Charlie Kirk and 9/11: Are We All Potential First Responders at Risk for Moral Injuries?

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

“The man who first flung a word of abuse at his enemy instead of a spear was the founder of civilization.” - attributed to Sigmund Freud

As we continue our series of columns on moral injury today, not much could have bumped the 24th anniversary of 9/11/01 from the news headlines this morning, but the assassination of the conservative activist Charlie Kirk does so. While speaking to the public outdoors, he was shot from a roof, shades of the unsuccessful assassination attempt of President Trump during his nomination process. So far, it is unclear how official first responders were stationed and prepared, nor how they and all the general public there responded immediately to the shooting. The manhunt for the perpetrator continues.

Twenty-four years ago, the unexpected and devastating terrorist attacks that occurred in Manhattan, Washington DC, and Pennsylvania used airplanes instead of guns to produce an emergency need for first responders. We know that those who survived were at higher risk for posttraumatic stress disorder (PTSD), as well as their loved ones and the loved ones of those who had died. Empathic pain rippled out into the country. What was not so readily apparent was how much moral injuries occurred, in part because the term was not clarified until 1994 by the psychiatrist Jonathan Shay, MD, PhD, and that it seemed to be inappropriate to connect such heroic rescuers and military with some sort of tarnished morality.

Besides, in the common causes of moral injury, it is very unlikely that it would emerge from what first responders did not do in 9/11. They generally were not bearing witness of broken values. They also were not complicit in the destruction, although vociferous critics of America might say that they were indirectly. However, moral injury is often caused by compromised trust in leadership and authority. That did peak through now and then out of the 9/11/01 heroism. That shattered trust could be our country’s leadership not preparing adequately to prevent the surprise attacks. Later, shattered trust could occur from inadequate health and mental health services for the traumatized. When we do contribute to our own moral injuries, trust in ourselves can also erode. How much of 9/11/01 can be seen in the assassination of Charlie Kirk, time will tell.

Psychiatrists and other mental health professionals were among the first responders for 9/11, especially after the initial attacks. By most media reports, we were helpful in initial support and in preparing for delayed PTSD and prolonged grief.

We are also first responders in many other health care situations, especially emergency departments. Emergency psychiatrists may be the first to have to respond to dangerous and threatening people with mental illness. The key to avoiding moral injury here is to have adequately trained staff and teamwork. Without that, the health care values of saving lives and producing healing will be imperiled.

Come to think about it, we are first responders to many patients who are coming for care for the first time, sometimes unwillingly, but not necessarily in an acute crisis. As long as a safe environment can be provided with adequate resources available for more ongoing care, moral injury likely will not occur. However, we know that for-profit business’ control of medicine has imperiled our ability to heal and threatened the quality of care that we can provide. No wonder, then, that we may be at as much risk for moral injuries as burnout, but for different reasons.

There are so many different kinds of first responders who are chronically at risk for PTSD, burnout, compassion fatigue, and moral injuries. Being appreciated helps. A colleague, Emily Diamond, PsyD, wanted to do something that would be uplifting for them, so is collecting recipes for what might be the first International First Responder Cookbook (share recipes and receive flyer at ediamond@wi.edu).

Besides such professional first responders, all individuals may at times be exposed to situations which can precipitate moral distress or injuries. That can occur in a crisis when one decides to be an innocent bystander or heroic upstander. It can occur with parenting when a parent feels they are unnecessarily falling short in child rearing. It can occur in exposure to individuals who are poor and homeless, if you wish to help improve the world. It can—and is—occurring in what one sees in the devastation of the current wars. The psychological pain in confronting such seemingly intractable situations can cause withdrawal of concern.

One way of assessing the character of a country or civilization could be how it addresses these situations that are likely to cause moral distress and that do not occur by chance or fortune. As we in mental health care are finding out more about moral injury, it behooves us to contribute to its reduction and prevention wherever we find it. Easily used public weapons seem to be a clear target. The limit of Freud’s quote is that publicly flinging words of abuse can cause humiliation in the target, which then can elicit revenge from modern equivalents of spears.

In the meanwhile, specialized interventions for moral injuries are evolving. Such developments would be the best way to honor those heroic 9/11/01 first responders.

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.