How Buddhist Spiritual Care Can Help Frontline Workers in the Caring Economy

“Moral Injury?” What’s that? 

Moral injury is a constant workplace risk for essential caregivers in our society. A few examples: The chronically short-staffed pediatric nurse facing impossible performance benchmarks tied to contract renewal. The police officer who attends a fatal teen drug overdose in a home the day before Christmas and must then carry on with a 12-hour shift. The professor fired for speaking at a political rally. The teacher after a school shooting. The active-duty soldier. The librarian facing a book ban.

Moral injury may present as shame and guilt for actions we have (or have not) taken, for which we now feel regret. It can lead to burnout, loss of trust, and withdrawal from social interactions. In situations where we feel we have been placed in difficult situations by others and constrained by societal or corporate expectations, moral injury can manifest as a constellation of anger at the system, contempt for those in charge, disgust directed at marginalized members of society, dehumanization of others, and/or a crisis of faith. These are unwholesome mental factors. But they can also motivate us to find more wholesome ways of being if we recognize their destructive nature.

“Buddhism’s focus on this very life, as opposed to an afterlife, positions Buddhist spiritual care providers to offer a valuable counter-narrative to the samsaric memes and messages that constantly surround us.”

Many in the field of psychospiritual care are now focusing on the challenge of moral injury and trying to develop best practices for responding. Happily, Buddhist chaplains and spiritual care providers have a unique perspective to share here, drawing from teachings on compassion, interdependence, and nonduality.

We know we can’t “fix” the problem, because dukkha — suffering, a pervasive sense of dissatisfaction — is part of life. But we can be with those suffering moral injury and hold space for them to find their own way forward. Out of radical acceptance comes self-care that nourishes us, opens new possibilities, and fosters the courage to take wholesome action. As Insight Meditation teacher Tara Brach notes in Radical Acceptance (her book, now available in a twentieth anniversary edition), it’s the ability to accept things beyond our control without judging, thus healing the negative emotions that bind our hearts. There are many online resources about how to integrate radical acceptance into one’s life and practice.

Moral emotions and the work that reconnects

In most cases, our emotions are centered on ourselves. But we also experience emotions centered on others and, more specifically, what are known as the four sets, or “families” of “moral emotions.” You can find references to these wholesome and unwholesome mental factors in the Abhidhamma teachings, but that can be a difficult read. In modern psychological literature, Jonathan Haight offers a more accessible framework:

The Four Families of Moral Emotions

While we may not talk much about moral emotions, they form the basis for much of our popular culture. The narrative arc of many a story involves a tragedy, a hero’s journey against oppression, injustice, insensitivity, or marginalization, followed by catharsis when compassion and elevation reset our faith in humanity. In some of those stories, it is people coming together who provide the way forward, rather than the lone hero or heroine.

It is this turning about in the heart-mind, from the unwholesome to the wholesome, where practitioners of Buddhist spiritual care have much to offer. Indeed, Shakyamuni is often referred to as the Great Physician, and the dharma as the medicine that relieves suffering. This is where Buddhist chaplaincy comes in.

Why Buddhist chaplaincy?

You may remember the children’s television icon, Mr. Rogers, saying that when trying to make sense of tragedy, we should “look for the helpers.” They are the essential frontline workers in the caring economy. How do these brave individuals who take on caregiver roles in society make sense of it all? Who has their back? What keeps them healthy? 

Among these frontline workers in the caring economy, a select few are called to psychospiritual care. They are usually called chaplains, a word that has Christian roots going back centuries. It is only for convenience that we have come to use mainstream Christian terms such as chaplaincy, ministry, and pastoral care to describe their work, since “psychospiritual care” is a bit of a mouthful. It should be noted, however, that all faith traditions comprise some form of spiritual care. Compassion is the central tenet of chaplaincy; nobody has a monopoly on that. 

You will not be surprised to hear that since the beginning of the COVID-19 pandemic, and continuing through its long tail, burnout amongst essential workers became widespread, leading to what some called The Great Resignation. We are still trying to figure out how to understand our new reality and clarify how to move forward.

It is only very recently that the moral injury faced by frontline workers in the caring economy has been clearly articulated and begun to be studied in the context of large societal systems, with chaplains recognized as central figures in their healing. At the same time, efforts to critique the Christian hegemony from other faith traditions, including Buddhism, have opened new perspectives on psychospiritual care. 

There are thousands of Buddhist centers in North America. Would you be surprised, then, to know that there are only 425 certified Buddhist chaplains in North America? (This is according to a survey made by a group of scholars collectively known as BSCENA, under an Internal Review Board from Harvard.) There are only six North American educational institutions that offer Buddhist chaplaincy training, in addition to the programs at just two Buddhist centers (Upaya Institute and Zen Center in New Mexico, and the New York Zen Center for Contemplative Care).

Thankfully, Buddhist spiritual care professionals have reached a critical mass in their organizational development and are starting to be widely recognized for their contributions to the field. Case in point, Emmanuel College at the University of Toronto (which offers Canada’s only Buddhist Master of Psychospiritual Studies program) recently hosted a landmark conference for Buddhist spiritual care educators, “Transforming Wounds into Wisdom: Interreligious Perspectives on Moral Injury Through a Buddhist Lens.” The Buddhist Spiritual Care Educators in North America (BSCENA) consortium, founded as the Buddhist Ministry Working Group in 2015, held their first annual conference in Canada in conjunction with the Emmanuel conference.

Structural barriers

It is part of the nature of dysfunctional systems to shift responsibility for failure onto individuals and scapegoats. Similarly, responsibility for recovery from moral injury is often put upon the victim in the guise of compassionate advice: get your sleep, eat right, get out in nature, try mindfulness, and so on. It would be more productive if organizations could focus on systemic changes that support their employees rather than externalizing the problems. However, well-structured organizational supports for staff mental health are far from mainstream. I’ve asked quite a few Buddhist chaplains about their interactions with their colleagues, and the vast majority have told me anecdotally that informal doorway chats are the most common type of staff touchpoints. Advocacy for more and better staff well-being programs is a part of service leadership where chaplains have the moral high ground and could provide significant leadership, but making headway is difficult. The types of large organizations that can afford to employ chaplains are often intensely focused on productivity, protocol, and profits rather than people.

Another issue facing chaplains (and especially Buddhist ones) is that in many organizations they are volunteers, paid (if at all) by the religious organizations with whom they are affiliated. Yet the places where they work require extensive education and accreditation. There is a disconnect between what it takes to become a Buddhist chaplain and the job prospects one might expect: Chaplains are not as highly valued as they could and should be. Their professional standing is often precarious. As volunteers, their role is discounted since they aren’t employed by the organization. As employees, their role is subservient to decisions made by departments where they are embedded, which may not be supportive of chaplaincy work.

We live in a pluralistic society where religious affiliations are manifold and increasingly include the “spiritual but not religious” and atheists. Increasingly, chaplains must learn to code-switch because their clientele come from all cultural and religious backgrounds. On one hand, this is good for Buddhist chaplains because it creates space for a Buddhist perspective and comfortable interactions for non-Christian careseekers. On the other hand, there’s a monoculture backlash underway. Shared assumptions about morality and the public good are fraying, leading to conflict and heightened moral injury. If Buddhist chaplaincy were posting a social media profile, it might say: “In a relationship. It’s complicated.”

Mapping conceptual bridges between Buddhist and Christian terminology in psychospiritual education is also a work in progress.

How Buddhist perspectives and tools help

The late Bernie Glassman Roshi focused much of his teaching on the Three Tenets: Unknowing, Bearing Witness, and Compassionate Action. Nothing is permanent, each of us is unique, but we are all in this together, and our best aspiration is to meet the moment with loving kindness. This teaching is one of the central pillars of modern Buddhist chaplaincy work.

Any chaplain will tell you that their role is to accompany others through difficult times. Compassion literally means “with the suffering.” The chaplain’s job isn’t to give advice, but to be with, and in many situations, their calm, supportive presence speaks louder than words. They seek to be fully present, deep listeners, because this is the wellspring of psychospiritual care. Through their act of bearing witness, chaplains work to connect care-seekers with spiritual strength, courage, hope, meaning, and purpose.

As meditators, Buddhists are very familiar with training in being in the present moment and open to life’s flow. This is the essence of mindfulness, which, when not divorced from its Buddhist roots, includes a dimension of ethics that resonates strongly with the moral emotions.

However, unlike dharma teachers in temples or monastic settings, chaplains’ encounters with care-seekers are often very short in duration, ranging across an enormous spectrum of spiritual perspectives and issues. For example, for college and university chaplains, these issues could include peer pressure, relationships, identity, sexual health, complex traumatic experience, substance-use health, social media, psychological wellbeing, unconventional religious/spiritual thoughts, family dynamics, politics, DEI, ESG, justice, career planning, or other life crises. 

Buddhism’s focus on this very life, as opposed to an afterlife, positions Buddhist spiritual care providers to offer a valuable counter-narrative to the samsaric memes and messages that constantly surround us. Worldly moral views are contextualized in place of apparent absolute “right” or “wrong,” replaced with notions of “unwholesomeness” identified with greed, hatred, and ignorance. Similarly, the antidote moral emotions such as gratitude, awe, and elevation are presented as a graduated path toward more wholesome outcomes. Instead of a body/mind dichotomy, Buddhism’s process-oriented approach also offers a relational framework of experiences within interbeing. However, although this provides a model for Buddhist spiritual care, the work of bearing witness requires many pragmatic skills that go beyond the basics of beginning Buddhist practice.

Buddhism offers a wide range of somatic practices to help ground thoughts and emotions, cultivate the four Brahmaviharas, or “four highest emotions” — loving-kindness (metta), compassion (karuna), sympathetic joy (mudita), and equanimity (upekkha) — and reconnect us to our interbeing with all that is. These capacity-building tools can help not just individuals, but also care provider teams to reconcile worldviews, resolve anger, and foster reconciliation through communal rituals, ceremonies of lament, and holding space for forgiveness, to name just a few possibilities.

Next steps

Buddhist chaplaincy is still very much the work of pioneers. Topical books, articles, associations, and in-person events are starting to appear, building a body of new theory, praxis, research and educational pathways for psychospiritual care, not just for chaplains, but also for dharma teachers caring for their own communities. It’s exciting. Yet there are still many interreligious and intercultural challenges to be addressed.

Concepts such as trauma-informed service delivery, critical incident stress management, and moral injury are not part of traditional Buddhist lingo, but they are certainly part of how society must speak about itself today. Just as Buddhism has transformed itself and evolved across different countries and times, so too is it transforming today as it adapts to new challenges. 

Bows then, to those among us at the forefront of this work. Those Buddhists who devote themselves to caring for the healers in our society are doing us all a great service, not only by supporting frontline workers in the caring economy, but by helping to elevate the culture of care in these troubled times.

[A free PDF from John Negru and Sumeru Books titled “Brightly Shining Jewel: How Sanghas Can Care for Their Chaplains,” is now available directly from the publisher at https://sumeru-books.com/products/brightly-shining-jewel]

John H. Negru (Karma Yönten Gyatso)

John H. Negru (Karma Yönten Gyatso) is founder and CEO at Sumeru Books, Canada’s leading indie Buddhist book publisher since 2009. He has been involved in many Buddhist community development projects in his more than 50 years of Dharma practice.