From the Desk of Dr. Cara English, DBH, MA, LAC
CEO and CAO of Cummings Graduate Institute for Behavioral Health Studies
My dearest US colleagues and friends,
So many of us are clinicians who stepped into “integrated care” roles that turned out to be integrated in name only. In our reality, collaboration is thin, values are misaligned, and our ethical compass is constantly under assault. Sound familiar? If so, what you are experiencing has many names; moral injury, ethical betrayal, gaslighting. And it’s all draining.
You are being asked to hold clinical risk without clinical authority, to absorb distress without structural support, to patch over systemic failures with your own nervous system, and to look away from the very real and very obvious solutions the system refuses and denies. You know the system can do better, but you feel like the only one who can’t stay quiet and just ignore it all.
At the same time, the world outside your clinic walls feels like it’s on fire. You are watching your nation and the world we know fracture. You are worrying about patients who are more vulnerable by the day, about family and friends who may not be safe, about loved ones who are quietly unraveling. And then, because life does not pause for collapse, you are making lunches, answering emails, documenting notes, and wondering how to explain any of this to your children without transferring your terror directly into their small bodies. You have learned that some of your loved ones have abandoned their values to the extent that you don’t know how to continue a relationship with them any longer. Your family may not feel safe or like a family at all anymore.
If you feel split in two, that makes sense.
If you feel numb one moment and flooded the next, that makes sense.
If you feel anger at institutions that promised care and delivered optics, that makes sense.
This is not a failure of coping. It is the cost of witnessing and of speaking truth in a world that pretends that’s what it wants, but immediately proves it isn’t ready for that and curses you for giving it so freely.
Please hear this clearly: your distress is a sane response to an insane set of conditions. The fact that you still show up; for your patients, your kids, your community – while carrying fear, grief, and ethical injury is not proof that you should carry more. It is proof that something is wrong with the systems, not with you.
You are not imagining this.
You are not alone.
And you are not failing.
I know it feels like you are trying to hold the world together with shaking hands and a broken heart. You are allowed to grieve. You are allowed to be angry. You are allowed to name betrayal without immediately transmuting it into “self-care.” And you are allowed to need and demand boundaries and care for yourself – real care, not platitudes.
When your world is falling, you are allowed to wail. You are allowed to rage. You are allowed to feel broken. How can we heal before the terror ends? Healing without justice feels like self abandonment.
Most of us do not have the ability to quit our jobs or simply move to another country. In uncertain times, strategic silence, timing, emotional regulation, and political skill keep us alive to fight another day. Wisdom is knowing that not speaking up all the time & everywhere does NOT equal moral failure, no matter what you may have read otherwise on social media.
We are bridge-builders, not martyrs. Survival is both a personal and a professional responsibility and it takes a lot of inner work. Who is helping you to do that work? Who is cheering you on? Who are your allies? How can you create an ongoing counter-isolation strategy for yourself; a social buffering that guards against everything the world is throwing at you right now? Isolation is an accelerant to demoralization, despair, and defeat.
Grief is not weakness when your people are being terrorized. Grief is the proof that you still belong to one another. When a nation is breaking, your sorrow is not private; it is political, it is sacred, and it is shared.
Know that you DO belong here and that just like you, there are many others who are mourning the tearing apart of the world. Love and protect each other fiercely. Rage honestly. Retreat when you must, and rise when you’re ready. Power is reborn every time you dare to return to your responsibilities beyond yourself.
To all of you code switching between the horrors and all the other things you need to do, just trying to scrape together some hope, I see you. Remember RuPaul said:
“With all the darkness going on in the world, you can look at the darkness. Don’t stare. It will make you crazy, it will make you cross-eyed, it will make you what IT is. The solution is to create magic, dance, sing, love. Create environments where you can find joy, because you can create joy.”
And that is an act of rebellion in itself.
