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  • Caroline Rowlader

The Presence of Moral Injury in 2020

For anyone living in Tennessee, it has been a rough year. Across the metro Nashville, Chattanooga, and Knoxville regions, Tennesseans have battled tornadoes, record-levels of rain, the pandemic, protests, unemployment, and more. It has been hard.

In March when the pandemic shut down the United States, thousands of people stepped up and stepped in to help. Essential workers showed up to battle the virus and a failing economy. Lineman showed up to give power back to the tornado victims of Nashville and Chattanooga while volunteers stepped up to clear debris. In May and June, courageous Black and White Americans took a stand against police brutality and systemic racism. There have been some truly wonderful acts of humanity despite the challenges of the year.


On some level, witness to each of these events warrants an assessment for anxiety and trauma. According to the DSM-5, of of the eight criteria for Posttraumatic Stress Disorder includes "Exposure to actual or threatened death, serious injury, or sexual violence". And while many people across Chattanooga have been exposed to threatened death in the form of tornadoes and COVID-19, they may also be at risk of another form of trauma: Moral Injury.

Essential healthcare workers battling COVID-19 Pandemic in April 2020: Photography by Susana Vera | Reuters

The definition of moral injury has changed since first mentioned in the 1990's, but essentially is defined as an act in which in individual has experienced an event by "“perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” and the moral/ethical violation resulted in “lasting psychological, biological, spiritual, behavioral, and social impact” (Barnes, 2019). Relevant examples may be an employee following instructions from a manager that felt unethical, or a healthcare worker feeling unable to provide high-quality care in the context of health care.


Has 2020 been a year ripe for moral injury?


Is it moral injury for a counselor to be forced to see clients face-to-face during a pandemic?


Is it moral injury to make teachers return to school when they fear for the health of themselves and their students?


Is it moral injury for a black person to feel they have to stay silent in order to survive when by a police officer?


Is it moral injury when a black person chooses to stay home to protect their personal health during a pandemic when they'd also like to be out protesting systemic racism?

While research is still being done to determine the best treatment for those who suffer from moral injuries, current research does show that "identifying trauma-related beliefs and cognitions that are at least partially inaccurate (e.g., exaggerated, distorted, erroneous)" typically yields a reduction in symptoms (Barnes, 2019). Having an individual make personal meaning of an injurious event also is significant in the treatment of moral injury.


With the tough events that have occurred throughout the country, and specifically Tennessee in the past 8-months, do you recognize any inaccurate beliefs or thoughts that need to be worked on? How do you find meaning and purpose in a pandemic?


Please feel free to share your purpose in the comments, or to contact me to process if needed.









Barnes, Haleigh A., et al. “Moral Injury and PTSD: Often Co-Occurring Yet Mechanistically Different.” The Journal of Neuropsychiatry and Clinical Neurosciences, vol. 31, no. 2, 2019, doi:10.1176/appi.neuropsych.19020036.

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