Season 3 Episode 6: Exploring Moral Injury with Dr Sophie Redlin

Welcome to the Wilderness Medic Podcast. Check out our website at www.thewildernessmedic.com. Expo-dissue resources, woodless meds and blog at much more. I welcome to the Wilderness Medic Podcast. My name is Daniel and today I'm really excited to be joined by Sophie Redlin. Sophie is a GP anthropologist and a filmmaker as well who has particularly interested in mental health and remade in expedition medicine. She works as GP in London and as well as doing sort of traditional GP work helps the service for homeless patients in Soho and she's also works as an expedition doctor all over the world. Recently supporting sailing voyages to Antarctica and the Antarctic and she's also involved in doing some research at UCL on different cultural approaches to mental health so we're going to explore some of those ideas. So yeah, welcome Sophie. Great to have you on the podcast. Thank you so much. Yeah, I'm really happy to be here. Fantastic. So I guess today we're going to sort of delve into the theme of moral injury and we've sort of chosen that based on an initiative that you've set up with some colleagues. That's right, yes, this is a project that I've developed with two others, yeah. Yeah, so I guess for people listening it would be helpful to obviously have a think about what we mean by moral injury but maybe we could explore as well how you develop this interest and why you set up the moral injury partnership. Of course, yeah. So as you kindly mentioned in the intro, I have a great interest in mental health and that particularly flourish during my GP training when as you'll know very well yourself, I began to see how much mental health we see in our everyday workload and that really prompted me to take time out of training and explore mental health around the world really, looking at different approaches to mental health, different mental health care tactics, etc. And during that period I was awarded a Churchill Fellowship to go to the US and I became very interested in Indigenous communities in the US and how they perceive mental health issues and how they cope with issues within their communities. And then back in 2020, gosh, beginning of the pandemic, so 2020 having just completed that fellowship, I was contacted by a guy called Simon Edwards who's also a Churchill Fellow and he done his research on mental health but he was particularly looking at this issue of moral injury within the military. And actually through conversations with him and through another Churchill Fellow, Alessandro Conner, we got together and began looking at the emerging issue of moral injury within healthcare workers which of course became very obvious and prevalent during the pandemic and in short joined forces using our kind of collective research knowledge to put together an intervention for that. Yeah, now I was going to say that, yeah, it became sort of a more widely used term, didn't it, during COVID as people sort of came to terms with facing things that were sort of completely or relatively unexpected at work and things. And I guess just to recap, what is moral injury? Sure, so moral injury is called the wound of service which I think is a really good way of describing it. It's basically the impact both emotionally and cognitively of having to act in a way that goes against our moral compass if you like and that's usually due to systemic failings or structures above or out of our control. So it's really that wound that arises from having to care in a way in the context of healthcare, to care in a way that doesn't sit well with us in terms of our own morals. Yeah, and yeah, that whole concept of systemic failings is obviously something that a lot of medics may be familiar with at the moment given the state of various healthcare systems. And I guess a lot of the research from what you're saying initially came out of the military, is that right? That's right, absolutely. So examples from the military might include tragically soldiers having to injure civilians in conflict zones or act in ways that don't sit morally right with them. And as you touched on just then, it became more obvious to us in terms of examples during the pandemic for healthcare workers who in some ways were experiencing similar sorts of events, you know, for example, nurses in intensive care having to care for five patients when they were ordinarily have cared for one and really being pushed out of that zone of what we feel morally comfortable with. But the reality is that moral injury has long existed within healthcare and many other sectors that have long before the pandemic and can you know, continues obviously today in very different ways. Yeah, that's interesting. I guess step one is sort of identifying it and naming it and defining it and things like that as we've just been saying. And I guess once we're aware of it as an issue is that anything we can do to sort of prevent it or prepare better for it is that sort of an individual thing or more of a systems wide thing, do you think? Absolutely. I think of course there's a huge systemic element to this. But I do think and of course there are things, although we often feel helpless and powerless when it comes to making systemic changes. Obviously as the strikes going on at the moment show, there are kind of collective movements that we can all join and hope will have some influence. But I think crucially there is a lot that we can do on an individual level and as collective groups of medics or nurses or whoever in terms of healthcare. And I think for me it's particularly about how do we prepare for moral injury and how can we look at potentially preventing it. And when I think about preparation, I think about really medical education, are we having conversations enough in medical education, in nursing training around what it's like to be in situations that don't feel morally right. I don't know about you but I don't remember any conversations in medical school about what it feels like when a patient dies on your own call or I'm being dramatic here. But this is a lot of our workload, particularly as junior doctors. And yet there's not enough conversation around that. And it's not about fear mongering but it's about as you say raising awareness and having those conversations early. And then I think in terms of prevention, it's really on an individual level for me about trying to alleviate the shame of moral injury. So I'll probably talk quite a lot in our conversation about how really one of the core emotions of moral injury is shame. It's something that really isolates us because we don't feel we can talk about mistakes we've made or difficult situations we've been in. And the way to alleviate shame, as you know, is to tell each other our experiences, is to share those experiences and realise that we're not the only one who feels like that. So I think in terms of prevention on an individual level and on a kind of grassroots ground level, it's about facilitating spaces where people can have those conversations more regularly in order to alleviate that shame and really build people's resilience in knowing that they're not alone and we're all in this together. Yeah, some particularly valid points. I guess first off, I can't recall having much, if any, teaching at medical school, maybe a little bit too postgraduate GP training but still not much. And I guess part of the challenge, talking about it is definitely the way forward, isn't it? Like there's so many things, but I suppose first off finding time for it is a challenge isn't it? In our work spaces and things, but also I suppose creating an environment where it's safe to be vulnerable and safe to talk about these things can also be, you know, it's not easy to talk about how you feel, particularly when it's to your peers at times. Have you had any sort of thoughts and perhaps through the partnership you're creating about how we can address these ideas? Absolutely. And I think it's such a good point that you said that it's not easy to talk about how we feel. And I would say that really part of the groundwork for this is acknowledging and understanding the stigma that exists, particularly within medicine around vulnerability being some kind of weakness. I mean, that's an issue that's widely talked about now in our society. I would argue that there is still feel such as medicine and such as the expedition world that we're both involved in, where there is still this need to keep calm. ac mae dod y tu, mae hunangwnau authymnau? Mae'narr hosten ay ywâr, yna fformymau fod i'n awr, da Ewrapod yn dimod ddiw broedd pbarierfodeng i dードysydd roeddwchuaeth cwościothatio. 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