Tag Archives: guilt

stethoscope and pen on medical chart

An Explanation of Moral Injury

Moral injury is defined as the profound psychological distress which results from actions, or the lack of them, which violate one’s moral or ethical code.

All in the medical profession sign up to a moral code that promises beneficence and non-maleficence. To not only do good for those in their care but to do no harm. The covid-19 pandemic as called on many frontline workers to push themselves to the brink. Previously called burnout, it is now recognised that when clinicians are asked, repeatedly, to act in a way, in a top-down administration, that is in opposition to their moral compass, it can cause untold damage.

Lack of resources such as beds, ventilators or medicines can mean frontline workers are unable to give the care they know can save lives, having to self-isolate while colleagues are stretched beyond capacity, knowing you’re not able to provide care for those with life limiting conditions because you’ve been re-deployed to give life-saving treatment or being involved in any keyworker roles under extreme pressure may lead to unnecessary risks being taken.

Ambulance technicians sitting in a queue instead of taking the next call, palliative care nurses preventing relatives from sitting with their loved ones as they die, admin staff sending out letters to push back patients’ outpatient appointments/surgery or any staff trying to follow policies set out by management that don’t appear to be patient centred are all events that could be considered potentially morally injurious. While in themselves, the worker may manage each individual event, it might be the build up or it might be the lack of support that can cause the most damage.

Man in scrubs looking depressed

Experience of potentially morally injurious events can lead to negative thoughts about oneself such as “I’m a terrible person” or “I’m not good enough” which can lead to shame and guilt. Although moral injury itself is not a mental illness, it can lead to symptoms of post-traumatic stress disorder when the sufferer can have flash back, lack of sleep and anxiety.

There is an increased risk of moral injury if the following occurs:

  1. Loss of life to a vulnerable person (e.g. child, elderly);
  2. Leaders are perceived to not take responsibility for the event(s) and are unsupportive;
  3. Staff feel unaware or unprepared for emotional/psychological consequences of decisions;
  4. The potentially morally injurious event occurs concurrently with exposure to other traumatic events (e.g. death of loved one);
  5. A lack of social support following the potentially morally injurious event.

Moral injury may not be restricted to frontline healthcare workers but can also be experienced by shop workers, teachers, social workers or prison staff for example. A lack of clear guidelines, training and resources mean they feel their own health is at risk and their unable to adequately care for those entrusted to them.

Man in scrubs sitting on the floor

Guilt or shame surrounding this issue can mean staff are reluctant to talk about it. Lack of support and a belief that it’s “all in a day’s work” means staff can turn to unhealthy coping mechanisms to manage the impact of moral injury.

It has been found that psychological screening or de-briefing is ineffective but the following may be beneficial for anyone exposed to potentially morally injurious events:

  1. Education and being made aware of the thoughts and feelings that could arise from the events and discussing the topic in advance to ensure staff are psychologically prepared;
  2. Seek informal support from colleagues, peer supporters, chaplains, managers etc as early as possible;
  3. If informal support doesn’t help and the events appears to be impacting the individuals daily life, professional help should be sought early. Sources of confidential support should be advertised within organisations so that it’s easily accessible.
  4. Those in leadership should have psychologically informed conversations upon checking in with their staff regularly. If they don’t poses the skills, trained peer-supporters could take on this role. These “check-ins” should involve encouraging staff to seek help whenever necessary.
  5. Frank discussion of events and team cohesion can help. It’s important to understand the impact on mental health as well as being aware psychological growth can be expected if staff do their best.
  6. Limiting exposure to media and unreliable news outlets and instead seeking information from trusted sources such as public health England and finding evidence-based coping resources (i.e. https://www.nhs.uk/oneyou/every-mind-matters/).

Experiencing moral injury and/or needing informal or professional support doesn’t make one person stronger or weaker than another.

1 piece of broccoli and 1 cherry tomato on a plate being eaten with a knife and fork bound with tape measure

Why “going on a diet” doesn’t work!

TW – Trigger Warning – I’m aware many of my readers have eating disorder either currently or in their history. Please be aware this blog talks about food frankly and openly. If this may be a trigger for you, please click onto another blog!

One of the hardest things I feel I’ve had to contend with while recovering from anorexia is full-on diet culture! It’s everywhere, from magazines in waiting rooms to everyday in the office. A day doesn’t go by where someone talks about the weight they’ve lost, or put on, or what diet they’re going to try next.

I’ve found it quite shocking, when I was ill, I was in a bubble of denial about these kind of things, I didn’t talk to people about food, nor them to me so I had no idea there was so much rubbish out there.

I think the most bizarre, to date, has to be the potato diet – you’ve guessed it – all my colleague ate for weeks was potatoes! I’m guessing the logic is that you’ll be so bored of them that eventually you’ll just stop eating and you might lose a bit of weight. But seriously…who dreamt this up?! How can just potatoes sustain a human being?!

I’m taking this back to basics. Very broadly there are 3 reasons we eat:

1. Food is available
Buffet table full of food

This may be simple, someone has brought some cakes into the office and they’re offered round. You eat one because they’re waved in front of your nose. You may feel “it’s rude not to” or you may just fancy one.

We also follow this rule when we live by strict habits. For example, lots of people eat 3 meals a day, each day fairly similar no matter how different their needs are on each day. Habitually, it’s 1pm, you prepare lunch and eat it because it’s there.

This is also the case when we live in family groups. “We eat dinner at 6.30pm because that’s when most people are likely to be hungry”.

2. We’re emotional

Females are renowned for this but it can happen to anyone. For some it’s a case of stuffing their feelings down, “If I eat, I don’t have to feel”. Or it may feel like a comfort, food just makes everything feel a bit better doesn’t it? All sorts of emotions may work in this way, living in the western world, food is available as a coping mechanism.

3. We’re hungry

Our body’s pretty clever, when it requires more food, you experience symptoms of hunger and we can use these as a signal to eat. Your stomach may physically feel empty or may be making noises, you may feel light-headed, irritable or lacking in concentration. If you’re feeling these things but you’ve only just eaten, they’re unlikely to be hunger, but if it’s been a couple of hours, they may signal hunger.

None of these reasons to eat are wrong

If you’re at a dinner party and not hungry, it’s totally fine to eat when food is available. It’s not just polite, it’s a sociable thing to do. If you’ve had a shocking day at work and you just fancy a a massive ice cream or block of chocolate, that’s ok.

However…
Square of carrot cake on a plate

It’s important to be aware of why you’re eating. When you’ve met up with your girlfriends for a coffee and chinwag, if you just fancy that slice of carrot cake because you saw it on the counter, do it – but make sure you know you’re eating it because it was there. Don’t pretend to yourself you’re hungry, or you’ll “make up for it later” or any other “excuse”. It’s ok to say “I’m having it because it was there and I want it.”

If however, you know you’re a grazer and you tend to just eat food “because it’s there”, try to become more mindful about this. Do you need snacks in the cupboard?

Emotional eating is a really important one to be aware of – eating our feelings is dangerous. The only healthy way to manage feelings is to fully experience them a talk about them. Say to yourself, “I’m having this bar of chocolate because I’m really sad” – you may then decided you don’t need the bar of chocolate and may express your emotion in a different way but as long as your acknowledge it, you can make sure that you deal with the underlying emotions as well.

As a generalisation, people are over weight because they have consumed more calories than they have expended. This is likely to be because they have done more eating for reasons numbers 1 and 2. I reiterate, these are not wrong, but we need to be mindful of them in order to keep them in check.

Being mindful of what we’re eating and why is the most important part of having a healthy relationship with food. Having a healthy relationship with food is not about say “yes” or “no” to “good” or “bad” foods, it’s not about having rules, it’s about listening to our body and being aware of what it needs and when.

(I’m not entirely sure I’m as in tune with my body as I’d like to be – I say I’m fully recovered form anorexia but I still struggle to know when I’m hungry, what it means when I’m craving food and most of the time I feel totally disconnected from my body – it’s work in progress!)

“Going on a diet” doesn’t change anything
Potato

Eating potatoes [insert latest fad] for a month may help you lose a few pounds but if you’ve not changed your relationship with food, when you come off the diet, it’s fairly predictable what’s going to happen…!

The way to a healthy body is a healthy mind

Biscuits are on the side during a tea break/cake is handed ‘round during someone birthday/chocolates are “calling you from the sweetie draw” – do you have one? Do a quick check with yourself:

  1. Are you hungry? – is this an appropriate thing to be eating at this time of day to satisfy the hunger you have?
  2. Are you feeling emotional? – is this an appropriate thing to eat to cope with how your feeling? Would you prefer to manage your emotions in another way?
  3. Do you want it just because it’s there? – that’s ok, but make sure you’re making a conscious decision and be aware that you are not eating this because you need it.
Discipline is choosing between what you want now, and what you want most. Quote attributed to Abraham Lincoln with background of mountains and trees

Because diet culture is so much the norm, language around food is really unhelpful. If you say “no” to the birthday cake, other people (who are probably feeling guilty* about eating some) will say “oh, you’re so good”. But it’s not about being “good” or “bad”. It is entirely up to you whether you say “yes” or “no” when feeling peer-pressure to join in, only you know why you’re eating it and whether you have a healthy relationship with food.

*I recently heard Raymond Blanc completely baffled by the question “what’s your guilty pleasure?” – he couldn’t comprehend why anyone would feel guilty about feeling pleasure from food. (Obviously) he’s right! We should never feel guilty about eating. If you’re eating, no matter what you’re eating, if you’re aware of why you’re eating it, no matter whether it’s reason 1, 2 or 3, and you’re ok with your reasoning, and it’s giving you pleasure – just enjoy it!

People end up feeling guilty when their relationship with food is such that they lie to themselves about why they’re eating. Tackling the reasons will in turn address the guilt. We should not feel guilty about nourishing our bodies!

Say no to fad diets text written using food to form the letters

We may need to re-educate ourselves about what a healthy diet looks like. For our bodies to function healthily and feel good we need a balance of carbohydrates, proteins, fats, fruits and veg. No foods are “off limits” but some may need to be eaten less often. A good relationship with food is about mindfully saying “yes”!

Eating disorders pictogram

EDAW myth busting! #2

This week is Eating Disorders Awareness Week! This year I’m busting some myths!

Eating disorders are only a problem for white people

This may be based on the assumption that other cultural backgrounds may protect against eating disorders, maybe we think having a more close knit family, or having particular moral and ethical views means you’re less likely to have an eating disorder?

Whatever the reasoning for this myth, it’s inaccurate. Clinical research has shown that eating disorders are just as common, if not more common in people from black and minority ethnic backgrounds than in people from white backgrounds.

If a black male in his 20s walks into their GP surgery with low self-esteem and poor body image, more questions need to be asked about eating behaviours, it cannot be assumed he does not have an eating disorder.

We also need to remember that people from different backgrounds may present differently. As hard as this may be to hear, the closer a family is, the more deceptive the eating disorder may need to be to thrive. Eating disorders can be very clever and stay undetected for years, gradually gnawing away at the individual.

There is a lot of shame and guilt involved in eating disorders and the behaviours that come with them. In some cultures, lack of understanding about eating disorders may even lead to disgrace or dishonour.

The brain, just like any other organ can get sick; when the brain is sick, it leads to unusual behaviours, such as eating more or less than our body needs.

It is important factual information is shared so that all people have equal opportunities to access support and treatment. No matter what someone’s ethnic origin, the earlier the receive help, the more likely a positive outcome. With the right support people can recover from eating disorders.

Group of people from different backgrounds sitting in a circle having a therapy session