What will America’s world of work look like as we emerge from the pandemic?

Second shot came 3 weeks later!

What will America’s world of work look like as we emerge from the pandemic? Now that vaccination numbers are up, new infections and COVID-19 fatalities are down, and businesses and cultural institutions are re-opening, it’s time to generate discussions about the future of work, workers, and workplaces during the months and years to come. 

Bullying and harassment

First, bullying, mobbing, and harassment at work — key topics for this blog — won’t be going away any time soon. As I reported last month, the Workplace Bullying Institute’s 2021 national scientific survey revealed that, during the pandemic, a lot of bullying behaviors simply migrated to online platforms such as Zoom. Furthermore, individuals of Asian descent have been targeted for racial harassment due to the apparent origins of the coronavirus in China. Also, retail workers across the country have been verbally abused and physically assaulted by out-of-control customers who disagreed with mask and public safety requirements. In short, while this pandemic has brought out the best in some people, it also has brought out the worst in others.

The face-to-face workplace

Second, we’re going to see a somewhat clunky and varied transition back to working in face-to-face office settings again. Some workers can’t wait to get back to the office, while others have found themselves working effectively — and more contentedly — at home. Employers have experienced differing productivity levels with people working remotely, and some have been re-evaluating their need for large office spaces. We may see greater reliance on hybrid approaches that mix-and-match working from home and coming into the office when necessary.

Restaurant recoveries?

Third, many retailers, especially those in the restaurant and food service industry, are going to be in recovery mode. For example, will the pre-pandemic fondness that many Americans have for eating at restaurants return as vaccinations and improved ventilation systems make indoor dining safe possibilities? Fingers crossed that these industries will make robust comebacks!

Frontline workers

Fourth, millions of essential frontline workers have been putting themselves in harm’s way to stock shelves, operate cash registers, produce and deliver goods and packages, and perform countless other tasks to help keep our society going during this time. Will a grateful nation reward them with higher pay, better benefits, and stronger job security? It’s anyone’s guess as to whether that will occur.

Women bear the brunt

Fifth, the labor market impacts of this pandemic have been very gendered, with more women than men bearing the brunt of caregiving at home for children and the ill. While it may be premature to assess how this will effect current generations of women workers in the long term, the short-term impact has been palpable and threatens to endure.

Health care workers

Sixth, health care workers across the country who have been treating COVID-19 patients face trauma, exhaustion, and burnout from working long hours under the most difficult circumstances. They have been in the trenches of this war against the virus, and many have paid a price in terms of their physical and emotional health. We owe them a debt of gratitude, which includes providing all necessary measures to support them as they recover from this ordeal.

Ch-ch-changes

Seventh, we may witness a stream of career transitions, job changes, and early retirements, the cumulative results of individual and family contemplations about their lives during this long period of semi-quarantine. As I wrote in my personal blog over the weekend:

The pandemic appears to have prompted a lot of self-reflection among middle-aged folks during the past year or so, and the results of these inner dialogues are starting to emerge. More and more we’re hearing about career and job shifts, accelerated retirement timelines, moves to places near and far, changes in personal relationships, new hobbies and avocations, and more active pursuits of “bucket list” plans.

This stuff is popping up in everyday conversations, Facebook postings, and news features about life transitions in the shadow of COVID-19. I don’t know if it’s a temporary blip on the screen or the beginning of some major social ground shifting, but for now the phenomenon is real.

Haves and have-nots

Finally, the pandemic has exacerbated the divide between the haves and have-nots. Those who could work remotely and safely, watch their retirement accounts grow amidst a strong stock market, and take advantage of generous, employer-provided health care plans are coming out of this pandemic in pretty good shape. Those who lost their jobs, tapped into meager savings, and have struggled to obtain needed health care have found themselves increasingly reliant on special safety net measures enacted by the federal government. This is among the reasons why I hope that the Biden Administration’s proposals to create millions of jobs with good wages and benefits to help repair our nation’s crumbling infrastructure and build a healthy green economy are enacted. 

These points raise but a few of the compelling matters related to the post-pandemic future of work in America. In all, they highlight persistent challenges of opportunity, equality, and worker dignity that existed before this virus transformed our lives. Accordingly, I hope that we, as a society, will take the high road in prioritizing the needs of those who have struggled the most during one of the most challenging times in our history.

2012-2020: When gaslighting went mainstream

I first wrote about gaslighting behaviors in connection with workplace bullying in December 2012. Since then, gaslighting has been a recurring topic on this blog. (See below for a list of related pieces.) In preparing an essay I’m writing on the nation’s political psyche during the years 2015-20, I was curious about the degree to which gaslighting has become a mainstreamed concept in our public discourse. I did a quick series of Google searches on “gaslighting” by year, starting in 2012 and going through 2020. Here is what I found:

Google search: “Gaslighting”

Year          # “hits”

2012          26,100

2013          29,000

2014          34,500

2015          49,500

  2016          320,000

2017          87,000

 2018          126,000

 2019          155,000

 2020         204,000

Several conclusions and informed speculations become evident:

• Clearly, the year-to-year pattern in hits indicates that gaslighting has been increasingly invoked in discussions of relationships, work, and civic life.
• The difference between 2012 and 2020 represents an increase in Google hits by approximately 800 percent.
• The 2016 spike may well have been fueled by that year’s U.S. presidential election, and possibly the 2020 increase was prompted by that year’s presidential election as well.

I’m glad that this term has taken hold, because it helps many workers understand the crazy making dynamics of their workplaces. That’s an important step toward both healing from abusive work experiences on an individual level and reforming workplaces on an institutional level.

RELATED POSTS

On gaslighting specifically

Gaslighting exists, and it’s horrible, so we should invoke the term carefully (2020)

Institutional gaslighting of whistleblowers (2018)

Reissued for 2018: Robin Stern’s “The Gaslight Effect” (2018)

Gaslighting at work (2017, rev. 2018)

Inauguration Week special: “Gaslighting” goes mainstream (2017)

Is gaslighting a gendered form of workplace bullying? (2013)

Gaslighting as a workplace bullying tactic (2012, rev. 2017)

Related posts (most mention gaslighting)

Integrity catastrophes: How lying becomes an organizational norm (2019)

Workplace bullying: Blitzkrieg edition (2017)

Workplace bullying and mobbing: Toxic systems and the eliminationist mindset (2017)

Workplace bullying and mobbing stories: “Do you have a few hours?” (2017)

How insights on abusive relationships inform our understanding of workplace bullying and mobbing (2017)

Workplace mobbing: Understanding the maelstrom (2016)

Workplace bullying as crazy making abuse (2014)

The bullied and the button pushers (2014)

When superficial civility supports workplace abusers (and their enablers) (2014)

Targets of workplace bullying: The stress and anxiety of figuring out what the h**l is going on (2014)

January 6, 2021: Workplace violence of Constitutional proportions in Washington D.C.

Screenshot from the Washington Post

Quite understandably, the January 6 mob attack on the U.S. Capitol Building is being framed largely in the context of America’s divisive political dynamics and the final days of the administration of Donald Trump. This was, after all, an unprecedented event, a violent occupation of one of the nation’s most important houses of government, at a time when the Congress was meeting to approve electoral votes for the next President and Vice President. It was preceded by a lengthy rally led by Trump and his minions, spurring members of white supremacist groups and conspiracy cults to storm the building, in an attempt to stop the Constitutional transfer of power inherent in every national election.

This event will rightly prompt a long and deep investigation, and many questions about how this could happen and what parties were responsible remain unanswered for now. True, the loss of life was minimal compared to other signature events threatening national security, such as the terrorist attacks of September 11, 2001, or the Japanese bombing of Pearl Harbor on December 7, 1941. However, this could’ve been much, much worse, with considerably higher fatality and casualty rates, hostage taking, and an extended occupation, had things transpired even a little differently.

I’d like to add another perspective on the Capitol attack, and that is to see it as a significant act of workplace violence, prompted by leaders who favor bullying and mobbing behaviors as ways of getting what they want. Anyone who is interested in preventing and responding to workplace violence should consider January 6 as a massive leadership, organizational, and systems failure and, quite possibly, corruption. I am confident that once we grasp the enormity of this event, it will become a case study of failed workplace violence prevention and response in public sector workplaces.

We also may eventually learn more about psychological trauma emerging from that day. It is likely that a good number of people who were lawfully in the building will experience post-traumatic symptoms. This includes elected officials, staff members, security personnel, media representatives, and others. Especially for them, working in that building may never again feel safe or secure.

It is no exaggeration that January 6, 2021 will be remembered as one of the most disturbing days in U.S. history. For those of us who study abuse, aggression, and violence in our workplaces, comprehending the events of that day will take on this added dimension.

Captain Ahab of “Moby-Dick”: Workplace trauma sufferer, bullying boss, or both?

If you’re even remotely familiar with Herman Melville’s classic novel, Moby-Dick (1851), then you may regard the Pequod‘s Captain Ahab as a mad, angry, and obsessed figure. After all, the novel is driven by Ahab’s relentless and rageful chase of the eponymous whale, seeking revenge for a grievous injury inflicted during an earlier encounter at sea. This obsession leads to Ahab’s undoing.

Earlier this year, I had an opportunity to consider Moby-Dick, via a fascinating online class offered by the Brooklyn Institute for Social Research, an independent school that offers non-credit courses in the humanities and social sciences. Taught by Dr. Rebecca Ariel Porte, “Moby-Dick: Reading the White Whale” was a four-week deep dive (ba dum) into this complex novel, examining it from a variety of literary and social perspectives. I had long wanted to read Moby-Dick, but previous efforts to do so on my own flamed out after a few chapters. I knew that I needed the prod of interactive class sessions to sustain my reading of the book. I am happy to report that the course was more than worth the effort, thanks to its brilliant instructor and a very smart group of fellow students.

Going into the course, I brought a hypothesis: Moby-Dick is, at least in part, a story of psychological trauma suffered by Capt. Ahab. During the course, I was stunned to read passages that, at least for me, vividly supported that hypothesis. I now submit that Herman Melville understood the guts and sinew of trauma, well before the acronym PTSD ever entered our nomenclature.

Indeed, Melville’s description of Ahab fits the profile of a trauma sufferer. Sprinkled throughout the novel, we are given these looks into Ahab’s mental state. Ahab, the narrator tells us multiple times, is a “monomaniac,” which one modern dictionary defines as “a person who is extremely interested in only one thing, often to such a degree that they are mentally ill.” In chapter 106, we learn how Ahab carries a deep sense of grievance linked back to the injury inflicted by the whale, including a subsequent mysterious “agonizing wound” that “all but pierced his groin.” In chapter 135, we are told that Ahab “never thinks; he only feels, feels, feels.”

Today, we know that Ahab’s mental state and behaviors are very consistent with psychological trauma. From Dr. Bessel van der Kolk’s superb book about trauma, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014), we learn that research on brain functioning shows how trauma can shut down logical thinking capacities and hyper-activate the emotions. Those who have experienced traumatic events may relive and obsess over them.

I have seen this on many occasions with some targets of severe bullying and mobbing at work. They face enormous difficulties in getting “unstuck” from a state of rumination and anger. A few become fixated on obtaining some measure of justice, or perhaps vengeance. Like Ahab, they sometimes only feel, feel, feel.

Of course, frequent readers of this blog may also classify Ahab as a bullying boss, given the way he treats the Pequod‘s crew. That’s a fair characterization, too. One senses that the ship’s crew members are walking on eggshells around Ahab. They fear him and question his mental state.

But seen as a trauma sufferer, perhaps Ahab becomes at least a slightly more sympathetic figure. I was recently introduced to the phrase hurt people hurt people, and I think that applies here. Put simply, some abused individuals turn their pain outward and mistreat others.

Thankfully, our understanding of trauma far exceeds what we knew about it in the mid-1800s. Among other things, we now know that PTSD can be treated. Many of these treatment modalities are discussed in The Body Keeps the Score. 

I readily confess that my fiction reading has tended towards mysteries, tales of spies and suspense, and the occasional horror story. But reading Moby-Dick with the help of this course turned out to be a welcomed intellectual workout, one that yielded surprisingly relevant connections to my work. I also came away very impressed with how one iconic author had a remarkable 19th century understanding of trauma and its effects.

Next Avenue on posttraumatic growth: PTG following PTSD

Barbra Williams Cosentino, writing for Next Avenue (link here), writes about recovery and renewal in a valuable piece on posttraumatic growth:

The concept of Posttraumatic Growth, or PTG, was developed in the 1990s by psychologist Richard G. Tedeschi, now distinguished chair of the Boulder Crest Institute for Posttraumatic Growth in Bluemont, Va., and his colleague Lawrence Calhoun.

It’s different from PTSD, or Post Traumatic Stress Disorder, a constellation of psychological and often physical symptoms experienced after profoundly upsetting events such as a natural disaster, an assault or a terrible illness. Posttraumatic growth can be the reward for pain and suffering, a positive ending which can lead to rich and unanticipated rewards in terms of emotional, social and even spiritual health.

Cosentino reports that Tedeschi and Calhoun have developed a Posttraumatic Growth Inventory instrument, which measures how those who have suffered from trauma can grow in several dimensions. In more tangible terms, this can lead to a variety of positive changes:

Internal changes in perception, self-awareness and one’s sense of competence often lead to positive actions. Trauma survivors of any age may switch careers, find intensely rewarding hobbies, go back to school or take early retirement and travel.

Fortunately, individuals can facilitate their own posttraumatic growth in many ways, according to Tedeschi:

• Learning the ways trauma can lead to a disruption of core belief systems
• Developing emotional regulation skills which allow you to manage negative emotions such as anxiety, guilt and anger
• Talking about the trauma and how you have been personally affected by it
• Producing an authentic narrative about the trauma and our lives afterward so you can accept the reality and envision moving on
• Providing service to others who experienced similar or different traumatic events

Targets of workplace bullying and mobbing: Getting “unstuck”

I especially recommend Cosentino’s article for targets of workplace bullying and mobbing who are experiencing the challenges of getting “unstuck.” As I wrote in 2014 (link here):

One of the biggest challenges facing many people who have experienced severe workplace bullying is getting unstuck. Some may feel trapped, helpless, or victimized. Others may be caught in a cycle of anger, defiance, or battle-like conflict. Oftentimes, these thought patterns and behaviors are associated with psychological conditions including depression, anxiety, and post-traumatic stress.

Our emerging understanding of posttraumatic growth offers genuine, tangible hope for those who are recovering from severe work abuse. Practitioners and researchers working in this mode are onto something, as I like to say, and the results have the potential to be life-changing for countless numbers of people.

MTW Revisions (August 2020)

Dear readers, I’ve gathered some posts that I’ve revised over the years and have not shared in previous “MTW Revisions” features. This particular collection emphasizes workplace bullying and toxic or difficult work environments. I hope you find the selections interesting and useful.

Weighing the exit option for a toxic job (orig. 2016; rev. 2019) (link here) — “But until more employers start to take abuse at work seriously and the law steps in to create stronger legal protections, leaving a bad job — voluntarily or otherwise — will remain the most common “resolution” of severe workplace bullying. Whenever possible, those who are experiencing toxic jobs should try to get ahead of the situation. It is not an easy thing to do — at first glance, it may feel downright impossible — but it’s much better than waiting for others to impose the choices.”

What separates the “best” workplace abusers from the rest? (orig. 2015; rev. 2019) (link here) — “One of my central observations is that many of the “best” workplace abusers — the ones who get their prey and continually evade being held responsible — are calculating, committed, and smart planners. With task-oriented surgical precision and detachment, they plot and scheme. Like the serial killer who manages to escape capture, they’re usually a step or three ahead of everyone else, with a scary sense of anticipation.”

When employees leave your organization, how do they feel about it? (orig. 2013; rev. 2019) (link here) —  “If you’re looking for a quick “status check” on the culture of your workplace, ask this simple question: When employees leave the organization, how do they feel about it?“

Is closure possible for targets of workplace bullying and injustice? (orig. 2011; rev.2016) (link here) — “Targets of workplace bullying or mobbing often hear some variation on the phrase you really need to get over this. I suppose there’s some truth in this. No decent human being wants to see another stuck in a place of stress, fear, anger, and trauma. But prodding someone with those words, however well meaning, is rarely helpful — especially absent more concretely useful assistance.”

Dealing with “gatekeepers” at work: Beware of Dr. No (orig. 2011; rev. 2020) (link here) — “In darker situations, gatekeeping can be a form of intentional exclusion, perhaps a passive-aggressive, bullying-type tactic. It’s a way of keeping someone in their place, blocking them from advancement, or preventing them from making a unique contribution.”

Is emotional detachment an antidote for a nasty workplace? (orig. 2010; rev. 2016) (link here) — “Emotional detachment does not come without its costs, as anyone who understands workplace bullying can comprehend. After all, indifferent slackers aren’t the ones typically targeted by abusive bosses or co-workers.  Oftentimes it’s the high achiever, or at least someone who is engaged in her work, who is marked for mistreatment. Telling this person to turn off the passion for her work is indeed an instruction to numb her soul, even if for the purpose of avoiding deeper injury.”

Coronavirus: What can we expect in terms of workplace bullying, incivility, and conflict as we reopen our physical workspaces?

(image courtesy of clipart.email)

With various plans, policies, and discussions addressing the critical question of how we reopen our economic and civic society in the face of the coronavirus pandemic, faithful readers of this blog may be especially interested in how these measures will affect interpersonal behaviors as people start returning to their physical workspaces.

I hope that our better natures will prevail. Perhaps the fears and ravages of a deadly virus affecting our health and lives, the economy, the state of employment, and the viability of our various civic, cultural, and educational institutions are humbling us and causing us to treat one another with greater understanding and care. Maybe we’ll see less bullying, mobbing, harassment, and incivility, as people welcome the return of some semblance of normalcy.

Furthermore, as I wrote earlier, I hope that more employers will find ways to pay all of their employees a living wage. After all, many of us have been able to shelter-at-home in large part due to the service rendered by a lot of workers who haven’t been earning much money.

Then again, it’s not as if bad workplace behaviors have disappeared during the heart of this pandemic. The news has been peppered with accounts of alleged worker mistreatment, especially that in retail, warehouse, and delivery employment. Many of these reports involve claims that management is strong-arming employees to show up to work without providing adequate protective gear or other safeguards. We’ve also seen an unfortunate and sharp uptick in harassment of people of Asian nationalities, linked to the origins of the virus in China.

So maybe my hopes for a great enlightenment are somewhat unrealistic.

In any event, I’m willing to make some mild forecasts about the workplace climate as we start to reopen physical workspaces:

First, I expect that most folks will be on their best behavior, at least initially. They will understand that we’re still in challenging times and be grateful to have paid employment.

Second, I think that various clashes, disagreements, and conflicts will arise, as a result of a mix of employer policies and heightened anxiety levels. Best intentions notwithstanding, a lot of folks will be on edge, and understandably so.

Third, I suspect that a lot of conflicts, incivilities, and micro-aggressions will move online, as we continue to conduct a lot of our work remotely and digitally. A barrage of email and text exchanges will accompany these transitions back to our workspaces. Some will get contentious; a (hopefully) much smaller share will be abusive.

Fourth, we may see a (welcomed, in my opinion) upturn in labor union organizing on behalf of our lowest paid workers in retail and service industries, many of whom have been the core of our essential workforce outside of health care providers. 

Finally, we’ll see coronavirus-related claims over disability discrimination, workers’ compensation, family and medical leave, workplace safety and health laws, and other legal standards related to worker health. Things could get quite litigious if managed poorly.

Coronavirus didn’t create the holes and divisions in the U.S. economy, but it surely has widened them

The U.S. Department of Labor’s monthly jobs report for April provides a jarring look at the effects of the coronavirus pandemic on the state of employment. The Washington Post‘s Tracy Jan summarizes (link here):

As the unemployment rate soared in April to its highest levels since the Great Depression, with 14.7 percent of workers without jobs, the coronavirus shutdown fell unequally on Americans according to age, gender, educational attainment as well as race.

Women became unemployed at higher rates than men. Hispanics and blacks were hit harder than whites and Asians. Those without high school diplomas fared the worst. As did teenagers, of whom nearly a third are now out of work.

Jan’s full story takes a deeper look at the labor market implications from these numbers. Suffice it to say that while the pandemic is now affecting people in virtually all demographic groupings except for the super wealthy, it is delivering especially painful blows on those who had already fallen behind.

***

Back in early-to-mid March (which now seems like another era ago), I anticipated a severe, coronavirus-induced recession (here) and the need for a significant economic bail-out of Main Street and its residents (here). I based my assessments on (1) the low cash reserves of most small and medium-sized businesses and non-profits; and (2) the millions of people who are living paycheck-to-paycheck.

However, if anything, I underestimated how rapidly these economic realities would manifest themselves. Recently I recalled the results of a Federal Reserve survey covering personal finances of Americans. As Soo Youn reported for ABC News last year (link here):

Almost 40% of American adults wouldn’t be able to cover a $400 emergency with cash, savings or a credit-card charge that they could quickly pay off, a Federal Reserve survey finds.

About 27% of those surveyed would need to borrow the money or sell something to come up with the $400 and an additional 12% would not be able to cover it at all, according to the Federal Reserve’s 2018 report on the economic well-being of U.S. households released on Thursday.

These survey findings basically tell us most of what we need to know about our financial readiness for a crisis.

***

As I wrote in early March, “(a)t least since the early 1980s, our economy has become one of (1) flattening wages; (2) widening wealth gaps; and (3) reduced and eliminated employee benefits, especially retirement plans.”

This was America’s shaky foundation as the pandemic appeared.

Thus, the already gaping holes and divisions in the U.S. economy and its social safety net simply awaited another seismic event to widen them. For now, at least, the pandemic has given us what appears to be a terrible choice: Re-open the economy while infection rates are steady or even increasing vs. remain in a quarantine state in order to squelch the spread of the virus.

A more equitable economic structure, stronger safety net protections, and/or more effective early public health responses would’ve made these choices less dire, but such is the cost of repeatedly bad policies, practices, and leadership. I hope that we learn these lessons for next time.

“Disastershock”: A free handbook for coping with disaster and trauma

Disastershock: How to Cope with the Emotional Stress of a Major Disaster is a free handbook (link here) for individuals and communities, co-authored by Drs. Brian Gerrard, Emily Girault, Valerie Appleton, Suzanne Giraudo, and Sue Linville Shaffer. First appearing in 1989, this valuable book has just been updated to include mental health challenges wrought by the coronavirus pandemic. Here’s a brief description:

This Disastershock book is intended to help families and communities to cope with disaster related stress such as that caused by the Covid-19 pandemic. Part I describes ten effective methods to be used to reduce stress. Part 2 describes 12 stress reduction methods to be used with children. Although Part 2 was written primarily for parents, teachers and other adults working with children will find it useful. A unique feature of Disastershock is that its practical stress reduction methods are described in an explicit manner making them easy to learn. 

You may freely download an English-language version of Disastershock by clicking here. It is currently being translated into languages of nations significantly affected by the coronavirus crisis.

Disastershock has been praised by mental health professionals and educators from around the globe. Practicality, accessibility, and brevity (under 50 pp.) are among its key strengths; you won’t feel overwhelmed by it. I became aware of the book from one of its co-authors, Dr. Brian Gerrard, emeritus faculty member at the University of San Francisco and chief academic officer and core faculty member at the Western Institute for Social Research, on whose board I serve. I recommend it enthusiastically.

***

Along these lines, I’d like to reiterate my earlier recommendation of the John Hopkins University’s Psychological First Aid course (link here) taught by Dr. George Everly and offered for free by Coursera, a leading provider of online, continuing education courses. As I wrote in a blog post last September: 

Dr. Everly developed his PFA model to provide first responders who are not trained as counselors with knowledge and training to assist those who have experienced traumatic events, such as displacement due to wars, severe weather events, and other man-made and natural disasters.

In addition to completing the course myself, I assigned it to students in my Law and Psychology Lab course at Suffolk University Law School, and they responded very favorably to it.

How COVID-19 has placed health care providers at grave risk of moral injury

Obviously the coronavirus pandemic is squeezing the capabilities of our health care systems. It also is impacting the psychological health and well-being of health care providers on the front lines of treating COVID-19 patients, especially as they strive to provide life-saving treatment without adequate resources.

The ultimate nightmare scenarios include choices that may have to be made when the number of severely ill patients exceeds the number of intensive care unit (ICU) beds and ventilators. For example, here in Massachusetts, a task force of doctors and medical ethicists has developed a controversial protocol for determining who gets ventilators and other treatments and who does not, when demand exceeds availability. As reported by Adam Gaffin for Universal Hub, a local online news site (link here):

The “crisis standards of care” guidelines are designed for a hospital system in the process of collapse – too many sick people and not enough medicine equipment and healthcare providers to care for them all – possibly because they themselves might be knocked out by the virus.

When that happens, and patients are coming in faster than hospitals can provide intensive care for them, doctors will have to switch from trying to care for each individual patient to trying to maximize total “life years saved” for the community as a whole, the task force concluded.

To do that, a designated a triage doctor will assign patients scores based on such factors that include not just the severity of their Covid-19 infection but their age and preexisting conditions, with points added for each. Doctors, nurses and other healthcare workers, as well as patients who otherwise would be involved in “maintaining societal order,” however, would have points subtracted….In the event of a tie score between two patients, the younger one would “win,” because of the priority of maximizing total “life-years” saved.

…Patients with the lowest scores would then have their medical records color coded – so that ICU staffers know at a glance who’s next for a ventilator – possibly even if that means removing somebody with a higher score from one. Red-tagged patients would be first in line, orange next and then all the older, sicker patients would be marked as yellow.

The guidelines promulgated in Massachusetts are similar to those developed in other states and nations. Basically, if the swell of COVID-19 infections is overwhelming the availability of hospital resources, doctors and other health care providers are directed to institute a triage system that determines who gets potentially life-saving treatment and who does not. 

The specter of moral injury

The excruciating challenge of treating patients with inadequate supplies is placing health care providers at grave risk of moral injury. “Moral injury,” as defined by Syracuse University’s Moral Injury Project (link here), “is the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct.”

As Dr. Wendy Dean, psychiatrist and co-founder of Fix Moral Injury, a non-profit organization, explains in Time magazine (link here):

If healthcare workers can’t provide the care they typically believe is medically necessary for their patients, they may experience a phenomenon known as “moral injury,” says Dr. Wendy Dean, a psychiatrist and the co-founder of the nonprofit Fix Moral Injury. Dean says that American healthcare providers are used to doing anything and everything to help their patients, but inadequate protective gear and triage procedures will force them to make “exquisitely painful” decisions, such as choosing whether or not to risk infecting themselves, their family and other patients in order to help everyone in their care.

The consequences of moral injury can be significant. According to the Syracuse Moral Injury Project:

Moral injury can lead to serious distress, depression, and suicidality. Moral injury can take the life of those suffering from it, both metaphorically and literally. Moral injury debilitates people, preventing them from living full and healthy lives.

The effects of moral injury go beyond the individual and can destroy one’s capacity to trust others, impinging on the family system and the larger community. Moral injury must be brought forward into the community for a shared process of healing.

The specter of moral injury is among the reasons why our health care providers will require ongoing help in dealing with the psychological burdens and health risks of working to save lives during this pandemic. This experience will leave its formative mark on current generations of health care workers for decades to come. We owe them our support for the short and long runs alike.