When Truth Hurts: Moral Injury, Group Work, and the Cowardice of the Moment
David Songco, PsyD
As a psychologist embedded in family medicine, I witness the intersections of science, suffering, and systemic failure every day. Patients come in with broken bodies and broken trust—trust eroded by inequity, misinformation, and a healthcare system that too often prioritizes efficiency over empathy. But what’s even more striking lately is not just the harm endured by patients, but the psychological toll carried by those of us trying to care for them within increasingly hostile institutions. It’s a kind of psychic bruising that doesn’t show up in diagnostic codes, yet shows up in our sleep, our supervision sessions, and our silence.
Moral injury—originally defined in military contexts as the psychological distress experienced when one perpetrates, witnesses, or fails to prevent actions that transgress deeply held moral beliefs—has become increasingly relevant in healthcare and mental health (Shay, 2014; Talbot & Dean, 2018). It’s what happens when professionals, bound by a code of ethics and a deep desire to heal, are asked to work in systems that betray both. It’s what happens when we’re told to be neutral in the face of cruelty, to say “both sides” when we know there’s a right one.
In today’s climate, moral injury doesn’t just come from watching patients suffer without resources. It also comes from watching truth itself become a casualty. With political figures like Robert F. Kennedy Jr. gaining traction through disinformation campaigns—misrepresenting vaccine safety, challenging public health protocols, and questioning the legitimacy of scientific consensus—we are no longer simply navigating a crisis of public health. We’re living in a crisis of epistemology, where evidence-based care is under assault and scientific literacy is framed as elitism (Freed, 2023).
This assault cuts especially deep for group psychologists. Our work is fundamentally relational—it depends on shared truth, mutual vulnerability, and collective accountability. What happens when the institutions we work within actively undermine these principles? When academic health centers shrink from naming racism, ableism, or transphobia under the guise of “civility”? When group leaders are expected to foster cohesion in classrooms, therapy rooms, and supervision settings without acknowledging the cultural trauma happening in real time?
The psychological cost is enormous. When clinicians, faculty, and trainees are asked to teach, facilitate, and show up “professionally” while suppressing their values, it creates a state of internal dissonance. That dissonance—between what we know is right and what we’re allowed to say or do—becomes the breeding ground for moral injury (Dean et al., 2019).
In the training room and the therapy group, we often teach that conflict is not the opposite of cohesion—it’s the gateway to it. Amy Edmondson’s (1999) work on psychological safety reminds us that innovation, risk-taking, and learning require space for dissent. And Yalom (2005) reminds us that growth is forged through rupture and repair. But in today’s academic and healthcare institutions, rupture is punished, and repair is performative.
We see it when DEI programs are defunded quietly. When universities post Black Lives Matter statements on their websites and erase critical race theory from their curricula. When trainees of color are called “unprofessional” for raising concerns about microaggressions, or when queer and trans students are asked to “debate” their existence for the sake of classroom “dialogue.” These acts are not benign—they are institutional betrayals.
And here’s the uncomfortable truth: moral injury is contagious. It is not just something clinicians feel individually—it’s something systems produce collectively. It spreads when leaders stay silent. It metastasizes when the people doing the emotional labor are the first to be blamed, the last to be protected, and rarely the ones promoted.
Belonging, a concept that’s often tacked onto DEI efforts as a feel-good afterthought, is not about everyone feeling comfortable. It’s about mattering. As John A. Powell (2012) argues, belonging requires more than inclusion—it requires the co-creation of space, voice, and power. It is a radical act, not a customer service initiative.
So where does that leave us?
It leaves us, as group psychologists and health professionals, with a choice. We can continue to accommodate institutional fragility, rewarding politeness over principle. Or we can lean into the very skills we teach our group members: authentic confrontation, emotional resilience, and a commitment to transformation over comfort.
We need a new kind of group contract—one not just between therapists and clients, or educators and students, but between professionals and the systems we uphold. A contract that says: We will no longer confuse neutrality with integrity. We will no longer pathologize anger while preserving institutional whiteness. We will name what’s happening—even when our institutions won’t.
Because silence is not neutrality. It’s surrender.
If we, as group psychologists, cannot model what it means to hold truth, challenge power, and build collective safety that includes accountability—then we are not just failing our clients and trainees. We are failing ourselves.
References
Dean, W., Talbot, S., & Dean, A. (2019). Reframing clinician distress: moral injury not burnout. The Federal Practitioner, 36(9), 400–402.
Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350–383. https://doi.org/10.2307/2666999
Freed, G. L. (2023). The weaponization of science: The growing public health threat of medical misinformation. JAMA, 330(2), 123–124. https://doi.org/10.1001/jama.2023.10626