The importance of identifying the moral shock in clinical care

Participated in his writing, Tyler Vandroel, and Jennifer Wathimam.

Our moral understanding of righteousness, error, and good and evil is essential to whom we are. This understanding directs our actions and assessments and constitutes our feeling of integrity and perfection. When our moral understanding is severely broken due Guiltand shameAnd confusion.

Concepts “” “Ethical injuryOr “moral pollution” resulting from commitment, experience or scene to make common mistakes in a lot SocietiesAnd it is given a living expression in the great literature in the world, from Oedipus to Lady Macbeth and beyond. However, in recent decades, psychologists have begun to use the term “ethical injury” to talk about a distinguished condition, due to the disruption of moral understanding. Jonathan provided early descriptions in documenting the experience between Old warriors. The idea was developed more in scientific literature by Brett Liets and his colleagues who concept The ethical injury that involves an act of infringement (either committed, witnessed or experienced as a betrayal) violates deep assumptions and beliefs about right, error or personal. The symptoms that some old warriors suffer from after after- were distinguished from-shock pressure Disorder (Post -shock disorderThe treatment of post -traumatic disorder is sometimes insufficient to treat difficulties. In a distinctive way moral You should handle the aspects of betrayal, or commit a wrong act.

Also, the relevant phenomena, described as “moral distress”, were also described in Nursing literature. Nurses may feel sometimes that they know the right thing to do to care for patients, but institutional restrictions may prevent them from behaving accordingly. The inability to behave truly can similarly lead to extreme distress from the moral nature.

Although many have written in the past decades about moral injury and moral distress, many definitions and assessments have been presented, and work in these two fields is often separate. In addition, a lot of work focused on moral injuries on the context of committing a wrong act, or being a witness to such an act and a sense of betrayal. Less written about the experience of an ethical injury that may arise sometimes from being a victim of such an act. However, in some cases, these experiences can shake a person’s sense of right, wrong or good.

Over the past few years, some of us have been in the Harvard University of Harvard, and they are trying to develop a more united approach to moral injury and moral distress that applies to perpetrators, witnesses and victims. We have gathered a number of experts on this topic to work with us, and earlier this year they published a paper about Moral shock Place this vision, and the other we hope will eventually lead to a better clinical attention For these things as well.

The spectrum of moral shock, definitions and evaluation

In an attempt to collect these concepts together, we depicted such moral distress like He lies On the “moral shock spectrum”, which included the issues of both the intensity and continuation of the distress. After months of synthesizing the previous work, we identified “moral distress” as “distress that arises because personal experience is disrupted or threatened: (a) One’s sense of commodity, or for others, institutions, or what is understood that it is higher power, or (b) the individual beliefs or intuition about righteousness, error, evil or evil.” When this distress became fixed enough, it will form a “ethical injury”. With regard to such moral distress or moral injury, some moral law was not violated, but rather everything that happened in one way or another was from understanding righteousness and error, good and evil, or good for others, institutions, or even divine. This disruption to understand the moral individual would sometimes lead to severe distress. When this distress was continuing and will not disappear, it will be appropriate to talk about a “ethical injury”. When the distress was severe enough to seriously weaken work over long periods of time, it may sometimes be appropriate to talk about an ethical disorder.

These definitions, which depend on the work and synthesis of others, were generally enough to be applicable to perpetrators, witnesses and victims; As well as to capture a variety of phenomena from the institutional moral distress of the nurses, to the experiences of old warriors, to the victims of other unethical acts, as is the case in cases Sexual assault.

The general definitions also allowed a joint evaluation of such moral shock, including the introductory assessments related to confusion, doubts and concerns about the concepts of righteousness, error, error and evil, or goodness of the self or others, but also the moral symptoms that may arise from this moral shock, including shame, shame, and Tarshayal, AngerDisability, despair, loss of meaning, struggle with faith, struggle with forgivenessAnd loss of confidence. Our paper provides more details about conceptual background, the same evaluation, and discrimination from PTSD. Although there is a need to work to verify the health of the psychometics and evaluate the clinical tool for the scale, our hope for this unified evaluation is that it will help enhance our understanding of moral distress and moral injury. Our hope for this work was that it would affect the provision of clinical care.

Confession in DSM-5

Parallel to the conceptual work and evaluation, the members of our cooperative team also worked with the American Psychiatry (APA) Association to provide recognition of these phenomena of moral distress and a large -scale ethical injury Diagnosis and Statistical Guide for Mental Disorders (DSM-5-TR). In December 2024, APA took a historical step by agreeing to add “moral” to “religious or” Spiritualism The problem of “category” in the section of other circumstances that may be the axis of clinical interest in “DSM-5-TR. DSM-5-TR update It includes aspects of the definition of moral distress above, saying, “Ethical problems include experiences that disrupt an individual’s understanding of right and error, or a feeling of goodness in particular, others or institutions.” There is a paper depicting and documenting this addition to DSM. Our hope is that the new DSM Z-Code opens important opportunities to raise awareness, treat ethical shocks, moral distress and ethical injury.

Acknowledging the whole person

As people from humans, we are not only physical and mental creatures, but we are also social, moral and spiritual creatures as well. Our ability to treat physical and mental diseases has expanded significantly over the past decades. However, more attention must be paid to the social, moral and spiritual aspects of our lives. While facing our social, moral and spiritual challenges, it requires efforts that go beyond the clinical field, these issues should not be ignored in caring for patients. If we really want to provide care for a person, the real possibility of moral cluster and moral injury must be recognized. The current recognition within psychiatry is a step forward in this regard, and a greater moral thinking and awareness throughout society, and perhaps especially when dealing with shock, will enable us better to enhance prosperity amid the suffering that we face individually and society.

Jennifer Wrighton He is a participant researcher in the Harvard University of Harvard.

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