Moral Injury: The ‘Bad Barrel’ and the Breaking Point

How organizational betrayal and ethical conflict shape the wounds of the fire service

I was recently given a challenge. Well, it was a challenge for me. I was asked to give an end-of-semester psychology talk to Grade 11 students. Could I cover some of their material and make some practical applications to the content? Or, in my eyes, can I summarize in an hour and a half, a semester of psychology? Challenge accepted, obviously. But it required me to revisit some of the fundamentals. You know, those facts and nuggets that when you learn it, write a brief paper about, pray to God it’s not on the final exam and then never think about it again? Yeah, those nuggets.

Simultaneously, I found myself in a conversation with another researcher around the topic of moral injury. It’s the new kid on the block, granted, so I have some skepticism. Much that has happened in the firefighter mental health space is renaming things with already perfectly fine names. So, I worry that it’s simply an aspect of traumatic experience with a new flashy name. In my review, though, of some of the fundamental experiments for psychology, it got me thinking.

Moral injury, roughly defined, is the experience of being betrayed by the organization while forced to engage in a behavior that defies one’s values. Before moral injury was a hot topic, I treated someone that I would think fit the bill perfectly. They were not scoring the threshold for PTSD on the Post Traumatic Checklist (33 or higher, you have a high likelihood of being diagnosed with PTSD if you were to meet with a psychologist), but they were still identifying significant struggles. They were an ICU nurse at the height of the pandemic – they were witnessing people dead and dying daily. But that wasn’t necessarily what bothered them the most.

When Values Collide With Orders

“Just because you can do it, doesn’t mean you should, you know?” – they would say, exasperated. The administration was requesting that the doctors and nurses continue to provide extensive support for a person that the entire clinical team (according to the nurse I was treating) agreed there was no saving. “It’s such bullshit, and just prolongs the suffering of the person, the family, and us. It goes against the “do no harm!” Betrayed by the organization by being asked to trespass on their values.

Suffice it to say, they ended up leaving that organization. Though, at least when I had finished treatment with them, they remained in the profession.

Ian Parker, discussing the Milgrim experiments, is quoted as saying (but, I pulled it from Paul Bloom’s Psych) – “people tend to do things because of where they are, not who they are.”

The Psychology Roots Beneath Moral Injury

Two fundamental experiments in psychology are of particular interest to me in exploring some of the mechanisms that may underlie moral injury. So, quickly, let me remind you of these studies that draw lines in the proverbial sands.

Philip Zambardo, was a social psychologist out of Standford University. He would go on to develop the idea that it’s not always “bad apples” that create chaos within situations, sometimes it’s “a bad barrel.” You see, he inadvertently orchestrated one of the most powerful (albeit ethically questionable) studies. The Standford Prison Experiment is infamous. Two groups of students, who volunteered for the study, were randomly assigned to guard or prisoner. Using only a few props to delineate the groups, quickly the guards descended into hedonistic practices and the prisoners continued to submit to their whims. Remember, both groups were here voluntarily. Anyone could have left at any moment. But, both groups remained. Zimbardo had to call the study off before it got any worse.

Zimbardo was later called as an expert witness to the Abu Gharib trials for the prison guards who were there that mimicked in many ways, though to a much greater, perverse, and dangerous degree, the Stanford Prison Experiment. These were very real situations without the benefit of a psychologist supervising.

When the Barrel Becomes the Problem

Zimbardo argues that sometimes the barrel that we have our apples in is the cause for the problems. This plays into the hand of those that argue for the organizational responsibility of the impacts of trauma. Steel manning the argument laid out above, it could be true, then, that the way the organization reacts to admissions of trauma or struggle create an atmosphere that supports dismissal, ridicule, and non-acceptance of trauma reactions. This would lead to an underreporting by those that experience traumatic reactions and could, then, lead to a worsening of outcomes for those individuals.

The barrel causes the problems. Not the person or the things they have had to do.

There are some that argue organizational stress outweighs the stress that traumatic events present when they experience them on the fire ground. They suggest that the organization is more responsible for the traumatic outcomes than the calls.

The Danger of Oversimplifying Trauma

I wish to digress to a small degree, to call to your attention the risk of a sleight of hand here. If this were true, and applied universally, we could lose sight of the impact of trauma itself. To suggest that our experience of being traumatized is only due to the organizational stigma and lack of resources, would suggest that what we do on the fire ground has a less impact. I understand that some studies might suggest that, but we must be super cautious suggesting universal principles of new studies. But, back to the main point.

Stanley Milgrim posted ads around his university looking for individuals to participate in a memory study. This was a lie, though. The study wasn’t about memory but about how far people would obey. The participants would meet in a room with the “researcher” who would be in a white lab coat and another participant, an actor, who would be the “learner.” The idea was simple: teach strings of words to the learner, the learner repeats them back. If they get it wrong, we shock them and repeat the right string of words. Every wrong answer also increases the intensity of the shock.

In some ways this was a response to what had just transpired in World War II. Milgrim would start his studies during the Nazi trials, where many would cite they were just “following orders.” Nothing short of the Nazis being absolute evil would suffice in understanding how such atrocity could occur. So, Milgrim was hoping that his experiments would show that Americans, at least, would stop an experiment if it meant harming someone despite being “ordered” to by an authority figure.

Obedience, Authority, and the Human Breaking Point

Humans are fickle, though. What Milgrim would find was most participants continued the experiment, even when advised they were giving lethal doses (all while the actor would scream, yell, beg for it to end, and then ultimately grow silent on the other end). It would seem, at least on the face, that human beings will abide by the orders they are given. And will follow them through, even if it means that someone will get hurt (or worse). And they would do this, I’ll remind, while being stressed, anxious, and significantly concerned about what was happening on the other side of the wall.

It seems we can be led to do some pretty horrible things depending on the environment and the pressures of authority. We can trespass on our ethics, values, and on good human decency. Leaders can also be forced to ask subordinates to engage in behaviors that trespass on their values. I think it’s wrong to think that leaders of the organization aren’t also a part of the impacts and impressions of the organization they work for.

If we look at these two studies together, it sends a powerful message about human beings. And, to me, lays a foundation for where moral injury could be a distinct phenomenon.

Where Moral Injury Takes Shape

Moral injury could be the intersection of these two approaches – the requirement for me to engage in something that goes against my values (call that the Milgrim Principle) and the organization that I work for is an antagonist for the wellness of its members (let’s call it the Bad-Barrel principle).

When the Milgrim Principle meets the Bad Barrel principle within an organization, this may increase the risk of trauma to the firefighter but not necessarily increase the risk of “guilt and shame.” Instead, it can increase the experience of betrayal – the heart of the moral injury experience.

Now, there needs to be much more in terms of literature to determine whether it is its own true and distinct disorder. But, it can be a way to at least conceptualize the experiences a firefighter is having when the reasons for the mental health languishing is related to the above pathways. Insofar as that we understand this as a conceptualization, we can name our experience within something that the service and the mental health field is aware of. If we can name it, we can tame it. And, regardless of whether this is a distinct and new thing, or if this is just the same old trauma wrapped in a new package, the person needing the help can feel validated and the therapist can understand what support is necessary.