The Many Faces of Trauma in Health-Care Work
Understanding OSI, Moral Injury & Cumulative Stress in Helping Professions
You care for people on the hardest days of their lives. You hear stories most will never hear, witness moments most will never see, and hold emotions most will never feel. You’re trained to stay steady, to act, to support — even when your own system is struggling.
And while trauma is often associated with patients, you already know something many don’t say out loud:
Trauma happens to healthcare workers too.
As Bessel van der Kolk writes, trauma isn’t the event — it’s what stays inside after the event is over. And in your work, those imprints can add up in ways that don’t always show on the outside.
You’ve likely gotten very good at functioning through it.
That doesn’t mean you’re unaffected.
It means you’re human doing superhuman work.
The Types of Trauma You May Be Carrying
Acute Stress & Shock Events
There are calls, shifts, and moments that stay in your body. The sudden loss. The traumatic case. The unexpected outcome. The sound, the image, the family’s face.
You might move on quickly because the system demands it — yet your nervous system holds the file open.
Chronic Emotional Wear
More often, trauma in this field is not one event — it's the constant, slow burn:
continuous exposure to suffering
chronic understaffing
ethical pressure to do more than possible
emotional labour without emotional support
Gabor Maté reminds us: stress without expression or repair becomes illness — emotional and physical.
You can't pour endlessly without refilling, but healthcare culture often tells you to.
Operational Stress Injury (OSI)
You may be familiar with this term from first responder and military communities — but it applies to you too. OSI happens when repeated stress, trauma, and moral strain reshape your nervous system and sense of self.
It’s not weakness — it’s biology adapting to chronic threat.
Vicarious Trauma & Compassion Fatigue
Janina Fisher calls this “the cost of caring deeply.”
You don’t have to be the one who experienced the trauma for it to live in you. Witnessing can be enough.
And when empathy becomes exhaustion or numbness — that’s not failure.
That’s a sign your system is overloaded.
Moral Injury
This one hurts at the soul level.
Moral injury happens when:
you know what care should look like but can’t provide it
you feel forced to compromise values
you witness preventable harm
systems betray trust
Judith Herman has long emphasized that trauma tied to betrayal wounds identity, meaning, and humanity. You didn’t “burn out.” Something in you was violated.
This isn’t about resilience.
It’s about ethics and heartbreak.
Why You Might Not Reach Out
Maybe you’ve said:
“Others have it worse.”
“I just need to push through.”
“If I talk about it, will it mean I can’t handle this?”
“I don’t want to burden anyone.”
You’ve built a life on helping, not being helped.
But as Diana Fosha (AEDP) teaches, healing requires undoing aloneness. Connection isn’t a luxury — it’s how humans repair.
What Healing Can Look Like
There is no one right way — but sustainable recovery usually blends body, mind, and relationship:
Bottom-up
Somatic work & regulation (Pat Ogden, Ruth Lanius)
EMDR for traumatic imprinting (Shapiro; Van der Kolk)
Parts work
Internal Family Systems (Richard Schwartz)
Supporting the part of you that “keeps it together” at all costs.
Emotion & attachment repair
AEDP (Fosha) to heal through co-regulation and safe emotional presence
Compassion & re-humanization
Self-compassion work (Kristin Neff)
Safe peers and supportive supervision
Healing doesn’t mean you’re broken.
It means your nervous system is asking for care in return for all you’ve given.
A Final Note — Human First, Healthcare Worker Second
You have seen things that change people.
You have carried things that deserve space and support.
Your exhaustion, irritability, shutdown, tears, numbness — none of it is weakness.
It's your body saying: you matter too.
You don’t need to collapse to deserve rest.
You don’t need to fall apart to deserve care.
You don’t need to leave the work to heal from it.
Help is not a threat to your identity — it's a way back to yourself.
