A Growing At-Risk Group for Moral Injury and Moral Distress

Coined in 1984 by philosopher Andrew Jameton, “moral distress” originally described the suffering that nurses experience when institutional or systemic barriers prevent them from acting with integrity, particularly when it comes to fundamental moral principles and ethical responsibilities. More recently, the concept has broadened to include other professions, such as medical professionals generally, social service providers, teachers, law enforcement, the military, emergency service providers, lawyers, journalists, and politicians, among others.

While research has proliferated on moral distress and moral injury, a related trauma condition centered on morally transgressive acts committed (or omitted) by oneself or others, including betrayal, one discrete group that has been far less scientifically investigated or publicly discussed is border security personnel.

As a therapist, clinical ethicist, and trauma researcher, specializing in moral injury and moral distress, I have seen firsthand the deleterious effects of unaddressed moral trauma, not the least of which is suicide. This is particularly poignant given that 14 U.S. border patrol agents died by suicide in 2022 (Siegel & Peller, 2022), the most ever in one year, and three more in 2023 (Homeland Security Committee Events, 2023) by this writing; that the rate of suicide among border patrol agents is nearly 30% higher than any other law enforcement agency (U.S. Customs and Border Protection, 2019); and that potentially morally traumatic experiences among border patrol agents occur almost daily (Brooks & Greenberg, 2022), creating a risk for themselves and others.

This last point bears some explanation, because as I’ve found it, the public is often uninformed about the actual roles and responsibilities of border patrol agents — me included, until I started working with them.

Understanding the Precarious Moral Landscape of Border Protection

High critical incident exposure is one type of moral challenge for border patrol agents. Said a 10-year border patrol veteran who asked to remain anonymous, “We regularly see things that people should never see, like rotting human remains, abuse of every kind, babies and kids dying or dead. Do you know what that does to you over time? You have shut down a part of yourself to keep going.”

There is also the issue of having to choose between competing “wrongs,” such as separating a child from their parent because that parent has a history of sexual abuse, including abusing their child, or else breaking with what is sometimes called a “virtuous disposition,” meaning “becoming someone you don’t want to be to stay safe and do the job,” as that same border patrol agent said. “Crimes of obedience,” that is responding to orders from a leader that are considered immoral or illegal by the larger community, can also weigh heavy for border patrol agents, as can temptation, particularly because of the vast and porous environment, with people and drugs flooding their way to the border, and because low morale and discontent can lead a person to seek out “compensatory rewards” in the form of drugs, money, sex, and trafficking. (Not an excuse, a rationale.)

Other moral dilemmas border patrol agents face include managing the line between profiling and discrimination; cultural sensitivities when interacting with migrants; regularly feeling lied to, manipulated, and deceived, which can result in “compassion fatigue”; conflict over who bears (and wears publicly) responsibility when things go wrong; the safety of border patrol agents themselves; and questioning the meaning and purpose of their work, particularly in the face of waning public trust.

There are also contributing occupational factors, such as an inferior life to other federal agencies, given the remote locations border patrol agents are stationed in, isolated work, irregular hours, long stretches away from family and friends, and less pay, which can lead to frustration, resentment, loneliness, and guilt. Such feelings are often exacerbated because the Border Patrol Academy is recognized as having one of the most challenging curriculums and hiring processes in federal law enforcement (U. S. Customs & Border Protection, 2023). Because border patrol operates within a rules-dominated environment, border security professionals also seem to have less discretion and autonomy than other professions (such as physicians), whose professional ethical standards in certain situations allow personal choice and behavior to prevail over the institutional rules and protocols, even law. Over time, feelings of being restricted, muzzled, or dismissed can cause “moral residue” to build up and eventually lead to moral distress.

Particularly problematic for border patrol agents are long-standing institutional challenges, such as poor working conditions, lack of resources, perceived organizational injustice, stigma around mental health, little professional mental health support, and little to no moral education for the dilemmas and tests of integrity border patrol agents are likely to face.

More recently, as the U.S. southern border has swelled with unprecedented numbers of migrants and asylum seekers, there simply have been too few agents to manage the crisis; as one border patrol agent said, “We’re all just feeling overwhelmed, resentful, and burned out.” Moreover, there is widespread anger and frustration that the purview of the job has fundamentally changed, with, at one point, up to 40% of border patrol personnel working to care for, transport, and process vulnerable individuals and families. “It feels like a bait and switch,” said another senior border patrol agent. “We’re meant to serve a law enforcement purpose. That’s what we signed up and are trained for. But suddenly, we’re now expected to act as a humanitarian relief agency, which requires an entirely different set of skills, expectations, resources, and responsibilities … ones that most of us don’t have.”

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When you add the perception of leadership betrayal over false allegations of border agents whipping migrants (Relman, 2021), and seeming leadership disregard for border agents' life-saving intervention in Uvalde, Texas (Karimi, 2022), you have the making of a potential moral mental health crisis.

What Can Be Done to Build Moral Resilience Among Border Patrol Agents?

As with any complex system, without meaningful structural change, the status quo prevails. In the case of potential moral distress and moral injury among border patrol agents, more research needs to be undertaken, specifically with border security personnel, not only because very little exists, but also to better understand how these experiences and moral dilemmas impact psychological and spiritual health, which could lead to constructive ways to better support this discrete group.

Destigmatizing mental health and embracing the moral realities and dilemmas inherent in the job, at an institutional level, is also essential. As a retired border patrol associate chief said, “We have to make asking for help with these stressors as easy as calling for backup when we need it.” More targeted internal and mental health programs and training, with professionals who are skilled with moral trauma is also necessary. Peer counseling (as Customs and Border Protection (CBP) offers) can be incredibly helpful, particularly with moral distress and moral injury, but counselors do not always have the knowledge or experience to deal with the magnitude of issues, such as threats of suicide. This can also result in vicarious trauma in peer counselors, who have not had the professional training for therapeutic self-care. The same is true for the border patrol’s chaplaincy program, which does not (as of this writing) require chaplains to have a Master of Divinity degree like professional chaplains at other agencies.

Moral education and training, specifically with regards to ethical aspects of border guarding, dealing with moral issues and dilemmas, and real-time moral distress tolerance techniques, would also be helpful, something apparently not currently offered through CBP. It might also be beneficial for the border patrol to ask difficult questions, like the American Medical Association and a recent handbook on military ethics have regarding ethical standards of the profession, namely whether being a member of the border security profession means adhering to the ethical standards of that profession, rather than simply complying with the law, and to what degree border patrol agents should have autonomy and agency to make principled choices in the field.

Lastly, this article (DeMarco, 2023) provides specific information and resources for individuals struggling with moral distress and building moral resilience.

We have come so far in our awareness of moral distress and moral injury since Andrew Jameton and Jonathan Shay, respectively, first coined the terms more than three decades ago. It’s time to extend our research, conversation, support, and resources to this population too. It might be one small step to affecting a stronger and more resilient approach to border security — one which redounds not only to the agents themselves, but also to the people who these agents encounter.