How do I live in a world without her?

“On the occasion of the death of Justice Ruth Bader Ginsburg”

I’m sitting out on my back porch early in the morning looking out into the yards behind my house and the only thought in my head is “How can I live in a world without her?”

And my next thought is that this isn’t the I first time I’ve awoken early from a sleepless night with this thought and a broken heart. There is a disorientation, an instability, a deep disbelief of the world after the death of someone important to you. It feels like there is less oxygen. It feels like you have to move more carefully. And the denial of death always makes me want to wait, hope the news was a mistake, just sit still long enough, patient enough for them to return. And then you breathe and take in reality again. How do I live in a world without her?

When someone dies it’s not just that the world feels emptier without them, it feels like there is something in us that has changed. What is the world without them? Who am I without them?

It’s an odd day to be thinking about identity—as today is a pilgrimage of sorts. This morning I am meeting my colleague Eddy and we are going on a short trip to my hometown in North Jersey. Not because there is anything really special about my hometown, or that there is anything really to do, especially now with Covid, but because in our work and travels I have been close to Eddy’s hometown in Zambia, and now we’re closing the loop on an old conversation and going to mine.

We are mosaics. We are made up of pieces that makes us who we are: we are where we come from, we are where we have been, we are who we love and have loved, and we are what we hold dear.

 In American culture there is such an emphasis on the individual—that I am solely myself. But this notion of identity is an illusion and that illusion is shattered when someone dies. In that moment you can see and feel that the person who died held an important support rope for you. You may not have even noticed it when they were alive. But in their absence you suddenly feel vulnerable, wobbly, as if you could topple without their support. You realize that you could be who you were because of them.

It was my friend Eddy who taught me this. In our work in Zambia and across the world, he brought the belief he was raised with, ‘Ubuntu’ to our work. ‘Ubuntu’ means ‘I am because you are’— that we are who we are because of our relationships—we are who we are because of our community.  As the psychologist Jean Baker Miller says we are selves-in-relation. And this is the fact we feel most keenly when someone dies: I am because of you. And now, who am I without you?

We are mosaics and when someone dies those mosaic pieces must shift. When someone is alive, they hold those pieces of themselves and through our connection to them we feel the benefits and borrow the strengths of those pieces. And then when someone dies we have the work, the growth, of taking in, of integrating those pieces that we are able to. Taking in those strengths and capacities into our own selves—for us and the community.

That’s why our hearts must break. This is why we must fall apart. This is why grief shatters.  We need the brokenness. Without the brokenness we can’t take in the new pieces. Falling apart allow us to absorb the mosaic pieces of the other. It is this grief that  allows us to rebuild a world without them, that includes them. This is why time is so necessary to grieving. It takes time to weave these new pieces in. It takes time to remake our mosaics.

How do I live in a world without her? Maybe the short answer is I don’t. Because I bring her into my life every day. I stand in the voting booth and my grandmother is standing next to me. I dig up plants and share them with my neighbors and my mother-in-law is right there with me handing me the spade. I rearrange my schedule to make time for writing and my friends Inger and Janet are raising their glasses and toasting my decision. Our hearts break open and our mosaics, the world’s mosaics, get bigger. First, let yourself grieve. And then, let yourself grow.

 Copyright 2020 Gretchen Schmelzer PhD

Making Kindness Cool Again

“Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. Love never fails. ”

— 1 Corinthians 13:4-8

I believe that most people would agree that caring for others, even if you don’t know them, is the right thing to do. This level of kindness or love or respect is a part of every world religion. It is the one thing that all of our Gods agree on: ‘love thy neighbor’ --with no exceptions.  It was the golden rule we were taught in school and scouts—and if you were lucky, at home. And I have never in all of my 54 years seen a more desperate time to stop what we were all doing and have a national day of kindness, a focus on caring for others, and a collective prayer of love. America needs a serious time-out to regroup and reconnect with this idea. Maybe the whole world does. We need love and kindness and caring for our fellow man to be cool again. We need kindness to be the coolest thing ever.

Yes, love is patient and love is kind. But love is also really hard. Love, kindness, care. These are not easy or weak emotions. They hold up the world. They require strength, patience and willingness to hold the other end of the rope—the willingness to be the bad guy, to be unpopular, the willingness to hold what is hard. The willingness to hold your stuff and their stuff. The willingness to do what you don’t want to do, to be inconvenienced, and at times to be burdened. Love requires us to hold the most difficult, impatient, cranky, frustrated, and stubborn aspects of ourselves and of others. Love requires muscles.

I’m not sure when it started, when it became a sign of weakness to be kind, to show love. When did acting on behalf of people, taking care of people, or protecting people become weak? When did love become a one way street that is only about ‘whether someone loves me?’ I’m sure it didn’t start with the President who behaves like a 7th grade bully but he has certainly worked hard to make a brand name of meanness and contempt. He demands love and adoration but cannot bring himself to exhibit it towards others. And now too many people are mimicking his words or behavior-- but the truth is we know better. All of us, even the people following him. Any thinking adult knows better. We know being mean isn’t the answer. The reason this bad behavior works in 7th grade is that it’s hard to feel a sense of belonging across difference when you are young and haven’t yet built a sense of self. It’s easier to connect around the things or people you don’t like—than find connections in the things you do like—or harder yet, hold that we could like each other and be different. That is a recognizable struggle of the young. But we grown-ups (and many young people) know better and we can do better. Even when we don’t want to. Even when it is hard.

I am especially talking to leaders right now because the recovery from the pandemic is going to be a long, hard struggle and in order to come out of this traumatic situation more whole than we went in we are going to need all of the kindness, love and care we can create. Leaders of states, communities and towns. Leaders of organizations, businesses, and colleges. Leaders of schools, churches, and clubs. Leaders of groups, neighborhoods and families. For all the leaders out there (and I really count every citizen as a leader) if you thought shutting down the world for the pandemic was the hardest thing you have had to do as a leader—wait for the recovery. Reopening the country is a bigger leadership challenge than shutting it down. And that terrifies me because I am a leadership consultant and I’m not sure I’ve ever witnessed a greater failure in leadership than the United States in the month of March. It was like watching a slow-motion car crash: leader after leader waiting to act. Waiting to follow someone else. Waiting for someone else to act to create the cover of their decision so no one could accuse them of being ‘weak’ or ‘making the wrong move.’

Leadership is the act of acting on behalf of someone else or something bigger than yourself. Leadership is working with and supporting other people to use their gifts to accomplish a goal. Leadership is an act of love and caring—of making hard decisions and risking the blowback that comes from them.  I was introduced to the idea that leadership is an act of love because my first big leadership position at the age of 21 was as a waterfront director at a day camp for 450 kids. I was responsible every single day for 450 of other people’s children. So when the skies darkened and it looked like thunderstorms (long before the age of the weather app) I cancelled swimming, the most popular activity at camp.  I had to tolerate the rage from kids, counselors and parents alike on multiple occasions. I spent many years working on waterfronts, leading canoe trips, counseling in residential treatment, and teaching in schools and colleges working with other people’s children. When you work with other people’s children you not only worry about the children, but you imagine the conversation with every parent or caregiver explaining to them about why their child was or was not kept safe based on your decisions and actions. When you work with other people’s children you know that you hold in your heart and your actions the most precious asset a family has. Working with other people’s children makes it easy to lead from a place of love, kindness and care. In fact, it’s your only option.

But really, don’t we all work with other people’s children? Or other people’s parents? Other people’s grandparents? Whether they are 8 or they are 8o? Aren’t they all a human in need of our kindness? Shouldn’t all of our leadership decisions be held with the level of care that we are responsible for the greatest asset of a family or community? Recovering from the pandemic is going to require all of us to simultaneously hold the losses of this year with the hope for the future. It’s going to require us to create a solid platform from which to recover. It’s going to require us to connect and communicate with people in ways we never had to before and across hurt, and frustration and difference in ways we never had to before.  And we are going to need to hold all of these leadership challenges with love and kindness and this behavior is a good bet because love never fails.  So, let’s make it easier to lead with love and kindness. Let’s make love and kindness cool again. Let’s make love and kindness the coolest thing ever.

 © 2020 Gretchen L. Schmelzer, PhD

Mourning a son on Mother’s Day: Racism and White Responsibility

Artwork by TL Duryea

www.TLDuryea.com

One hundred years ago, during a deathly viral outbreak, a woman sought to bring together mothers to collectively mourn the death of their sons in war, to create safer conditions from the virus, and if possible, to have mothers heal the divide across communities in the aftermath of the Civil War. The hope was that mothers could talk to each other because all mothers understand the painful loss of the death of a child. The foundation of mother’s day was loss and love.

And so on this Mother’s Day I ask all of us to collectively mourn the loss of a son who was killed in February, though his death came to light last week. Ahmaud Arbery. Yes, he was the son we all have, even if like me, you don’t even have children. I picture our son leaning over to tie his shoelaces. A scene every parent of a teen and young adult son has witnessed over and over. Tying the shoelaces of his running shoes, maybe talking about the next pair that he wanted, and then sitting up, looking at you and saying he’s going for a run. The door closes behind him.  He gets killed. Our son gets killed because he is Black and you are not safe in your body in this country unless you are a White, straight man.

I read the article about Ahmaud Arbery last week. Actually, I didn’t read the article. I read the headline. A ‘25 year old Black man running in a neighborhood is shot to death, no arrests’ and I put my computer down and spent the next two days crying. I couldn’t bring myself to read the article. The headline was all I could bear because this is such an old, old story.  This brutal death broke my heart and broke through some veil of patience shattering some foggy belief that the long arc was bending toward justice. It’s not.

This was a lynching. A young man goes out running and gets shot because he is Black. A young man goes to the store and is killed because he is Black. A young man walks through a neighborhood and is killed because he is Black. A young man drives home from work and is pulled over in his car by police and is killed because he is Black. The killers of these men are not held accountable. Their cases are dismissed. They are exonerated. Our systems of laws of accountability are broken. But even more than that, our culture of responsibility is broken.

This isn’t the first time I have been outraged about a racist brutal death, but it is the first time I am writing about it. I have spent much of my career writing about trauma and I believe that experiences and stories of trauma belong to the survivors. And racism and the acts and outcomes of White supremacy and genocide are traumatic and writing about acts of racism has always felt dangerously close to usurping someone else’s story, a story that belongs to the people who have endured those particular traumas.  I am a White woman and I don’t tend to write personally about traumas that I have not endured. But I need to write about the racism of this event because this particular week not writing about it, staying silent feels like an act of violence. I don’t mean I was not talking about it—talking it about it with friends and colleagues or voicing outrage at the injustice. But talking about it in my own world is a private conversation. And today, I can feel in my bones that a private conversation for a public evil amounts to silence. And when our son gets killed, we cannot be silent.

And I want to be clear that this isn’t a piece of writing about White guilt, though there is plenty of behavior by White people to be ashamed of, and plenty of my own behaviors and inaction around race to be ashamed of. This is a piece of writing about White responsibility. It is time for the people who consider themselves White, who benefit from being White, to take responsibility for the racism in this country and the resulting violence.

White America has lost the meaning of responsibility. We lean lazily on some legal definition of responsibility –that if we can’t be blamed directly with committing a racist act with proof that would hold up in a court of law, we aren’t personally responsible. It seems that the legal definition of responsibility or fault has replaced a much more common sense moral responsibility—a responsibility to what is just and right. A responsibility to something bigger and at the same time something much more basic. A sense of ownership of the problem--that we all, as White people, every single one of us, have a responsibility to the racism that killed that young man. He belonged to us, as one of our children and we have failed him, as we have so many others. We have a responsibility to this young man and his family even if we didn’t pull the trigger because we go along with a society that allows others to pull the trigger and we don’t hold them accountable.

I have gone along in society because I have often fallen for the great lie that ‘it’s getting better’ because I have believed in what Ta-Nehisi Coates names as the ‘dream.[i]’ The vision of America that Americans who consider themselves White envision. A country that is made up of Memorial Day parades, and picnics and school plays. Baseball games and hot dogs. As a woman I have fallen for the same dream of gender equality and it doesn’t exist either. Every example of ‘progress’ –a Black President, a Black CEO, a woman Supreme Court Justice only makes the dream stronger. The dream is an opiate that allows you to keep living in a deeply unequal and unjust society without feeling the pain of it. And if you don’t feel the pain of it, you don’t take on the hard work of repairing it.

But leaning on legal definitions of responsibility is not going to dismantle and end racism. It has never just been the laws on the books that have held people accountable. Laws are important and crucial to justice because they provide a means to establish minimum behavior. But laws on the books only get upheld because the community wants them to.  In the 70’s there were laws on the books that prohibited assault and battery, but growing up in a household of domestic violence I witnessed that even when the police came, they didn’t treat the violence as a crime.  It was illegal for one adult to hit another. But domestic violence was seen as a private matter and not a matter for criminal proceedings. Laws are upheld when culture and community say “this is wrong.” There was a turning point with domestic violence, and in many places it’s no longer tolerated in the same way it was in the 70’s. The laws did not change. People’s tolerance of violent behavior changed.

Racism and White male supremacy continue because as a culture we let them continue. We tolerate racism in our culture and media as a ‘difference of opinion.’ Racism is not a difference of opinion. Racism is the underpinning of violence and death. There has become an obsession with hearing both sides of something as if they have equal value. There isn’t another side to racism, it is just wrong. But just because it is wrong doesn’t mean we don’t all struggle with it. As the playwright Suzan Lori Parks states, “Racism is a virus and we all have it. So, what do we do with that information[ii]?”  

What I am doing with that information, and I invite you to join me, is sitting as long as I can with the pain of Ahmaud’s death. Letting that pain find the places in me that have fostered indifference or inaction in situations of race. Letting that pain find the places that have ignored where I could have acted differently—said something or not said something. Done something or not done something. Feeling that pain in my heart because in the very fabric of my being I love children and I feel the ache and the shame of behaving in ways that have put the lives of other people’s children at risk. And using that pain, and especially that love to motivate me to keep looking at racism and owning my part in it.

 © 2020 Gretchen L. Schmelzer, PhD

[i] Coates, T. (2015). Between the World and Me. NY: Spiegel & Grau. p.11

[ii] https://www.latimes.com/entertainment/arts/la-et-cm-white-noise-suzan-lori-parks-oskar-eustis-20190417-story.html

Between the World and Me

By Coates, Ta-Nehisi

Supporting resilient survival during Covid-19: Understanding traumatic stress and moral injury for health workers, their loved ones and health care leaders.

*Please note that this blog is longer than usual. I wanted to answer specific questions that have been arising in the healthcare community with enough space to give the topic the depth it deserved. While I know not everyone needs this, please share with health care providers, their loved ones, and heath care systems.

Healthcare Providers-- your job was never easy. You worked long hours and you have endured terrible losses of patients. You had years of grueling training. You had to learn how to manage fear, grief and shame the best ways you knew how—mostly by compartmentalizing—a strategy research showed didn’t work that well in the best of times.[i]  But the scale of Covid-19 is different. You are seeing patients who need 8 blood transfusions. You are seeing young, previously healthy people stroke out. You are trying to stay ahead of a rising tide of severe illness and death and the tide keeps rising. You are having to hold the phone to the ear of dying patients and shepherd families though loss. You are their medical provider and the person who is holding their hand and comforting their families.

Many doctors, nurses and other health professionals deal with death in their work. And in my work counseling and coaching physicians I can tell you that it is never easy. They take it hard, and they take it seriously. But the scale of death and the severity of illness at a massive scale that we are seeing now takes this crisis into a new place for the medical profession. Your work, which has always been stressful, is now war-level traumatic and it is really important that all health professionals, the people who love them, and the people who run the health systems understand the impact of this trauma and take seriously the kind support that is needed right now and begin to plan for the kind of support that will be necessary through a recovery.

This level of trauma is dangerous and last week, it proved deadly. Last week an emergency room doctor committed suicide while home recovering from the illness. The doctor didn’t have a history of mental health issues and indeed, had a long list of coping strategies during in pre-Covid-19 times. She lived a full life and yet in the article her father noted that “when he last spoke with her, she seemed detached, and he could tell something was wrong. She had described… an onslaught of patients who were dying before they could even be taken out of ambulances.[ii]”  

 Physiological and Psychological Impact of Trauma

 I want to start first with the physiological and psychological impact of trauma. These things aren’t separate—because trauma elicits an emergency response system from our bodies and our brains are part of our physiology—not some separate aspect. Trauma responses are normal and not some sign of psychological weakness. A working definition of trauma is any event that overwhelms your system of protections and leaves you fearful of your life and/or safety rendering you helpless. This is where Covid-19 is different than many crises that healthcare providers and the healthcare systems have grappled with before—typically you haven’t feared for your own safety as you have cared for patients—and you haven’t feared for the safety of your family as you have cared for patients. And your families haven’t had to worry about your safety or protect themselves from you. And healthcare leaders haven’t had to try to support their people from a distance and worry about the safety of their people or their loved ones all while managing their job.

When I talk about trauma it is important to understand that all trauma is not equal. If the hospital you were working in was affected by a single incident trauma—if it were hit by an earthquake, for example, it would be horrible and traumatic. You would have all the impact of severe stress which overwhelms the normal system of psychological defenses and floods your body with adrenaline. In short term trauma, the system is overwhelmed, and the effect is an over-sensitized system. This adrenaline helps us focus in a crisis and this ‘hypervigilance’ is often trained into professionals as a requirement of their job in roles like Emergency Room doctors, police, first responders and military.  The definition of hypervigilance is  “let me pay attention to every sight sound and other sensory input available to increase my awareness of the environment and thus lower my chances of being victimized by an unknown.[iii]” Other symptoms of a one-time trauma are startle response, flashbacks, nightmares, difficulty eating, difficulty sleeping, difficulty concentrating, or persistent avoidance of anything that reminds the person of the traumatic event.⁠ You may recognize some of these symptoms right now. They are common and they are a pretty normal response to trauma. If these symptoms persist for a month, they meet the criteria for PTSD.[iv] 

But what the healthcare world is experiencing right now is the equivalent of getting hit by an earthquake every day. A single incident of trauma catches us off guard and breaks through our defenses. But when trauma is repeated we don’t wait to get ‘caught off guard’ -- we unconsciously, yet wisely, build a system of defenses against being overwhelmed and getting caught off-guard again. Building defenses to survive and experience the repeated trauma conserves our energy for survival. Instead of getting flooded with emotion—with terror, fear, and all the responses to it—we go numb, we feel nothing, and we do whatever we have to in order to maintain our distance from ourselves and others. Repeated trauma is really three forms of trauma: What is happening (the massive scale of illness and death), the psychological protections you are using to survive the trauma, and what isn’t happening: all the aspects of your life that have needed to halt because of the trauma that is happening. And healing from repeated trauma will need to address all three.[v]

But right now, the focus is on a resilient way of surviving the trauma and likely, given the fact that as health professionals you are toggling back and forth between a traumatic workplace and going back to your families—you are experiencing a roller coaster of trauma responses from high adrenaline, hypervigilance and energy to exhausted, shut down, apathetic and angry.

As healthcare folks you learn about the impact of stress on the body but you are enculturated to believe that you are immune from this response. You aren’t. Yes, you trained long hours and you can shift your attention from your bodies, but your physiology is having an experience, and you will be affected by it. This roller coaster you are experiencing is real and it is important to own the impact of the rollercoaster on your brain and body. Understanding this will help you survive the trauma while it is happening with greater resilience, and it will help you understand the impact of the trauma when you are finally able to heal from it. To understand it better look at the following illustration.

When you are on-shift, you are on the top of this illustration—you are hit with a flood of adrenaline— you are in a necessary state of hypervigilance—paying attention, highly energized, ready for action. And when you go off shift you are below the lines-- your body sinks into a state that may be exhasuted, apathetic, and irritable.[vi]  As Gilmartin, who works with police professionals states,  “for every action there is an equal and opposite reaction,” and this rollercoaster is your body’s attempt to recover from the onslaught of stress hormones. This recovery typically takes 18-24 hours making it likely that on most days you will barely get the time to recover before you are back in it. You may notice that you feel more ‘alive’ at work. That you feel more like ‘yourself’ with the adrenaline and you feel more detached or numb when you are home. This crash in to numb may make it harder to connect to your families or friends when you are home, or make it harder to connect with them via phone or FaceTime if you have moved away to protect them. Trauma makes it seem like the only people we can connect with are people who are in the trauma with us. It’s a ‘war buddy’ phenomenon: the people we are with ‘above the line’ can feel more connected to us than the people we are with ‘below the line.’ This doesn’t mean we love them less, but this is physiological and psychological response to trauma. But it doesn’t have to rule your reality, and there are ways to manage this roller coaster and bring awareness to your recovery and reconnection to support survival in this difficult time.

What can health professionals do right now to support resilient survival of the physiological and psychological trauma of Covid-19.

1)    You have to own the roller coaster. By being aware of the impact on your body and brain you have some choices about what actions you can take to bring yourself into the best possible state.

2)    Plan your transitions between work and home: create a ritual that helps you connect with people, and previous aspects of yourself (favorite music, something nourishing).

3)    Avoid television, or things that make you more likely to sit in ‘numb’ for too long.

4)    Attend to your body. Above the line, you want to do things that ‘soothe’ you. Below the line you want to do things that bring you back into a feeling state.

5)    Start wherever you are: sometime simply stating how you feel “I feel numb” allows you to be heard and understood and help you feel more connected to yourself and others and mitigate the experience of feeling detached.

 What can loved ones do right now to support resilient survival of their health care professional’s physiological and psychological trauma of Covid-19:

1)    Stay engaged: Imagine holding the other end of the rope. Sometimes you will hold it lightly, and sometimes you will tug on it. But stay connected in ways that you can.

2)    You need to have conversations—even when they feel awkward and repetitive—for all of you during this time: what is helpful, what is stressful, what are your signs of stress, how will I know you need help, what are you grateful for, what brings you joy?

3)    Your health professional may not be able to support you in the way you need right now, who else can be on your team to support you and your family right now? Who else can you talk to to make sure you aren’t alone with your worries either?

4)    Plan activities to share time that isn’t just about the pandemic. This will be different for everyone, but both you and your loved one needs to connect to their pre-pandemic self to stay afloat.

What can healthcare leaders do right now to support resilient survival of their colleagues and healthcare professional’s physiological and psychological trauma of Covid-19.

1)   Help your health professionals and colleagues understand and own the impact of stress and trauma. Normalize it and encourage conversation and coping.

2) Make sure that the mental health resources are easily available, easy to find and widely distributed.

3)  All leaders should have conversations with their teams: what is helpful, what is stressful, what are your signs of stress, how will I know you need help, what are you grateful for, what brings you joy? These are not conversations that you have just once. They are ongoing and help you stay in contact with the level of stress people are experiencing.

3)    Health care leaders need to be brave enough to welcome the truth from their people in terms of what their health care providers are feeling and the level of stress. You need to thank people for the information. Information is the only way you will be able to lead effectively and they will only give it to you if you listen and don’t judge or punish.

 The Hidden Wound: Moral Injury

But the problem with surviving and healing from trauma is that often the discussion stops with the physiological and psychological impact. The discussion stops at the symptoms of PTSD and never gets to the impact of repeated trauma—the changes we make in ourselves to survive, let alone one of the biggest hidden wounds of trauma: moral injury. We have a self-concept of ourselves as a person with integrity who is helpful and does the right thing. Most people never have to test this self-concept of themselves, and in trauma, this test can be brutal. It can be devastating to a health professional, whose self-concept is to save people’s lives, to watch person after person die, with no real ability to change the outcome. It doesn’t matter if realistically it wouldn’t have been possible there is something mammalian about our desire to be effective in the face of doing our jobs as helpers. Indeed, the search and rescue dogs during 9/11 got so distraught and depressed at not finding survivors that their handlers had first responders hide in the rubble to be found so the dogs didn’t’ experience their own version of moral injury.  The psychiatrist Joseph Shay calls PTSD a primary injury--it's symptoms are visible like the break of a bone. But a moral injury is like internal bleeding. It is a silent killer. Soldiers often report feeling like a piece of them died during the war and others have referred to it as ‘soul murder.’

It is important to note that moral injury is not a ‘psychological disorder.’ It’s deeper than that—it hits identity, it hits values, spirituality, it hits at your very soul. It is the ‘consequence of violating one’s conscience, even if the act was unavoidable or seemed right at the time.[vii]” As health professionals you have a set of beliefs and principles that guide your work and life, “I help save people’s lives” “I never leave a patient to die alone” “I support my coworkers” “I value my family above all” and this crisis doesn’t allow you live those principles at all times and may have you behaving in ways you could have never imagined because it was never required of you. Crucially, it is about you as an individual trying to hold the weight of a collective trauma all by yourself. As a doctor, nurse, respiratory therapist or other health worker helping a patient’s family talk to a dying patient on their Ipad is holding the devastation by yourself, but it shouldn’t be yours to hold alone.

What can Health Professionals Do Right Now:

For war veterans, having to hold their own stories of moral injury—the things that they had to do to survive—is one of the risk factors for suicide with a staggering suicide rate of 22 a day. It is imperative, and may be lifesaving, for you as health professionals to know about moral injury and know that, tragically, it is part of trauma. You will need to need to hold this concept of moral injury for yourself and you need to remind your colleagues. It is a wound that will need healing, but in the short term the most important thing you can do is to not hold your experience and your story alone. This is a world-wide collective trauma, While your individual experiences are personal to you and important to you—the trauma of this pandemic is bigger than you and you must lean on others to hold it. Start with your colleagues and fellow health care workers and share the burdens you are carrying. And then bravely begin to share your stories with your loved ones as you are able, and with the systems and communities within which you work.

What Can Health Care Leaders and Loved Ones Do Right Now:

So that means work for loved ones and health care leaders. In order to heal from moral injury health professionals will need to be able to tell their stories, and most importantly, every one of us, from loved ones, to health care leaders to community members are going to have to hold these stories with them. Holding these stories means holding the humanness of not being able to rise to every occasion. It means sitting with the grief and loss and tragedy that this pandemic has wrought. It means not being able to fix it, but instead sit with it. It is, in fact, the opposite of the behavior that we have for Veterans and now for Health Care Workers, where we thank them for the service and call them ‘heroes.’ The problem isn’t that we are grateful and consider them heroic. The problem is that their lived experience of failure and helplessness during their trauma feels so far away from the word ‘hero’ that it makes them feel alien from themselves. And this alienation is dangerous. And most importantly, it keeps them, then, from trying to tell the real story, the real trauma story, where they didn’t feel heroic, or indeed it wasn’t possible to act heroic. In our attempt to be kind, we can cruelly isolate them and that is something we need to avoid. We need to simply listen and acknowledge their sacrifices. We need to let them tell us what it was like. We need for them to not hold it alone.

© 2020 Gretchen L. Schmelzer, PhD

For more reading on trauma, stress and moral injury:

Emotional survival for law enforcement: A guide for officers and their families

By Gilmartin, Kevin M

Buy on Amazon

War and the Soul: Healing Our Nation's Veterans from Post-Traumatic Stress Disorder

By Edward Tick

Buy on Amazon

Soul Repair: Recovering from Moral Injury after War

By Brock, Rita Nakashima, Lettini, Gabriella

Buy on Amazon

Journey Through Trauma: A Trail Guide to the 5-Phase Cycle of Healing Repeated Trauma

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[i] Granek et al., (2012). Nature and Impact of Grief over patient loss on oncologists personal and professional lives. Archives of Internal Medicine 172 964-966. In Ofri, D. (2013). What Doctors Feel. NY: Beacon.

[ii] Ali Watkins, Michael Rothfeld, William K. Rashbaum and Brian M. Rosenthal (2020). Top E.R. Doctor Who Treated Virus Patients Dies by Suicide. NY Times, 4/27/2020. https://www.nytimes.com/2020/04/27/nyregion/new-york-city-doctor-suicide-coronavirus.html

[iii] Gilmartin, K. (2002). Emotional Survival for Law Enforcement: A guide for officers and their families. Tuscon, AZ: E-S Press.

[iv] American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

[v] Schmelzer, G. (2018). Journey Through Trauma. NY: Avery.

[vi] This citation is a combination of Gilmartin, K. (2002). Emotional Survival for Law Enforcement: A guide for officers and their families. Tuscon, AZ: E-S Press and Siegel, D. (2010). Mindsight. New York, NY: Bantam Books

[vii] Brock, R., & Lettini, G. (2012). Soul Repair: Recovering from Moral Injury after War. Boston: Beacon Press.