The wound that needs an audience
When people think about radicalisation, they tend to imagine extremists, conspiracy theorists, political activists, or people captured by increasingly rigid ideologies. I’m more interested in a different group: healthcare professionals, educators, academics, HR practitioners, social workers, and other members of the professional managerial class whose identities are built around helping, caring, educating, protecting, and doing good.
Many of these professions have become increasingly ideological over the past decade. The usual explanations focus on politics, incentives, institutional capture, or personality pathology. I suspect unresolved moral injury plays a larger role than is acknowledged.
A reliable way to generate engagement on LinkedIn is to post about moral injury. The comments fill quickly with people describing their own experiences, validating each other’s distress, and agreeing that workplaces should be safer, leaders more accountable, and the whole situation generally less awful and traumatising. The post gets shared. Someone adds a fire emoji and nothing changes.
I’ve watched this cycle long enough to find it interesting and irritating, especially when I test out that theory on my posts. The visibility of these posts tells me how many people are carrying the residue of experiences they can’t yet describe accurately. The algorithms amplify victim grievance posts, rewarding the production of more victim grievance posts, which is part of why I think the discourse stays where it is.
The discourse on moral distress and injury tends to focus on what was done to people while ignoring the uncomfortable reality that people contributed to the conditions that later became the source of their injury. This reinforces the innocence narrative that prevents the wound from healing while building a fortress, even an industry, around it.
The discourse protects the wound instead of helping people examine it. Moral distress and moral injury were not only descriptions of suffering. They were attempts to understand what happens when a person knows something is wrong and continues participating regardless.
Moral distress was first described by philosopher and nurse Andrew Jameton in 1984, who defined it as the experience of knowing the right thing to do and being prevented from doing it by institutional constraints1. His original context was nursing, where practitioners regularly encountered situations in which they could identify the right course of action and were structurally blocked from taking it. The distress was the accumulating weight of being unable to act on what they knew to be right.
Moral injury is a different and more serious condition. Jonathan Shay developed the concept through his work with Vietnam veterans where he observed that what broke many of them was being required by legitimate authority to participate in actions they knew were wrong while believing the authority they served was just and the mission worthwhile2.
The injury came from perpetrating or witnessing serious wrongdoing under the sanction of a trusted authority, the failure of that authority to acknowledge it, and the absence of any place where the truth could be spoken and taken seriously. Shay called this the second wound.
Litz and colleagues later expanded the definition of moral injury to include perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs3. Perpetration was always part of the definition. The popular discourse amputated that dimension because victimhood generates engagement and perpetration generates disgust. We can empathise with the victim and condemn the perpetrator. The difficulty begins when they are the same person. The compartmentalisation occurs when that person is us.
For those in the helping professions, participation threatens a deeply held identity as a good, caring, ethical person. The injured self and the benevolent self can coexist comfortably, whereas the participating self is harder to accommodate. So naturally, one self is preserved while the other is split off.
Both terms have since migrated into healthcare and, more recently, into corporate and institutional life. In the process they have been laundered into near-uselessness by the same people who put fire emojis on LinkedIn posts about trauma. Moral distress is now invoked for any frustration with a manager. Moral injury for any experience that leaves someone feeling wronged. Because feelings.
The original concepts were concerned with the conditions that produced the suffering, not merely the suffering itself. Moral distress referred to a gap between what a person knew to be right and what they were permitted to do. Moral injury involved a betrayal by legitimate authority compounded by participation in, or witness of, a serious moral violation and the absence of any meaningful resolution.
Unresolved or disowned moral injury appears to be one pathway through which otherwise reasonable people become increasingly radicalised over time.
During COVID, clinicians administering triage protocols made decisions about whose life was worth resourcing, along lines encoding existing assumptions about age, disability, and perceived social utility4. They were simultaneously victims of impossible conditions and the instrument through which institutional judgments about human worth got enacted.
The moral injury literature from that period consistently downplayed the perpetrator or participant dimension into the language of impossible choices — both accurate and incomplete explanations. Frameworks that place responsibility entirely on institutions become much easier to embrace when one's own participation remains unexamined, particularly when doing so threatens a benevolent self-image.
This can help explain why systemic explanations have become so compelling across medicine, education, academia, HR, and other helping professions. After years of being told the problem was their resilience, coping skills, emotional regulation, or adaptability, the pendulum swung in the opposite direction, shifting responsibility from the individual to the institution. Pendulums rarely stop in the middle. The outcome was a discourse that became sophisticated about institutional harm and increasingly reluctant to examine participation.
Moral injury becomes more likely when institutions prioritise self-protection over their stated purpose. In these environments, people witness attitudes and behaviours that place them in a bind. Speaking up has consequences and so does staying quiet. Some begin protecting themselves by becoming passive, others align themselves more closely with the dominant authority, and some play both sides.
The progression from distress to injury is difficult to interrupt because participation doesn’t look like participation. A person stays quiet when someone is mistreated and interprets the discomfort as a performance problem rather than a moral one. They become more determined to remain in good standing than to examine what that standing requires of them. By the time the pattern is visible, they have already participated in behaviours they would once have condemned in others.
The discourse never quite gets to the possibility that the same people generating engagement on posts about moral injury may also have participated in the conditions that produced it. Sometimes unwittingly, sometimes through the ordinary compliance that comes from needing to keep a job, status, reputation, and security which exert a stronger influence on behaviour than most people care to admit.
The observation rarely survives for long because acknowledging one's participation disrupts the innocence narrative. The conversation remains focused on suffering, which after years of stigma around suffering, particularly in healthcare, comes as a relief. The incentives, social pressures, and behaviours that helped produce the injury receive less attention.
I started paying attention to this pattern by noticing it in myself. I could talk fluently about moral injury, institutional betrayal, and complicity while constructing a story in which I was the person things had been done to. The story was true enough to be convincing and incomplete enough to be useful. Like most half-truths, it allowed me to avoid examining what I was getting from the story and what examining it might cost me socially, professionally, and in terms of the identity I'd built around having survived something that came with lived experience points and vanity metrics.
The pattern becomes harder to recognise because moral injury can become part of a person's identity, hardening over time into embitterment5. Experiences of betrayal, exclusion, humiliation, and injustice accumulate to form a self-image that becomes increasingly difficult to challenge.
The self-image attached to the injury and its preservation can become more important than examining the conditions maintaining it. The wound becomes part of the person's identity, how they understand themselves, how they are seen by others, and the status that comes with it.
This is one pathway through which otherwise reasonable people become increasingly radicalised over time. The wound becomes harder to challenge because challenging it now threatens an identity, an earned social position and its privileges, and a community of people who think and feel the same. The beliefs attached to the wound form a scab protecting against alternative explanations, rendering them intolerable and narrowing the range of conclusions the person is willing to entertain. The person becomes increasingly certain about who is responsible for their suffering and increasingly unwilling to examine their own participation in it. The wound now has an audience invested in its preservation.
Many people assume they will recognise a moral violation when they encounter one and respond in a way that is consistent with their values. The vast body of research on human behaviour and psychology suggests otherwise.
I developed the assessment below to identify the conditions under which beliefs, loyalties, and interests come into conflict. Moral injury often begins in situations where competing obligations, incentives, relationships, and pressures make it difficult to see clearly. The assessment is designed to help identify those conditions before you find yourself in them.
If the assessment is helpful, what did you discover about yourself?
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Hacking Narcissism is for people trying to make sense of and effectively navigate a morally distorting and chaotic age. When moral development is disincentivised, people lose reliable reference points for discernment and struggle to distinguish between what’s real, what’s performative, and what’s covertly shaping their perception.
Narcissistic traits are expressed in everyone (often referred to as Cluster B traits). They flourish during periods of moral decline because they help secure status, protection, and significance in environments where norms of what appears correct, rather than what is grounded in moral principles, regulate behaviour. The effect of this behaviour is experienced in all types of relationships, including in workplaces, where people can be punished for violating norms they never agreed to and were never made explicit.
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Jameton, A. (1984). Nursing practice: The ethical issues. Prentice-Hall.
Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. Atheneum.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706.
Jeffs, L., Merkley, J., Tregunno, D., & Yamada, J. (2024). Long-term impact of the COVID-19 pandemic: Moral tensions and moral injury in healthcare workers. PLOS ONE, 19(9), e0309385.
Linden, M. (2021). Embitterment and posttraumatic embitterment disorder (PTED): An old, frequent, and still underrecognized problem. Psychotherapy and Psychosomatics, 90(2), 73–80.
This is such a great read. Reminds of me of Philip Zimbardo’s Stanford Prison Experiment. And of course it took an outsider to point out that he was complicit in the institutional abuse—- and that it was his individual choice that mattered!
The wound is real, but if it needs an audience more than healing, eventually you have to ask what you participated in, what you stayed quiet about, and whether the story is moving you forward or keeping you in the same place.