David, a 42-year-old journalist, sturdily built with a rugged demeanor, was sent to my psychotherapy practice by his internist. David told me he has trouble sleeping and suffers from chronic stress, exhaustion, and stomachaches. For more than a decade, David has been covering conflicts and crises around the world. To his surprise, he recently found he couldn’t continue to function as a journalist covering crisis situations due to his debilitating symptoms. He sought the evaluation with his internist to determine whether he could qualify for a leave of absence.
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In particular, he is haunted by images of children in Afghanistan who were crushed when their school building was hit by a bomb and collapsed. He vividly recalls seeing their small feet protruding from the rubble. While he was able to continue his work for a decade, David’s post-traumatic stress is now easily triggered by world events that he sees on the news. Based on his evaluation, David’s physician prescribes time off from work and recommends psychotherapy to address his current distress.
As I get to know David, he reports feelings of anxiety, grief, and guilt because he was not able to save the schoolchildren. He experiences intrusive flashbacks, sees jarring images, and engages in relentless self-criticism about his inability to be as professional and objective as he once was. Consequently, he has experienced feelings of detachment and disengagement from his profession for the past year.
Moral distress is a term that has been used to describe conflicting personal and professional values in healthcare professions (Hamric, 2012). More recently, however, the definition of this term is being reconsidered and expanded to apply to all people and professions. Moral distress arises when individuals find themselves caught between what they believe is ethically and morally the right thing to do and external pressures applied by their employers or societal expectations to the contrary (Morley et al., 2017). Often, individuals may face ethical dilemmas in their livelihoods but find themselves constrained from taking a morally appropriate action.
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David is an example of moral distress in response to work-related conditions that have been out of his control for at least a decade. As a psychologist serving at a diverse university campus, I have seen students and faculty members in deep distress over ongoing and recurring political conflicts. Activists, including students and faculty, fight for social justice, human rights, and environmental causes. They often experience moral distress when they witness what they perceive as injustice and feel powerless to effect change due to organizational, systemic, and bureaucratic constraints.
Juan, a faculty member who tries to mediate between opposing parties, reports feeling anger, frustration, and an overwhelming sense of helplessness. Physically, he experiences chronic stress, sleep problems, nightmares, and heart palpitations.
Perhaps most relatable, moral distress can be described as the way anyone might feel when they read another devastating geopolitical headline or watch a disturbing video of footage from a war-torn country. We want to stay informed about world politics, and we care deeply about the innocent lives that are lost, yet it feels that there is so little within our personal scope of control. Many of us are left with feelings of sadness and grief, often followed by a deep numbness or detachment from suffering. How can we strive for a meaningful, happy life?
Moral distress in the context of political and cultural conflict is a complex and pervasive issue. In David’s case, his profound post-traumatic stress symptoms need to be addressed carefully, possibly with a psychiatrist and a therapist working together. While David’s may be a relatively extreme example, entire populations of people affected by moral distress would benefit immensely from emotional and insight-based psychotherapy, which helps us better understand what is occurring inside of ourselves when we feel this inner (and often subconscious) conflict. Doing so allows us to experience our feelings freely and safely. When we feel and express uncomfortable and often repressed emotions such as grief, fear, and frustration, we can release their heavy impact on us while returning to a place of presence, ease, and care for the world.
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Practicing mindfulness, self-compassion, and other self-care techniques can decrease and begin to heal emotional and physical symptoms of stress (Bartlett et al., 2021). Journaling is a tool that many people are beginning to incorporate in their self-care routines, as it provides an opportunity to become aware of our complex internal landscape and to express emotions healthily (Ullrich, 2002).
Moral distress related to cultural diversion involves conflicts between an individual’s cultural values and the prevailing cultural expectations. This might involve a situation in which an individual feels alienated for having different beliefs, opinions, or cultural values at their workplace, in school or other educational settings, or in their community.
In our contemporary and increasingly multiculturally diverse psychotherapy practices, we need to be aware that moral distress is common and is often associated with traumatic stories from a client’s past. Publicized global tragedies can activate feelings of helplessness and distress tied to past hurts that may contribute to our worldwide mental health crisis.
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Professionals who are assisting clients with moral dilemmas must be particularly sensitive sensitivity about the complexity of circumstances and the complex co-mingling of external triggers and internal psychological issues. We must recognize the impact of outside events and treat those with related trauma with utmost care.
References
Bartlett, L., Buscot, M.-J., Bindoff, A., Chambers, R., & Hassed, C. (2021). Mindfulness is associated with lower stress and higher work engagement in a large sample of MOOC participants. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.724126
Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2017). What is ‘moral distress’? A narrative synthesis of the literature. Nursing Ethics, 26(3), 646–662. https://doi.org/10.1177/0969733017724354
Wurtz, H. M., Willen, S. S., & Mason, K. A. (2022). Introduction: Journaling and mental health during COVID-19: Insights from the pandemic journaling project. SSM – Mental Health, 2, 100141. https://doi.org/10.1016/j.ssmmh.2022.100141
Journaling about stressful events: Effects of cognitive processing and emotional expression
PM Ullrich, SK Lutgendorf – Annals of behavioral medicine, 2002 – Springer
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Publish date : 2024-06-27 19:19:01
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