Of the World and In the World

Moral Injury, Rest, and the Lie of Laziness

It is not an exaggeration to say that I think about moral distress and moral injury all the time. As a professional ethicist and physician, I’ve been deeply interested in these issues for many years. The more I’ve worked in clinical ethics, the more I believe that unaddressed moral distress is a profound source of suffering for many of us and is unrecognized. Sharing the language of moral distress and moral injury can be healing on its own - giving a name to a nameless bogeyman that disturbs our sleep and knots our stomachs.

The Comfort of Certainty

When I started the Moral Injury Clinic last year, I knew in my soul and in my bones that there was value in the work of learning about and exploring moral harms in real time, not just for myself, but for other people, aiming to make sense of the pain we experience related to our moral lives. I thought about limiting my writing to healthcare workers - the group where I have the most direct experience and expertise. But that felt too small, like sidestepping the bigger truth I know is waiting to be explored. Who are healthcare workers but people who witness the suffering of patients, people from all walks of life, whose bodies and minds need of care in one form or another? To treat this suffering is separate and apart from the experiences of non-healthcare workers does not feel honest. In so many parts of my life, I speak with people from diverse communities and industries, and keeping the niche concept of moral distress and moral injury even more niche, feels like a betrayal of the stories I hear from the broader community.¹

Practicing Moral Courage in Uncertainty

Like many of you, I have also been overwhelmed by life in the micro, meso, and macro levels. We’re all on a ride around the sun, on a planet we seem committed to destroying through unchecked capitalism. The government in my country is careening towards authoritarianism and Lysenkoism. I keep going to work and sending our kids to school and then camp. I keep trying to choose the next right action, to avoid slipping into a warm bubble bath of despair. No matter how comforting, I know the comfort of despair is a lie. So while I have been navigating bouts of my own moral distress, I have struggled to bring myself to write about it.

What can I possibly have to offer to you when I am not even sure what to offer myself?

In deciding to remain broad, I have struggled with exactly what to say and how to say it. I have reread my previous posts and felt they come across as flat and uninspired. I have written, erased, and rewritten an essay on moral resilience more times that I care to admit. It just doesn’t seem right. I worry I’m not living up to some magical set of expectations. In reality, it’s more likely these are my magical expectations of myself, rather than anyone else’s.

Part of my brain knows this is absurd, and of course, I could just write something. I have 50 drafts of essays about the moral features of life waiting to be organized, polished, and published. Yet, I let time pass. I decided I was being ridiculous and that what I needed to do was rest - something I am not good at and constantly need practice in.

Rest Over Anxious Reactivity

I chose to rest and sit with my experiences, discerning what would be next. I let the writing field lie fallow for a bit. I needed to rest and rejuvenate enough to have something to give. I chose to rest so I could be responsive, rather than anxiously reactive. It is easy to moralize rest as laziness in a world that demands we prove the worthiness of our lives through our labor. I know resting does not mean I am lazy. I chose what I chose, but I still feel guilty because… I’m as skillful at guilt as I am unskilled in rest.

Seen on a recent trip to Acadia in Maine. I imagined this little trailer is lying in savasana and being reabsorbed into the earth.

In perhaps a great moment of irony, I finally wrote a similar - yet different - first draft of this essay this morning. I was quite proud of it and proud of myself for cracking open this first seed of creativity. I decided to step away and come back to it to add a photo and headings. But, poof, the draft was gone. The Substack editor had eaten it, despite the assurance that my draft had been saved.

Hope is a Discipline

In my own moments of hopelessness and loss of faith, I know that hope is a choice I can make. This is the core of moral resilience - to choose to have hope in the face of hopelessness. To choose to help despite the sense of helplessness. This is the kind of faith I feel I need every day. The faith to believe there is capacity for change.

I love Mariame Kaba’s words on this:

“I always tell people, for me, hope doesn't preclude feeling sadness or frustration or anger or any other emotion that makes total sense. Hope isn't an emotion, you know? Hope is not optimism. I think for me, understanding that is really helpful in my practice around organizing. I believe that there's always a potential for transformation and for change. And that is in any direction, good or bad… The idea of hope being a discipline is something I heard from a nun many years ago who was talking about it in conjunction with making sure we were of the world and in the world… the hope that she was talking about was grounded hope that was practiced every day, that people actually practiced all the time.”

- Mariame Kaba, We Do This ‘Til We All Get Free²

I left the Catholic church a long time ago, but there are still parts of my doctrinal religious upbringing that bubble to the surface on occasion. In particular, I often think of lessons in faith and good works. I no longer claim to have faith in any sort of god, but I hold tightly to my faith in the capacity for goodness that lies in each one of us. I have faith that hurt people hurt other people, perpetuating a cycle of emotional, psychological, and physical violence. I have faith that attending to this suffering offers a chance to co-create the world we want to be in, and the relationships of care and mutual respect that I believe we all deserve.

Regardless of my reconstructed ideas about faith, I have always been a fan of good works. I ask myself regularly, who am I becoming through my actions? I cultivate moral resilience by choosing the next right action again and again, and when I have chosen incorrectly, I make amends.

What good is it, my brothers and sisters, if someone claims to have faith but has no deeds? Can such faith save them? Suppose a brother or a sister is without clothes and daily food. If one of you says to them, “Go in peace; keep warm and well fed,” but does nothing about their physical needs, what good is it? In the same way, faith by itself, if it is not accompanied by action, is dead. - John 2: 14-17³

What is moral courage but making the audacious choice to push back against moral adversity? To choose to do good in the world - to choose to take the actions to become the people we know we can be?

This essay is very different than what I have promised you. This one has no framework, no pathway. No pithy list. I hope you understand.

The best advice I have on living a moral life is to be honest with yourself about who you want to be and look for the other people who are trying to figure it out as well. It’s so much harder than it sounds. I’m still working on it every day.

I’m committed to exploring this on the page with all of you.

Be not afraid.

You are not alone.

1. If my primary goal were to sell you things, being this ultra-niche would be a good business move. I’m not a business person. I’m a meaning maker, not a money maker.

2. I also highly recommend Kelly Hayes and Mariame Kaba’s Let This Radicalize You.

3. There are long-standing theological do you know what's so fun about being postal no idea what day it was so sorry for abandoning you I am OK a new a new pic case Communication talk to each other how excitingarguments among Catholics and Protestants over whether faith alone is enough for salvation (Ephesians 2:8-9) or if good works are also required, as John contends. As someone uninterested in salvation, I leave this argument to believers who are.