Moral Injury Support Network Podcast

When Your Job Violates Your Soul

• Dr. Daniel Roberts • Season 4 • Episode 2

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What if the pain keeping you up at night isn’t stress or fear, but the belief that you crossed your own line? We unpack moral injury—the wound to your moral identity—through vivid stories from emergency rooms, newsrooms, child protective services, prisons, and the lives of survivors. Instead of fear-based PTSD, we focus on judgment, shame, guilt, and betrayal, and why soothing a nervous system isn’t enough when the verdict in your head is I am a bad person.

We walk through acts of commission and omission, along with betrayal by leaders and institutions, to show how good people get trapped in impossible choices. You’ll hear Emily’s ER crisis during COVID, a reporter’s split-second decision when a friend becomes the story, and CPS workers forced to choose between insufficient evidence and urgent protection. We step inside prison life to see how the “code” demands a survival mask that hardens into identity, and we examine how survivors of sexual assault and trafficking can be coerced into harming others, carrying a double weight of victimhood and perpetration.

From there, we map a path forward. Three pillars help prevent and mitigate moral injury: clear ethical grounding before the crisis, psychological safety and peer support to break silence, and institutional integrity so systems stop forcing dehumanizing trade-offs. For those already hurt, we frame healing as moral repair: meaning-making, atonement, truthful accountability, and self-forgiveness that integrates the scar without denying harm. This is not about excusing; it’s about rebuilding a life aligned with your values.

If this resonates, share it with someone who might need the language for their pain. Subscribe, leave a review, and tell us: what line will you refuse to cross next time—and what support do you need to hold it?

Learn more about the The Healing Path Project: Advanced Trauma-Informed Training for Licensed Counselors at: https://misns.org/programs/workshops/

(This episode was made using NotebookLM).

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SPEAKER_00:

Okay. I want to start today by asking you to imagine a specific kind of pain. And I don't mean, you know, a broken leg or something physical. I'm not even really talking about grief, though that's obviously heavy. Right. Trevor Burrus, I'm talking about a pain that hits you when you look in the mirror. It's that uh sinking feeling that comes from doing something that just goes against the very core of who you are.

SPEAKER_01:

Aaron Ross Powell It's a heavy place to start, isn't it? Usually when we talk about work stress, we're talking burnout, exhaustion.

SPEAKER_00:

Trevor Burrus, Yeah, needing a vacation. Trevor Burrus, Jr.

SPEAKER_01:

Exactly. But today it's different. We're looking at what happens when your job doesn't just tire you out, but um actually violates your soul.

SPEAKER_00:

Aaron Ross Powell Violates your soul. That is a terrifying phrase. But it brings us right to the topic of this deep dive. Trevor Burrus It does. We are unpacking a concept called moral injury. And honestly, when I first saw that term in our source material, this training deck from the Healing Path project, my brain immediately went to like war movies.

SPEAKER_01:

Aaron Powell, which is a very common reaction. For decades, moral injury was a term we we really only use for veterans. Trevor Burrus, Jr.

SPEAKER_00:

Solders in combat.

unknown:

Trevor Burrus, Jr.

SPEAKER_01:

Right. Soldiers who had to do terrible things to survive, or who saw things they couldn't unsee. But the fascinating thing about this research is that they're blowing the doors off that definition.

SPEAKER_00:

How so?

SPEAKER_01:

They're arguing that this isn't just a military issue, it's a human issue.

SPEAKER_00:

Aaron Powell And that's the mission for today. We're going to find out how this weight of what's right shows up in the ER in a newsroom. And this is the one that really threw me for a loop in prisons.

SPEAKER_01:

Yeah.

SPEAKER_00:

Among the prisoners themselves.

SPEAKER_01:

Aaron Powell It really shifts the whole conversation. We're moving away from asking what is clinically wrong with you and asking a much deeper question. Like is what happened to your moral compass? And can it be fixed?

SPEAKER_00:

So let's get into the weeds of this training session. The title is The Weight of What's Right. And right off the bat, I kind of ran into a wall with the terminology. Okay. We hear PTSD all the time, post-traumatic stress disorder. I think most people, myself included, assume moral injury is just a fancy synonym for it. But they seem pretty adamant they're different things.

SPEAKER_01:

Aaron Powell They are very different. And that difference is crucial. If you think about PTSD, the engine driving it is fear.

SPEAKER_00:

Right, fight or flight.

SPEAKER_01:

It's a survival mechanism. You hear a loud noise, you duck. Your body thinks the tiger is still in the room.

SPEAKER_00:

Pure biology.

SPEAKER_01:

Exactly. But moral injury, it isn't about fear. It's about judgment. The core emotions aren't I'm scared. They are guilt, shame, and a sense of betrayal.

SPEAKER_00:

So if PTSD is I am in danger, then moral injury is what I am.

SPEAKER_01:

Moral injury is I am a bad person.

SPEAKER_00:

Wow.

SPEAKER_01:

Or I did something unforgivable. It's a loss of your moral identity. You're not looking over your shoulder for a threat. You're looking inside and hating what you see.

SPEAKER_00:

That distinction hits hard. I am a bad person. That feels infinitely harder to treat than just, you know, calming down a nervous system.

SPEAKER_01:

It is. And while there's overlap, sure, both people might have nightmares, insomnia, depression. The route is completely different. You can't just medicate a moral crisis.

SPEAKER_00:

The presentation breaks down how this happens. And they use these terms that uh frankly sound a little legalistic to me. Acts of commission and acts of omission.

SPEAKER_01:

It sounds legal, but it feels incredibly personal. Think of commission as the act of voice. I did this.

SPEAKER_00:

I pulled the lever, I signed the paper.

SPEAKER_01:

Yes. I followed the order. You took an action that violated your own conscience.

SPEAKER_00:

Okay, so that's the act of wound. What's omission?

SPEAKER_01:

Omission is the passive ghost that haunts you. I stood by, I watched it happen, and I didn't scream.

SPEAKER_00:

I didn't stop it.

SPEAKER_01:

Exactly. It's the failure to act when your gut told you that you had to.

SPEAKER_00:

And then the slides mention two others betrayal and targeting.

SPEAKER_01:

Aaron Powell Betrayal is the external force. It's when the leadership or the system you trusted, it just turns out to be rotten. The people in charge are the ones forcing you to compromise your ethics.

SPEAKER_00:

Aaron Powell That feels like a perfect segue into the real world. Because theories are great, but the stories in this material are what actually kept me up last night. I want to talk about Emily.

SPEAKER_01:

Aaron Powell Emily's case is just heartbreaking because it's so relatable. It takes us back to June 2020.

SPEAKER_00:

Aaron Powell The early scary days of COVID. Yeah. I think we all have a visceral memory at that time. So Emily's an ER nurse, 17 years of experience.

SPEAKER_01:

So not a rookie. She's seen it all.

SPEAKER_00:

Right. But she has a medically fragile son at home. So she's going to work every day, terrified that she's going to bring the virus home and kill her own child.

SPEAKER_01:

Aaron Ross Powell So that's her baseline. She is already operating in a state of high moral stakes.

SPEAKER_00:

Her duty to patients versus her duty to her family.

SPEAKER_01:

It's a war.

SPEAKER_00:

Then comes this specific incident. She has a critical patient dying. The family is calling the ER, begging, I mean literally begging, to come in and say goodbye.

SPEAKER_01:

And Emily wants to let them in. Her humanity is screaming, let them in.

SPEAKER_00:

But the hospital protocol says absolutely not.

SPEAKER_01:

And there it is, the act of omission. She couldn't advocate enough. She couldn't break the rules. She had to be the wall keeping a family from their dying father.

SPEAKER_00:

But it gets worse. A doctor orders a treatment that Emily disagrees with. She thinks it's the wrong call. But she's exhausted. The hierarchy is rigid. So she does it.

SPEAKER_01:

And that is the act of commission. She physically performed an action she believed was harmful.

SPEAKER_00:

Because the system demanded it. Two days later, the patient dies. Alone.

SPEAKER_01:

And this is where we see the difference between burnout and moral injury. Emily didn't quit because the hours were long. By 2022, she was showing symptoms that looked like PTSD.

SPEAKER_00:

Can't sleep, crying in therapy.

SPEAKER_01:

All of it. But the loop in her head wasn't I'm scared of the virus. The loop was I killed him.

SPEAKER_00:

I failed that family.

SPEAKER_01:

Yes. That narrative, I killed him. That's the moral wound. It's not just stress, it's a verdict she's passed on herself. She eventually left nursing. We lost a 17-year veteran to the weight of those decisions.

SPEAKER_00:

Now, one of the authors of this training, Gina Hernandez, she actually shares a story from her past life as a journalist. And this one, man, it made me sweat just reading it.

SPEAKER_01:

It's a perfect example of how fast this can happen. It's 2001. Gina's a reporter covering a car accident.

SPEAKER_00:

Pretty standard stuff.

SPEAKER_01:

Standard stuff. She gets to the scene, but then she sees a police officer she knows, a friend, and she realizes the victim in the car, the DOA, is the officer's father.

SPEAKER_00:

Oh no.

SPEAKER_01:

Imagine that moment. Your human instinct is to back off, offer comfort, protect your friend. But Gina has a producer in her earpiece.

SPEAKER_00:

And the producer wants the name. Who is it? We need to go live. Get the scoop.

SPEAKER_01:

The producer doesn't care about the friendship. Gina knows the name, but the police haven't officially released it yet.

SPEAKER_00:

So here's the dilemma. The system, the newsroom, is demanding an act of commission. Report the name.

SPEAKER_01:

But her internal moral code is screaming, you do not scoop a friend's tragedy before the family is even notified.

SPEAKER_00:

It's that split second where your career says one thing and your soul says another.

SPEAKER_01:

And that friction is the injury. Whatever she chooses, she loses a piece of herself.

SPEAKER_00:

So you have the nurse who can't save everyone, and the reporter who has to invade privacy. But what about the job where you're legally required to break up families? The training deck moves into child protective services.

SPEAKER_01:

CPS, yes. And this looks like a factory for moral injury.

unknown:

A factory.

SPEAKER_01:

It is one of the most systemic traps we see. The sources describe it as a damned if you do, damned if you don't environment.

SPEAKER_00:

I was really struck by the evidence trap. The slides talk about the guilt of knowing a child is in danger, your gut tells you, but you don't have enough legal evidence to remove them.

SPEAKER_01:

Think about the weight of that. You are a protector, that's your identity. But the supervisor says close the case.

SPEAKER_00:

Not enough proof.

SPEAKER_01:

So you have to walk away, leaving a child in a house you know isn't safe. That is a profound act of omission forced on you by the law.

SPEAKER_00:

And the flip side is just as bad. Removing a child who is screaming and begging to stay with their parents.

SPEAKER_01:

Even if the parents are abusive, the trauma of that moment and the worker has to be the bad guy. It creates what we call a fragmented self. You have to shut down your own empathy just to do the job.

SPEAKER_00:

There was one specific point in the CPS section that really twisted the knife for me this idea of betrayal of a child's confidence.

SPEAKER_01:

Aaron Powell Yes. This is devastating. A child trusts you. They whisper a secret because you're the nice lady. But as a mandated reporter, you have to use that secret to open a case.

SPEAKER_00:

Aaron Powell Which might blow up their entire world.

SPEAKER_01:

Aaron Powell So the child feels betrayed and you feel like a traitor. It's like the system weaponizes your kindness against you.

SPEAKER_00:

Aaron Powell That's a powerful way to put it. Okay. Speaking of systems, this next part of the deep dive honestly changed my entire perspective on this. We usually think of moral injury happening to the good guys, the helpers, but the sources discuss moral injury in prisoners. And my first thought was wait, aren't they the ones who caused the injury?

SPEAKER_01:

It's a common bias. We view prisoners solely as perpetrators, and yes, they may have guilt over their crimes, but Dr. Roberts and Gina Hernandez highlight something fascinating called the prison code.

SPEAKER_00:

Aaron Ross Powell This idea that to survive in prison, you have to become someone else.

SPEAKER_01:

Right. There's a quote in the materials from Kurt Danish. He explains that moral injury in prison comes from witnessing the brutality of incarceration, but being unable to act.

SPEAKER_00:

Because of the code.

SPEAKER_01:

Because of the code. If you see someone being beaten, or if you're told to do something violent to prove you aren't soft, you have to do it. Not because you want to.

SPEAKER_00:

But to survive.

SPEAKER_01:

You have to act as a prisoner willingly. You put on a mask, you adopt this persona of violence or indifference. But the tragedy is that the mask, it sticks to your face.

SPEAKER_00:

That image is terrifying.

SPEAKER_01:

Yeah.

SPEAKER_00:

The source says this mask is hard to shed later because of the shame.

SPEAKER_01:

Exactly. Imagine getting out after 10 years. You want to be a gentle father, a loving partner, but you have spent a decade violating your own moral code every single day just to stay alive.

SPEAKER_00:

So when they try to reintegrate, they aren't just fighting the stigma of being an ex-con.

SPEAKER_01:

They're fighting this internal belief that they are fundamentally a violent, uncaring person. It's a spiritual wound.

SPEAKER_00:

This theme of doing what you have to do to survive leads us to the final group, and this is the most delicate one.

SPEAKER_01:

Victims.

SPEAKER_00:

Specifically, victims of sexual assault and sex trafficking.

SPEAKER_01:

This is where the concept really explains things that a traditional PTSD diagnosis often misses. We ask, why didn't they report it sooner? Or why do they blame themselves?

SPEAKER_00:

The case study of Amy is the example here. Assaulted at a college party at 19. Didn't tell anyone for six years.

SPEAKER_01:

Six years of silence. And why? Because of the distorted narrative of moral injury. Amy wasn't just hurt, she judged herself. The source material says she told herself I was drinking. I went with him.

SPEAKER_00:

Well, I did this to myself.

SPEAKER_01:

So in her mind, she committed an act of commission. She framed her own victimization as a moral failure.

SPEAKER_00:

I am a disgusting person. What's the symptom? That's not fear, that's shame.

SPEAKER_01:

Right. But the case of Maria, the trafficking survivor, this one is a labyrinth of betrayal.

SPEAKER_00:

Maria's story shows how the system fails. She was 14, she went to a school counselor for help.

SPEAKER_01:

She trusted an adult.

SPEAKER_00:

And the counselor did what they were supposed to do, reported it to CPS, but that scared Maria, so she ran away. Straight into the arms of a trafficker.

SPEAKER_01:

That's betrayal by system. The attempt to help actually pushed her into hell. But once she was in the trafficking ring, the moral injury got even more twisted.

SPEAKER_00:

The sources mentioned she was forced to recruit other girls. This is the part I just can't wrap my head around. To survive, she had to become a perpetrator.

SPEAKER_01:

Yes. The traffickers force victims to victimize others. It's the ultimate control mechanism. She had to lure other girls in. The source labels this as a forced act of commission.

SPEAKER_00:

And an act of omission because she couldn't help the girl she was recruiting.

SPEAKER_01:

Exactly. This creates a deep, profound self-loathing. Even though she was a victim, she carries the guilt of a perpetrator. You have to address that specific moral wound.

SPEAKER_00:

Which brings us to the so what? We've covered so many groups. It's clear this is everywhere. But we can't just leave people bleeding. No. The sources list protective factors. How do we actually fix this?

SPEAKER_01:

The training highlights three main pillars. The first is strong ethical grounding.

SPEAKER_00:

Which sounds a little like just be a good person.

SPEAKER_01:

It's more practical than that. It means knowing your lines before you get to the crisis. You need to know this is what I will do and this is what I will never do. If you wait until the producer is screaming in your ear to decide your ethics, you lose.

SPEAKER_00:

Okay, that makes sense. Pre-deciding your values. What's number two?

SPEAKER_01:

Psychological safety and social capital. This just means having a space where you can say, I think we did the wrong thing today without getting fired.

SPEAKER_00:

Breaking the silence. Unlike Amy, who held it for six years.

SPEAKER_01:

Right. Moral injury thrives in the dark. If you can turn to a colleague and say, I feel like we betrayed that family, and they say, I feel it, that shared burden is so much lighter.

SPEAKER_00:

And the third one, institutional integrity.

SPEAKER_01:

This is the hard one. This is on the bosses. Hospitals, newsrooms. They have to stop putting their people in impossible situations. You can't demand efficiency at the cost of humanity and then wonder why everyone is quitting.

SPEAKER_00:

But let's say the system doesn't change. Let's say I'm listening to this and I'm already hurt. The authors have a very specific take on healing, right? Trevor Burrus, Jr.

SPEAKER_01:

They do. And this is probably the most important takeaway from the whole thing.

SPEAKER_00:

Okay.

SPEAKER_01:

They say moral injury is not a mental illness, it is a moral wound.

SPEAKER_00:

Aaron Powell Uh that sounds like semantics, but I feel like it changes the treatment.

SPEAKER_01:

Aaron Powell It changes everything. If you treat it as an illness, you try to cure the symptoms, take a pill for the anxiety, do breathing exercises. But if it's a moral wound, you have to treat the soul.

SPEAKER_00:

Aaron Powell So what does that look like?

SPEAKER_01:

It looks like meaning making. It looks like uh atonement.

SPEAKER_00:

Atonement. That's a very old school word.

SPEAKER_01:

It is, but it's necessary. Maybe it means writing a letter to the family you couldn't help, even if you never send it. Maybe it means forgiving yourself for doing what you had to do to survive.

SPEAKER_00:

Aaron Powell So it's about integrating that scar into your story.

SPEAKER_01:

Aaron Powell You can't just say it didn't happen. You have to say it happened, it hurt, I am imperfect, but I am still good.

SPEAKER_00:

I am imperfect, but I am still good. That's the destination.

SPEAKER_01:

That is the healing.

SPEAKER_00:

You know, we've talked a lot about these extreme professions today, but I want to bring this right into the listener's lap.

SPEAKER_01:

Mm-hmm.

SPEAKER_00:

Because we demand a lot from people. We expect the nurse to follow orders, the reporter to get the scoop, but we rarely ask what the cost is to their soul where that duty conflicts with their humanity.

SPEAKER_01:

Aaron Powell And more importantly, we rarely ask ourselves that question.

SPEAKER_00:

Aaron Powell Exactly. So here's my challenge to you listening right now. Where in your own life, whether you're a parent, a manager, or just a friend, are you carrying the weight of what's right in silence? What is the conversation you haven't had because you're afraid to admit that a choice you made still keeps you up at night?

SPEAKER_01:

Aaron Ross Powell Recognizing the wound is the first step. You aren't broken, you're just injured. And injuries can heal.

SPEAKER_00:

Maybe it's time to put down the illness label and start treating the wound. Thanks for diving deep with us today.

SPEAKER_01:

Take care of yourselves.

Head Shot

Dr. Daniel L. Roberts

Host