🧵 COVID-19 and being overwhelmed by moral outrage and moral injury*:
(Because a lot of us are)
This is about the recurrent feelings of horror, disbelief, sadness, helplessness & anger in response to the callousness & cruelty we continue to see during the pandemic.
(1/18)
The majority of us (I'd like to think) share important ethical values & standards that we believe should guide how we & our leaders handle a disaster like the pandemic. These include:
-We should prioritise life & health for everyone.
-We should protect our kids
(2/18)
-We should protect our most vulnerable (CEV, the disabled, the elderly, the poor, etc)
-We should try to look after and help all our fellow humans, everywhere.
These are all 'as much as possible' values & standards i.e. you aim to do the most you can.
(3/18)
Moral outrage is the justifiable anger, disgust, or frustration directed toward those (govt, media, advisors, fellow citizens,etc) who violate these values & standards.
'How could they do this?'
'How could they deliberately devise a policy that meant so many would die?'
(4/18)
'How could they plan to let kids be infected?'
'How can they refuse to accept responsibility?'
'How can they refuse to change track after seeing what their mistakes have wrought?'
'How could they use this to enrich themselves & their friends and push through their agenda?'
(5/18)
'How can they care so little for others?'
'How did this become normal and acceptable? Especially in a country and a media that is so readily outraged by nonsense and still is*?'
'How can they be so corrupt?
* anti-trans, anti-refugee outrage going as strong as ever.
(6/18)
'How can they lie so blatantly?'
'How can they keep gaslighting us?'
'They are doctors! They are scientists! How can then argue for or support something so heinous?
(7/18)
'HOW CAN THEY FEEL NO SHAME, NO TWINGE OF CONSCIENCE? My conscience could not bear even a sliver of the wilful cruelty they are inflicting! Surely there must a red line even for them?'
This last point is one of the core issues.
(8/18)
More sickening than seeing what is being done, is trying to imagine the mind that could do these things. It something we do automatically and it makes you feel sickened in your own mind.
Which brings us to moral injury.
(9/18)
Moral injury is the damage done to one’s conscience when one perpetrates, witnesses, or fails to prevent acts that violate one's moral code and ethical standards. This has been studied a lot in the military and it includes the betrayal of what is right by one's leaders.
(10/18)
Some of us who have carried out acts that violated our moral codes e.g. healthcare workers who have had to give suboptimal care and/or fail patients because of various failures higher up in the system.
There are many of us who have witnessed so many violations.
(11/18)
There are also many who tried very hard to prevent this, doing the research, challenging the government, fighting the case for controlling transmission. The vast majority of them did not do it for any personal gain but at considerable personal cost.
(12/18)
Many of them (scientists, doctors, teachers, parents, lawyers, etc) are still fighting, to stop things getting even worse, to still try and protect people. To my mind, the vilification and abuse they receive is an active violation.
(13/18)
But here's the thing, despite their best efforts, they've lost. The people who were working to help everyone & save as many as possible, lost.
For them, they failed to prevent these egregious violations.
For the rest of us, the good guys lost.
(14/18)
Moral injury rocks your sense of the world, it can rock your sense of you (especially if you are a perpetrator). It leads to anger, frustration and rage (at the world, at the perpetrators, at those who don't seem to see the terrible violations).
(14/18)
It can disconnect you from other people and parts of the world, 'how can people just carry on like normal when this has happened, when this is still happening?'. It can make you feel suffocated, like you're almost choking on disbelief and injustice.
(15/18)
Like you're stuck.
Like the world does not make sense anymore.
Like you don't know what else you can do.
And you still have to carry on like at least some things are normal. For your kids, for your family, for your patients, for the stability of your own mind.
(16/18)
Also moral injury can also contribute to depression, PTSD and other mental illnesses.
I wrote this thread because I have felt overwhelmed like this several times in the last 19 months but this thread from today was a bit too much.
(17/18)
Is there anything that helps?
Find the other people who feel the same.
The empathy, kindness and support of people on Twitter has been amazing & heartening.
(18/18)
Survival mode can be thought of as a state of living in which managing each day takes pretty much all the capacity you have. And by the time you are in survival mode, you're already working with a significantly depleted capacity.
(1/12)
You can end up in survival mode because: 1. The demands on you have been heavy and unrelenting and have exhausted your spare capacity. 2. Your capacity has been diminished by illness/stress* (mental or physical). 3. A combination of both of the above over time.
(2/12)
In reality often things may start with either 1 or 2 but then over time the other one will get involved so you end up with 3 anyway.
* Re: stress, it's important to consider environmental stresses including poverty, precarity and discrimination (ableism, racism, etc).
(3/12)
It's a part response as it's going to be about how to think about the MH impacts and not actual numbers. I've only cursorily followed the research measuring the impact of the pandemic on mental health and mental illness, and in any case, I'd like to take a different tack.
(2/n)
I'm going to try and walk you through how I'd usually think about the impact of a difficult event/experience on a person, if I was seeing them in clinic. This hopefully sets up the approach I'm going to be taking and perspectives I'm going to try and cover.
(3/n)
🧵Some reflections on the responses to this thread👇
This is about some of the criticisms I received for this thread. This is not meant to be a massive subtweet, apologies if it feels like it. I think that some of the points raised were worth airing and addressing.
(1/30)
1. A fair few people took 'the people in power' to mean the government. I certainly do include the govt in this category but it's not just the government. There are a lot of powerful players who are not part of the govt and we have known about them for a long time.
(2/30)
A COVID example: the Koch Brothers, AIER and GBD (check out @NafeezAhmed's work for @BylineTimes)
Even if we don't consider this, we know that our current UK government has a lot of wealthy people who we know are serving their own interests while in govt.
(3/30)
'I hear what you're saying but remember there are two sides to every story.'
🧵 'Two sides to every story' is a common technique used to dismiss victims.
Actually there are as many sides to a story as there are involved parties.
(1/8)
However, the more important point is: 'How many sides have you listened to?'
Because 'two sides' is used in multiple ways: 1. To refuse to hear other sides. 2. To stop other sides being voiced by implying the person is vexatious, unreliable or has malicious intentions.
(2/8)
3. To make clear that the speaker has decided on which side they favour/believe- they are either not going to listen to the other side or will make no attempt to reconcile the accounts. 4. To imply that you have been mistaken in some way or misunderstood what happened.
(3/8)
🧵COVID-19: how do you convince people that the people in power actually want them to die?
This may seem dramatic but it isn't & given that we* have lost the war against COVID to the GBD & Co, we can't cushion this.
*Everyone trying to control the pandemic & save lives.
(1/25)
In fact looking back, I am not sure if ever came close at any point to a temporary draw, let alone a win but now there is no doubt.
The GBDers, the 'herd immunity through natural infection' proponents, the individual freedom fighters, the eugenicists, they've won.
(2/25)
Their misinformation and disinformation campaigns have so muddied the situation that despite the huge amounts of evidence (and deaths and illness), the basic realities of COVID-19 and controlling it remain somehow contentious.
(3/25)
Mini 🧵: Is the idea of women's intuition misogynistic?
(Completely speculative and very likely very badly wrong)
I'm wondering if at the idea of female intuition is a way of dismissing both how women collect and use information, as well as their success in doing so.
(1/n)
'Is it your female intuition telling you we should consider that in our plans?'
'So you were right, must be that women's intuition.'
The implication of both statements is that there is no 'rational' reason why the woman would have suggested that and then got it right.
(2/n)
While this is mainly about women and girls, much of this would apply to anyone whose approaches differ from that of the dominant group in their system. However in patriarchal systems, this would only be one of many interacting (often synergistic) elements of misogyny.
(3/n)