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IN:SIGHT Moral Injury

September 14th, 2018—It is a well-known fact that teachers are leaving the profession at increasingly higher rates.  50% of teachers leave the profession in 5 years and in urban or rural schools the rate can be as high as 50% in three years.  Burnout is the current explanation for this phenomena.  There are, it seems, a lot of good reasons to accept this account.  It is challenging to keep the tender flame of calling burning when the fierce storms of testing, accountability, and low-social status are blowing hard.  Most teachers value data, assessments, and information that guides their instruction.  The best teachers are not anti-testing and accountability.  They know that data can provide a true-sense of how well their teaching is impacting learning.  But the daily grind of doing your best with little or no recognition or acknowledgement of improving student learning can wear the spirit of the teacher down; wellbeing becomes a concern.  Burnout happens when the idealism of serving the intellectual, emotional, and spiritual needs of students drifts to the background in the face of institutional imperatives that are narrowly focused on standards and performance indicators.


Burnout is an occupational hazard of teaching, but there may be a more complex undercurrent to burnout that is worth considering.  The struggle to retain deep meaning and purpose is a phenomena wider than teachers. Other members of the “helping professions” also experience it.  Physicians, for instance, find that the institutional demands, structures, and narrowly defined performance indicators they experience daily tend to divide their professional identity in two.  Their inner calling to heal begins to separate from the outer requirements of the profession. Doctors, like teachers, are increasingly practicing medicine in professional settings that are less concerned with their wellbeing (humanity) and more attentive to efficiency metrics, bottom lines driven by prescribed daily contact hours, pay for performance, and pre-determined treatment protocols.  A recent article in STAT on physician burnout by Simon Talbot, M.D. and Wendy Dean, M.D. (2018) makes the argument that doctors are suffering less from burnout and more from “moral injury” because of the health care system.  Most doctors, like teachers, support accountability and value the link between performance, effectiveness, and patient satisfaction.  What they resist, like their teacher counterparts, is the commodification of their identity and numeric narrowing of the profession.

I think the argument Talbot and Dean make for shifting the language away from burnout, which can seem rather deterministic, to moral injury is worth considering as a more accurate descriptor for teachers as well.  The first concern they raise is that burnout, for physicians, “suggests a failure of resourcefulness and resilience”.  How can this be, they ask, given the strain and stress associated with the long-years of medical training?  Resourcefulness and resilience, it seems, are baked into the professional education of doctors.  When it comes to teachers the financial, emotional, and relational demands of learning to teach may not be as severe or demanding as medical school.  Yet, the year of student teaching followed by the first three-years of teaching, by all account, is pretty intense and challenging.  Resilience, self-determination, and resourcefulness are important skills that all successful early-career teachers have mastered.

From a critique of resourcefulness and resilience they move to a more troubling description of the work of physicians: “Physicians on the front lines of health care today are sometimes described as going to battle. The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care. Continually being caught between the Hippocratic Oath, a decade of training, and the realities of making a profit from people at their sickest and most vulnerable is an untenable and unreasonable demand.” Moral injury was first used when describing the emotional and psychological costs of a soldiers’ actions in war which often violated their deeply held beliefs and values about life.  In the world of medicine, moral injury describes the impact of the gap between who physicians want to be because of training or calling to heal and what is required by the current system.  It is defined by journalist Diane Silver as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.” The strain of constantly struggling to serve the needs of patients can have profound impact on the psyche of physicians.  As Talbot and Dean note: “Navigating an ethical path among such intensely competing drivers is emotionally and morally exhausting.”


The metaphor of going to battle is not as farfetched for teachers as it might seem. The cover of the September 9th, 2018 issue of The New York Times Magazine boldly claims: “Teachers just want to teach but the classroom has become a battleground”.  The influential book on the history of teaching in America by Dana Goldstein (2015) is titled, “Teacher Wars: A History of America’s Most Embattled Profession”. Alfred North Whitehead in Aims of Education described the outcomes of an education that stunts the enjoyment of the learner as “soul murder”.  And now policy makers and pundits are pushing to arm teachers in their classrooms. Teachers regularly face choices that cut against their training and moral instincts to care for students and facilitate learning.  For instance, when a teacher makes a pedagogical choice that doesn’t really address a particular student’s learning needs but it does fit the assessment rubric they are being evaluated by.  The battlefield metaphor of teaching, it seems, has a certain resonance with the profession.  Like physicians, the concern for teachers is less the need to navigate these choices, that is what professionals do, it is part of the work.  The concern is that the cumulative effect of the persistent feeling of moral exhaustion, like the repeated moral exhaustion of a soldier in war, leads to a condition where physicians and teachers can “stay—wounded, disengaged, and increasingly hopeless.”


Maybe it is time in education to shift from the soft language of burnout to the starker but perhaps more accurate description of moral injury to describe the experiences and choices teachers face in schools.  What if a teacher or school were rated equally on the ability of the system to help teachers sustain their moral integrity—consistent with their calling and training—with the same vigor that well-crafted external metrics of success are held?

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