Latest / The Well with Dr. Wendi / It's Not Burnout. It's Moral Injury

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It's Not Burnout. It's Moral Injury · The Well with Dr. Wendi

• 0:00
  SPEAKER_00: Welcome to the Well, a wellness-centered podcast for leaders.
• 0:04
  SPEAKER_00: I'm your host, Dr.
• 0:05
  SPEAKER_00: Wendy Williams.
• 0:06
  SPEAKER_00: I've spent more than two decades working with leaders and studying the relationship between work and wellness and how that shapes and feeds our leadership.
• 0:14
  SPEAKER_00: Wherever you are on your leadership journey and wherever you lead, you will learn something here.
• 0:20
  SPEAKER_00: You are welcome here, exactly as you are.
• 0:24
  SPEAKER_00: Welcome to the well.
• 0:42
  SPEAKER_00: Wherever you are, whatever you've carried in with you, you don't have to carry it for the next little while.
• 0:49
  SPEAKER_00: Let's go ahead and place that down.
• 0:52
  SPEAKER_00: This is a place to draw from.
• 0:54
  SPEAKER_00: Not one more place that has something of you.
• 0:58
  SPEAKER_00: So let's take a breath in together.
• 1:03
  SPEAKER_00: And let the outbreath be the longer one.
• 1:07
  SPEAKER_00: Let it linger a bit.
• 1:08
  SPEAKER_00: Slow it down.
• 1:12
  SPEAKER_00: You've been holding something up, maybe for a long time.
• 1:17
  SPEAKER_00: You don't have to name it.
• 1:19
  SPEAKER_00: You don't have to fix it.
• 1:22
  SPEAKER_00: Just for now, set it down, put it beside you.
• 1:26
  SPEAKER_00: It will certainly still be there when we're done.
• 1:30
  SPEAKER_00: But you won't be quite as alone with it.
• 1:33
  SPEAKER_00: We will be in the well together.
• 1:36
  SPEAKER_00: And this is what the well is for.
• 1:39
  SPEAKER_00: You came to replenish to think.
• 1:44
  SPEAKER_01: And when you're ready to lead from a full place, not an emptied one.
• 1:51
  SPEAKER_01: So one more breath in.
• 1:57
  SPEAKER_01: Let's begin.
• 2:00
  SPEAKER_00: So hello and welcome back to the well.
• 2:03
  SPEAKER_00: I'm your host, Dr.
• 2:04
  SPEAKER_00: Wendy.
• 2:05
  SPEAKER_00: So before we begin, as we always do, I want to name where we are in this cycle.
• 2:10
  SPEAKER_00: Last time we talked about remember the first stage.
• 2:13
  SPEAKER_00: And that's when we sort of are looking back at what the season took and the architecture beneath that remains and is something that we continue to carry forward no matter what the title, no matter what the job was or has been.
• 2:27
  SPEAKER_00: Today we are moving into the repair and recover stage.
• 2:30
  SPEAKER_00: That's the focus of this episode.
• 2:33
  SPEAKER_00: And we want to be careful with this word repair because repair is not about an absence of work or an absence of stress in a particular context.
• 2:40
  SPEAKER_00: It's not about just feeling better.
• 2:43
  SPEAKER_00: Repair is active, it is the work to address what has happened.
• 2:47
  SPEAKER_00: And before we can ever do that, we first have to properly and accurately name what has happened because the wrong name can send you to the wrong help.
• 2:57
  SPEAKER_00: And so we want to make sure that we're using the right tool in the toolbox for ourselves.
• 3:01
  SPEAKER_00: So that's what we're going to be focusing on today.
• 3:04
  SPEAKER_00: And remember what the cycle is.
• 3:06
  SPEAKER_00: The cycle is not a ladder, right?
• 3:08
  SPEAKER_00: It's not linear in that way.
• 3:11
  SPEAKER_00: It is cyclic, it is spiral.
• 3:12
  SPEAKER_00: We are always returning and coming back to levels in the cycle because being human beings in a society that engage us, our work and our leadership in these repetitive and stereotypical ways means that we return back to some of these cycles and some steps rather in the cycle to address and be responsive to how we're managing and navigating that.
• 3:36
  SPEAKER_00: So I'm going to argue with my own episode title today.
• 3:39
  SPEAKER_00: I want to give you a heads up to that.
• 3:42
  SPEAKER_00: I'm not losing my mind, but I part of it is the teaching and teaching the distinction.
• 3:47
  SPEAKER_00: Getting the naming right is important.
• 3:49
  SPEAKER_00: And so that's what we'll be doing.
• 3:51
  SPEAKER_00: So stick with me as we do so.
• 3:53
  SPEAKER_00: And by the end, you will have a distinction that you can use, not only for yourself, but with the people that you work with, that you're leading, and those that you are in relationship with who can benefit from what you're learning at the well.
• 4:14
  SPEAKER_00: And it is a Zoom room that I'm sitting at as a dean of a small college.
• 4:21
  SPEAKER_00: In about six weeks, the entire universe of the institution will have been toppled.
• 4:27
  SPEAKER_00: We're learning, we've just learning that COVID has hit, and we all went home.
• 4:32
  SPEAKER_00: And then beneath the cloak of privilege and confidentiality, which is lawyer language for we're telling you something and you just have to hold and deal with it.
• 4:50
  SPEAKER_00: And now I'm sitting with that trying to figure out like what does it all mean?
• 4:55
  SPEAKER_00: I'm what I call a baby dean.
• 4:57
  SPEAKER_00: I am new to this and I'm learning my way and figuring that out.
• 5:01
  SPEAKER_00: And I'm excited about it.
• 5:02
  SPEAKER_00: It really matters to me the leadership role that I have been entrusted with, and I feel quite honored.
• 5:10
  SPEAKER_00: And at the same time, I'm trying to make sense of what that means for the folks that I've been entrusted with.
• 5:16
  SPEAKER_00: So I log into my own little version of the Hollywood Squares to tell my colleagues, my faculty, my staff, that the institution that they love, that the programs that they've poured their hearts into, uh, that the students who they stay up late for, uh the missed soccer games that and and other family uh obligations that they've taken time away for, uh that they've toiled over manuscripts to get tenure, to impress and and to show other colleagues that they are scholars in their area, that that institution, while it might exist in the way um, while it might continue to exist, will no longer be in the ways that they have always known it.
• 6:01
  SPEAKER_00: Uh and and for that, um I am entrusted to sort of share that news with them.
• 6:08
  SPEAKER_00: As I said, baby Dean, like little baby Dean.
• 6:11
  SPEAKER_00: Smart, capable, believing I can save the world, much more energy, much more flexibility in my knees, I'm sure.
• 6:19
  SPEAKER_00: But seriously, that, you know, I was holding a lot of bright-eyed and bushy-tailedness in that season.
• 6:25
  SPEAKER_00: And I was in this moment where I had to take that kind of news to my colleagues and sit with the despair that I knew would come with that.
• 6:34
  SPEAKER_00: Um, and, you know, I can admit and knew then that I was not thoroughly prepared for that, uh, for what it would take to hold the depth, uh, the um, the heaviness, um, and that the hope that I was bringing to this work as a new baby dean, um, that it would be fleeting over the next two years of this cycle that we had begun in, um, and that I had begun my tenure as dean in, and that that would sit alongside the pain, the hurt, and the heaviness that they would be grappling with, really the loss that they would be grappling with.
• 7:09
  SPEAKER_00: So it it was a bit to it was a bit uh to contend with.
• 7:15
  SPEAKER_00: So I learned pretty early and clearly that this concept, the way I've been thinking about my leadership uh as my ego and my youth have led me to believe, actually just doesn't matter.
• 7:26
  SPEAKER_00: It's not a useful way of conceptualizing what's happening in front of us because, you know, there is a way that I want to sort of be seen as navigating this, but that is of no real value uh in the face of what our colleagues, what my colleagues were grappling with, and and and their real experience of loss cannot be toyed with.
• 7:50
  SPEAKER_00: And so my sense of myself there just doesn't get to take up the room that it might otherwise take.
• 7:55
  SPEAKER_00: And it's one of the first lessons uh that that experience taught me and brought me into.
• 8:01
  SPEAKER_00: You know, clarity matters as much as the respect for the gravity of the moment.
• 8:04
  SPEAKER_00: And there are no outs for the weight of what we will have to carry.
• 8:08
  SPEAKER_00: And I wanted to make sure that I just simply didn't play with that and that I took it, I took it seriously, but it meant leading in and leaning into a type of leadership in a way that um in a way that I was being introduced to more clearly than from the textbooks and the theories.
• 8:29
  SPEAKER_00: The people here, you know, they're they were my people.
• 8:32
  SPEAKER_00: They're on the other side of the screen.
• 8:33
  SPEAKER_00: They were waiting to hear something from me and they were waiting to hear it from me specifically because I'm their person.
• 8:40
  SPEAKER_00: I'm their dean.
• 8:41
  SPEAKER_00: I'm their person who knows, I'm the one who sits in the rooms uh that you have to sign an NDA to sit inside of that tells me all the things that I can't talk about once I come back out of that room.
• 8:52
  SPEAKER_00: And so the task is between myself and them of trying to convey as openly and as honestly what I can while at the same time holding fidelity to uh the responsibilities that I have to the institution, but also that the promise I made around what it meant to be told everything while at the same time not being able to do much with it.
• 9:13
  SPEAKER_00: The content of holding answers to all the questions that they would have and that they would ask in or in order to know more, to gain a sense of what the future would hold, perhaps even have a sense of control of that, um, what would happen to them.
• 9:28
  SPEAKER_00: I knew much of that and I couldn't tell them.
• 9:31
  SPEAKER_00: Um, you know, I had the language that the consultants provided, typically talking points, you know, that were approved by outside and also our inside or general counsel.
• 9:42
  SPEAKER_00: Uh it was language that I did not write.
• 9:44
  SPEAKER_00: It was language that I could, you know, provide feedback on, but ultimately whether or not the way that I wanted to frame things and the amount of information I wanted to share would be permissible, that was altogether something that I did not have control over.
• 9:59
  SPEAKER_00: You know, the language that is offered tends to be something along the lines of a very slick truth that is open to some levels of interpretation or lacks a level of precision that makes it in some ways utterly useless for people who are really looking for specifics and that you can't share with them.
• 10:18
  SPEAKER_00: And ultimately what they do is fill in the blanks where they can try to find some comfort and uh, you know, make some meaning and some sense.
• 10:26
  SPEAKER_00: And that's always a complex place to be.
• 10:29
  SPEAKER_00: The language I had said partnership, uh, where merger and acquisition were probably more aptly uh were more apt description of what descriptions of what would happen.
• 10:40
  SPEAKER_00: And, you know, it uplifted the value of the institution and its people, knowing that what does not conform to the acquiring entity, that partner, would likely be cut away or reconfigured or required or asked to pivot whether the people or the organization, the programs felt that they could.
• 11:02
  SPEAKER_00: I say all of it and I say it entirely.
• 11:07
  SPEAKER_00: Um I answer the questions, I'm I'm composed, I am good at this, I know how to do it.
• 11:13
  SPEAKER_00: I I have the executive sheen, I know how to construct this this whole thing to conduct it effectively.
• 11:21
  SPEAKER_00: And that's the part that I sit with truly, is that I am good at this.
• 11:27
  SPEAKER_00: And that unsettles me a bit.
• 11:32
  SPEAKER_00: I do log off ultimately, and then I just sit there because you know I am grappling with what it means to be a vessel for a decision, to communicate a decision that I know will devastate uh my colleagues.
• 11:46
  SPEAKER_00: I know it to the core, and yet that is what I am charged to share and to convey.
• 11:50
  SPEAKER_00: The folks on my Hollywood Squares on the Zoom, they trust me.
• 11:54
  SPEAKER_00: And I I didn't say or do anything that did, you know, that that broke their trust.
• 11:59
  SPEAKER_00: But there's also a part of me that wants to say more that I know that they need and want more, and that I can't do that.
• 12:07
  SPEAKER_00: All I could give them was the sentence as it was written by someone who'd never witnessed a desperate search in their faces for something that felt tangible.
• 12:19
  SPEAKER_00: On that day, I can tell you that I was not tired.
• 12:23
  SPEAKER_00: I wasn't necessarily depleted.
• 12:25
  SPEAKER_00: I was actually well rested.
• 12:27
  SPEAKER_00: Um, but what I was sitting with was something that felt really difficult for me.
• 12:32
  SPEAKER_00: And it was because in that moment I had become a bit unrecognizable to myself.
• 12:39
  SPEAKER_00: Again, not because I betrayed or lied or forsake for you know myself, forsaken myself, but because there was just a part of me that wanted the who that I am, wanted to give and do more.
• 12:52
  SPEAKER_00: And, you know, to feel that, you know, there's no amount of rest that will relieve you of that.
• 12:59
  SPEAKER_00: You know, if you have ever logged out of that kind of meeting, walked out of that room where that kind of thing happened, or driven home from a conversation like that, if you've ever done the thing that you were charged to do because you had to do, and then had to reckon with yourself afterward, then the well and this particular episode is for you.
• 13:20
  SPEAKER_00: I'm gonna leave that scene for the moment, but we'll come back to it and we'll we'll we'll work it through a bit.
• 13:28
  SPEAKER_00: So there's a phrase that everyone has been moving through helping or that's been moving through the helping professions for the last couple of years.
• 13:34
  SPEAKER_00: And I think it lands every time.
• 13:36
  SPEAKER_00: It's not burnout, that's the one that we're used to.
• 13:39
  SPEAKER_00: The word or or the term has is called is is moral injury.
• 13:44
  SPEAKER_00: And it came from two physicians, uh, Simon Talbot and Wendy Dean in 2018.
• 13:50
  SPEAKER_00: And their argument essentially was that for doctors, that the situation wasn't burnout in the healthcare system.
• 13:56
  SPEAKER_00: These doctors were being asked every day to do to know exactly what their patient needs.
• 14:01
  SPEAKER_00: You know, they were good doctors, they knew how to help, and they and they wanted to provide that, but then they were prevented from doing so.
• 14:08
  SPEAKER_00: They found the word burnout actually lands badly on physicians because that implies a failure of having the resources to do the thing.
• 14:17
  SPEAKER_00: These doctors, um, it wasn't a lack of resources.
• 14:21
  SPEAKER_00: They were able to do that.
• 14:23
  SPEAKER_00: What burnout suggests is that you lack the resource and therefore you have, you can't build in the resilience to respond to that.
• 14:30
  SPEAKER_00: And so um that is the challenge there.
• 14:34
  SPEAKER_00: The writing that they had, you know, really hit home and made clear the distinction between burnout and moral injury.
• 14:43
  SPEAKER_00: Burnout puts the problem on the individual.
• 14:46
  SPEAKER_00: There's something about you, something about the situation that, you know, you're not able to deliver.
• 14:52
  SPEAKER_00: You don't have what you need, you're not smart enough, you're not capable enough, you don't have the knowledge base, time, something, you know, one feels individually responsible.
• 15:01
  SPEAKER_00: Moral injury puts the places the problem, the source of the problem, on the system.
• 15:08
  SPEAKER_00: And I get why that landed because I felt that myself.
• 15:12
  SPEAKER_00: So it landed personally for me.
• 15:14
  SPEAKER_00: Uh, and what is helpful sometimes in the academic literature and then just in the, you know, the popular um largesse of the space is that once you have a name for it, that that can bring you some comfort.
• 15:25
  SPEAKER_00: But here's the thing: what they were defining as burnout wasn't actually what burnout is.
• 15:31
  SPEAKER_00: And so I want to take you a little bit more deeply into the literature, into like what these concepts actually mean.
• 15:38
  SPEAKER_00: Uh, Christina Masleck and Susan Jackson gave burnout its definition in 1981.
• 15:46
  SPEAKER_00: And that definition has been one that folks have been using ever since.
• 15:51
  SPEAKER_00: Burnout occurs in three parts.
• 15:53
  SPEAKER_00: So, first there's exhaustion, then there's cynicism, and then there's the distancing from the people who you're supposed to serve.
• 16:00
  SPEAKER_00: And that ultimately results in a collapsing sense that you aren't any good at this, uh, whatever it is that you're doing.
• 16:06
  SPEAKER_00: Uh, and so what Masledge and uh Michael Leader went on to do is that they went looking for what are then the causes of burnout, like what creates this situation?
• 16:15
  SPEAKER_00: And you may be surprised or not, but that 100% of the causes of burnout are at the are at the organizational level.
• 16:24
  SPEAKER_00: So they found six of them.
• 16:26
  SPEAKER_00: That it's either workload, one sense of control of their situation, the reward or reward structure within the organization, community, so folks in the space and how they're interrelating with one another, fairness.
• 16:39
  SPEAKER_00: So when we see discrimination or any inequity in the spaces, and then values operating in um opposition to one's values.
• 16:50
  SPEAKER_00: A values mismatch between what you believe and what your institution is requiring of you was written into the burnout model from the very beginning.
• 16:58
  SPEAKER_00: Masslatch has spent nearly 40 years basically saying this.
• 17:02
  SPEAKER_00: It's the essence of it really, that burnout is a workplace problem and that we should stop handling it as a worker-level issue.
• 17:11
  SPEAKER_00: It's an organizational level issue.
• 17:13
  SPEAKER_00: But for some reason, we keep attaching burnout to the individual, and that is problematic.
• 17:20
  SPEAKER_00: So the burnout theory was never the thing that blamed the individual.
• 17:25
  SPEAKER_00: But for me or anybody else, we kept doing, we kept placing that blame on ourselves rather than the institution or the organization.
• 17:34
  SPEAKER_00: Burnout is given individualized practices, and I think you can imagine why.
• 17:39
  SPEAKER_00: The reality is that it's cheaper to focus on individual-level intervention rather than to address the systemic and structural challenges that create workload control, reward, community, fairness, values, et cetera, challenges.
• 17:52
  SPEAKER_00: Those are structural, organizational, and cultural shifts.
• 17:56
  SPEAKER_00: Those require those shifts.
• 17:58
  SPEAKER_00: And those shifts require additional resources, financial, definitely.
• 18:03
  SPEAKER_00: Resources, uh mental, emotional, uh time-wise from individuals as well.
• 18:09
  SPEAKER_00: And so, in the absence of an interest in investing those resources, you get what you get.
• 18:16
  SPEAKER_00: Moral injury, on the other hand, um, became popular because it is a term that resists the individual blaming, if you will.
• 18:26
  SPEAKER_00: You know, you can't yoga your way out of the notion that, you know, my institution betrayed what it told me it stood for, right?
• 18:33
  SPEAKER_00: And that's something more deeply foundational and fundamental.
• 18:37
  SPEAKER_00: Now, yoga is great, and I love yoga, uh, but we're gonna need the solve for the moral injury, it will never live at the individual level.
• 18:48
  SPEAKER_00: Uh, and I think it's so important that we honor that because that is where the real challenge is.
• 18:53
  SPEAKER_00: Um, and it's why I believe that the phrase has spread so robustly.
• 18:59
  SPEAKER_00: But here's what we lose if we simply trade one word for the other.
• 19:02
  SPEAKER_00: So, burnout, as we know, has a formal classification with the World Health Organization.
• 19:07
  SPEAKER_00: It has its own ICD number or international classification of diseases as an occupational phenomena rather than a medical condition.
• 19:16
  SPEAKER_00: And there is a substantial body of work on the area.
• 19:19
  SPEAKER_00: We've talked just a bit about it.
• 19:20
  SPEAKER_00: Moral injury has no diagnostic status at all, no agreed definition across the instruments that can be used to measure it.
• 19:28
  SPEAKER_00: And the treatment evidence is fairly young.
• 19:30
  SPEAKER_00: So we're not quite sure what addresses it and fixes it.
• 19:34
  SPEAKER_00: We know that we're gonna have to take an organizational approach.
• 19:37
  SPEAKER_00: And my guess is that, and my knowing is that industrial and organizational psychologists work with organizations and institutions to address those issues.
• 19:45
  SPEAKER_00: But still, what exactly are, you know, the evidence-based, time proven and tested um uh treatments or interventions, those are still coming into focus.
• 19:58
  SPEAKER_00: The best supported responses we have right now are more peer conversation and entrusted relationships, which is meaningful, but at best a modest uh display of what can be done.
• 20:10
  SPEAKER_00: So if you swap out burnout for moral injury and stop there, you've basically traded one term for another, um, and one that comes with interventions, burnout, rather than that addresses the individualized story.
• 20:25
  SPEAKER_00: And the story piece is important, but we do need to figure out what we do with that story, how we support institutions and organizations through those stories.
• 20:33
  SPEAKER_00: A more dignified name doesn't address a problem.
• 20:36
  SPEAKER_00: And that's what we really have to sit with and allow to be contested with and among us.
• 20:42
  SPEAKER_00: What I actually want to give all of you are not these two things.
• 20:46
  SPEAKER_00: It's there's a third, uh, and I'm sure I'm complicating things just a bit more, but I think that there's more here and we need to see a bit more.
• 20:54
  SPEAKER_00: Like, where do we uh grapple with interventions for a term that does that comes with a story, right?
• 21:04
  SPEAKER_00: Where do where where's the middle ground where we have something that we can do about it?
• 21:09
  SPEAKER_00: Um and so we'll we'll spend some time thinking about that because there's an area in the middle that most almost no one's talking about outside of nursing and bioethics.
• 21:19
  SPEAKER_00: And what's so interesting and important for our work is that it's interdisciplinary and we can borrow it and and and utilize and and lean on the language and the scholarship and the expertise as it's growing across multiple and different types of workplaces and context.
• 21:34
  SPEAKER_00: Hey there.
• 21:35
  SPEAKER_00: I hope that you all are enjoying this episode.
• 21:37
  SPEAKER_00: And I also wanted to just take a quick moment to remind you that there are multiple ways for you to engage some of the work that we have happening at the well.
• 21:45
  SPEAKER_00: Yes, we have this wonderful podcast and this community that we're growing, a newsletter as well.
• 21:50
  SPEAKER_00: But some people are looking for something a little bit more, some direct work and service with me.
• 21:55
  SPEAKER_00: Uh that can happen in one to one coaching, coaching with your institution or your organization.
• 22:00
  SPEAKER_00: And so if there are ways in which you'd like to dive a little bit deeper, please feel free to find the link below in our show notes.
• 22:07
  SPEAKER_00: You can click on to book a discovery call and we can talk through a path that's right for you and your organization.
• 22:14
  SPEAKER_00: As always, you are welcome at the well, and we always want you to be well so that you can lead well.
• 22:19
  SPEAKER_00: You don't have to figure out the next step alone.
• 22:21
  SPEAKER_00: We're right here with you and we will be here together.
• 22:26
  SPEAKER_00: So one, burnout.
• 22:28
  SPEAKER_00: Let's get into it.
• 22:30
  SPEAKER_00: It is the mechanism for burnout is a mismatch between what is demanded of the individual, of you, and what you are given, the resources that are provided by an environment.
• 22:40
  SPEAKER_00: It is sustained over time until it hollows you out.
• 22:43
  SPEAKER_00: So we see folks who are really depleted and they they get to this place where they just feel like they have nothing left.
• 22:49
  SPEAKER_00: They don't care the way that they used to.
• 22:51
  SPEAKER_00: So they feel a lack of connection or passion for their work.
• 22:54
  SPEAKER_00: And they begin sometimes to even feel like they're not good at it anymore.
• 22:58
  SPEAKER_00: That last one matters the most because burnout doesn't only drain you, it actually can rob you of your sense of purpose or your sense of your expertise and your capability.
• 23:09
  SPEAKER_00: And I hope that you are able to see here this parallel with imposter syndrome, the relationship between burnout and imposter syndrome.
• 23:16
  SPEAKER_00: So number two, and this is the new third ideal I want to introduce to you, is moral distress.
• 23:22
  SPEAKER_00: Now, this came out of the nursing ethics field.
• 23:25
  SPEAKER_00: Um, started with a philosopher, his name was Andrew Jamton, and named it in 1984, so a while ago.
• 23:32
  SPEAKER_00: And his definition is so precise and it's worth memorizing.
• 23:36
  SPEAKER_00: So I'll be slow with it for you.
• 23:39
  SPEAKER_00: You know the ethically right course of action to do, and institutional constraint makes it nearly impossible for you to take that measure or to make that effort.
• 23:48
  SPEAKER_00: Notice what is intact there.
• 23:50
  SPEAKER_00: You know, you have the knowing.
• 23:52
  SPEAKER_00: Your judgment, your expertise, what you trained in, that's not the problem.
• 23:57
  SPEAKER_00: The suffering lives in the gap between what you know and what you're permitted to do.
• 24:02
  SPEAKER_00: Think about me and that NDA.
• 24:04
  SPEAKER_00: There literally is a contract that I had to sign to learn more, to know more, and then I couldn't do with it what I knew.
• 24:12
  SPEAKER_00: And it wasn't just what I was learning that I couldn't exercise.
• 24:14
  SPEAKER_00: I couldn't exercise my good leadership practice knowledge base as a psychologist and a leader over many years in this instance to address an issue in the way that I knew would be supportive of uh the organization as well as the team that I was working with and to support us moving forward.
• 24:32
  SPEAKER_00: When this is occurring for an inst for an individual, it sounds something like this.
• 24:37
  SPEAKER_00: I know exactly what needs to happen, I know what the student needs, I know what the patient needs, I know what my community needs, and I just can't get it to them.
• 24:49
  SPEAKER_00: Sit with that for a moment, that you know what they need.
• 24:53
  SPEAKER_00: This reminds me of the Tuskegee uh experiments uh where we knew the antidote to the syphilis as it was growing and they tried the different uh treatments that penicillin was working.
• 25:06
  SPEAKER_00: But in Tuskegee, uh the experiment was allowed to continue, though we knew the treatment, we knew the answer, we knew penicillin, very cheaply made, accessible, uh uh wasn't being provided.
• 25:20
  SPEAKER_00: And the um scientist had to sit with that knowing and not act on that.
• 25:27
  SPEAKER_00: How many of you, especially in this season, are sitting with with that kind of knowing that you can't act on?
• 25:35
  SPEAKER_00: But for all of us, I think, if you are in that situation, there is a loss there that we have to that we have to acknowledge, you know, and it's it's painful to sit with that.
• 25:45
  SPEAKER_00: And this is what makes moral distress dangerous instead of just merely miserable.
• 25:50
  SPEAKER_00: Um, and it is the idea of this residue, we call it moral residue.
• 25:55
  SPEAKER_00: When you're forced to act against your conscience, something stays behind after the episode ends because you know that there's something more that can happen, something more that you can do.
• 26:07
  SPEAKER_00: It doesn't clear up or settle just because time passes.
• 26:10
  SPEAKER_00: In fact, you can carry uh guilt, shame right alongside it.
• 26:15
  SPEAKER_00: And two researchers, Elizabeth Epstein and Ann Harmerich, uh named what can occur and what that that residue um what the with holding on to and what the the lasting impact of that residue can do for you.
• 26:29
  SPEAKER_00: They call it the crescendo effect, crescendo like an asymphony that it builds up.
• 26:33
  SPEAKER_00: So that every new episode begins from the higher baseline of the last thing that happened.
• 26:40
  SPEAKER_00: So when you are in highly stressful times, you you rise your level of stress.
• 26:45
  SPEAKER_00: And their hypothesis, their their thesis is that it's not that you go back to your baseline, but this now becomes your baseline.
• 26:51
  SPEAKER_00: And so the new stressful or new um situations that activate that stress, you just keep rising higher and then higher and then higher and then higher.
• 27:00
  SPEAKER_00: A crescendo.
• 27:01
  SPEAKER_00: Each episode builds on the last, and the distress spikes and comes down, but not all the way down.
• 27:08
  SPEAKER_00: Um, and then this is what then causes there to be um, you know, what, you know, this higher um, you know, you can experience something happening over and over again, and it can appeal that it's not affecting you.
• 27:23
  SPEAKER_00: Um, you know, the idea is that, you know, this it's a story about the 40th bad room.
• 27:28
  SPEAKER_00: And while the 40th one broke you, right?
• 27:30
  SPEAKER_00: It's the 39th that didn't.
• 27:32
  SPEAKER_00: And so you thought that you were just fine, but there was this buildup.
• 27:35
  SPEAKER_00: And I can't help but see the connection between the concept of weathering that um Arlene Duronomis put forth and her research on black women and health as being, you know, in parallel here and in relationship with this concept, the idea that uh there is a buildup over time and that that has an impact on the individual.
• 27:54
  SPEAKER_00: These, you know, are those hairs that break the camel's back.
• 27:58
  SPEAKER_00: So the third one and the final is moral injury, which we've talked about.
• 28:02
  SPEAKER_00: And it has two lineages, um, and they are sort of uh coming out of different wounds uh from different um areas of study.
• 28:10
  SPEAKER_00: So, first, Jonathan Shea was working with Vietnam veterans, and he defined it around the portrayal of what is right by a legitimate authority and a high-stakes situation, that the wound is relational because one knows that trust is broken, and then that breaks a faith that others have in you, and maybe even faith that you have in yourself.
• 28:31
  SPEAKER_00: Um that's deeply disappointing.
• 28:33
  SPEAKER_00: Brett Litz and colleagues in 2009 defined it around uh perpetrating or failing to prevent or bearing witness to acts that transgress what you deeply believe.
• 28:43
  SPEAKER_00: This feels more like the Tuskegee experiment.
• 28:46
  SPEAKER_00: That wound is about your own conduct and about what you know about yourself as a function of having participated in and maybe um compromising yourself in that way.
• 28:58
  SPEAKER_00: Most of the popular writings right now uh collapse those two.
• 29:02
  SPEAKER_00: Uh, but we aren't going to do that because in our world and institutions and organizations and leadership and the work that you do, the portrayal version is usually the one that uh with the one running the narrative, right?
• 29:15
  SPEAKER_00: In the back of your mind, you're like, you feel betrayed, you feel like you've betrayed others, it's it's difficult.
• 29:19
  SPEAKER_00: But the moment that uh they meet is when one that undoes that undoes people really breaks them a bit, and is that I was betrayed by this institution, organization that I believed in, and I was made the instrument or the tool to actualize on the thing that is causing the betrayal.
• 29:38
  SPEAKER_00: You become complicit, and that that sits differently.
• 29:43
  SPEAKER_00: And so for the individual in this, it sounds a little bit different.
• 29:48
  SPEAKER_00: Something like something broke faith with me uh and I did what it asked, and I don't recognize myself anymore.
• 29:57
  SPEAKER_00: Like I became a tool for it, for something I didn't believe in.
• 30:04
  SPEAKER_00: So hear the difference there, and we'll we're gonna take us through each of them.
• 30:08
  SPEAKER_00: Burnout says, I have nothing left, right?
• 30:11
  SPEAKER_00: Moral distress says, I know what's right, I just can't do it, right?
• 30:16
  SPEAKER_00: I'm told I can't do it.
• 30:17
  SPEAKER_00: And moral injury says something broke faith with me, and I don't know who I am anymore.
• 30:24
  SPEAKER_00: Identity is tied up in there.
• 30:27
  SPEAKER_00: Burnout is depletion, moral injury is self-condemnation and broken trust.
• 30:32
  SPEAKER_00: And that is the precisely why rest doesn't really touch it or catch it up.
• 30:38
  SPEAKER_00: Sleep restores a depleted person.
• 30:40
  SPEAKER_00: If you're exhausted, you rest, you right?
• 30:43
  SPEAKER_00: But sleep cannot repair shame.
• 30:46
  SPEAKER_00: Sleep cannot repair shame.
• 30:48
  SPEAKER_00: In fact, shame might keep you awake most nights.
• 30:52
  SPEAKER_00: So now let's go a little bit deeper because it can be tempting to stay on the surface here, and that would be a mistake.
• 30:58
  SPEAKER_00: And I want us to state the evidence, not just the framework.
• 31:03
  SPEAKER_00: These three blend into each other and the research knows it.
• 31:07
  SPEAKER_00: Uh, when people try to measure moral injury, the items overlap substantially with burnout's exhaustion and cynicism, which means that when someone scores high on both, they usually do uh the instruments cannot cleanly tell, you know, which one you're looking at, burnout or moral injury.
• 31:29
  SPEAKER_00: A national survey of health workers in France found that more than half uh reporting moral injury found it was indistinct, found it distinct rather from burnout, and found the two that correlated and compounded such that they had folks had worse anxiety and depression together than either of the instances alone.
• 31:50
  SPEAKER_00: So the accurate sentence isn't that it's not burnout, it's moral injury.
• 31:55
  SPEAKER_00: It's more so the um most people carrying this have more than one.
• 32:00
  SPEAKER_00: And the mechanisms are different even when the symptoms are not.
• 32:04
  SPEAKER_00: And that makes it more complicated to know what exactly you're experiencing.
• 32:08
  SPEAKER_00: And if you don't know what you're experiencing, then finding remedy becomes a little bit more of a challenge.
• 32:13
  SPEAKER_00: So, you know, there's a published warning within the British Journal of Psychiatry that I'll name, and it's against romanticizing moral injury.
• 32:21
  SPEAKER_00: Uh, their argument is that the term does not merely describe suffering.
• 32:25
  SPEAKER_00: It's not just about, oh, I'm going through a hard time.
• 32:28
  SPEAKER_00: It makes a claim about wrongdoing, that there's a victim and that there's a betrayer built into the word, the injury.
• 32:36
  SPEAKER_00: And sometimes that is exactly right.
• 32:39
  SPEAKER_00: It can also harden it into a frame or a constraint that forecloses repair because, you know, who is going to repair if, if, you know, and and how do you how do you find remedy for that?
• 32:50
  SPEAKER_00: And it has been difficult to say that part out loud because criticizing the concept sometimes feels like dismissing the pain that comes with it.
• 32:58
  SPEAKER_00: And that's not what we're doing here.
• 33:01
  SPEAKER_00: Um, we really want folks to find the sense of languaging that creates some ease here, but we also don't want to shortcut it for simplicity when there is deeper complexity around that.
• 33:12
  SPEAKER_00: Um, and so I'm not asking us to do that.
• 33:15
  SPEAKER_00: Um, I'm only wanting us to be real with ourselves and so to hold it precisely rather, to let it be what it is naming, but don't allow it to have that sort of concept spread or, you know, across multiple spaces when it's it's not a multiple ideal when when really it's defining itself.
• 33:35
  SPEAKER_00: Um, because a word this powerful can be misused.
• 33:38
  SPEAKER_00: Um we've seen a lot of mis and disinformation out there.
• 33:41
  SPEAKER_00: And we want to make sure that we're applying the concepts correctly.
• 33:46
  SPEAKER_00: Now, one boundary I'll name, and then we'll move on, is that shame, self-condemnation, hopelessness, loss of trust in everything.
• 33:55
  SPEAKER_00: That's a very heavy overlap with depression and with post-traumatic stress, which can also come out of some of these environments that we have been describing, particularly in the workplace.
• 34:06
  SPEAKER_00: And here is where I say that, you know, a podcast is nice, coaching is nice, but there is some work that you just need to have happen in a clinical setting with a mental health provider who is licensed and um within your state or licensed to provide treatment within your state, and that's where that work happens.
• 34:25
  SPEAKER_00: Um, the concepts here and what we're doing here is really information sharing, consciousness raising around these ideas so that you can know what's happening.
• 34:33
  SPEAKER_00: But the treatment, uh, you can't get that in a podcast.
• 34:36
  SPEAKER_00: And you really, uh when when facing into the depth of some of the challenges that we face, need to really think about what does uh effective treatment look like for you and what is fair for you.
• 34:48
  SPEAKER_00: Okay.
• 34:49
  SPEAKER_00: Now, here's something you may find a little interesting.
• 34:52
  SPEAKER_00: I know I did.
• 34:53
  SPEAKER_00: The moral injury literature lives mostly in two places the military and healthcare, which is so interesting to me.
• 35:00
  SPEAKER_00: Soldiers and clinicians, life and death.
• 35:03
  SPEAKER_00: These are obviously very high stakes.
• 35:05
  SPEAKER_00: But there's a third situation, and I don't think that we get it named that often.
• 35:09
  SPEAKER_00: What happens to a person who was hired to be the face of an institution's stated values and is then required to preside over the abandonment of those values?
• 35:18
  SPEAKER_00: Now I know that the diversity, equity, and inclusion space is one of those instances where that's happened, where the director or the VP is now set to uh asked to sunset their office, or the professor told, uh, you know, who created this beautiful program in ethnic studies or whatever the material is and justice-oriented work is asked to uh design the closure of their program as a part of strategic alignment or the renaming of these programs or these offices.
• 35:48
  SPEAKER_00: Um there are a number of instances where we're watching where folks are watching their good work be torn apart and that they're actually the one that has to be a part of the tearing.
• 35:58
  SPEAKER_00: Run that against Shay's definition that the betrayal of what is right by a legitimate authority.
• 36:05
  SPEAKER_00: So in a high-stakes situation, this fits exactly.
• 36:09
  SPEAKER_00: And I think that that's one of the ways that we want to think about the stress and the disappointment, but the hurt and the moral harm that folks are feeling when they're walking away from some of these institutions and organizations that they have really given a lot of love and care in their work for.
• 36:24
  SPEAKER_00: And there's this compounding feature that the frameworks do not capture, and I think we need to name.
• 36:29
  SPEAKER_00: When you are the only person in the room, when everyone else experiences the meeting as a meeting, but you are the leader carrying the meeting, delivering the news, legally obligated to transmit a particular story or narrative, the injury arrives with isolation.
• 36:46
  SPEAKER_00: And so being on your own to address this, to feel that turns a wound into a chronic condition or can.
• 36:54
  SPEAKER_00: Peer connection is one of the best ways to uh to to widen out and to allow ripple effects of stress.
• 37:02
  SPEAKER_00: Um, and you don't get to have that if you're one of a few carrying this, and especially if you're not agreeing with the leadership team that's making the decisions that you're you are prompted and and and instructed, um, directed to lead.
• 37:18
  SPEAKER_00: This is where the moral injury hits hard.
• 37:21
  SPEAKER_00: And it's the exact resource that the leader doesn't have when they don't have peers that they can talk to about what's going on.
• 37:28
  SPEAKER_00: In episode one, we talked about the architecture uh that no one can take from you, the skills, the background, the wisdom that comes with you in any institution, no matter where you go, because that walks with you.
• 37:39
  SPEAKER_00: Um but this is the other side of the coin.
• 37:41
  SPEAKER_00: That same institutional logic that made those roles visible and what gave you this esteem and made you um uh, you know, like someone who uh is is just the one, the the go-to person is also can be what made them expendable and what made that person holding them the one person asked to sign the paperwork uh that is betraying their values.
• 38:07
  SPEAKER_00: So we're back at the story, and I'm back at my desk, and I've logged off from my Hollywood squares.
• 38:13
  SPEAKER_00: For a long time, I told myself that what I felt in that moment was exhaustion because exhaustion is a respectable way for a leader to feel, right?
• 38:21
  SPEAKER_00: I'm tired, you know, feel you feel that heaviness.
• 38:24
  SPEAKER_00: We call, we call that heaviness, uh, we card, or rather, we call tired many things.
• 38:30
  SPEAKER_00: But exhaustion means that you've worked hard and that you can remedy that with rest.
• 38:34
  SPEAKER_00: You can put some time on the calendar to um to address that.
• 38:39
  SPEAKER_00: But what I was feeling was not exhaustion.
• 38:43
  SPEAKER_00: What I was carrying was the knowledge that I had been, I had uh conveyed to good people that I cared about a narrative that I knew would not suffice in the face of the uncertainty that was coming.
• 38:56
  SPEAKER_00: That my competence and their trust in me made that possible, right?
• 39:01
  SPEAKER_00: That they trusted me to be a competent leader, that I had exhibited that so far.
• 39:05
  SPEAKER_00: Um what more can I ask for, right?
• 39:09
  SPEAKER_00: I knew that there was a deeper heartbreak coming and that I was also going to have to steward that too.
• 39:16
  SPEAKER_00: I was going to have to in some ways serve as a type of midwife for that.
• 39:20
  SPEAKER_00: Um, and and and I was what I can say is that I've learned a lot about how to sit with and hold difficulty, how to hold pain.
• 39:32
  SPEAKER_00: But those lessons came at a very steep price.
• 39:37
  SPEAKER_00: Underneath all of that is a real wound, uh, not only for me, uh, but for the others, because what we are all coming to grips with is that the institution for which we had, that I had so much regard and faith, had known exactly who they could send, who they should and did send into the room to take one for the team.
• 39:59
  SPEAKER_00: And I was alone in there.
• 40:00
  SPEAKER_00: And no matter all the folks that you can blame, um the reality is that accountability is real and that what your colleagues, your faculty, your team, whoever it is that you're reporting who reports to you and who is looking to you to lead them, that your excuses for the people who set you up to be the one to deliver that news doesn't really get them very far.
• 40:25
  SPEAKER_00: And so, yeah.
• 40:28
  SPEAKER_00: So there's that.
• 40:30
  SPEAKER_00: I had a role to play in it, and that was the shape of the thing.
• 40:33
  SPEAKER_00: And I had to hold that and I had to live with that and walk with that.
• 40:36
  SPEAKER_00: And often leadership is about just that.
• 40:39
  SPEAKER_00: And naming it and knowing it intellectually doesn't make the sting go away.
• 40:43
  SPEAKER_00: Um, it doesn't fix it.
• 40:45
  SPEAKER_00: You have to just kind of sit with it and and be with it.
• 40:50
  SPEAKER_00: But here's what I what it did do too, is what I can say.
• 40:56
  SPEAKER_00: It stopped me from looking for the wrong cure.
• 40:59
  SPEAKER_00: I stopped scheduling self-cure rituals and waiting to feel better because those were not the response to that issue, to that moral injury.
• 41:07
  SPEAKER_00: I stopped treating my own reaction as it was evidence, as if it was evidence that there was something wrong with my leadership.
• 41:14
  SPEAKER_00: I wasn't lacking.
• 41:16
  SPEAKER_00: I and you, we have every right to grow in our leadership, um, unencumbered by a hostile context.
• 41:22
  SPEAKER_00: It's just that contexts are hostile, you know, they are toxic, uh, and the precarity of the moment, the vulnerability and uncertainty, the complexity and the ambiguity, buca, of the moment, uh means that there are likely many fewer uh instances of leadership that don't carry this level of of complexity.
• 41:45
  SPEAKER_00: My reaction was not a malfunction.
• 41:47
  SPEAKER_00: My reaction was my conscience, working exactly as a conscience is supposed to work.
• 41:54
  SPEAKER_00: And it was doing so in a room that was being in which I was being asked for it not to do that.
• 42:01
  SPEAKER_00: And that was the unfairness.
• 42:03
  SPEAKER_00: So here we are with all of that.
• 42:07
  SPEAKER_00: And the question is how do we then leverage this knowing and and and and effort toward our leadership?
• 42:14
  SPEAKER_00: If it is burnout, the answer is load and design, not resilience training.
• 42:20
  SPEAKER_00: Rather, it's the six levers that we've talked about workload, control, reward, community, fairness, and values.
• 42:27
  SPEAKER_00: These are the things that you can move and maneuver, shift and adjust in order to address burnout.
• 42:32
  SPEAKER_00: Pick one or two that you can focus on and just work on that.
• 42:36
  SPEAKER_00: Design a plan around that.
• 42:37
  SPEAKER_00: Um, it won't be perfect, but it will start to carve away out at some of the challenge there and create some spaciousness for you.
• 42:45
  SPEAKER_00: You know, if you're the one leading, cut out, cut scope out loud in front of folks so they can see that, you know, we're just gonna put this one on the back burner so that we can focus on what's of most import.
• 42:55
  SPEAKER_00: Name what you are dropping.
• 42:57
  SPEAKER_00: Telling exhausted people to take care of themselves while demands stay exactly the same is, you know, gaslighting.
• 43:04
  SPEAKER_00: And we just, you know, that's a structural failure, relocating problems on somebody else's body, time and and mental health.
• 43:10
  SPEAKER_00: And that's that's not going to serve long term or even in the short term.
• 43:14
  SPEAKER_00: When you do it publicly, especially for you and for yourself, you're normalizing and modeling for the organization that this is a practice that you're going to engage in.
• 43:23
  SPEAKER_00: If it's moral distress, the answer is voice and constraint.
• 43:27
  SPEAKER_00: So the person already knows the right answer.
• 43:29
  SPEAKER_00: They trust their judgment.
• 43:30
  SPEAKER_00: They should trust their judgment.
• 43:31
  SPEAKER_00: They know exactly what's going on.
• 43:34
  SPEAKER_00: They have the intelligence, the expertise.
• 43:36
  SPEAKER_00: So your job is not to coach them out of their judgment, and your job is also not to do that to yourself.
• 43:42
  SPEAKER_00: Reduce the constraint or give the knowing somewhere productive to go and try to close the loop around that.
• 43:48
  SPEAKER_00: You know, residue accumulates in silence and people have to make meaning and make sense on their own.
• 43:53
  SPEAKER_00: A decision that goes against someone, but is followed up with a reason that leaves far less behind.
• 44:00
  SPEAKER_00: Than it, then a decision that disappears into the void.
• 44:03
  SPEAKER_00: So if you can communicate as effectively as possible, even to say, you know what, it is what it is.
• 44:08
  SPEAKER_00: This is at least normalizing that it's not on the fault of the individual and that it's something that we are now sharing and understanding is just a challenge of the moment.
• 44:19
  SPEAKER_00: And if it is moral injury, the answer is repair.
• 44:22
  SPEAKER_00: And repair is not simply rest.
• 44:24
  SPEAKER_00: This one is a different in kind.
• 44:26
  SPEAKER_00: You do not rest your way out of and you do not reframe your way out of this.
• 44:32
  SPEAKER_00: What helps is disclosure to someone who will not flinch, someone who can look you in the eye, hold what you're sharing.
• 44:38
  SPEAKER_00: Because shame survives on secrecy.
• 44:41
  SPEAKER_00: Guilt survives on feeling like you have betrayed.
• 44:44
  SPEAKER_00: And so you need to be able to name the truth openly, somewhere where you can trust that space and where you can think that through with someone.
• 44:52
  SPEAKER_00: Acknowledgement from the institution is helpful when it's possible.
• 44:55
  SPEAKER_00: Sometimes it's not going to come and you have to live with that as well.
• 44:58
  SPEAKER_00: And honesty is when it is not, is as best a cure for that for you as anything else.
• 45:07
  SPEAKER_00: Particularly because, you know, many folks, I can tell you, are grieving apologies that were never offered and were never going to come.
• 45:13
  SPEAKER_00: And so there is a way of freeing ourselves up from that that we just have to think about.
• 45:18
  SPEAKER_00: More than anything, you need to slowly rebuild the story about yourself that gets degraded when you feel personally responsible or you are holding with integrity things that did not hold integrity with you.
• 45:30
  SPEAKER_00: And one more note of caution because there's another framing that's sort of finding its way into the discourse.
• 45:36
  SPEAKER_00: And I want to disabuse you and the institutions that may be preparing themselves to sort of use this as a way to sort of navigate these complex conversations.
• 45:48
  SPEAKER_00: Moral resilience is the term that you're probably going to hear more about.
• 45:51
  SPEAKER_00: So Cinder Rushton is the scholar in this area.
• 45:54
  SPEAKER_00: And the work is quite serious and careful.
• 45:58
  SPEAKER_00: Dr.
• 45:58
  SPEAKER_00: Rushton is in articulating, articulating that it takes redesign systems and not only strengthen individuals to actually realize the resilience, the level of resilience that would require or that would lead lend itself to moral resilience.
• 46:15
  SPEAKER_00: So as we know, when there is a new concept or word or catchphrase, folks use it and overuse it, even though the actions are not showing themselves in the environments in which we're working.
• 46:26
  SPEAKER_00: And so the offer here is know it and be on the lookout.
• 46:32
  SPEAKER_00: Watch how and in what ways your organization may try to use this.
• 46:37
  SPEAKER_00: If you hear the words moral resilience in a room, uh and people are not also talking about resources, human, financial time, et cetera, uh, that those constraints can have an effect on that, and also what those investments will, what will what investments will be made in order to adjust for those constraints, then you may be watching uh burnout get individualized again.
• 47:00
  SPEAKER_00: And again, we know why that happens, because it's easier to say individuals should address the um impact of overwork and burnout and those the those six levers that we've talked about that are controlled at the organizational level, um, but given an individual uh remedy that will never solve the organizational challenge.
• 47:24
  SPEAKER_00: Resilience is not a substitute for repair.
• 47:27
  SPEAKER_00: You gotta repair if you're gonna repair, right?
• 47:30
  SPEAKER_00: Okay.
• 47:32
  SPEAKER_00: So we're now at the stage of our grounding.
• 47:35
  SPEAKER_00: So we've talked a lot about the literature because as you know, I'm not just working with feelings or vibes.
• 47:40
  SPEAKER_00: We want to work with real actual, tangible evidence base or real tangible evidence base, I should say.
• 47:46
  SPEAKER_00: So let's talk a little bit about some of the scholars who brought this work.
• 47:48
  SPEAKER_00: And I've mentioned them through so you know where we've populated them.
• 47:52
  SPEAKER_00: And also all the work that we mentioned here is available in the show notes with links to those um resources uh that you can access and learn more.
• 48:01
  SPEAKER_00: So, first, the burnout definition comes from Christina Maslatch and Susan Jackson, and it was developed in 1981.
• 48:08
  SPEAKER_00: That's a real long time ago.
• 48:09
  SPEAKER_00: This has been around.
• 48:11
  SPEAKER_00: This has been around for a while.
• 48:13
  SPEAKER_00: The six areas of work life that Maslatch and Michael Leaders later work uh raised um come from again Masslatch's work and her um collaboration with Michael Leaders.
• 48:27
  SPEAKER_00: Moral Distress, and the definition that I asked you to memorize, comes from Andrew Jamton, again, developed in 1984, again a while ago, um, with moral residue from Webster and Bayliss in 2000, and the crescendal effect uh from Epstein and Hamrick in 2009.
• 48:44
  SPEAKER_00: Moral injury has two founding lineages.
• 48:48
  SPEAKER_00: One is by Jonathan Shea's work on betrayal by a legitimate authority.
• 48:51
  SPEAKER_00: Those are with the Vietnam veterans, and also Britt Letz's and colleagues' work in 2009, excuse me, on transgression witnessed or committed.
• 49:01
  SPEAKER_00: The phrase that this titles this episode comes from Talbot and Dean in 2018.
• 49:06
  SPEAKER_00: The caution against overclaiming comes uh from Tanay Mulenjak in the British Journal of Psychiatry and the overlap problem in terms of mental health with these effects uh in terms of burnout and you know the depletion and the overpro the overlap with the with measures is documented in a 2026 analysis, very recent, of the instruments themselves.
• 49:31
  SPEAKER_00: So every one of these, and again, points to access them are available in the show notes with links.
• 49:39
  SPEAKER_00: Okay.
• 49:40
  SPEAKER_00: So we are at our replenish assignment.
• 49:42
  SPEAKER_00: Every solo episode comes with a little work.
• 49:46
  SPEAKER_00: Uh, this is my way of giving away a little bit of the coaching and the type of work that we tend to do in my practice, because I know that some of you can have access to that and will find value there, and some of you can access it here.
• 49:57
  SPEAKER_00: And I'm really glad to share.
• 49:58
  SPEAKER_00: So this replenish assignment comes in three parts.
• 50:01
  SPEAKER_00: Uh, there are no wrong answers.
• 50:03
  SPEAKER_00: There's, and there's no one else who needs to see it.
• 50:05
  SPEAKER_00: And also you can use it as a jumping off spot for your own work with your own individual coach or with your therapist or in any ways in which you're processing things that are coming up for you.
• 50:14
  SPEAKER_00: So, first, name which one is happening for you.
• 50:17
  SPEAKER_00: We know that there's overlap, but if you had to choose, um, you know, and using some of the framing that I use, you know, is it that you're feeling like I have nothing?
• 50:26
  SPEAKER_00: Burnout, or is it that I know what's right, but I cannot do it?
• 50:31
  SPEAKER_00: Moral distress.
• 50:32
  SPEAKER_00: Or is it something broke faith with me and I do not record myself?
• 50:36
  SPEAKER_00: Moral injury.
• 50:38
  SPEAKER_00: Again, choose the one that's the loudest for you.
• 50:41
  SPEAKER_00: These there is overlap here and they are interrelated, but figure out which one really feels like those words are really hitting it for me.
• 50:49
  SPEAKER_00: This is not a diagnosis, but it's just to give you a direction because as we talked about before, naming helps us then choose the right tool that will support us in addressing the issue uh that we're facing and that we're challenged with.
• 51:01
  SPEAKER_00: Two, number suit, second, name what is asked of you.
• 51:04
  SPEAKER_00: So one specific thing you were required to do uh or say or to stay silent about that did not match what you believe, but you value what you know.
• 51:13
  SPEAKER_00: Not the whole season, just this one thing, right?
• 51:17
  SPEAKER_00: Because again, the whole season might represent and have representation across all of those.
• 51:21
  SPEAKER_00: But name the thing that, you know, maybe kind of hit you more at your core and focus there.
• 51:25
  SPEAKER_00: That might have the bigger bang for your buck in terms of uh some relief.
• 51:29
  SPEAKER_00: Be specific and notice how hard specificity can be sometimes.
• 51:34
  SPEAKER_00: Vagueness uh is a trap.
• 51:36
  SPEAKER_00: It makes it hard to know how to respond.
• 51:38
  SPEAKER_00: And so you want to try to be as clear with yourself as possible so that your responses to yourself can be more impactful.
• 51:44
  SPEAKER_00: And number three, name what you did, not give away.
• 51:49
  SPEAKER_00: Okay, so a lot of times we can focus on the negative.
• 51:53
  SPEAKER_00: Um, but our nervous system, our our our brain, our cognitive systems, our whole body, you know, the beautiful system that is the the our body responds well to positivity.
• 52:06
  SPEAKER_00: So let's finish this sentence stem.
• 52:09
  SPEAKER_00: Even then, I did not dot dot dot.
• 52:12
  SPEAKER_00: What's one thing that you did not give up, that you did not give away?
• 52:17
  SPEAKER_00: One way you did not forsake yourself or others.
• 52:20
  SPEAKER_00: Maybe you did not lie outright.
• 52:22
  SPEAKER_00: Maybe you told one person the truth in the hallway.
• 52:24
  SPEAKER_00: Maybe you simply refused to pretend or or you agreed.
• 52:28
  SPEAKER_00: Maybe you um said something at the table where it mattered in such a way that shifted the conversation.
• 52:35
  SPEAKER_00: And even if it didn't change the whole scope of things, it at least made for one or two more impactful landings not to hit your team or others in the organization.
• 52:45
  SPEAKER_00: And you should feel good about that.
• 52:47
  SPEAKER_00: Whatever fills that blank space is the piece of your integrity that walked out that room intact, and that is something that you need to hold on to.
• 52:54
  SPEAKER_00: It's the thing that repair can be built on.
• 52:57
  SPEAKER_00: I know for me, coming back to where I did not portray my values and my voice always reaffirms me in a way that nothing else can and that I cannot explain.
• 53:08
  SPEAKER_00: So now we're set at our renewal practice.
• 53:11
  SPEAKER_00: I want you to set down anything that you've been writing or any, even set down thoughts that feel heavy or things that you've been sort of processing.
• 53:18
  SPEAKER_00: We're gonna close the way that we always do, uh, with care for ourselves, with softness for ourselves, with compassion for ourselves and in stillness.
• 53:28
  SPEAKER_00: So find a place where your body can be held.
• 53:32
  SPEAKER_00: Maybe it's a chair.
• 53:33
  SPEAKER_00: You're allowing yourself to just kind of reorient yourself, maybe it's the floor, the ground.
• 53:38
  SPEAKER_00: Let your breath uh lengthen without forcing it and allow yourself to be held.
• 53:46
  SPEAKER_00: Allow yourself to fall into wherever you are setting your body against.
• 53:56
  SPEAKER_00: And now gently, go back to the room.
• 54:01
  SPEAKER_00: Not to relive it, not to fix it, just to stand in the doorway for a moment.
• 54:08
  SPEAKER_00: That room being the room that you were in, the zoom room you were in, where you faced into a moment that you aren't very proud of, that you know perhaps took something from you, and that you're gonna reclaim.
• 54:23
  SPEAKER_01: Find the version of who you were in that room.
• 54:31
  SPEAKER_01: Look at you.
• 54:36
  SPEAKER_01: That is the whole reason it hurt.
• 54:41
  SPEAKER_00: Seeing you, seeing who you were, what you knew, and what you did or did not do with that.
• 54:47
  SPEAKER_00: That is the reason why it hurt.
• 54:51
  SPEAKER_00: And it was painful not to be able to rap it in that moment.
• 54:57
  SPEAKER_00: So say to yourself, either out loud, or just to yourself.
• 55:04
  SPEAKER_00: I was not wrong.
• 55:07
  SPEAKER_00: I was constrained.
• 55:11
  SPEAKER_00: I was not wrong.
• 55:14
  SPEAKER_01: I was constrained.
• 55:23
  SPEAKER_01: And now the part that may be a little harder.
• 55:26
  SPEAKER_00: If you did the thing, if you said the words, if you signed the paper, if you stayed quiet, do not rush to absolve yourself.
• 55:35
  SPEAKER_00: And do not leave yourself there alone either.
• 55:39
  SPEAKER_00: Just witness you.
• 55:42
  SPEAKER_00: Be with you.
• 55:45
  SPEAKER_00: Because the truth is that someone should have been in that room with you.
• 55:49
  SPEAKER_00: And the truth is that right now you can be that person who can be there for you.
• 56:01
  SPEAKER_01: Okay.
• 56:08
  SPEAKER_00: For whatever it is that you carried.
• 56:13
  SPEAKER_00: And then release it into the one who is here now, who can finally call it by its name and forgive yourself.
• 56:23
  SPEAKER_01: And when you're ready, and only then come on back to us.
• 56:34
  SPEAKER_01: All right.
• 56:36
  SPEAKER_01: I want to thank you.
• 56:37
  SPEAKER_00: This was this was a heavy one today, and I hope that it reached you in a place you can receive it.
• 56:45
  SPEAKER_00: And I also hope you can give yourself space to let it go as it feels appropriate and as you feel ready.
• 56:54
  SPEAKER_00: You were never too sensitive for this work.
• 56:57
  SPEAKER_00: What you felt in that room was your conscience, and it was doing what a conscience is supposed to do.
• 57:04
  SPEAKER_00: The problem was not you, the problem was the room.
• 57:08
  SPEAKER_00: The problem was the situation, the circumstances, the system, the organization around you asking that of you.
• 57:16
  SPEAKER_00: Okay.
• 57:18
  SPEAKER_00: So name it accurately and then ask for the thing that matches it.
• 57:24
  SPEAKER_00: Whether that's rest if you're depleted, room to act if you feel distressed, and room for repair if you are experiencing that injury.
• 57:35
  SPEAKER_00: More than anything, explore what forgiveness feels like and can look like for you.
• 57:42
  SPEAKER_00: I'll be back soon.
• 57:43
  SPEAKER_00: But until then, remember your architecture.
• 57:46
  SPEAKER_00: Whatever you walk out of that room, out of that organization with is yours, and that is what we build the future on.
• 57:53
  SPEAKER_00: Until next time, be well.
• 57:58
  SPEAKER_00: Thank you so much for listening.
• 58:00
  SPEAKER_00: I hope this message found you in a good place and left you even better and with something that you can use in your work this week.
• 58:08
  SPEAKER_00: If you'd like to learn more about the well and the work that we do, please visit drwendywilliams.com.
• 58:15
  SPEAKER_00: W-e-n-d-i, not y drwendywilliams.com, and also follow me on Instagram, on LinkedIn, at drwendywilliams.
• 58:24
  SPEAKER_00: I'd love to hear from you.
• 58:25
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• 58:30
  SPEAKER_00: If you're finding something of value, please write us a review and also pass on the good work with others.
• 58:36
  SPEAKER_00: We know that there are many people who are trying to lead well in this time, and we want to make sure to broaden into our community, and you are the number one way to help us to do that.
• 58:45
  SPEAKER_00: Welcome to the well, and we'll see you next time.