Moral Injury: Podcast with Shira Maguen
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
41 min
3 speakers
8 chapters
transcribed 6 hours ago
Transcript
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Transcript generated automatically by AI and may contain errors.
What is moral injury and how is it defined?
The Jerry Pal Podcast is brought to you by Archstone Foundation, improving the health and well-being of older Californians and their caregivers.
Welcome to the Jerry Pal Podcast. This is Eric Guadera. This is Alex Smith. And Alex, who do we have with us today?
Well, joining us again as co-host is Anne Kelly, social worker at the San Francisco VA. Welcome back to the Jerry Pal Podcast, Anne.
Hi, guys. Nice to see everybody.
Otherwise known as the voice of Jerry Pal. I think we had a couple weeks where Ann was not introducing Jerry Pal podcast at the start. Yeah, apologies for that. And we
got hate mail.
My fan base was very upset, but I'm back,
everybody. Very vocal fan base.
I was a little sleepy. We also have Shira McGann. Did I get that right? All right. I did. Good. Who is a professor at UCSF in the School of Medicine and is also mental health director of the Post 9-11 Integrated Care Clinic at the San Francisco VA. Welcome to the Jerry Pal podcast, Shira.
Thanks so much for having me.
We're going to be talking today about moral injury, including moral injury with COVID-19 and veterans and a lot of different issues. But before we jump into that, Shira, do you have a song request for Alex?
I am a big Beatles fan. So I would love to hear something like, I want to hold your hand.
Oh, I'll tell you something. I think you'll understand when I say that something. I want to hold your hand. I want to hold your hand. I want to hold your hand.
Impressive. Thank you.
Nicely done, Alex. Shira, let's talk about moral injury. First of all, what the heck is moral injury?
So I'm going to offer a definition and see if it feels like it's a good one for people to work off of. So the definition that we most typically use for moral injury is a mouthful, but I'll kind of walk us through it. So it's perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. So the idea here is that you actually cross a line. So moral injury requires actually an act of transgression that contradicts either personal or shared expectations about the rules or the codes of conduct. It's really the idea behind moral injury is that you are crossing some kind of line, and as a result, you're experiencing distress. And most typically, people, some of the hallmark symptoms of moral injury include guilt or shame, anxiety, distress, and really withdrawal.
People have suffered quite a bit because they experience again, what they perceive as a crossing of a line of their morals and values.
How does it differ from other DSM-5 conditions like PTSD in reactions to stress and fear?
How does moral injury differ from PTSD and other trauma diagnoses?
Great question, so I think you know when we think of moral injury we don't think of a diagnosis, but we think really of moral injury is more of a dimensional issue so. it's a reaction that people sometimes have that is not something that you can look in the DSM and diagnose, but that it really is about about how you perceive yourself how you perceive your spirituality. and how you're really integrating what you did or what you witnessed in terms of your own morals or values. And so with PTSD, we really think of you have to be exposed to some kind of trauma. Right. As a as the basis of PTSD, you know, similarly with moral injury, we you're exposed to what we call a potentially morally injurious event.
Right. So that can be many things in the context of war that it can be. as we talked about before, perpetrating, taking another life. It can also be witnessing something horrific. But it's not necessarily a trauma. In moral injury, you may have done something, whereas more typically in PTSD, you're experiencing some kind of life threat. So the type of the trauma is really, really different in both of those conditions. But what follows with PTSD is very much a list of symptoms that you have to meet in order to get a diagnosis, right? So we know that with PTSD, people may have re-experiencing symptoms. So that comes in the form of intrusive thoughts about the trauma. It comes in the form of nightmares. People might withdraw.
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Chapters
8 chapters
1
What is moral injury and how is it defined?
0:01–3:32
2
How does moral injury differ from PTSD and other trauma diagnoses?
3:32–8:23
3
What kinds of combat experiences can lead to moral injury in veterans?
8:23–13:26
4
Can moral injury occur in healthcare workers during the COVID‑19 pandemic?
13:26–19:36
5
How can clinicians assess for guilt, shame, or betrayal related to moral injury?
19:36–24:00
6
What treatment approaches are effective for healing moral injury?
24:00–29:58
7
Why is creating a safe space and language important for patients with moral injury?
29:58–36:21
8
What single action does the expert wish all providers would take to address moral injury?
36:21–41:13
Speakers
3 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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