Moral Injury in First Responders, Understanding the Hidden Wound With Dr. Lorraine Smith McDonald

Moral Injury in First Responders: Understanding the Hidden Wound. In this powerful conversation, Dr. Lorraine Smith McDonald joins host Arjuna George to break open one of the most misunderstood wounds in public safety, moral injury. Dr. McDonald is an Assistant Professor and Co-Chair in the Department of Psychotherapy and Spirituality at St. Stephen's College, University of Alberta. She has spent more than a decade researching moral injury across military, veteran, firefighter, paramedic, and police populations.

Together, we explore what moral injury actually is, why it shows up so strongly in first responders, how it differs from PTSD (Operational Stress Injury), and why leaders need to understand the moral pressures their people face every day.

Dr. McDonald brings evidence, compassion, and clarity to a subject that is shaping the mental, emotional, and spiritual well-being of our frontline communities.

00:00 Intro, welcome, and episode overview
03:02 Early work with military chaplains, guilt, shame, and emerging patterns
04:00 PhD research: What harms veterans the most?
05:00 Transitioning research into first responder populations
05:54 Why moral injury matters in today’s public safety environment
06:20 How the term gained traction in Canada
07:00 Post-traumatic guilt, how it works, and how it differs from moral injury
09:00 Moral injury symptoms, definitions, and “what happens to our humanity”
10:40 A simple, powerful way to understand moral injury
12:45 DSM update: what changed and what it means
15:02 What moral injury truly wounds, the “injury to selfhood”
17:40 How identity, character, and worldview are impacted
18:40 Recognizing moral injury in yourself
19:57 Symptoms, emotional indicators, and overlaps with Operational Stress Injury
23:30 Losing faith in humanity and spiritual disconnection
24:10 The link to depression, substance use, and suicidality
25:20 Daily inner conflict and emotional exhaustion
26:00 How first responders are commonly exposed to moral injury
27:00 “Meat in a Seat,” impaired systems, and expectations you can’t meet
30:00 Organizational mistrust and betrayal
31:30 The “underbelly of society” and repeated exposure
33:00 Accumulation of small moral wounds over time
34:10 The biggest surprise in Dr. McDonald’s research
35:40 The intensity of exposure for first responders
38:20 Acts of omission vs acts of commission
40:00 Can moral injury be prevented? What supports healing?
41:10 Building moral resilience and knowing your own values
43:00 Forgiveness, self-compassion, and worldview repair
45:00 The importance of identity outside the job
46:20 Self-care that is more than “bubble baths”
47:40 The power of joy, meaning, and connection
48:20 Moral courage and the moral compass
51:00 Boundaries as moral protection
52:10 Advice for leaders wanting to reduce moral injury in their organizations
54:40 Why transparency and authenticity matter
56:40 Prevalence of moral injury in first responders
59:10 Gaps in current research and where we need to go
01:01:30 Final reflections
01:03:00 Closing thoughts from Arjuna

Lorraine Smith-MacDonaldEmail: smithmac@ualberta.ca

If this conversation resonated with you, please take a moment to subscribe, share this episode, and help expand this essential conversation across the fire service and all of public safety. Your support allows Beneath the Helmet to reach the people who need it most.

Stay well, and keep taking care of the people who take care of others.

Arjuna George - Fire Chief (ret)

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