The collectivist spirit of sewing masks and applauding health care workers from the spring has given way to vitriolic politicization of basic public health measures like mask-wearing, said Wendy Dean, a physician who co-founded the nonprofit Moral Injury of Healthcare to highlight issues of clinician distress.

“All of us have the need to feel normal,” she says. “But we’re continuing to demand as much of ourselves as we did before – to be the perfect parent, the perfect worker, the perfect student. People have to find a way to have forgiveness for themselves and recognize that they’re doing the very best they can.”

What exactly is moral injury – and how do we address the continued challenges faced by healthcare workers?

Researchers are concerned that nurses working in a rapidly changing crisis like the pandemic can develop a psychological response called “moral injury.”

“Probably the biggest driver of burnout is unrecognized unintended moral injury.”

In parts of the country over the summer, nurses got some mental health respite when cases declined, said Dr. Wendy Dean.

In this episode, Chris McDonald from Nothing Left to Give interviews Moral Injury of Healthcare Associate Elizabeth Holman, PsyD who is the palliative care psychologist at a Hospital in Colorado where she also serves on the ethics consult service. She is the handler of facility dog Tootsie and her research has focused on human-animal interactions.

“The pandemic arrived to a healthcare system that’s already deeply in crisis,” said Wendy Dean, a psychiatrist and president of Moral Injury of Healthcare, a group that advocates for more sustainable medical workplaces. “All of the challenges that clinicians are facing prior to the pandemic are just highlighted, exacerbated, and added to.”

In a recent article by Pratihba Gopalakrishna, a new study is discussed that focuses on burnout and how commonplace it may be. However, Drs. Wendy Dean and Simon Talbot believe the definition of burnout needs to be reexamined.

“If we’re going to talk about the condition of burnout, then we need to be much more rigorous about applying a strict definition and measure so that everybody’s talking about the same thing using the same scale,” said Wendy Dean, a psychiatrist and the co-founder of the nonprofit organization Moral Injury of Healthcare. Dean was not involved in the new research.

In this piece entitled A Yoga Mat Won’t Fix Your Moral Injury by Ira Bedzow, PhD, moral injury is explored by Dr. Bedzow as a medical ethicist.

But people who suffer from moral injury are not slogging through endless tasks, and they are certainly not losing interest and motivation–they are hurting. And their hurt comes from their perceived inability to meet personal and professional expectations and the moral accountability they feel by their sense of failure.

In this segment with NPR’s Here and Now, Dr. Wendy Dean is interviewed by Amanda Peacher on the toll the COVID-19 crisis is taking on front line staff in hospitals.

Some psychiatrists are even manning a hotline to help their fellow healthcare workers.

In this most recent article from Drs. Dean and Talbot, they explore the concept of mindfulness as a diagnostic, rather than treatment for moral injury.

What would happen if clinicians flipped the script on mindfulness, and instead of using it to tolerate a broken system, used it to sharpen awareness of the challenges?

During this pandemic, most people have been grateful for the courage of medical workers. We have heard about the physical demands and emotional burnout they have suffered; but far less about moral injury.

Clinicians wade into the breach of COVID-19 without sufficient protection, even as their pay is cut, their protests gagged, their employment threatened, and as they watch their colleagues and friends fall ill.

We mustn’t lose sight of how moral injury is in the fabric of this pandemic.

“It’s going to take weeks or months before people are really able to take a breath and start thinking about all they’ve seen, all they’ve experienced and to start processing it,” Dr. Wendy Dean says. “I firmly believe that the mental health surge is going to be significantly delayed from the viral surge.”

In this piece for the Richmond Academy of Medicine, Dr. Wendy Dean warns of a looming mental health crisis for the physicians on the front lines of COVID-19. Entitled COVID curve 1.5: a brewing crisis of clinician mental health, Dr. Dean addresses hero-worship and the stigma facing physicians for seeking support.

Dr. Wendy Dean was invited to testify at the New York City June 16, 2020 City Council hearing. During this testimony, she shared that a “culture of self-sacrifice” stops medical staff from seeking help for mental-health issues in the first place.