First responders make sacrifices to serve their communities, sometimes to the detriment of their own mental health. Mental health challenges such as depression, anxiety, and post-traumatic stress injury occur at higher rates among first responders compared to the general population. These issues can often lead to dangerous and unhealthy coping strategies, such as substance abuse. Post-traumatic stress disorder, or PTSD, was a term initially used to describe the lasting trauma experienced by combat veterans.
Within the spectrum of PTSD, some concepts pertain to certain circumstances, one of which is the experience of moral injury. This term applies to first responders that experience damage to their core values after trauma at work. Moral injury can create a lasting emotional and psychological impact. This impact increases the risk of mental health challenges such as anxiety and depression, as well as the risk of substance use disorders and suicide.
Beyond PTS
While PTS explains the brain’s reaction to near-death experiences and its lingering effects on mental health, some experts believe this term isn’t sufficiently specific. Moral injury is the term for experiencing a fundamental betrayal of “what is right.” It can occur when there is “a betrayal of what is morally right by someone who holds legitimate authority in a high-stakes situation.”
First responders may experience a moral injury after witnessing injury or death due to things that should have never happened. Emotions often associated with moral injury are a deep sense of shame and despair. These feelings go beyond the typical symptoms of PTS.
Symptoms
Only an expert can assess if an individual is suffering from moral injury. Symptoms may include anxiety, inappropriate fear, demoralization, and intrusive thoughts or memories. Additionally, moral injury may cause an individual to lose their sense of self, have difficulty trusting themselves and others, and feel powerless to change their circumstances. People suffering from a moral injury might blame themselves or others, believe that they are weak or morally corrupt, and feel perpetually haunted by their past. These feelings can lead to significant issues in relationships and at work, as well as unhealthy coping strategies such as substance abuse. The most severe cases of moral injury may result in suicidal ideation. In these cases, the individual or their loved ones should seek emergency medical care.
Prevention and Treatment
Jonathan Shay proposes the implementation of three principles to prevent moral injury. He advocates for “positive qualities of community of the face-to-face unit that create ‘cohesion,'” “expert, ethical, and properly supported leadership,” and “prolonged cumulative, realistic training for what they have to do and face.” One way that shame is remedied is by fostering emotions and values that have been shown to decrease guilt and improve self-esteem. These values include humility, gratitude, and compassion. For those who believe they or a loved one may be suffering from moral injury, PTSD, or any other mental health disorder caused by the extreme conditions of their profession, it is important to seek professional care as soon as possible.
First responders and their families experience more acute stress and trauma than the general population, and the statistics are staggering. With years of experience serving First Responders, our Family of Companies has a distinctive view of their career and family life – from new recruit training, wellness visits, peer support services, counseling, crisis support, department training, and long-term treatment. We are here to help. Email info@frhealth.com or call 888.443.4898 to connect with our culturally competent team.
