Burn-out & moral injury

The terms—burnout, compassion fatigue, vicarious trauma, and moral injury—all relate to mental and emotional strain, particularly in caregiving or high-stress professions.

To be clear: I don’t love the terms "burnout" or "compassion fatigue." I use them because they’re the language most people recognize. These terms often miss the larger, systemic forces at play and tend to place the blame on individuals for not practicing enough self-care.

  • Burnout

    A state of emotional, physical, and mental exhaustion caused by prolonged stress, often in the workplace. It typically occurs when someone feels overwhelmed, emotionally drained, and unable to meet constant demands.

  • Compassion Fatigue

    Emotional strain that caregivers or helping professionals experience after prolonged exposure to the suffering of others. It has been called "the cost of caring" and can result in reduced empathy or emotional numbness.

  • Vicarious Trauma

    Stress experienced by those who hear about the traumatic experiences of others. It’s akin to secondary trauma, where a person’s psyche absorbs some of the emotional burden of someone else’s trauma.

  • Moral Injury

    Distress that results from actions, the lack of actions, or witnessing actions that violate one's ethical or moral code. This often occurs in situations where people are asked to act in ways that contradict their values.

Real-world scenarios: identifying burnout and moral injury

Here are some common scenarios across different professions that illustrate the impact of these challenges:

1. Being asked to do more than is humanly possible

Imagine working as a public defender with an overwhelming caseload. Despite your best efforts, you have very little time to meet with your clients, investigate their cases, or prepare adequately for trial. You're constantly racing against the clock, unable to give each person the attention they deserve. You begin to feel that no matter how hard you work, you can't provide the legal representation your clients need. Over time, you start to feel like you're letting people down—failing both your clients and yourself.

Indicators: You feel emotionally drained, stressed, and detached from your work. You start doubting your ability to do the job, which leads to frustration, decreased performance, and a sense of helplessness.

2. Skipping breaks to get everything done

As an emergency room nurse in a constantly short-staffed hospital, you find yourself charting on your breaks and meals because there are simply too many patients to attend to. You’re constantly running from one crisis to the next and neglecting your own physical needs. After a while, you feel disconnected from your body, constantly fatigued, and unable to fully recover between shifts.

Indicators: physical exhaustion and emotional detachment. You struggle to remain focused or empathetic with patients, and you begin resenting the very work you once found fulfilling.

3. Seeing your work undone due to political changes

You’re a public health official working on a program that has significantly improved community health outcomes. After a change in political leadership, the new administration cuts funding for the program. You watch as the work you’ve done unravels, leaving the vulnerable populations you serve in even worse conditions.

Indicators: Frustration, resentment, and emotional numbness in the face of systemic failures that override personal efforts.

4. Seeing harm done to people you are supposed to help

Working as a case manager for a housing program, you watch as several of your clients are placed in .group home with countless complaints. You know that these living conditions will harm their health and well-being, but you feel powerless to change it. Each time you hear of another preventable issue, the weight of it becomes unbearable.

Indicators: You feel helpless and guilt-ridden because your ethical duty to protect your clients is being compromised by external forces. The emotional toll of witnessing harm without being able to intervene weighs heavily on you.

5. Being told your concerns are invalid

In a psychiatric hospital, you notice a patient suffering from severe side effects from their medication. They tell you they’re contemplating suicide because of the toll these effects are taking on their body and mind. You report this to their prescriber, but instead of taking your concerns seriously, the prescriber accuses you of feeding into attention-seeking behavior. You continue to watch the patient suffer, knowing that they’re not getting the help they need.

Indicators: You experience a deep conflict between your professional responsibility to advocate for your patient and the dismissal of your concerns by authority figures. This leads to a profound sense of frustration, guilt, and powerlessness, and a betrayal of not only the person you're serving, but of your own values and the ethics of your profession.

Moral injury and burnout can be intensified for members of marginalized groups due to additional systemic barriers and discrimination. This can lead to greater feelings of isolation, devaluation, and an increased risk of mental and physical exhaustion.

Finding a space where your sensitivity is valued can make a difference

I understand the emotional toll of your commitment to change and am dedicated to helping you find your way through it all while maintaining and strengthening your integrity.

It can be incredibly helpful to talk to someone who is completely outside of the situation—someone who doesn’t have any personal stake in your work. You deserve a space where you can express your feelings freely, without worrying about how it might impact your career or reputation. Having this support allows you to explore your emotions, gain clarity, and begin the healing process. If you’re feeling weighed down by moral conflict or stress, therapy could provide the understanding and guidance you need to move forward.

As a therapist who has experienced moral injury, I offer nuanced support grounded in personal understanding of ethical challenges and emotional complexity.

Whether you choose virtual sessions or prefer in-person meetings in the Milwaukee area, my practice is tailored to fit your needs and preferences. My commitment to tracking progress and incorporating your feedback ensures that each session is as effective and supportive as possible. I aim to help you maintain your drive for positive change while building a life that feels balanced and fulfilling.

If you’re caught in a cycle of shutdowns and doom scrolling and are seeking renewed purpose and balance, request an appointment today for a free consultation. Let’s work together to turn your experiences into a path of meaningful growth and renewed pride in the work you do.