The Sackler family - a name that resonates through the chilling caverns of the opioid crisis, their legacy a symbol of the suffering that has descended upon countless lives. But in this bleak tableau, they inadvertently unveiled a critical paradigm we'd previously overlooked in healthcare: the role of pain as the fifth vital sign.
Now, let's reclaim this revelation. Instead of quantifying the fifth vital sign as physical pain, let's assess something that the Sacklers seemed to have tragically mislaid: a moral compass. Welcome to an era where 'vital signs' take on a deeper, more profound significance. In this world, your encounter with healthcare takes on an entirely new dimension.
Imagine, for a moment, stepping into the hushed tranquility of a clinical space. The routine melody of health checks ensues. Blood pressure - check. Pulse - check. Oxygen saturation, respiratory rate - check, check. But then, a shift in the cadence, an unexpected note. An exploration into your moral health.
Embark on this thought experiment with me. Questions, not of physical wellness but of ethical vitality, begin to unfurl: "Do your daily actions echo the rhythm of your core values? Does your family life breed tranquility or unleash tempests? Do your social interactions ignite fulfillment or spark disquiet? Does the ethos of your workplace align with your moral compass or veer off course? In your interactions with nature, do you feel an exultant connection, indifference, or a pang of guilt? Are the decisions of your government, the laws and policies that orchestrate your life, harmonious with your beliefs or do they strike a dissonant chord?"
This is not a rhetorical exercise; you're prompted to chart these facets on a scale from one to ten. Each number, a reflection of your moral equilibrium within the grand tapestry of life. Your moral health, thus, revealed not as an abstract notion, but as a tangible, measurable entity, ripe for introspection and growth.
Could the way we make moral decisions, how we interpret and act upon what we perceive as right and wrong, be intrinsically linked to our health? This thought might appear to be hanging by a thread at first, but give it a chance, let it steep in your mind for a moment.
The concept of 'moral injury' might help tie these seemingly disparate domains together. To break it down, moral injury is the damage done to our conscience, our moral compass, when we commit, witness, or fail to prevent acts that transgress our deeply held moral beliefs. Now think about the unease, the restlessness that lingers when we go against our core values. We might try to numb it, drown it under indulgences - food, leisure, shopping, alcohol, or drugs. But in the quiet moments, it seeps out, a gnawing discomfort that refuses to be silenced.
This isn't merely a philosophical musing. What if this moral discomfort, this nagging 'injury,' plays a significant role in our overall mental and physical health?
A Lawyer's Struggle with Morality and Addiction
With this backdrop, allow me to introduce you to Greg. A wonderful human I met while working at an ultra-high-net-worth rehab in New York City. He isn't just a man grappling with the complexity of life, but a soul wounded by the profound betrayal of his moral beliefs by a system he trusted. His personal tragedy paints a vivid picture of how societal corruption, and individual choices, infiltrate our being, deeply influencing our emotional, mental, and physical health.
In the tranquility of the upmarket rehab, Greg and I found ourselves nestled on plush armchairs, splitting a tub of Ooey Gooey Butter Cake ice cream as the Statue of Liberty twinkled outside the panoramic windows. The ambiance of the room echoed a quiet yet luxurious solitude.
"Greg," I said gently, "Would you feel comfortable sharing with me the point in your life where you felt alcohol started to take a greater hold over your life?"
His spoon stilled mid-air, and for a moment, he was somewhere far away. Then, shaking his head as if to dislodge the troubling thoughts, he replied, "I suppose it started when I was a fresh-faced lawyer under Roy Cohn."
"Cohn? The infamous Roy Cohn?" I couldn't conceal my surprise. Greg merely nodded, the ghost of a smile playing on his lips.
"Indeed, the notorious Roy Cohn. Words like ‘snake,’ ‘scoundrel’ and ‘a new strain of son of a b***h’ barely do him justice. Law school, even the best one, doesn't prepare you for working with someone of that caliber," Greg said, pausing to draw a long, slow breath. "I was so young then, brimming with hope and dreams," he recalled, his gaze fixed on a past only he could see. "Ideals of justice and fairness, these were what fueled me. I remember the countless hours spent in the dead of night on each case, firmly believing that every word I penned, every argument I presented, could bring about a change."
"Okay, so what went wrong? Weren’t you able to effect that change?" I asked, trying to trace the turning point in his narrative.
"It’s bizarre," Greg replied with a humorless chuckle. "The scales of justice tipped at the most unexpected times. I'd party at Cohn's behest, show up to court unprepared with a hangover, and win. But when I'd stay in, bury myself in my work until the early morning hours, preparing diligently for the case ahead... that's when I'd lose. It was like a twisted joke that I couldn't comprehend."
One night, fuelled by alcohol and frustration, Greg confronted Cohn. "I asked him, 'How can this be? Why am I winning when I shouldn’t, and losing when I’ve given it my all?'"
"And what did he say?" I prompted.
"He laughed," Greg's voice faltered, shaking off years of silenced torment. The room seemed to contract around us, the chill of his past filling the space, making the butter cake ice cream taste bitter. "It was a laugh I won't forget... Cold. Hollow. As though he was amused by my naivety. He leaned back, staring at me through half-lidded eyes. 'Greg,' he said, 'you've got it all wrong. It's never been about the well-crafted arguments or the compelling evidence. ' He had paused then, that smirk still playing on his lips, and I remember the dread that had started to build in my stomach. "
'It's about who has the wealth to buy the judge, to... tip the scales.' His words hung in the air, a veil of corruption revealing itself. 'It's all about who's got the judge snugly fitted into their pockets. You could lay out the best argument of your life and if it wasn’t us who bought the judge it wouldn’t matter.' He had stated it like a simple fact, an unspoken rule of the game that everyone knew but me."
The weight of those words hung heavy in the air. The devastating blow to Greg's faith in the legal system, his vales crushed by the raw, corrupted reality, began the downward spiral.
"I couldn’t cope," he confessed, his voice just a whisper, "My entire worldview was shattered. My whole identity was just wiped away. Where was the justice I had been working for? Where was the difference I was supposed to make in this world?"
"I can only imagine how devastating that must have been," I responded, allowing the weight of his revelation to sink in.
"Yes," he said, a tear tracing the line of his cheek, "The system I had trusted was corrupt. My hope was broken, and I felt so lost. I didn’t know how to make room for this reality in my body so I decided not to feel it and just to drink. It's not a justification, just the harsh truth." His words tumbled out, raw and unfiltered. He was a man well into his golden years, yet there he was, laid bare, tears pooling in his tired eyes.
In that shared silence, I truly saw Greg. Not as a broken man but as a wounded spirit, his journey tainted by a deceitful system that betrayed his core principles. His disillusionment wasn't just a personal tragedy, but a stark reflection of how societal corruption can seep into our very marrow, eroding our physical, mental, and emotional health.
Yet, through the veil of his vulnerability, I saw a stubborn flicker of resilience. It was buried deep, numbed over by years of self-medication, but it was undeniably there. The road to recovery was not just about detoxing his body, but about rehabilitating his faith in humanity, in justice. It would be a strenuous journey, riddled with confrontation of his painful past, but as long as he was honest in his pursuit, there was room for redemption. His journey underscored a profound truth - for healing to occur, it isn't enough to treat the body. We must address the moral injuries that our souls carry.
Unfolding the Concept of Moral Health: Individual and Collective Impact
So, what exactly are we referring to with this concept of 'Moral Health'? Allow me to elucidate: it's not about enforcing a universally accepted moral code or advocating for an elusive state of moral perfection. Instead, it's about acknowledging the significant influence our personal morals, community values, and the ethics of the systems we are part of exert on our physical and mental health. My experience in nursing has laid bare the intricate interplay between morality and health, and the devastating consequences when the moral compass goes astray.
Our moral compass acts as a guide, leading us through life's labyrinth. When that compass is disrupted—when we, or our organizations or communities, lose our direction—it adversely affects our health. As people in positions of influence, our actions can ripple out, impacting the wellbeing of those around us. Conversely, when we live in harmony with our moral principles, our bodies and minds respond positively, fostering healing at a profound, holistic level.
In healthcare, our primary focus often rests on physical and mental health, but the necessity to consider our patients' moral health is increasingly apparent. This might involve facilitating discussions about ethics, understanding their moral dilemmas, or even providing guidance to help them align their actions with their deeply held values—discussions as critical as those about blood pressure and heart rate.
While I'm not suggesting we start prescribing morality, I am advocating for a recognition of its significant role in our overall health. As a nurse dedicated to healing, I believe it's essential to consider all facets of our patients' wellbeing, and that includes moral health.
As we begin to attune our moral health, we'll inevitably start to see transformations within ourselves and in our relationships. When we're grounded in our moral principles and align our actions with our values, we foster a sense of integrity and coherence that radiates outward. This alignment could significantly alter the dynamics of our relationships, making them more authentic, nurturing, and interconnected, with undeniable effects on our physical health.
Moreover, these transformations and ripples of moral alignment could resonate throughout our communities, organizations, and governments. As each one of us engages with our moral health, we collectively foster healthier, more morally responsive systems—systems where honesty is commonplace, compassion is the norm, and these values serve as the bedrock of our shared existence.
So, as we delve deeper into the exploration of moral health, let's remember: it's not solely about individual transformation. It's about fostering healthier relationships, building morally aligned communities, and above all, recognizing our shared humanity in the process.
Thank you, dear friends. But remember, don't just take my word for it; seek silence, listen to yourself.
Michelle & Moral Health
Reflect. Write. Transform: Narrative Medicine
Take a closer look at the artwork below and allow the feelings it evokes to wash over you. What memories and stories does it bring to mind?
Take three minutes to reflect and jot down your narrative. Whether you choose to express your thoughts in a journal or share them in the comments, the critical thing is that you take the time to consider the art and what it signifies to you.
Reflect on a time when you sought refuge in excess—be it alcohol, food, or even exercise—as a means to escape the emotional impact of a moral decision made either by you or someone close to you.
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