This is a guest post by Art Therapist (ATR-BC, LCAT) and Licensed Professional Counselor (LPC) Amy Ponteri.
I worked for 16 years as a mental health therapist in a hospital emergency department, including the first 2+ years of the CoVid-19 pandemic. Our ED was not prepared. America was not prepared.
In February 2020, science didn’t know what the virus was, how it was transmitted, or whom it would strike. My hospital, like most nationwide, and despite warnings for years, hadn’t stocked enough PPE for a pandemic; what was available was certainly not sufficient. We were allowed one surgical mask per shift, kept it in a personal brown paper bag between patients. Nurses, assistants, and MDs wiped down their plastic gowns between patients. The community began making masks and headcaps for us, most staff eventually bought their own eye protection and face masks, and one tenacious MD sewed extra gowns out of house insulation. We were scared and left largely unprotected, just like our patients.
I was conflicted: I wanted to keep showing up to help others and be of service in a critical time. But because of the PPE shortage, I worried I would take the virus home to my family, that I would get infected, or that I would infect someone especially vulnerable and cause their death. I felt angry at the hospital for its short-sightedness, for failing to protect us in a health crisis—something it is, by design, supposed to treat.
I recently learned the term “moral injury” which captured my quandary at the ER. Moral injury is when our sense of what is good and right in the world is challenged. By definition, a morally injurious event violates our values, and the stakes are high. This may be something we witness (like extreme violence), something we are a part of (like following orders to provide direct care without proper PPE), or even something we ourselves fail to do (like texting and causing an accident).
Moral injury happens to all of us. Our morals and values should be guiding lights for our behavior, but the world is a harsh place, full of inequities, and we are presented with many circumstances when head and heart are not aligned.
So, what do we do when we realize our values have been violated, or we have violated our own? When we feel awful, but the reason is in the past?
First, just recognizing that our values have been violated is an important step in articulating why we are feeling pain. Something has happened to us that was hurtful, or we behaved in a way that hurtful to others. We feel pain (and grief and anger) as a signal that we have become disconnected.
Ask yourself which values have been violated. There may be more than one.
Step back. Look at the larger context. If you violated your own values, were you prioritizing one value over another? For example, maybe you texted while driving to let the sitter know you were running late, because you value punctuality and their time, but you let go of your value of safety.
Practice awareness in the moment. The present moment is where choice lives. We are bigger than even our biggest oversights. Likewise, by recognizing ways in which our values have been violated, we can make other choices – to leave an organization or a relationship, to better shield ourselves or seek other supports if we are unable to walk away, or to get involved in meaningful work, like antiracism or social advocacy.
Connect with others to share your story. This might be a trusted friend, a therapist, or a support group. We cannot get through life without pain, but pain does not have to become suffering. Moral injury disconnects us. Healing happens when we reconnect to others and the selves we want to be in this world.
Amy Ponteri is a Licensed Professional Counselor (LPC) and Art Therapist (LCAT, ATR-BC) in Portland, Oregon. She has a private art therapy practice, and until recently, also worked frontlines as a mental health therapist in a local ER. In her private practice, she sees adolescents, adults, and couples, and she has a specialization in helping human services and frontline professionals find renewed purpose and meaning in their work roles and lives. You can find her, her contact information, and learn more about my offerings, including art groups, at www.amyponteri.com.