot be “just and fair” all the time. The irony is, you think of it in terms of your conscious faults but ignore the remedies that focus on you. Your best effort was not good enough, does not mean that you weren’t good enough.

3. Talk: Relate with your resolve to get back up. Your moral values have stood with you for a lifetime and they cannot be disregarded for momentary lapses. Morality defines you but you also define your morality. Being a Frontline Staff, you have to share your challenges with those who face the same moral conflicts, dilemmas, pain-points, shame, outrage or guilt. Healthcare workers are each other’s support group and a support system for the therapist. Furthermore, if you deem it necessary, you must speak up your disagreement with the system without compromising your duties. Easier said than done? Perhaps therapy can help. Maybe you do not voice your concerns due to the fear of losing your job, but you can frame a common cause of concern for your co-workers and pursue something motivating that improves your overall work conditions and patient care.

4. Normalise: The label of “hero” can burden you with some extraordinary expectations. Don’t let it get into your head. You are a human being capable of feeling despair, anger, stress grief and fear just like anyone else. When you do, it is time to address your emotions. The pandemic may not allow you to step away from your work, but it doesn’t mean that you don’t seek support or assist someone in need that does. Get in touch with a qualified therapist right away.

If you or someone you know if affected by post-traumatic stress disorder, please contact me ,Richard Reid, on +44 7624 499 511 or visit our website here.

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