In the previous article, I addressed moral injury in the workplace and the factors that can place neurodivergent individuals at a higher risk. In this follow-up, I will focus on coping, healing, and post-traumatic growth in the context of moral injury and neurodiversity.
As a review, moral injury across occupations can be defined as a “trauma response to witnessing or participating in workplace behaviors that contradict one’s moral beliefs in high-stakes situations with the potential of physical, psychological, social, or economic harm to others.”
Not all workplace negative emotion is moral injury. While the experience of distress is subjective, all distress should not be labeled a moral injury. Morally injurious situations are high stakes with the potential of significant harm to others.
Injurious events typically fall into three categories:
1) Transgressions by others, including managers, coworkers, or clients (e.g., a construction company using inferior and unsafe building materials, which may lead to a building collapse, to save the cost; healthcare insurance companies only approving cheaper treatments that are unlikely to help the patient).
2) Transgressions individuals committed themselves (e.g., a construction supervisor overseeing the use of unsafe materials; a healthcare professional prevented from providing effective treatments to patients).
3) Betrayal—feeling that managers, colleagues, or policymakers had betrayed occupational values, employees, or clients/customers.
Experiencing a moral transgression may result in a range of intense negative feelings such as grief, anxiety, guilt, shame, or anger. This may in some ways resemble the experience of PTSD, although the moral injury is specific in its focus on damage to one’s sense of morality and trust.
Moral injury and neurodiversity
Neurodivergent individuals often have characteristics that make them particularly susceptible to moral injury, such as the autistic tendency to consistently follow moral rules, and the strong reaction to unfairness associated with ADHD.
Moreover, several characteristics can make dealing with moral injury more difficult for neurodivergent populations. On the physiological level, autonomic nervous system (ANS) hyperarousal due to a chronic biologically elevated threat response associated with autism may contribute to the constant state of “alert.” On the psychological level, the autistic tendency toward rumination – a form of passive, repetitive negative thinking often focused on guilt and criticizing oneself, is associated with higher levels of depression and anxiety in the autistic population.
It is important to note that although distress in the situation of moral injury can be amplified by neurodivergent characteristics, such distress in itself is a normal human reaction to moral injury. It’s not the “lack of resilience,” “oversensitivity,” or in some other way an indication of psychological deficiency. Individuals are not “wrong” to react negatively to transgressions – rather, allowing morally injurious situations in the workplace is wrong. Trying to gaslight employees into thinking that ethical transgressions are not a big deal is wrong.
Unfortunately, ethical individuals are often placed into morally distressing situations through choices made by those in positions of authority. This may result in moral injury – however, we are not powerless, and we have tools for coping and healing.
The experience and the response
Neither the injurious experience nor susceptibility mean that individuals will or must suffer the long-term negative effects. Moreover, even the injury experience can become a catalyst of growth.
In one of my early jobs, I witnessed large-scale embezzlement. When this was reported, the embezzler was given even more power, and the honest person was fired. In another job, ethnic discrimination and dehumanization were typical experiences of those who did not belong to the dominant group. While traumatic, these experiences fueled my passion for creating more inclusive and ethical workplaces.
Experiencing injurious events is not the entire story. A Buddhist parable speaks of two arrows. The first arrow is a stressful or painful event. The second arrow can be even more painful – and it represents our reaction to the event. Our mind can dwell on our past mistakes or hold onto grudges. We can develop self-condemnation and a harsh inner voice. We can be stuck in an endless cycle of blame and victimhood. But – we can also learn the lessons and move forward, resolving to do better the next time.
In 1990s, Richard Tedeschi and Lawrence Calhoun observed that some military veterans or people who experienced natural disasters and other traumatic events developed a new appreciation of life and explored new possibilities, found personal strengths they did not know they had, developed better relationships, and grown spiritually. These observations laid the foundation of the idea of post-traumatic growth. Rather than becoming trapped in sadness or anger, individuals developed positive ways of sense-making.
The “good” rumination
Rumination is typically seen as a negative. However, it can also promote healing through meaning-making and reappraisal. Tedeschi and Calhoun identified two types of rumination:
- Intrusive rumination involves unintentional and unwanted thinking related to the stressful events. It is difficult to control and emotionally distressing. Intrusive rumination is likely to be related to various kinds of post-traumatic stress.
- Deliberate rumination involves voluntary and purposeful sensemaking – trying to understand events and their implications and find learning and meaning in the experience. It is more likely to be related to post-traumatic growth.
Making rumination deliberate is possible with this exercise I developed for myself based on Tedeschi and Calhoun’s work, adapted to moral injury in the workplace. Please do this exercise when you have sufficient time to process deep feelings. If you experience significant psychological distress, make sure to seek professional help.
- What am I really feeling? What am I really, really feeling?
- What do I want to feel? What kind of person do I want to be?
- What would it take to feel how I want to feel?
- What is in my control?
- What needs to be released or forgiven to set myself free?
- I release
- I forgive
- What have I learned?
- If this happens again, how will I act next time?
Forgiveness, self-forgiveness, and amends.
The importance of forgiveness cannot be overstated – but it is often misunderstood. Benefits of granting forgiveness include positive health outcomes, higher joy, empathy, and perceived control. Unforgiveness, on the other hand, is associated with cardiovascular threat, as well as sadness, anger, and fear.
Forgiveness, however, is not the same as relinquishing justice. Forgiveness means freeing yourself from resentment, the bound to the past, and from being controlled by the other party. It does not mean excusing the wrong.
Forgiveness is compatible with seeking justice because seeking justice is not the same as revenge. Revenge is driven by anger, and its goal is making an offender suffer. Seeking justice does not require a personal grievance; it is driven by the commitment to what is right and fair, rather than seeking the satisfaction of revenge.
The same is true about self-forgiveness. It is possible to forgive oneself and still engage in the necessary restoration and amends – not out of self-hate, but out of the sense of justice.
In ethically problematic situations that occur on an organizational level, individual-level restorative action might be limited – but it is not impossible. It may include collaborating with others to effect change within the organization. It may also involve external whistleblowing. In our most immediate sphere of influence, restorative action may also involve doing one’s job according to higher ethical standards and treating clients and customers right even if your company does not. I tend to focus on the direct impact I make even if organizations execute their missions imperfectly, while doing all I can to improve those organizations.
In many cases, leaving the situation or organization is a necessary step. It is often said that we cannot heal in the same situation where the damage has occurred. We also cannot restore our conscience while continuing to violate our values.
It is important to remember that our value systems, our physical and psychological health, are all very different. There is not one prescription that will work for everyone. When a moral injury occurs, most of us benefit from leaving or actively changing the situation and making amends, if at all possible. Beyond that, some may thrive with self-care or journaling. Others particularly benefit from spiritual guidance, group work, coaching, or may need professional therapy. Carefully exploring what works best for you while extending kindness and understanding to others is essential for creating a world where a moral injury is increasingly uncommon.