This is part 2 of my series on moral hardship and cultivating moral resilience. Read part 1 here.
Moral distress is a term coined by philosopher Andrew Jameton in 1984 to describe the suffering of nurses when institutional or systemic barriers prevent them from acting with integrity, particularly when it comes to fundamental moral principles and ethical responsibilities. More recently, the concept has been extended to other professions, including healthcare professionals in general, social service providers, teachers, law enforcement, the military, emergency services, lawyers, journalists, and politicians. In our daily lives, this type of suffering can take a serious toll on beliefs, relationships, and affiliations.
Moral distress is the feeling that we have had to compromise ourselves or something we hold dear because of external forces that seem beyond our control. It is also the feeling that others do not grasp a moral meaning or moral imperative that is clear to us. Moral distress arises when our values are repeatedly not respected, be it individually or collectively.
Moral distress causes anger, disgust, fear, and frustration; also the feeling of being silenced, restricted, devalued, unheard or rejected. Research (Rushton, 2017) also shows that moral stress has long-term consequences, such as burnout, exhaustion, numbness, separation, and decreased moral sensitivity (also called “compassion fatigue”).
The following practices can help you develop moral resilience when you are feeling constrained by a morally difficult situation and are struggling to hold on to your integrity.
1. Self-Control: The art of self-regulation
Self-control is the present-focused realization that we can always be in control of ourselves—body, mind, and spirit—even as we accept that we may not be able to control all situations or outcomes. It’s about learning how to do it fight well, beginning with turning our attention inward, or activating interoceptive awareness. Interoception helps us become aware of what’s happening beneath the surface that might be driving our feelings, thoughts, and actions.
When we go within ourselves, we don’t try to suppress uncomfortable emotions or judge them as wrong or weak. We give them space to tell us something new about what is happening. We observe and become curious as to what moral values, obligations or responsibilities are not being met; what that says about the stressful situation and us; and how we might find other ways to satisfy them.
2. Self-knowledge: “Be true to yourself”
Moral resilience is based on moral conscientiousness. It reflects an alertness to live in a way consistent with who we are and what we stand for amidst situations that seem inconsistent with integrity (Rushton, 2016, p. 113). This vigilance, or desire to be moral, requires that we be fundamentally aware of what values, commitments, and imperatives make up our moral core. This requires regular review, otherwise we risk becoming complacent or losing our moral sensitivity. At the same time, we want to avoid becoming rigid or dogmatic.
Being self-aware is an intentionally embodied dance that requires us to continually explore our feelings, thoughts, and desires—and do so humbly, carefully, and boldly, with what I “benevolent honesty.” We must also do so with transparency, meaning being willing to acknowledge when our beliefs have become biased, distorted, short-sighted or wrong, and being open to change, revision or alternative outcomes. Self-awareness gives us space to discover ways to respond to morally distressing situations with our heads held high, eyes wide, shoulders relaxed, and trust grounded in our core, all at the least personal cost.
3. Self-expression: Choose and contribute in an ethically clear and competent manner
There are many ways to express yourself, but when it comes to moral resilience, two avenues can be particularly helpful: developing ethical skills and speaking with clarity and confidence.
Ethical competence includes ethical embodiment (Rushton, 2016), which means living the values we hold by ensuring that what we hold to be true and sacred is reflected in our actions. It is about immersing ourselves in the “moral” world by cultivating a moral vocabulary, an imagination, an attitude and a coherent character, as well as a dynamic moral attitude – being patient and open and flexible towards the values, hopes and fears of others .
Speaking with clarity and confidence means voicing our concerns by bringing troubling issues to the attention of committed others. Do not view moral distress as a dead end, but as an entry point into a broader and more informed conversation about the dynamics of the situation. Speaking with clarity and confidence also involves knowing when to apologize from a situation, system, or relationship, be it momentary or permanent, because that situation could damage our conscience beyond repair.
4. Creation of meaning: Don’t demand it, create it
Meaning making is the process of how we perceive, interpret and make sense of events in life, in relationships and within ourselves. It gives us a way to organize memories and shape the narrative of an experience. Purpose also helps us to reconcile mismatches in our values, beliefs, and expectations, and in our approach to life. This is especially important in times of moral need.
Senseless suffering is a big theme in moral resilience. We often think: “Why do I keep doing ‘this’ if nothing changes?” Or: “I do everything I can to make things better, but nothing I do is enough.” And : “I am fighting a system that is inherently flawed or harmful.” These nudges can either fuel a disempowering, dead-end narrative or become the basis for principled and embodied action.
One way to create meaning is to consider alternatives that may not seem obvious or that you have previously rejected. Think about it, is there any information you missed or misinterpreted? Are your complaints obscuring relevant information? How can you look at the situation from a more nuanced and multi-stakeholder perspective?
Also, consider how this situation prompts you to grow. What new insights about yourself, others and life have come to light? What core competencies did you rely on? What weaknesses have you identified? Which values, responsibilities or moral imperatives have remained constant – and which have changed? How does all this meaning live in you?
A mistake often made when it comes to finding meaning is to think that it is a lesson to be learned or the “moral of the story”. Not so. Meaningfulness does not attempt to turn pain into a happy ending, nor does it necessarily attempt to teach us cautionary tale realities. Meaningfulness simply helps us expand our thinking and feeling about a morally difficult situation and allows us to move forward with integrity and principled action.
5. Connectedness: Interact with others
Being connected is one of life’s realities; In fact, recent neuroscientific research (Wolpert, 2013) shows that we’re hardwired to do this: When we talk to other people, mirror neurons in our brain light up to mimic the emotions and behaviors that the other person is conveying. Matthew Lieberman, director of UCLA’s Social-Cognitive Neuroscience Laboratory, points out that people’s need for connection is even more fundamental than food and shelter, and is the primary motivation for a person’s behavior.
Reaching out and letting in trustworthy people is an absolute must when it comes to cultivating moral resilience. And notice the word “trustworthy” here. This is also the key. Sharing challenges, difficult emotions, and frustrations can make us feel vulnerable. Being in the depths of moral need is not necessarily the time to test the waters with those whose presence cannot be counted on, to listen and listen, to have empathy and show compassion, and to offer benevolent honesty and reasoned hope. Knowing that you are not alone in your moral struggle can go a long way in relieving feelings of isolation and despair.
We never want to take control more than when we don’t have it—and when we’re morally distressed, it can Yes, really feel like we don’t have it. Shifting the narrative from powerlessness, hopelessness, and helplessness to one defined by opportunity and principled choices will help both mitigate the effects of moral distress and cultivate moral resilience.