Stay Home – Stay Safe -Week 5

Its interesting to me how each week seems to have its own narrative, a distinct flavour which often is identified once it is named. This week it is “I don’t want to be good anymore” I expressed this first on Monday, that feeling that eating healthily, watching my sleep, prioritising self care, getting daily exercise, was itself becoming a chore, except rather like cleaning the toilet, one that has to be done. I have sensed very simular from all around me, and it has led to a certain “mehness” (it is a word honest!

My answer has been gentleness – I have allowed walks to replace runs, let myself watch junk TV, used some of the prepared food in the freezer. I can’t let go toally, spend all day in bed eating icecream, but I can relax the grip. This journal isnt about advice on how to “do the pandemic” but if you too have had that not wanting to be good anymore feeling, then perhaps a simular relaxation will help. It is a short term relaxation, as I have said before this is a marathon not a sprint, running and cooking from scratch have returned, but with a conscious, this is what I choose, rather than this is what I must do.

Choice is vital right now, anxiety is high, and anxiety is simply our brains trying to tkeep us safe. The problem is there genuinely is a threat, so many of the challenges we would use to work with anxiety are no longer useful – so we need concrete actions we can take which say “I am doing X to keep myself safe – so shut up anxious brain”> This is top neuroscience folx take my word for it!

This week started with seeing a vague idea take concrete form which is always so cheering. During the Pink Therapy Queer desire conference, when I was offering tech support, a couple of us were throwing around the idea of free seminars during lockdown, to help the therapeutic community and improve the experiences of GRSD folx in therapy. Out of that idea Kink On Pink was born. It “sold out” almost instantly, and I am very excited at the idea of being able to educate therapists on the highly stigmatised world of Adult Babies

I also took part in an excellent workshop on Moral Injury this week. I have been worried by many counsellors leaping to offer free counselling for key workers, particuarly NHS staff. It may sound like an odd thing to be worried about – so let me explain. The desire to help right not, to support those keeping us all safe at increible personal risk is incredibly human, and one I share. However it has to be the right support, at the right time, for the right things. PTSD may be an issue, although research shows that medical staff are remarkably resilant to experiencing it, due to their training, stress, anxiety and burn out are certainly going to be present. However I believe moral injury will be far more prevalent than people realise, and it is an area that counselling training doesnt usually cover. Moral injury has been defined as

experiences of serious inner conflict arising from what one takes to be grievous moral transgressions that can overwhelm one’s sense of goodness and humanity.

Nancy Sherman

Moral injury occurs when we perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs. In the health care context, that deeply held moral belief is the oath each of us took when embarking on our paths as health care providers: Put the needs of patients first. That oath is the lynchpin of our working lives and our guiding principle when searching for the right course of action. But as clinicians, we are increasingly forced to consider the demands of other stakeholders—the electronic medical record (EMR), the insurers, the hospital, the health care system, even our own financial security—before the needs of our patients. Every time we are forced to make a decision that contravenes our patients’ best interests, we feel a sting of moral injustice. Over time, these repetitive insults amass into moral injury

Dean W, Talbot S, Dean A. Reframing Clinician Distress: Moral Injury Not Burnout [published correction appears in Fed Pract. 2019 Oct;36(10):447]. Fed Pract. 2019;36(9):400–402.

We do not know what the impact of working in healthcare might be right now, but, if we are to offer our support, and/or professional services to those who are risking their lives across the country to keep us alive, then we need to consider how that might best be done. One of the things about moral injury is that it is treated very differently to PTSD, and one of the most effective interventions is peer support. As we move forward ensuring our doctors, nurses and all other keyworkers receive the support they need is vital, but it may be that the best thing we can do is agitate for better funding, a reliance on science and of course PPE rather than individual counselling sessions. But, I shall leave that there before I get too political!

The spectacularly good weather has continued, so it has also been a week for remembering my huge privileges at the moment, and reflecting on the beauty which surrounds me.

2 thoughts on “Stay Home – Stay Safe -Week 5

  1. “Burnout suggests that the problem resides within the individual, who is in some way deficient. It implies that the individual lacks the resources or resilience to withstand the work environment. Since the problem is in the individual, the solutions to burnout must be in the individual, too, and therefore, it is the individual’s responsibility to find and implement them” (Dean, Talbot, & Dean 2019).

    The WHO however, classifies burnout as an occupational phenomenon: The distinction is important as when burnout is caused by a mismatch between the WORKLOAD and the RESOURCES available to an employee, the solution need to be sought in the work environment.
    It has also been recognized that those who are dedicated and committed are more prone to burnout.
    So, rather than adding another “syndrome or disorder” it might be helpful to critically look at the definition of burnout and look to what extent moral injury leads to symptoms of burnout.

    I also agree that peer support is very likely more helpful than individual counselling.

    Thank you Karen, excellent post and very thought provoking!


    1. thank you for such a thoughful comment, and I quite agree that another label or disorder is the last thing we need, I suppose my thought is that without that more inclusive definition of burn out, many people will be left trying to work with individuals and overlook the feelings of moral injury, not as a label, but as a very human reaction to impossible choices

      Liked by 1 person

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