Moral Injury and Vicarious Trauma

The potential consideration

In previous articles we have explored the impact of trauma upon our guests by thinking about the potential emotional impacts of being displaced, the key facts about Post-Traumatic Stress Disorder (PTSD) and managing triggers. We have also touched upon the impact that hosting someone experiencing these responses can have. In this article we are going to explore host mental health further by introducing two related phenomena which hosts may experience as a result of being exposed to a guest’s trauma. These are ‘vicarious trauma’ and ‘moral injury’. Not all hosts will experience these, but it helps to be aware of them so you can spot the signs early and manage them effectively if they do arise.

Moral injury: The psychology facts

Moral injury is a natural response to witnessing something that has violated your moral or ethical code, which you have been unable to prevent, and/or the systems that you trusted to prevent the harm have failed to do so. Moral injury is being seen more frequently in our society at the moment in response to the pandemic (e.g. individuals feeling let-down by the government or by the organisations they work for), increased awareness of systemic racism through movements such as Black Lives Matter, and of course the war in Ukraine. Responses to moral injury include:

  • Feelings of shame and guilt

  • Feelings of disgust, resentment and anger. In this situation these responses may be directed towards certain global leaders, or the systems in our own country which your guest is navigating

  • Changes in deeply held beliefs about yourself, other people, the world and the future. For example, if you have always held beliefs that other people are generally trustworthy and that the world is generally safe, you might start to doubt these deeply held core beliefs.

  • In response to these beliefs being affected, you might start to have thoughts that are more negative and self-critical towards yourself and others. Or you might start to feel more hopeless about the future.

Moral injury is not a mental health condition, but it can have a significant impact upon a person’s wellbeing and lead to an increased risk of mental health difficulties, because it affects our deeply held beliefs and our trust in society.

Vicarious trauma: The psychology facts

Vicarious trauma is a response to engaging and empathising with the traumatic experience of another person. It is not technically a mental health disorder, but is associated with a higher risk of developing PTSD and other mental health difficulties. Much of the literature on vicarious trauma relates to healthcare professionals, but this article will relate it to hosts. Here are some signs of vicarious trauma:

Signs adapted from the British Medical Association website https://www.bma.org.uk/advice-and-support/your-wellbeing/vicarious-trauma/vicarious-trauma-signs-and-strategies-for-coping:

  • experiencing lingering feelings of anger, rage and sadness about your guest’s victimisation (the key here is lingering – it is natural and appropriate to feel these emotions at certain times, but they should not become chronic experiences)

  • becoming overly involved emotionally with your guest

  • being preoccupied with thoughts of your guest and/or their experiences

  • feeling responsible for “rescuing” your guest and over-stepping boundaries (e.g. trying to play the role of a therapist, parent, partner, etc)

  • experiencing bystander guilt, shame, feelings of self-doubt

  • loss of hope, pessimism, cynicism

  • emotional distancing, numbing or detachment

  • avoiding your guest

Tips for managing these as a host

There is much overlap in the tips for managing these two phenomena. We have indicated here when tips are more relevant to one than the other. Unless otherwise specified, the tip is important for preventing and managing both!

  • Basic self-care. As we’ve advised in previous posts, the importance basic self-care should never be overlooked when managing your wellbeing. This includes not losing the balance of your own work and leisure activities – make sure you are giving attention to all areas of your life, not just focusing on your guest.

  • Seek social support. Social support is one of the best predictors of wellbeing. Whether it is your friends, family or networks of other hosts – reach out!

  • Validate your feelings. One of the top tips for managing the impact of moral injury is recognising and acknowledging the moral or value that has been violated. Speaking to others about this is important for processing the resulting emotions and gaining a sense of solidarity. Label and validate how your feeling – remember that the reason you are affected by this is because you are a person with good morals and values!

  • Engage in ‘moral repair’. To reduce moral injury, the literature recommends taking actions to engage in ‘moral repair’. By hosting, you are already doing something incredibly valuable, so focus on the things you are doing to help, rather than the things you can’t control.

  • Reframe unhelpful thoughts. Both phenomena can lead to negative and self-critical thoughts. In situations like this, we can’t deny the truth of the reality or pretend everything is OK. The best strategies are therefore those that help balance our thoughts rather than deny them. Using ‘both-and’ thinking can help with this, for example “these atrocities are horrific and while I cannot fix the situation, I am doing my part to help in ways that I can”.

  • We can also use this strategy to hold onto the positive aspects of our lives while acknowledging the very difficult emotions that we may be faced with, for example “I’m feeling very sad about the experience my guest has been through and I feel guilty I can’t do more and it is my partner’s birthday today so I can allow myself to have some fun and enjoy the celebration”. In the face of horror it is important not to lose sight of the positives that still exist in the world.

  • Practice self-compassion. Related to the previous point, strategies based on acceptance and self-compassion are most recommended to manage the impacts of moral injury. Neither of these try to pretend everything is OK, but they encourage us to let go of the struggle with the distress and be kind to ourselves. My favourite resource for learning about and developing self-compassion is here: https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Self-Compassion

  • Boundaries. Holding emotional boundaries is crucial for maintaining healthy wellbeing in general, and for preventing vicarious trauma in particular. See our previous post on this topic.

  • Be realistic about what you can do. You can’t “fix” the situation. Set yourself practical boundaries about what support you’re able to offer and stick to this. Don’t take on responsibility for your guest’s wellbeing. It is better to support and empower them by guiding them towards tools and support networks, so that they can regain their sense of self-efficacy and autonomy. While important in all situations, this is especially important for preventing vicarious trauma.

  • Reduce unhelping coping. Try to avoid using coping strategies such as withdrawal, increased substance use or self-destructive behaviours. These may provide relief in the short-term, but are likely to lead to more difficulties in the long-term.

  • Ask for help. If you notice several of the signs of vicarious trauma becoming persistent, or you feel the impacts of moral injury are significantly impacting your wellbeing, reach out for professional support. It is brave and courageous to know when to ask for help and there is support out there. Consider making an appointment with your GP to ask for specialist support. 

Dr Natalie Isiah