Moral injury: The missing link between stress and PTSD
The recognition of moral injury could be a major advance in the understanding of stress-related challenges to officer wellness over the course of a career
Mental and emotional wellness is finally becoming a priority within first responder agencies. After years of neglect, denial and even contempt, police leaders are realizing that the health and longevity of their officers are tied to wellness of mind and body.
There is no greater or more expensive asset than the human capital at risk from the constant, compounding stressors facing first responders. A new awareness of a form of distress that nearly all law enforcement officers experience is moral injury.
Myriad sources of stress
The stress and trauma faced by police officers and their fire, EMS and dispatcher colleagues, are easy to describe but hard to personalize. There is the daily stress and pressure of performance in both routine and dangerous activities. Hypervigilance is a well-known attribute of police officers. Keeping one’s head on a swivel, being careful how the patrol car is positioned, and scanning any room for danger whether on a call or on a lunch break is a practiced survival skill.
Adrenaline dumps from hot calls and pursuits can keep officers charged up all day. In the presence of injuries, pain, death and general unpleasantness of the sights, sounds and smells of chaos assault the senses on a regular basis. Then there are those calls that for whatever reason punch the gut and draw out especially intense feelings. Officers often face unexplainable unfairness where the innocent are victims and the guilty fare too well.
An accumulation of traumatic experiences over time – 200 or more are likely in a career – or a single traumatic event can cascade into a PTSD diagnosis. There are many anxiety and stress-related conditions short of PTSD, and many symptoms that can appear before an officer feels the need to seek assistance.
Moral injury research
Recent attention is being given to an important concept that bridges the gap between the normal stresses of police work and a debilitating stress disorder.
Sgt. Boston Ross (now also Dr. Ross) recently published his dissertation, partly relying on survey results from Police1 readers, on the subject of moral injury titled "Responding to Wounds of the Soul: American Law Enforcement, Moral Injury and Religious Coping.” The recognition of moral injury could be a major advance in the understanding of stress-related challenges to officer wellness over the course of a career.
Moral injury is not yet a clinical term but is a sense that what one must do creates friction with a sense of what is ultimately morally right. An example might be a domestic violence call where the evidence requires the arrest of one party when the officer knows that the other party is probably historically at fault, taking a child out of an abusive home when the child is crying to return to the abuse, ticketing someone who is already suffering from the consequences of their actions, or even a general sense that the way the real world works, as seen by a police officer, is so far from the ideal that it seems hopeless.
Police officers want to help but often find that their help is temporary, ineffective, or unappreciated. They want to make a difference but so seldom see the fruit of their efforts. They want to stand tall but are beaten down by a hostile public and out-of-touch administration. They want to be peacemakers but are called upon to use violence as a necessary means to resolve problems.
This sense of disease is frequent among police officers and manifests in many of the same ways that other stress disorders do. Shared characteristics of moral injury and PTSD include guilt, frustration, depression, self-harm, shame, loss of spirituality, a sense of rejection, avoidance behavior, intrusive thoughts and sleep disturbances. It is somewhere between knowing that police work is stressful and that stress is desirable to a point, and having a severe enough stress disorder that it interferes with work, health and relationships.
The resilience movement seems to emphasize PTSD recognition and prevention, but a PTSD diagnosis is abstract to officers who do not have symptoms or who deny them. The recognition of the nearly universal existence of moral injury can help wellness and resilience efforts to move forward because it is something familiar to almost all first responders. Dr. Ross’ work deserves attention from police leaders and those active in wellness reforms.