The Redesigning Wellness Podcast

250: The Impact of Moral Injury with Noël Lipana, Doctor of Social Work

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Noel Lipana

Moral injury is the act, or omission of an act, that goes against one’s deeply held personal, spiritual, or moral beliefs. Although moral injury has been documented as far back in history as 336 BC (think Alexander the Great), the term is gaining attention within the military and is now being considered in occupations such as healthcare and social work. Causing profound feelings of shame and guilt, alterations in beliefs, and maladaptive coping responses, the topic of moral injury in the workplace is one that needs to be discussed. 

Podcast guest, Noël Lipana, is a Regional Prevention Coordinator for The Center for Prevention Programs and Partnerships, US Department of Homeland Security. Noël’s outside work includes the use of performing arts to educate communities about moral injury and trauma among veterans and marginalized populations. His connection to those populations stems from his twenty-year service in various Air Force, Army, and Joint military units in Active Duty and National Guard units.

In this episode, Noël defines moral injury and how it shows up both personally and in the workplace. He explains the different levels of moral injury and if it can be prevented. We spend a bit of time talking about veterans but also go into healthcare settings and first responders. Finally, Noël talks about what we can do personally to recover from moral injury as well as what organizations can do.

Episode Highlights:
  • Moral injury is the act or omission of an act that goes against one’s deeply held personal, spiritual, or moral beliefs. It’s not a medical condition and is different than trauma (but can sound like trauma). It’s an inner conflict at moral level with origins in military service and combat.
  • Examples includes – the act of killing in service (military combat), hospital setting (decision making in who gets medical care/ventilator), insurance claims (processors who make coverage decisions), childcare services (removing kids from one bad situation to one that’s no better or could be worse).
  • Symptoms of moral injury – guilt, shame, anxiety, loss of trust, anger, depression, anxiety, self-medication, overwork, and unresolved grief.
  • Different levels of moral injury – moral perfectionism: expectation of zero defects by following policy and procedures; moral luck: chance of upbringing and culture of moral currency; not having timely information; moral uncertainty: doing what you think is right but never knowing.
  • Trauma and/or moral injury can’t be seen as an individual rather than collective experience. What about the systems, policies, and practices that contribute? Organizations can ask themselves – “are we making human centered values-based decisions or are the policies there to generate revenue and force individuals to pay a trust tax?”
  • Businesses need to take a hard scrub to review what their purpose is, especially if they are in the business of taking care of people.
  • It takes moral courage to deconstruct a system that has been in place for decades.
  • Individual treatments of moral injury – experiential group therapy using practices of empathy first, radical acceptance and checking judgement at the door. That person is affirmed in their feelings and experiences. Other treatments are writing, a co-created ceremony or ritual, and identifying the narrative(s) you hold.
Links Mentioned:

Resilience for Self-Leadership

Noël’s LinkedIn

Recent Panel: “What is Our Responsibility for Our Government’s Wars?” https://youtu.be/rDwS_Sy35Ns

Quiet Summons is a performing arts event that takes attendees on a journey that awakens our sense of humanity. Each act and scene reveal a deeper understanding of moral injury, trauma, and connection at the spiritual level for veterans and society as a whole. https://www.youtube.com/watch?v=urwJiElP8xc

Full Bio:

Noël Lipana is a Regional Prevention Coordinator for The Center for Prevention Programs and Partnerships, US Department of Homeland Security. He performs community-level social work to prevent targeted violence and terrorism. His region covers Northern California, Oregon, Idaho, and Alaska.

Noël’s outside work includes the use of performing arts to educate communities about moral injury and trauma among veterans and marginalized populations. He is a founding board member and current president of the DJD Art Foundation, a 501(c)(3) that provides arts programming to veterans and military-connected families. His connection to those populations stems from his twenty-year service in various Air Force, Army, and Joint military units in Active Duty and National Guard units. He has participated in multiple civil support operations in California and Louisiana and was a Counter-Improvised Explosive Device Officer in Afghanistan.

He earned his Doctor of Social Work at the University of Southern California in 2018, where he did work-study at their Center for Innovation and Research on Veterans and Military Families. Noël is a 1996 graduate of the U.S. Air Force Academy and holds a M.A. from the Center for Homeland Defense and Security at the Naval Postgraduate School (2011). Noël resides in Sacramento, CA and is an adjunct instructor for the University of Kentucky’s College of Social Work doctoral program.