Reconciling The Battle Within
Coping with Moral Distress in our Everyday Lives
Picture this — you’re a young adult who grew up in the messy sociopolitical ecosystem of a country classified as the global south, who then immigrated to the so-called Glorious West to pursue educational and career goals. Your values are deeply rooted in being an active advocate for intersectional social justice pertaining to both your position as a settler benefitting from oppressive colonial structures in your new home, as well as the complex, multi-layered interplay of identity politics from your culture of origin. Every afternoon, you peruse through your news feed to stay updated on current events, and every so often, you join forces with your friends and community to organize/engage with activism through the likes of peaceful protests, events, and fundraisers.
One evening, while volunteering at an event to gather resources for populations affected by the housing crisis, you witness police-initiated force directed at an individual you think might be experiencing acute mental health distortions, which then escalates into a bigger scene of violence. This leaves you feeling extremely activated, with anger, fear, and despair swirling around in unending circles; questions around fairness and harm caused by institutions are reignited at full volume alongside feelings of powerlessness and desolation. You find yourself torn between your desire to continue your advocacy for justice and a very real concern for your safety. This is then amplified by the constant exposure to news and media outlining the near-daily occurrences of social injustice, taking a heavy emotional toll.*
This is a common and relatable example of a situation that fosters moral distress (Jameton, 1984) — a phenomenon described as an emotional response to being faced with external barriers that prevent us from responding to a crisis with integrity. Here, your moral values clearly flag the needless use of physical force against a member of a marginalized population as an injustice, and when possible, your moral compass pushes for you to take action to resolve the harm caused. However, external barriers like your physical safety, or political implications surrounding your status as an immigrant may prevent you from taking direct action the way your inner voice urges you to.
Behind the scenes of the brain
Exploring the jumble of uncomfortable emotions often leads to a motif of feeling angry, frustrated, disgusted, and undervalued with these emotions being directed both at the self and the world (Rushton, 2016). This often nurtures a deep sense of discomfort that in turn externalizes as depression with a touch of moral/ethical desensitization if left untouched. Understanding the brain science of this phenomenon, however, brings us a step closer to processing this (inevitable) alphabet soup of discomfort in healthier, more functional ways, reducing the intensity of emotional whiplash that we would otherwise need to deal with.
The human brain is but a soft mush that zapped itself alive by being able to create/conduct tiny electric signals, not unlike a squishy, grey Arduino board. One of its foundational components that has been instrumental in our journey of evolution is the amygdala — a.k.a the almond-shaped region that processes external stimuli to ensure the neural system is responding appropriately to any detected threats. It is also famously known for its ability to generate false positives where a minor inconvenience triggered by a small cause gets interpreted to be on par with being attacked by a prehistoric big cat on the African savannah at the early stages of Sapiens’ development.
While the amygdala is known to respond beyond proportion to a lot of different stimuli (here we say hi to the friendly neighbourhood anxiety disorders), moral quandaries actually have been found to be essential to human existence. Decades of research into moral and evolutionary psychology tells us that moral foundations played a key role in the ways ancient humans learned to socialize, organize themselves into communities, and create frameworks for interacting with the world around us (Haidt & Joseph, 2004). Thus a challenge to our morality is in essence a threat to our core human functioning.
Much like the issues that arise from ignoring symptoms of other illnesses, not finding healthy ways to regulate moral distress can snowball into much bigger problems that in turn manifest themselves as problematic, and potentially harmful, behaviour. The most studied manifestation of chronic moral dysregulation is the behaviour of “othering” individuals that may fall outside our own unique experience of moral distress (which, naturally, is most people who aren’t ourselves) where we slowly but surely develop a sense of isolation — both socially and morally. And once the isolation sets in, it becomes infinitely easier to overlook the mountain of well-being benefits we gain from solidarity in community (Wolpert et al., 2013).
Making changes
So how do we cope with moral distress in healthy and prosocial ways? As with most procedures in dealing with psychological health, the first step is awareness, closely followed by acceptance and action.
i. Taking stock
Recognize that you are experiencing moral distress. Are you feeling a sudden pang of anger and fear when you think about an incident or event? Or maybe an overwhelming sense of powerlessness, like the world is burning all around and there’s nothing you can do to stop it. These are often tell-tale signs that there is a forced misalignment between what you believe is the right thing to do and what you are able to do.
The logical next step is to understand the root of the discomfort. What about the situation feels wrong, what frustrates you? Lay it out like you are telling a story at a dinner party, complete with all the details, tangents, and detours and walk yourself through it like you would a friend. Once you have a story in your head, it becomes easier to understand how it all fits together, forming the bigger picture for more clarity.
ii. Holding space for feelings
Now comes the hard part — it’s time to validate and hold space for your feelings. Having an understanding of why we feel the way we do can be a good first step to building compassion for ourselves, but now it’s time to do the actual dirty work. Find yourself a comfortable spot to settle into and just, well, feel your feelings.
If you’re anything like me, you might notice yourself switching into a mode of judgment, where the incentive to act on your feelings comes from the need to avoid the space you find yourself in, rather than finding the best way forward.
Breathe, hydrate, journal (or cook/paint/go for a walk), and remember that what you are feeling is both temporary and in reaction to your situational space — it’s not a global indictment on you, the person.
iii. Offsetting for self-care
You’re feeling more grounded emotionally, with a better understanding of yourself within the context of the world around you at this given time. But despair is a difficult thing to work around, especially with just radical acceptance and feeling a little grounded. This is where offsetting comes in handy.
Offsetting is a simple behavioural concept that can help alleviate the feelings of powerlessness we find ourselves in when we see the world burning. It works on the idea of mapping out our locus of control and reminding ourselves that there is still meaning and that we still have control over our lives. In the context of moral distress, I like to practice offsetting in these 3 simple steps
Recognize the injury; figuring out what makes me feel powerless is essential to combating the problem.
Find something to engage with that falls within my locus of control. This helps me keep busy while simultaneously helping me feel like I’m not totally helpless.
Connect with community. Sometimes all we can do is have a hearty rant session with a friend who understands our situation, and that can be medicine enough.
Feeling like we cannot act on a moral need is a cause for deep emotional turmoil for many of us. But it is possible for us to take the feelings of helplessness and powerlessness and work them into opportunities for growth, personal empowerment, and moral resiliency. It’s not always an easy path to walk (in fact, it’s almost never easy) but taking care of ourselves is key to taking care of each other and the world. Breathe, hydrate, and offset — you’ve got this!
*The example scenario laid out in this article is entirely fictional, modelled after common anecdotal experiences of the author and members of her community.
Haidt, J., & Joseph, C. (2004). Intuitive ethics: How innately prepared intuitions generate culturally variable virtues. Daedalus, 133(4), 55–66.
Jameton, A. (1984). Nursing practice: The ethical issues.
Rushton, C. H., Caldwell, M., & Kurtz, M. (2016). Moral Distress. The American journal of nursing, 116(7), 40–49.
Wolpert, M., Humphrey, N., Belsky, J., & Deighton, J. (2013). Embedding mental health support in schools: Learning from the Targeted Mental Health in Schools (TaMHS) national evaluation. Emotional and Behavioural Difficulties, 18(3), 270–283.
