PSYCHIATRIC VIEWS ON THE DAILY NEWS
In “Heads-Up for Moral Injury,” my September column that was part of my moral injury series , I noted that we were expecting the release of the preliminary results of a year-long study by the Physicians for a National Healthcare Plan (PNHP). It was released this week,. ironically on October 7, 2025, the very same anniversary day of the invasion of Israel by Hamas 2 years earlier and, therefore, the same day that there seemed to be so much moral injury for caregivers in both Gaza and Israel. In both areas, health and mental health care were being overwhelmed with need. In addition, caregivers were subject to their own primary and secondary trauma. For many of us so far away, we can be morally injured from bearing witness to the horrors of the war, especially the impact on innocent children.
Why This Matters
- Psychiatrists were strongly represented among PNHP study leaders and speakers, highlighting the field’s role in defining and addressing moral injury.
- Understanding the distinction and overlap between burnout and moral injury is crucial for developing effective clinician support systems.
- Rising moral injury may directly impact workforce retention and continuity of psychiatric care across systems.
- Psychiatrists can play a key advocacy role in addressing systemic drivers of moral distress, including inequitable access and profit motives in care.
- The findings reinforce the need for collective action and policy reform, such as pursuing a single-payer national health system to restore ethical and spiritual balance in medicine.
Yet, “hope springs eternal”, as the saying goes. Yesterday, just after the 2-year anniversary, a first phase of a peace plan was announced and is poised to produce a ceasefire in Gaza, the release of the remaining hostages, a prisoner exchange, and an increase in humanitarian aide into Gaza. If completed, some relief of moral injuries in connected caregivers and citizens should ensue.
The PNHP study only focused on physicians and other health care workers in the United States. The preliminary results are, not surprisingly, quite worrisome. Moral injury was rising quickly, and exemplified in such ways as these:
- Almost 70% have left or considered leaving their current job;
- About 25% are considering leaving now due to moral distress; and
- Systems - once called managed care1 seem to emphasize business profiteers over quality of care.
An example of a Black male patient who, despite having with insurance, was limited in where he could get care, elicited many comments about feeling morally injured, including:
- “Violating my Hippocratic oath”
- “Haunted by recurring memories of the incident, wondering what was the outcome of the patient”
- “It is beyond painful”
I was proud of the representation of psychiatrists in the program. Half of the key speakers were psychiatrists.
I was concerned, though, with the way moral injury was compared to burnout. There was a question on burnout, and 38% of respondents self-described a moderate degree of it. However, the study seemed to define burnout as being individually based and inadequately intervened by wellness programs, rather than by the systemic causes that were commonly blamed.2 Moral injury was alternately described in the study as systemically caused, which actually seemed to be the cause of burnout. Moral injury seems to be based on individual moral values, which can vary to various degrees, rather than the common professional ethics we all share, like the Hippocratic oath. The confusion and apparent overlap of burnout and moral injury needs further clarification.
Even with this concern, this looks like it could be a very important landmark study about moral injury in health care.
One of the antidotes is becoming more active in addressing it, rather than trying to just “tough it out” with more and more resilience.
Ultimately, that takes us, once again, to advocate for a single payor national health care system, like most every major country currently has, even more important now as “ObamaCare” premiums are poised to increase dramatically in 2026.
Now the damage is not only to those with inadequate or no health insurance, but also to our own spiritual health.
Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.
Reference
1. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.
2. LoboPrabhu S, Summers R, Moffic HS. Combating Physician Burnout: A Guide for Psychiatrists. American Psychiatric Publishing; 2019.
