Navigating the Depths of Moral Injury: Rita Brock on Healing, Resilience, and the Power of Community
August 13, 2024 • 38 mins
What happens when actions or events violate your deepest moral beliefs? Join us for an essential conversation with Rita Brock, Senior Vice President for Moral Injury Recovery Programs at Volunteers of America, as we dissect the profound suffering known as moral injury. Unlike PTSD, moral injury stems from moral and ethical violations, often leading to harmful coping mechanisms and even life-threatening situations. Rita shares powerful insights on how addressing these painful experiences through supportive discussions and therapeutic practices can lead to growth, wisdom, and resilience.
Hear the compelling story of a Vietnam veteran who discovered the true nature of his trauma after learning about moral injury. Through this narrative, we explore the intricate overlap between moral injury and PTSD, and the heated debate over their distinct treatment approaches. Gain a deeper understanding of alternative healing methods, such as Native American rituals, and learn about an impactful pilot study by Volunteers of America that utilizes peer-facilitated group therapy to help veterans and first responders find relief and recovery.
In our final chapter, we discuss the significant role of emotional intelligence in recognizing and addressing moral injury. Sharing personal experiences within a supportive community can immensely lighten the burden of suffering. High-stakes responsibilities, whether in professional roles or personal life—like motherhood—can also contribute to moral injury. This conversation aims to foster resilience and community, underscoring the immense courage required to navigate life's moral challenges. Tune in for a transformative discussion that highlights the importance of addressing moral injury for a healthier, more connected society.
As a First Responder, you are critical in keeping our communities safe. However, the stress and trauma of the job can take a toll on your mental health and family life.
If you're interested in personal coaching, contact Jerry Lund at 801-376-7124. Let's work together to get you where you want to be and ensure a happy and healthy career.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jerry (00:02):
Welcome to today's episode of Enduring the Badge
podcast.
I'm your host, jerry Dean Lund,and if you haven't already done
so, please take out your phoneand hit that subscribe button.
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On whichever platform youlisten to this podcast on, such
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(00:22):
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this to other people that neverlistened to this podcast before,
and that allows our podcast togrow and make more of an impact
on other people's lives.
So if you would do that, Iwould appreciate that from the
bottom of my heart.
My very special guest today isRita Brock.
(00:43):
How you doing, rita?
Rita (00:44):
I'm doing great.
How about you?
Jerry (00:46):
I'm doing great as well.
Thank you for joining me today.
Rita, can you introduceyourself to the audience?
Rita (00:51):
Sure, I'm Rita Brock and I am Senior Vice President for
Moral Injury Recovery Programsat Volunteers of America, which
is a giant nonprofit.
Jerry (01:02):
It does social services and affordable housing is a
giant nonprofit social servicesand affordable housing yeah.
Rita (01:10):
It seems like a pretty big project that you're on.
Yeah, yeah, I got interested inthis in 2009 when I read an
essay that was the first thingpublished in a long time about
the suffering of militaryveterans.
That's not PTSD, that's not amental health problem, but is a
(01:30):
kind of suffering that the VAwas trying to figure out what to
do about.
And when I read that essay, oneof the things that they said
was helpful to people who hadmoral injury was having a
conversation with a benevolentmoral authority because their
consciences were bothering them.
(01:52):
And I thought to myself that'sa great idea.
And since I work in religionand with chaplains and ministers
, I thought we should starteducating that people that do
that kind of counseling workabout moral injury so they know
what to do and how to handle it.
(02:13):
And so that's what I've beendoing for the last since 2010,
is trying to educate the publicvarious publics about what moral
injury is and why it'simportant to pay attention to it
.
Jerry (02:25):
All right.
Well, that's a great question,leading question for me, so you
kind of touched on it.
So let's kind of break down themoral injury.
Rita (02:33):
The moral injury piece yeah.
Jerry (02:35):
Yeah.
Rita (02:35):
So it comes from the fact that human beings have
consciences and so we operateautomatically all day long being
good people because we learnthe right behaviors and as long
as things work we're good.
But when something goes wrong,we might hurt somebody, they
(02:56):
hurt us, it bothers us.
So then we have to, like figureout what to do about it and in
the course of a normal day ifyou did something or something
was done to you, an apologywould be involved and it'd be
okay.
But sometimes things go wrongat a magnitude that they can't
(03:18):
be fixed or it isn't clear whatto do, and they start to bother
you Like you might even losesleep over it kind of mull it
trying to sort it out.
That's kind of a level beyondmoral conflict.
It's more like moral distressis a term for it.
You're distressed about it, itwon't let you go, and eventually
(03:39):
you may shrug and say, well,nothing I can do, I need to move
on.
Or you try to do somethingindirect to fix it, or you
apologize, knowing it can't befixed, but the person says, well
, okay, so there's a ways toresolve even moral distress
sometimes.
But you can have a lot of moraldistress, like it can start to
(03:59):
accumulate like it did duringthe pandemic.
For so many people it wasdisaster after disaster and they
couldn't really even adapt tothe few things that happened
because they just keptaccumulating.
You could have something likethat happen.
Or it could be so cataclysmic athing that happened, like
somebody dying, that you justfeel devastated by it.
(04:23):
Like you start to wonder whoyou are.
You start to wonder how, ifyou're a good person, you may
decide to give up on a careeryou loved.
A lot of doctors did thatduring the pandemic.
Or you might begin to cope withthe negative feelings of shame
or guilt or remorse or anger.
(04:44):
Sometimes it's happened to youand you're toxically angry, but
those are painful feelings.
So people start to cope withthat by drinking, using drugs,
overworking, like so they don'thave to think about it.
Like working to exhaustion orgiving up on a career, giving up
on themselves, giving up ontheir family, giving up in some
kind of way.
(05:04):
That's a sort of a defeat.
It feels like a defeat, afailure, a defeat or even think
about dying by suicide, and somoral suffering, that kind of
moral suffering is profound andit can be it's health
endangering and it can belife-threatening, but it's not a
(05:26):
disorder.
You're not having a distortedrelationship to reality.
Reality really is that bad.
That's the worst part about itis you can't go to a therapist
and say, okay, fix me, so Idon't have these feelings
anymore because I'm not orientedto reality.
No, actually you are, andthat's why the suffering can be
(05:46):
pretty profound and to deal withit you have to actually those
feelings that you're trying toavoid in every way possible,
because they're really intenselypainful and often very
isolating, like if you'reashamed, you don't want to talk
to anybody about it, so thosefeelings don't go away.
It's like so you just bury theminside and they still live there
(06:10):
.
They don't die in there.
And so if you can find a way tocough them up, as it were, to
let yourself go through thosefeelings, and you can diffuse
them so they don't run your lifeand threaten your health or
your life and they just becomesomething that you know about
(06:32):
yourself, you might even becomewiser from having considered all
the things that happen.
You might even be strongerbecause you now know what it's
like to face those kind ofdevastating things.
But that's hard, it's reallyhard to do, and what we've
learned is that not all peoplewho are therapists are trained
(06:55):
to understand moral injury,because their job is to fix you,
their job is to make you better, and so a moral injury isn't,
isn't exactly fixable.
It's.
You have to come to terms withit and accept it, and that's
different from fixing it.
You can't make a goal.
Jerry (07:16):
That is true.
Rita (07:17):
Yeah and so, but every this is a thing.
You can't have moral injuryunless you're a good person.
Jerry (07:25):
I mean seems appropriate.
Rita (07:28):
So the suffering is the sign of your good person wanting
back, wanting back out, and soif you keep running from the
suffering, you keep running fromthat person.
Jerry (07:41):
It's very, very interesting to me because I can
see I feel like that I could seewhere PTSD and moral injury may
be confused as being the samething.
Rita (07:57):
They've been confused a lot because they share symptoms.
Yeah, share symptoms, yeah,right, so um, with pts, pts.
One of the issues of ptsd isit's it happens because you're
terrified.
It's very traumatic, it's atrauma-based disorder, um, and
if you were terrified, it meantyour memory processing system
(08:19):
wasn't working, because fearshuts that down.
So you remember things, but it'sin pieces and fragments, and
often there's holes in yourmemory or you can't even
remember the incident well atall, and so part of the therapy
is to get you a coherent memory,to take you back in a safe
environment to relive somethings and put the pieces
(08:41):
together so you can have acause-effect memory of what
happened.
And that's important torecovering from PTSD is to move
those memory fragments that aresort of attacking you and
pushing them over into thethinking part of your brain
where the narrative getsconstructed.
(09:01):
But then when you move it overto that thinking part of your
brain, that's also yourconscience brain, so you may
actually feel worse emotionallyafter you have a memory of
something and the feelings ofPTSD are fear-based, right so
(09:22):
it's.
Anger can be a fear, responsiveaggression, um or um.
You can um freeze, which issometimes turns into depression,
um.
Or you can um, uh, run away.
I mean, there's there's allthese different fear responses
and come with certain feelingsand uh, and you may even feel
(09:43):
some guilt because of somethingthat happened.
But with moral injury theemotions aren't fear-based.
So you can be depressed becauseyou're morally upset, and it
can be confused with depressionthat's associated with PTSD.
And you can be angry with moralinjury because somebody did the
(10:05):
wrong thing and you're upsetabout it.
Or you were forced to dosomething that you knew was
wrong but you didn't have achoice, or you were in a
situation where there was nogood choice and you're angry
about that.
In some way You're angry atyourself or someone else or the
situation.
So you can also have anger frommoral injury, but it's
different from fear anger, butthe symptoms look alike.
(10:26):
You can also have anger frommoral injury, but it's different
from fear anger, that's.
You know, it's so there, butthe symptoms look like.
Jerry (10:29):
Yeah sometimes.
Rita (10:32):
But you can have moral injury without any trauma at all
, with no PTSD.
You can just have moral injurybecause you did some like I work
with, spoke to a group calledthe Hyacinth Group, which is
people who have killed people inaccidents and they may not have
(10:54):
had PTSD or anything, but theyfeel terrible.
Jerry (10:58):
Right right.
Rita (10:59):
Right and they have moral injury, but they don't have PTSD
symptoms necessarily.
Jerry (11:06):
Yeah, that's just fascinating because, yeah, I
could see I feel like they couldbe easily confused.
Can you have?
Rita (11:14):
I'm assuming you can have both yeah, a lot of combat
veterans have both, becausethey're they're like in a
situation where people areshooting at them and they're
shooting back and something mayhappen where they kill somebody
and then they feel they may not.
The thing with combat veteransor I would.
I would say this is alsosometimes true to first
responders You're in a situationwhere someone does die and it
(11:39):
may like, if you're in lawenforcement or another in a
situation where you actuallyactively had to kill somebody,
you may get a medal for saving abunch of lives.
Right, you may have been theright in that moment, the thing
you really needed to do.
Jerry (11:57):
Sure.
Rita (12:00):
And you could even be, like everybody, grateful to you
for saving their lives orwhatever, and so it may not hit
you for a long time, like you,may go years without thinking
much about it, and then suddenlyyou start to wonder what human
being celebrates killing anotherhuman being, or, like you, just
(12:22):
don't.
You start to like, puzzle itout.
Or like you just don't you startto like puzzle it out and you
may actually have moral injurymuch later because your
conscience is now mulling it ina different way.
Yeah, yeah, I talked to an AirForce veteran that his moral
injury didn't really hit him for40 years.
(12:42):
Wow, At 40 years out.
What happened was he got sickenough in the hospital that he
thought he was going to die andI think all those memories from
40 years before just floodedback and he was really super,
super upset.
He was really struggling with.
(13:03):
How could I have been capableof that?
And he didn't actually ever doanything, so he didn't have PTSD
trauma to go with it.
He was just in a situationwhere, if asked, he would have
started a nuclear war.
Jerry (13:15):
Yeah, that would be stressful.
Rita (13:18):
Yeah, during the Cuban Missile Crisis he was a B-52
bomber pilot.
Jerry (13:22):
Okay.
Rita (13:23):
His target was Russia.
He said I could tell a story.
His target was Russia.
Jerry (13:30):
I'm not sharing secrets.
His target was Russia.
Rita (13:34):
So 40 years later, he's like I don't know who I was as a
23-year-old married father oftwo, that I was willing to start
a war that would end in 15minutes and I wouldn't know if I
had a country or a family to gohome to.
How could I?
Jerry (13:52):
I could see maybe, like in that at that age, probably
just being in the air force oryou know, and being around those
different things being veryproud of his service.
Rita (14:05):
His.
His crew made crew of the yearthree of the four years he
served, so he was really goodand yeah, he's really good and
I'm sure he took great pride inthat and he had an enormous
responsibility and you know um,but he was only in for four
years yeah um I'm assuming life,big life events maybe bring up
(14:29):
these thoughts to bring aboutthese facing death does.
There's something about lookingat the end of your life and
feeling anything unresolvedneeds to get fixed.
So hospice workers talk aboutlots of people who want to
confess something on theirdeathbed that they've been
carrying a long time yeah, andyou can function.
(14:52):
You know people who arehigh-functioning and talented
and just able to hold ittogether can function a long
time with a moral injury.
But it weighs them down in somesort of invisible ways, like
they're not fully emotionallypresent to people or they maybe
(15:13):
drink a little too much orthey're doing four jobs to try
to stay busy, so, but it's likeyou can't run from it forever.
Jerry (15:25):
Right.
Rita (15:27):
They don't die when you bury them.
Jerry (15:30):
No, they just, they just reappear at another, at another,
another time.
Rita (15:35):
It's also going to be inconvenient, yeah yeah, yeah,
and your and your thinking braincan be quite powerful in terms
of repressing those things andnot not going there, but, um,
they just don't disappear andyou don't have to carry them.
Jerry (15:48):
That's the thing you don't, yeah I want I've said
this before on the podcast a lotlike carrying things like that
is like it, disease, right it's.
It's dis-ease which causesdisease yeah, yeah.
Rita (16:03):
No, it can cause um high blood pressure and heart.
I mean it's bad for your health, especially if it interferes
with good sleep.
You you might have nightmaresabout things, they might haunt
you.
I remember talking to a veteranin San Quentin Prison.
I worked with a group of vetsin San Quentin Prison and he
(16:26):
told this story of when he heardme talk about moral injury.
He said you know?
He said I've had this dream.
It comes to me sometimes.
I don't have it all the time.
But he said but, but it's a.
I see this child, thisVietnamese child, and he has a
giant hole in the top of hishead and he's staring at me with
(16:49):
these big eyes.
And he and I said, said, and hesaid and it wakes me up.
I see him staring and I said doyou know what that's about?
And he said yeah, yeah, I do.
He said we were sent into avillage to find the Viet Cong.
We were told the VC were hidingthere and we had to go and, you
(17:12):
know, clean out every hut andwe couldn't find any VC.
And so there was this one longbuilding.
They said they're hiding inthere.
Shoot that building up.
So he said, so wemachine-gunned it.
Good, we just tore it up.
And then he said and we went inthere and it was a school and
we killed all these little kids.
And I said, you think that'swhat he said?
(17:37):
Yeah, that's what the dream wasabout.
And that's when he realized hehad been carrying this horror
this sense of awfulness ofhaving killed little kids.
Jerry (17:51):
That would be awful.
Rita (17:52):
It would.
But he didn't know, he didn'tactually ever think about, he
just knew he had this dream buthe hadn't actually connected it
to something that had actuallyhappened in Vietnam until he
heard the term moral injury.
And then he kind of like thedots got connected for him and
he did so well in that groupthat he went, he was paroled.
Jerry (18:16):
That's good.
Rita (18:17):
Yeah, he went out on parole.
Yeah, yeah.
Jerry (18:21):
Is there a way to I don't know if this is the right
terminology for this diagnosepeople with more energy, or how
does it?
I mean, how's this work?
Rita (18:30):
There are symptoms.
How would I put it?
With more energy?
Or how does this work?
There are symptoms, how would Iput it?
There's actually a debate goingon with some people who want to
create a diagnosis so thatmoral injury can be treated by
therapists, because they can'ttreat for a thing that doesn't
exist as a diagnosis becausediagnosis means protocols for
(18:51):
how to treat.
But the VA clinicians, thepsychiatrists and psychologists
that originally did the majorresearch on moral injury and got
the conversation started.
Most of them and I know quite afew of them most of them don't
think it's a disorder and theydon't think it belongs in the
manual because it's toocomplicated a thing you know
(19:15):
it's like.
Well a person you could,because you can confuse PTSD and
moral injury.
There's going to be overlap insymptomology to diagnose it.
But the things that work forPTSD don't necessarily work for
moral injury.
Jerry (19:29):
Yeah, it seems like there would be a little bit different
path.
Rita (19:32):
There would be moral injury.
Yeah, it seems like there wouldbe a little bit different path.
There would be, and in fact,one of those people who worked
on the original research is awoman at the San Francisco VA
and she's been studying theimpact of killing.
She has a team that works onthe impact of killing on
veterans, because they have adouble suicide rate from other
veterans.
That's how seriously it affectspeople, and so she actually
(19:56):
they published an essay forclinical people who do therapy.
That said, if you think youhave a veteran who's
experiencing the impact ofkilling, you need to do a
different process for thembecause you cannot fix what they
have.
And so they actually did a10-step protocol that you could
drop into PTSD therapy to dealwith the killing part, which is
(20:19):
about learning to accept it, andit involves things like writing
a letter of unfinished businessor an apology, things like that
, rather than feeling okay withit.
So even the therapists in theVA who work on both she's an
expert on PTSD, but she's alsoan expert on moral injury
(20:40):
understand that they'redifferent, and if you don't
understand that very well, youcan miss the moral injury piece
and not address it.
So I've talked to so manyveterans who went to therapy.
A friend that is now aprofessor of anthropology was an
Iraq vet and he said I got goodhelp from the VA for my PTSD
(21:01):
and I had PTSD and I did havethose flashbacks and symptoms,
he said.
So I learned to manage mysymptoms.
But he said after a couple ofyears of therapy he said I still
felt miserable and I couldn'tfigure out why.
And he actually went and triedthis thing another vet
recommended, which was to go toa Lakota sweat lodge ceremonial
(21:22):
process, which isn't exactlytherapy, it's a spiritual
reorientation process and that'swhat made him feel better.
So his PhD dissertation wasresearch on non-Native American
veterans like him who use NativeAmerican rituals to get better.
That's what he studied as ananthropologist.
(21:46):
I mean that sounds fascinatingin a lot of ways yeah, he said
the guy that started that they,they, they had a, a native
american leader, a spiritualleader, do the sweat lodge
ceremony and that leader waswilling to have non-native
american veterans in the groupand he started out by saying
(22:06):
what we have to fix in you isthe need to kill people.
And so they went throughintense stuff praying, crying.
I've done sweat lodge.
Jerry (22:20):
Yeah, me too.
Me too, A few of them.
Rita (22:24):
Yeah, yeah, and so that's how he got better.
And we did a Volunteers inAmerica had a pilot study that
was funded, that we did withmilitary veterans 100 of them in
small groups that were peerfacilitated by other veterans.
That had really good results.
We had to stop it because ofCOVID, because it was 50 hours
(22:47):
in person at a retreat center,so it was pretty intense too,
but we're trying to restart itnow.
Jerry (22:54):
Yeah, I can see where that would be extremely helpful.
Rita (22:57):
Yeah, we actually did a one-day adaptation of it for
first responders and we did itfor Miami Rescue and Fire, miami
Dade.
We did a day with them and wedid it in Houston with a
collection of folks not Houston,but Arlington, texas, and yeah,
(23:19):
Is this something you want toget started like all over the
country again?
We would like to.
Yeah, and we attended.
We learned some things tooabout how to how to improve it.
We went to the Kentucky Academyfor Critical Incident
Processing and they do threedays, I think it is.
(23:41):
It's a lot.
They do a lot of informationdelivery, but they also offer
EMDR therapy during the process.
During the process and thereare about 30 or 35 of them that
were at it and they all told thestories of what was really
bothering them.
And as they told their stories,I thought, yeah, moral injury,
moral injury, moral injury.
And they only had like 10minutes on moral injury.
(24:05):
So one of our suggestions thenwas that they do a more robust
discussion about moral injuryand give people a chance to
process, because they alreadyuse peer support groups anyway.
Yeah right, and so we think weare on the right track with our
one-day processing, and it's aprogram that we took to
(24:26):
Miami-Dade, where in one day, wedid the day-long processing
with people, and so some of themwanted to become peer
facilitators for it.
So the next day we trained agroup of facilitators and a
staff person to give the support, so they had their own program
when we left.
Jerry (24:48):
That's fascinating to me because there's peer support
right that they use throughoutprobably their department and
stuff like that, and this isjust a different model of that
kind of peer support for moralinjury.
Rita (25:04):
Yeah, specifically for moral injury.
Peer support is you know youcan talk to.
They're there to talk to people.
They're there to offer how toget them the right services if
they don't know and stuff likethat.
But this is a more formal,almost scripted process for
doing the things that need tohappen to help people come to
(25:25):
terms with morally challengingthings that have happened to
them.
So, it's very directive.
Yeah, but it's peers and it'stotally confidential, and then
nobody knows what happens.
It's all, it's you know, it's.
It's a sacred space.
We don't right right nothinggets reported out.
It's not therapy um, it'straining.
Jerry (25:47):
We call it resilient strength training I would be
fascinated to sit in on that.
Rita (25:53):
Okay, next time we do that , I'll let you know yeah.
Yeah.
Jerry (25:59):
I would just like to tie all the different worlds that I
kind of know about therapy andPTSD and all these different
things and peer support to likeokay, what's this piece and how
can this piece be added in tohelp first responders?
Rita (26:13):
Yeah, we started those one day things for our own staff
volunteers of america has youknow um mental health facilities
and low-income housing andtransitional housing for
unhoused people and all thosesorts of things and our staff
were pretty fried from thepandemic um sure it was rough on
.
So we put it together just tohelp our own staff process and
(26:37):
um, and that's when we got theidea.
You know, we could do this fora lot of other groups too, Um,
and we could even tailor it forspecific kinds of groups,
because every group has its ownculture.
Jerry (26:48):
Yeah, right True.
Rita (26:50):
Yeah, so we've got I think it's three affiliates that have
their own programs now becausewe went and did it for them Very
good.
Hopefully that keeps spreadingacross the country and the globe
as well.
It's not a moral injury, but ifyou have some moral distress or
(27:11):
something that bothers you thatyou need to process.
You can just go into thisvoaorg slash rest and you can go
there and you'll see the firstresponder section.
There's a whole section that'sfor first responders and you
sign up by putting in your nameand email.
(27:32):
You know so they can send you areminder of when your time is
and you can see the schedulewhen groups are meeting.
And it's small groups.
It's only one hour, so it's nota huge amount of time and there
are different times because weknow there's shift work going on
and it's completely peerfacilitated by other people
who've been first responderscompletely peer facilitated by
(27:53):
other people who've been firstresponders.
Jerry (27:54):
Very interesting, very cool yeah yeah, it is so, yeah.
Rita (27:56):
So if you just wonder what it might look, you could go in
there for an hour.
Jerry (28:02):
Yeah, I have this burning question.
Rita (28:05):
Let me like this, like like oh, this I feel terrible.
Maybe, maybe this will help me.
It's pretty simple too.
It's just some mindfulbreathing to help you calm down,
and then a guided meditation tohelp you remember something you
want to share, and then eachperson gets time to share and
(28:26):
there's no crosstalk, it's not aconversation, there's just
silence to receive everybody'stestimony and there's something
really validating, I think,about people believing you and
listening in silence.
Jerry (28:39):
Oh, yeah, definitely, Definitely.
Rita (28:41):
And then also people can connect around similar
experiences or after everybodyis shared that wants to share,
then there's a chance to saysomething and people often say,
wow, I got that.
You know it's like, and somehowthat lessens the pain of it.
Jerry (28:58):
It really does lessen.
Well, I think, because we oftenfeel like we're alone in our
what we're going through and oursuffering, that we're the only
people that maybe have gonethrough this, and I mean and
that may be true to the factthat it's just your own thing
that you went through, but likethere's the similarities are so
(29:20):
close to things that many peoplehave gone through that you know
you're almost the same.
Rita (29:26):
Find out that this horrible thing that happened to
you might be valuable tosomebody else.
Jerry (29:31):
Right, right.
Rita (29:32):
Right, that is not so bad, then it's it's like oh okay,
there's, there's some value tobe had, that somebody was helped
by my, my honesty here insharing this.
Jerry (29:42):
Yeah, that's how we got the podcast started.
Through my trials andtribulations, I thought you know
(30:04):
people together on the podcastto share different experiences
or resources or just information.
The more you know, you know,the better off you are, and I
think a lot of people listeningare probably like I thought I
had ptsd, but maybe I, maybe Ihad this, this moral injury
thing instead, and like thatprobably sounds a lot better to
me than having PTSD because likethis can be worked through a
(30:25):
little bit better or faster orsomething I don't know.
Rita (30:28):
Yeah, I don't know exactly , but but it's also um when
people and they can legitimatelyhave PTSD and moral injuries.
So I don't want to disparagethe therapy piece.
but but the therapy piece ismore about something that's
actually wrong with you, um, andmoral injury is more like
(30:51):
you're a good person and thatwhat the world you're in is is
messed up, and that's adifferent nuance there.
It's different.
The other is also that withmoral injury, other people, just
ordinary people, can help you.
Right, your own peers can helpyou.
In fact, it's better when thathappens, because then this
(31:15):
person knows this truth aboutyou and you know this truth
about them and it deepens yourfriendship, right, it deepens
your relationship right whereasin therapy you are the person
with the problem.
You're seeing somebody thatknows how to fix the problem,
perhaps, and so they work withyou, but really it's on you to
fix yourself yeah and then whenyou're done, if you do, actually
(31:37):
, if they're good and you'redone, you never see them.
Actually, if they're good andyou're done, you never see them
again.
Jerry (31:42):
That's a very different kind of transactional
relationship, right, yes, yes.
Rita (31:46):
And it can be really important if you do have a
mental health disorder.
So you know, I'm not sayingdon't have therapy, sure, but
it's a different relationshipfor a problem you're having, and
moral injury is really more ofan anguish and struggle that
you're in, that other peoplemight be able to understand and
that alone can make you feel alot better.
Jerry (32:08):
I'm like in my mind, I'm like is there anybody out there
that doesn't have a moral injury?
Rita (32:15):
That is a good question.
There may be people I don't.
Probably there's no one outthere that hasn't felt moral
distress.
Jerry (32:23):
Yeah.
Rita (32:24):
But not everybody has had an identity crisis, meltdown and
thought about killingthemselves.
Jerry (32:30):
Right.
Rita (32:31):
Right so.
So not everybody gets to thatlevel of intensity with moral
distress, but plenty of peopledo right, I could, I could see
that for sure if you do highstakes work, you're you're at
risk for it, because high stakeswork means a lot of harm can
(32:56):
happen.
Even death can happen, and thatnever feels good right you know
, one of the one of the placesthat nobody I think it's not
often thought of as aspotentially morally injurious
work, is being the mother of anewborn I can see that yeah very
(33:16):
high stakes, totally vulnerableinfant, totally dependent on
you and're exhausted, and youmay be the only one doing the
care, and you can be soexhausted that you could resent
your baby.
I mean there's just that's suchhigh stakes work.
Yeah yeah, and there's not alot of social support for it.
Jerry (33:40):
Right.
Rita (33:41):
Yeah, yeah, and there's not a lot of social support for
it, right?
I remember the story of amother with a 10-month-old
colicky baby that had alwaysbeen colicky and her husband
worked and she was alone in afifth-floor walk-up apartment
taking care of this baby and shenever got enough sleep because
it was colicky and cried a lot.
It was colicky and cried a lotand in one really bad week she
(34:02):
finally got the baby to sleepand she crashed on her bedroom
bed and then within a half hourthe baby was screaming again and
she was in such a state thatshe went to the nursery and saw
herself throwing the baby outthe window to the nursery and
(34:23):
saw herself throwing the babyout the window, and then she was
freaked out by her vision andshe wrapped the baby up and put
on her coat in the middle of thenight and went down to the
street and rode the bus allnight so she wouldn't kill her
baby.
Jerry (34:33):
Oh, wow yeah.
Rita (34:34):
Yeah, she wrote the article about it after it was a
child.
Her daughter was graduatingfrom college interesting right,
so so she managed to to not killher baby yeah but you can
imagine that how high risk thatkind of work is um does
emotional intelligence play afactor in any of this?
Jerry (34:57):
it?
Rita (34:57):
It can, it can.
If you know your feelingsbetter that's what emotional
intelligence is You're moreaware of your own inner feeling
world, then you can pretty fastfigure out you feel terrible and
address it.
But if you're running from them, you're not addressing it.
Jerry (35:17):
Right.
Rita (35:18):
Right.
Jerry (35:19):
Yeah, yeah.
Rita (35:20):
Emotional intelligence takes courage.
I'm telling you.
Jerry (35:25):
All of this sounds like it takes courage to me.
Rita (35:27):
Life takes courage, you know.
Jerry (35:29):
It does, it does.
Rita (35:31):
It really does yeah.
Jerry (35:32):
Some days more than others.
Rita (35:34):
Yeah.
Jerry (35:34):
Takes more courage.
Rita (35:35):
Yeah, yeah.
But so there's lots of highrisk situations we find
ourselves driving a car is highrisk.
Jerry (35:44):
Yeah.
Rita (35:47):
You know, they're just situations and some people
actually go into high risk work.
Jerry (35:51):
Yeah, yeah.
Rita (35:53):
The law enforcement or firefighting or EMT work, where
it's always an emergency.
Right, right, the adrenalinerush there are people that want
to do that work because we needit done, right, yeah, but it is
high stakes and um I and I thinkthat has to be respected
definitely, definitely okay,rita.
Jerry (36:14):
Where can people go to learn more about this, you know,
and maybe like do a littledeeper dive than what we've done
on the podcast.
Rita (36:23):
There is.
We have a website that isvoaorg slash moral injury and
that's where the Shay MoralInjury Center site is and you
will find videos, movie lists,books, all kinds of resources.
There's videos posted also andif you go to voaorg slash rest
(36:46):
R-E-S-T you'll find those onehour meetings and some
information about moral injurythere in first responders also.
Jerry (36:53):
Awesome.
Well, thank you so much forbeing on today.
This is very intriguing to mebecause it's an area that I
don't know a lot about and I'mlike I'm pretty sure I got some
mortal injury to deal with Icertainly do, though possibly I
have these groups yeah, yeah,you're lucky.
(37:14):
Yeah.
Well, thanks again for being ontoday it was my pleasure.
Rita (37:19):
Thank you for having me.
Yeah, thanks again for being ontoday.
It was my pleasure.
Jerry (37:21):
Thank you for having me.
Yeah, thanks again forlistening.
Don't forget to rate and reviewthe show wherever you access
your podcast.
If you know someone that wouldbe great on the show, please get
a hold of our host, jerry DeanLund, through the Instagram
handles at JerryFireAndFuel orat enduring the badge podcast,
(37:44):
also by visiting the show'swebsite, enduring the badge
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date information regarding theshow.
Remember, the views andopinions expressed during the
show solely represent those ofour host and the current
episode's guest.
Welcome to today's episode of Enduring the Badge
podcast.
I'm your host, jerry Dean Lund,and if you haven't already done
so, please take out your phoneand hit that subscribe button.
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On whichever platform youlisten to this podcast on, such
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(00:22):
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and that allows our podcast togrow and make more of an impact
on other people's lives.
So if you would do that, Iwould appreciate that from the
bottom of my heart.
My very special guest today isRita Brock.
(00:43):
How you doing, rita?
Rita (00:44):
I'm doing great.
How about you?
Jerry (00:46):
I'm doing great as well.
Thank you for joining me today.
Rita, can you introduceyourself to the audience?
Rita (00:51):
Sure, I'm Rita Brock and I am Senior Vice President for
Moral Injury Recovery Programsat Volunteers of America, which
is a giant nonprofit.
Jerry (01:02):
It does social services and affordable housing is a
giant nonprofit social servicesand affordable housing yeah.
Rita (01:10):
It seems like a pretty big project that you're on.
Yeah, yeah, I got interested inthis in 2009 when I read an
essay that was the first thingpublished in a long time about
the suffering of militaryveterans.
That's not PTSD, that's not amental health problem, but is a
(01:30):
kind of suffering that the VAwas trying to figure out what to
do about.
And when I read that essay, oneof the things that they said
was helpful to people who hadmoral injury was having a
conversation with a benevolentmoral authority because their
consciences were bothering them.
(01:52):
And I thought to myself that'sa great idea.
And since I work in religionand with chaplains and ministers
, I thought we should starteducating that people that do
that kind of counseling workabout moral injury so they know
what to do and how to handle it.
(02:13):
And so that's what I've beendoing for the last since 2010,
is trying to educate the publicvarious publics about what moral
injury is and why it'simportant to pay attention to it
.
Jerry (02:25):
All right.
Well, that's a great question,leading question for me, so you
kind of touched on it.
So let's kind of break down themoral injury.
Rita (02:33):
The moral injury piece yeah.
Jerry (02:35):
Yeah.
Rita (02:35):
So it comes from the fact that human beings have
consciences and so we operateautomatically all day long being
good people because we learnthe right behaviors and as long
as things work we're good.
But when something goes wrong,we might hurt somebody, they
(02:56):
hurt us, it bothers us.
So then we have to, like figureout what to do about it and in
the course of a normal day ifyou did something or something
was done to you, an apologywould be involved and it'd be
okay.
But sometimes things go wrongat a magnitude that they can't
(03:18):
be fixed or it isn't clear whatto do, and they start to bother
you Like you might even losesleep over it kind of mull it
trying to sort it out.
That's kind of a level beyondmoral conflict.
It's more like moral distressis a term for it.
You're distressed about it, itwon't let you go, and eventually
(03:39):
you may shrug and say, well,nothing I can do, I need to move
on.
Or you try to do somethingindirect to fix it, or you
apologize, knowing it can't befixed, but the person says, well
, okay, so there's a ways toresolve even moral distress
sometimes.
But you can have a lot of moraldistress, like it can start to
(03:59):
accumulate like it did duringthe pandemic.
For so many people it wasdisaster after disaster and they
couldn't really even adapt tothe few things that happened
because they just keptaccumulating.
You could have something likethat happen.
Or it could be so cataclysmic athing that happened, like
somebody dying, that you justfeel devastated by it.
(04:23):
Like you start to wonder whoyou are.
You start to wonder how, ifyou're a good person, you may
decide to give up on a careeryou loved.
A lot of doctors did thatduring the pandemic.
Or you might begin to cope withthe negative feelings of shame
or guilt or remorse or anger.
(04:44):
Sometimes it's happened to youand you're toxically angry, but
those are painful feelings.
So people start to cope withthat by drinking, using drugs,
overworking, like so they don'thave to think about it.
Like working to exhaustion orgiving up on a career, giving up
on themselves, giving up ontheir family, giving up in some
kind of way.
(05:04):
That's a sort of a defeat.
It feels like a defeat, afailure, a defeat or even think
about dying by suicide, and somoral suffering, that kind of
moral suffering is profound andit can be it's health
endangering and it can belife-threatening, but it's not a
(05:26):
disorder.
You're not having a distortedrelationship to reality.
Reality really is that bad.
That's the worst part about itis you can't go to a therapist
and say, okay, fix me, so Idon't have these feelings
anymore because I'm not orientedto reality.
No, actually you are, andthat's why the suffering can be
(05:46):
pretty profound and to deal withit you have to actually those
feelings that you're trying toavoid in every way possible,
because they're really intenselypainful and often very
isolating, like if you'reashamed, you don't want to talk
to anybody about it, so thosefeelings don't go away.
It's like so you just bury theminside and they still live there
(06:10):
.
They don't die in there.
And so if you can find a way tocough them up, as it were, to
let yourself go through thosefeelings, and you can diffuse
them so they don't run your lifeand threaten your health or
your life and they just becomesomething that you know about
(06:32):
yourself, you might even becomewiser from having considered all
the things that happen.
You might even be strongerbecause you now know what it's
like to face those kind ofdevastating things.
But that's hard, it's reallyhard to do, and what we've
learned is that not all peoplewho are therapists are trained
(06:55):
to understand moral injury,because their job is to fix you,
their job is to make you better, and so a moral injury isn't,
isn't exactly fixable.
It's.
You have to come to terms withit and accept it, and that's
different from fixing it.
You can't make a goal.
Jerry (07:16):
That is true.
Rita (07:17):
Yeah and so, but every this is a thing.
You can't have moral injuryunless you're a good person.
Jerry (07:25):
I mean seems appropriate.
Rita (07:28):
So the suffering is the sign of your good person wanting
back, wanting back out, and soif you keep running from the
suffering, you keep running fromthat person.
Jerry (07:41):
It's very, very interesting to me because I can
see I feel like that I could seewhere PTSD and moral injury may
be confused as being the samething.
Rita (07:57):
They've been confused a lot because they share symptoms.
Yeah, share symptoms, yeah,right, so um, with pts, pts.
One of the issues of ptsd isit's it happens because you're
terrified.
It's very traumatic, it's atrauma-based disorder, um, and
if you were terrified, it meantyour memory processing system
(08:19):
wasn't working, because fearshuts that down.
So you remember things, but it'sin pieces and fragments, and
often there's holes in yourmemory or you can't even
remember the incident well atall, and so part of the therapy
is to get you a coherent memory,to take you back in a safe
environment to relive somethings and put the pieces
(08:41):
together so you can have acause-effect memory of what
happened.
And that's important torecovering from PTSD is to move
those memory fragments that aresort of attacking you and
pushing them over into thethinking part of your brain
where the narrative getsconstructed.
(09:01):
But then when you move it overto that thinking part of your
brain, that's also yourconscience brain, so you may
actually feel worse emotionallyafter you have a memory of
something and the feelings ofPTSD are fear-based, right so
(09:22):
it's.
Anger can be a fear, responsiveaggression, um or um.
You can um freeze, which issometimes turns into depression,
um.
Or you can um, uh, run away.
I mean, there's there's allthese different fear responses
and come with certain feelingsand uh, and you may even feel
(09:43):
some guilt because of somethingthat happened.
But with moral injury theemotions aren't fear-based.
So you can be depressed becauseyou're morally upset, and it
can be confused with depressionthat's associated with PTSD.
And you can be angry with moralinjury because somebody did the
(10:05):
wrong thing and you're upsetabout it.
Or you were forced to dosomething that you knew was
wrong but you didn't have achoice, or you were in a
situation where there was nogood choice and you're angry
about that.
In some way You're angry atyourself or someone else or the
situation.
So you can also have anger frommoral injury, but it's
different from fear anger, butthe symptoms look alike.
(10:26):
You can also have anger frommoral injury, but it's different
from fear anger, that's.
You know, it's so there, butthe symptoms look like.
Jerry (10:29):
Yeah sometimes.
Rita (10:32):
But you can have moral injury without any trauma at all
, with no PTSD.
You can just have moral injurybecause you did some like I work
with, spoke to a group calledthe Hyacinth Group, which is
people who have killed people inaccidents and they may not have
(10:54):
had PTSD or anything, but theyfeel terrible.
Jerry (10:58):
Right right.
Rita (10:59):
Right and they have moral injury, but they don't have PTSD
symptoms necessarily.
Jerry (11:06):
Yeah, that's just fascinating because, yeah, I
could see I feel like they couldbe easily confused.
Can you have?
Rita (11:14):
I'm assuming you can have both yeah, a lot of combat
veterans have both, becausethey're they're like in a
situation where people areshooting at them and they're
shooting back and something mayhappen where they kill somebody
and then they feel they may not.
The thing with combat veteransor I would.
I would say this is alsosometimes true to first
responders You're in a situationwhere someone does die and it
(11:39):
may like, if you're in lawenforcement or another in a
situation where you actuallyactively had to kill somebody,
you may get a medal for saving abunch of lives.
Right, you may have been theright in that moment, the thing
you really needed to do.
Jerry (11:57):
Sure.
Rita (12:00):
And you could even be, like everybody, grateful to you
for saving their lives orwhatever, and so it may not hit
you for a long time, like you,may go years without thinking
much about it, and then suddenlyyou start to wonder what human
being celebrates killing anotherhuman being, or, like you, just
(12:22):
don't.
You start to like, puzzle itout.
Or like you just don't you startto like puzzle it out and you
may actually have moral injurymuch later because your
conscience is now mulling it ina different way.
Yeah, yeah, I talked to an AirForce veteran that his moral
injury didn't really hit him for40 years.
(12:42):
Wow, At 40 years out.
What happened was he got sickenough in the hospital that he
thought he was going to die andI think all those memories from
40 years before just floodedback and he was really super,
super upset.
He was really struggling with.
(13:03):
How could I have been capableof that?
And he didn't actually ever doanything, so he didn't have PTSD
trauma to go with it.
He was just in a situationwhere, if asked, he would have
started a nuclear war.
Jerry (13:15):
Yeah, that would be stressful.
Rita (13:18):
Yeah, during the Cuban Missile Crisis he was a B-52
bomber pilot.
Jerry (13:22):
Okay.
Rita (13:23):
His target was Russia.
He said I could tell a story.
His target was Russia.
Jerry (13:30):
I'm not sharing secrets.
His target was Russia.
Rita (13:34):
So 40 years later, he's like I don't know who I was as a
23-year-old married father oftwo, that I was willing to start
a war that would end in 15minutes and I wouldn't know if I
had a country or a family to gohome to.
How could I?
Jerry (13:52):
I could see maybe, like in that at that age, probably
just being in the air force oryou know, and being around those
different things being veryproud of his service.
Rita (14:05):
His.
His crew made crew of the yearthree of the four years he
served, so he was really goodand yeah, he's really good and
I'm sure he took great pride inthat and he had an enormous
responsibility and you know um,but he was only in for four
years yeah um I'm assuming life,big life events maybe bring up
(14:29):
these thoughts to bring aboutthese facing death does.
There's something about lookingat the end of your life and
feeling anything unresolvedneeds to get fixed.
So hospice workers talk aboutlots of people who want to
confess something on theirdeathbed that they've been
carrying a long time yeah, andyou can function.
(14:52):
You know people who arehigh-functioning and talented
and just able to hold ittogether can function a long
time with a moral injury.
But it weighs them down in somesort of invisible ways, like
they're not fully emotionallypresent to people or they maybe
(15:13):
drink a little too much orthey're doing four jobs to try
to stay busy, so, but it's likeyou can't run from it forever.
Jerry (15:25):
Right.
Rita (15:27):
They don't die when you bury them.
Jerry (15:30):
No, they just, they just reappear at another, at another,
another time.
Rita (15:35):
It's also going to be inconvenient, yeah yeah, yeah,
and your and your thinking braincan be quite powerful in terms
of repressing those things andnot not going there, but, um,
they just don't disappear andyou don't have to carry them.
Jerry (15:48):
That's the thing you don't, yeah I want I've said
this before on the podcast a lotlike carrying things like that
is like it, disease, right it's.
It's dis-ease which causesdisease yeah, yeah.
Rita (16:03):
No, it can cause um high blood pressure and heart.
I mean it's bad for your health, especially if it interferes
with good sleep.
You you might have nightmaresabout things, they might haunt
you.
I remember talking to a veteranin San Quentin Prison.
I worked with a group of vetsin San Quentin Prison and he
(16:26):
told this story of when he heardme talk about moral injury.
He said you know?
He said I've had this dream.
It comes to me sometimes.
I don't have it all the time.
But he said but, but it's a.
I see this child, thisVietnamese child, and he has a
giant hole in the top of hishead and he's staring at me with
(16:49):
these big eyes.
And he and I said, said, and hesaid and it wakes me up.
I see him staring and I said doyou know what that's about?
And he said yeah, yeah, I do.
He said we were sent into avillage to find the Viet Cong.
We were told the VC were hidingthere and we had to go and, you
(17:12):
know, clean out every hut andwe couldn't find any VC.
And so there was this one longbuilding.
They said they're hiding inthere.
Shoot that building up.
So he said, so wemachine-gunned it.
Good, we just tore it up.
And then he said and we went inthere and it was a school and
we killed all these little kids.
And I said, you think that'swhat he said?
(17:37):
Yeah, that's what the dream wasabout.
And that's when he realized hehad been carrying this horror
this sense of awfulness ofhaving killed little kids.
Jerry (17:51):
That would be awful.
Rita (17:52):
It would.
But he didn't know, he didn'tactually ever think about, he
just knew he had this dream buthe hadn't actually connected it
to something that had actuallyhappened in Vietnam until he
heard the term moral injury.
And then he kind of like thedots got connected for him and
he did so well in that groupthat he went, he was paroled.
Jerry (18:16):
That's good.
Rita (18:17):
Yeah, he went out on parole.
Yeah, yeah.
Jerry (18:21):
Is there a way to I don't know if this is the right
terminology for this diagnosepeople with more energy, or how
does it?
I mean, how's this work?
Rita (18:30):
There are symptoms.
How would I put it?
With more energy?
Or how does this work?
There are symptoms, how would Iput it?
There's actually a debate goingon with some people who want to
create a diagnosis so thatmoral injury can be treated by
therapists, because they can'ttreat for a thing that doesn't
exist as a diagnosis becausediagnosis means protocols for
(18:51):
how to treat.
But the VA clinicians, thepsychiatrists and psychologists
that originally did the majorresearch on moral injury and got
the conversation started.
Most of them and I know quite afew of them most of them don't
think it's a disorder and theydon't think it belongs in the
manual because it's toocomplicated a thing you know
(19:15):
it's like.
Well a person you could,because you can confuse PTSD and
moral injury.
There's going to be overlap insymptomology to diagnose it.
But the things that work forPTSD don't necessarily work for
moral injury.
Jerry (19:29):
Yeah, it seems like there would be a little bit different
path.
Rita (19:32):
There would be moral injury.
Yeah, it seems like there wouldbe a little bit different path.
There would be, and in fact,one of those people who worked
on the original research is awoman at the San Francisco VA
and she's been studying theimpact of killing.
She has a team that works onthe impact of killing on
veterans, because they have adouble suicide rate from other
veterans.
That's how seriously it affectspeople, and so she actually
(19:56):
they published an essay forclinical people who do therapy.
That said, if you think youhave a veteran who's
experiencing the impact ofkilling, you need to do a
different process for thembecause you cannot fix what they
have.
And so they actually did a10-step protocol that you could
drop into PTSD therapy to dealwith the killing part, which is
(20:19):
about learning to accept it, andit involves things like writing
a letter of unfinished businessor an apology, things like that
, rather than feeling okay withit.
So even the therapists in theVA who work on both she's an
expert on PTSD, but she's alsoan expert on moral injury
(20:40):
understand that they'redifferent, and if you don't
understand that very well, youcan miss the moral injury piece
and not address it.
So I've talked to so manyveterans who went to therapy.
A friend that is now aprofessor of anthropology was an
Iraq vet and he said I got goodhelp from the VA for my PTSD
(21:01):
and I had PTSD and I did havethose flashbacks and symptoms,
he said.
So I learned to manage mysymptoms.
But he said after a couple ofyears of therapy he said I still
felt miserable and I couldn'tfigure out why.
And he actually went and triedthis thing another vet
recommended, which was to go toa Lakota sweat lodge ceremonial
(21:22):
process, which isn't exactlytherapy, it's a spiritual
reorientation process and that'swhat made him feel better.
So his PhD dissertation wasresearch on non-Native American
veterans like him who use NativeAmerican rituals to get better.
That's what he studied as ananthropologist.
(21:46):
I mean that sounds fascinatingin a lot of ways yeah, he said
the guy that started that they,they, they had a, a native
american leader, a spiritualleader, do the sweat lodge
ceremony and that leader waswilling to have non-native
american veterans in the groupand he started out by saying
(22:06):
what we have to fix in you isthe need to kill people.
And so they went throughintense stuff praying, crying.
I've done sweat lodge.
Jerry (22:20):
Yeah, me too.
Me too, A few of them.
Rita (22:24):
Yeah, yeah, and so that's how he got better.
And we did a Volunteers inAmerica had a pilot study that
was funded, that we did withmilitary veterans 100 of them in
small groups that were peerfacilitated by other veterans.
That had really good results.
We had to stop it because ofCOVID, because it was 50 hours
(22:47):
in person at a retreat center,so it was pretty intense too,
but we're trying to restart itnow.
Jerry (22:54):
Yeah, I can see where that would be extremely helpful.
Rita (22:57):
Yeah, we actually did a one-day adaptation of it for
first responders and we did itfor Miami Rescue and Fire, miami
Dade.
We did a day with them and wedid it in Houston with a
collection of folks not Houston,but Arlington, texas, and yeah,
(23:19):
Is this something you want toget started like all over the
country again?
We would like to.
Yeah, and we attended.
We learned some things tooabout how to how to improve it.
We went to the Kentucky Academyfor Critical Incident
Processing and they do threedays, I think it is.
(23:41):
It's a lot.
They do a lot of informationdelivery, but they also offer
EMDR therapy during the process.
During the process and thereare about 30 or 35 of them that
were at it and they all told thestories of what was really
bothering them.
And as they told their stories,I thought, yeah, moral injury,
moral injury, moral injury.
And they only had like 10minutes on moral injury.
(24:05):
So one of our suggestions thenwas that they do a more robust
discussion about moral injuryand give people a chance to
process, because they alreadyuse peer support groups anyway.
Yeah right, and so we think weare on the right track with our
one-day processing, and it's aprogram that we took to
(24:26):
Miami-Dade, where in one day, wedid the day-long processing
with people, and so some of themwanted to become peer
facilitators for it.
So the next day we trained agroup of facilitators and a
staff person to give the support, so they had their own program
when we left.
Jerry (24:48):
That's fascinating to me because there's peer support
right that they use throughoutprobably their department and
stuff like that, and this isjust a different model of that
kind of peer support for moralinjury.
Rita (25:04):
Yeah, specifically for moral injury.
Peer support is you know youcan talk to.
They're there to talk to people.
They're there to offer how toget them the right services if
they don't know and stuff likethat.
But this is a more formal,almost scripted process for
doing the things that need tohappen to help people come to
(25:25):
terms with morally challengingthings that have happened to
them.
So, it's very directive.
Yeah, but it's peers and it'stotally confidential, and then
nobody knows what happens.
It's all, it's you know, it's.
It's a sacred space.
We don't right right nothinggets reported out.
It's not therapy um, it'straining.
Jerry (25:47):
We call it resilient strength training I would be
fascinated to sit in on that.
Rita (25:53):
Okay, next time we do that , I'll let you know yeah.
Yeah.
Jerry (25:59):
I would just like to tie all the different worlds that I
kind of know about therapy andPTSD and all these different
things and peer support to likeokay, what's this piece and how
can this piece be added in tohelp first responders?
Rita (26:13):
Yeah, we started those one day things for our own staff
volunteers of america has youknow um mental health facilities
and low-income housing andtransitional housing for
unhoused people and all thosesorts of things and our staff
were pretty fried from thepandemic um sure it was rough on
.
So we put it together just tohelp our own staff process and
(26:37):
um, and that's when we got theidea.
You know, we could do this fora lot of other groups too, Um,
and we could even tailor it forspecific kinds of groups,
because every group has its ownculture.
Jerry (26:48):
Yeah, right True.
Rita (26:50):
Yeah, so we've got I think it's three affiliates that have
their own programs now becausewe went and did it for them Very
good.
Hopefully that keeps spreadingacross the country and the globe
as well.
It's not a moral injury, but ifyou have some moral distress or
(27:11):
something that bothers you thatyou need to process.
You can just go into thisvoaorg slash rest and you can go
there and you'll see the firstresponder section.
There's a whole section that'sfor first responders and you
sign up by putting in your nameand email.
(27:32):
You know so they can send you areminder of when your time is
and you can see the schedulewhen groups are meeting.
And it's small groups.
It's only one hour, so it's nota huge amount of time and there
are different times because weknow there's shift work going on
and it's completely peerfacilitated by other people
who've been first responderscompletely peer facilitated by
(27:53):
other people who've been firstresponders.
Jerry (27:54):
Very interesting, very cool yeah yeah, it is so, yeah.
Rita (27:56):
So if you just wonder what it might look, you could go in
there for an hour.
Jerry (28:02):
Yeah, I have this burning question.
Rita (28:05):
Let me like this, like like oh, this I feel terrible.
Maybe, maybe this will help me.
It's pretty simple too.
It's just some mindfulbreathing to help you calm down,
and then a guided meditation tohelp you remember something you
want to share, and then eachperson gets time to share and
(28:26):
there's no crosstalk, it's not aconversation, there's just
silence to receive everybody'stestimony and there's something
really validating, I think,about people believing you and
listening in silence.
Jerry (28:39):
Oh, yeah, definitely, Definitely.
Rita (28:41):
And then also people can connect around similar
experiences or after everybodyis shared that wants to share,
then there's a chance to saysomething and people often say,
wow, I got that.
You know it's like, and somehowthat lessens the pain of it.
Jerry (28:58):
It really does lessen.
Well, I think, because we oftenfeel like we're alone in our
what we're going through and oursuffering, that we're the only
people that maybe have gonethrough this, and I mean and
that may be true to the factthat it's just your own thing
that you went through, but likethere's the similarities are so
(29:20):
close to things that many peoplehave gone through that you know
you're almost the same.
Rita (29:26):
Find out that this horrible thing that happened to
you might be valuable tosomebody else.
Jerry (29:31):
Right, right.
Rita (29:32):
Right, that is not so bad, then it's it's like oh okay,
there's, there's some value tobe had, that somebody was helped
by my, my honesty here insharing this.
Jerry (29:42):
Yeah, that's how we got the podcast started.
Through my trials andtribulations, I thought you know
(30:04):
people together on the podcastto share different experiences
or resources or just information.
The more you know, you know,the better off you are, and I
think a lot of people listeningare probably like I thought I
had ptsd, but maybe I, maybe Ihad this, this moral injury
thing instead, and like thatprobably sounds a lot better to
me than having PTSD because likethis can be worked through a
(30:25):
little bit better or faster orsomething I don't know.
Rita (30:28):
Yeah, I don't know exactly , but but it's also um when
people and they can legitimatelyhave PTSD and moral injuries.
So I don't want to disparagethe therapy piece.
but but the therapy piece ismore about something that's
actually wrong with you, um, andmoral injury is more like
(30:51):
you're a good person and thatwhat the world you're in is is
messed up, and that's adifferent nuance there.
It's different.
The other is also that withmoral injury, other people, just
ordinary people, can help you.
Right, your own peers can helpyou.
In fact, it's better when thathappens, because then this
(31:15):
person knows this truth aboutyou and you know this truth
about them and it deepens yourfriendship, right, it deepens
your relationship right whereasin therapy you are the person
with the problem.
You're seeing somebody thatknows how to fix the problem,
perhaps, and so they work withyou, but really it's on you to
fix yourself yeah and then whenyou're done, if you do, actually
(31:37):
, if they're good and you'redone, you never see them.
Actually, if they're good andyou're done, you never see them
again.
Jerry (31:42):
That's a very different kind of transactional
relationship, right, yes, yes.
Rita (31:46):
And it can be really important if you do have a
mental health disorder.
So you know, I'm not sayingdon't have therapy, sure, but
it's a different relationshipfor a problem you're having, and
moral injury is really more ofan anguish and struggle that
you're in, that other peoplemight be able to understand and
that alone can make you feel alot better.
Jerry (32:08):
I'm like in my mind, I'm like is there anybody out there
that doesn't have a moral injury?
Rita (32:15):
That is a good question.
There may be people I don't.
Probably there's no one outthere that hasn't felt moral
distress.
Jerry (32:23):
Yeah.
Rita (32:24):
But not everybody has had an identity crisis, meltdown and
thought about killingthemselves.
Jerry (32:30):
Right.
Rita (32:31):
Right so.
So not everybody gets to thatlevel of intensity with moral
distress, but plenty of peopledo right, I could, I could see
that for sure if you do highstakes work, you're you're at
risk for it, because high stakeswork means a lot of harm can
(32:56):
happen.
Even death can happen, and thatnever feels good right you know
, one of the one of the placesthat nobody I think it's not
often thought of as aspotentially morally injurious
work, is being the mother of anewborn I can see that yeah very
(33:16):
high stakes, totally vulnerableinfant, totally dependent on
you and're exhausted, and youmay be the only one doing the
care, and you can be soexhausted that you could resent
your baby.
I mean there's just that's suchhigh stakes work.
Yeah yeah, and there's not alot of social support for it.
Jerry (33:40):
Right.
Rita (33:41):
Yeah, yeah, and there's not a lot of social support for
it, right?
I remember the story of amother with a 10-month-old
colicky baby that had alwaysbeen colicky and her husband
worked and she was alone in afifth-floor walk-up apartment
taking care of this baby and shenever got enough sleep because
it was colicky and cried a lot.
It was colicky and cried a lotand in one really bad week she
(34:02):
finally got the baby to sleepand she crashed on her bedroom
bed and then within a half hourthe baby was screaming again and
she was in such a state thatshe went to the nursery and saw
herself throwing the baby outthe window to the nursery and
(34:23):
saw herself throwing the babyout the window, and then she was
freaked out by her vision andshe wrapped the baby up and put
on her coat in the middle of thenight and went down to the
street and rode the bus allnight so she wouldn't kill her
baby.
Jerry (34:33):
Oh, wow yeah.
Rita (34:34):
Yeah, she wrote the article about it after it was a
child.
Her daughter was graduatingfrom college interesting right,
so so she managed to to not killher baby yeah but you can
imagine that how high risk thatkind of work is um does
emotional intelligence play afactor in any of this?
Jerry (34:57):
it?
Rita (34:57):
It can, it can.
If you know your feelingsbetter that's what emotional
intelligence is You're moreaware of your own inner feeling
world, then you can pretty fastfigure out you feel terrible and
address it.
But if you're running from them, you're not addressing it.
Jerry (35:17):
Right.
Rita (35:18):
Right.
Jerry (35:19):
Yeah, yeah.
Rita (35:20):
Emotional intelligence takes courage.
I'm telling you.
Jerry (35:25):
All of this sounds like it takes courage to me.
Rita (35:27):
Life takes courage, you know.
Jerry (35:29):
It does, it does.
Rita (35:31):
It really does yeah.
Jerry (35:32):
Some days more than others.
Rita (35:34):
Yeah.
Jerry (35:34):
Takes more courage.
Rita (35:35):
Yeah, yeah.
But so there's lots of highrisk situations we find
ourselves driving a car is highrisk.
Jerry (35:44):
Yeah.
Rita (35:47):
You know, they're just situations and some people
actually go into high risk work.
Jerry (35:51):
Yeah, yeah.
Rita (35:53):
The law enforcement or firefighting or EMT work, where
it's always an emergency.
Right, right, the adrenalinerush there are people that want
to do that work because we needit done, right, yeah, but it is
high stakes and um I and I thinkthat has to be respected
definitely, definitely okay,rita.
Jerry (36:14):
Where can people go to learn more about this, you know,
and maybe like do a littledeeper dive than what we've done
on the podcast.
Rita (36:23):
There is.
We have a website that isvoaorg slash moral injury and
that's where the Shay MoralInjury Center site is and you
will find videos, movie lists,books, all kinds of resources.
There's videos posted also andif you go to voaorg slash rest
(36:46):
R-E-S-T you'll find those onehour meetings and some
information about moral injurythere in first responders also.
Jerry (36:53):
Awesome.
Well, thank you so much forbeing on today.
This is very intriguing to mebecause it's an area that I
don't know a lot about and I'mlike I'm pretty sure I got some
mortal injury to deal with Icertainly do, though possibly I
have these groups yeah, yeah,you're lucky.
(37:14):
Yeah.
Well, thanks again for being ontoday it was my pleasure.
Rita (37:19):
Thank you for having me.
Yeah, thanks again for being ontoday.
It was my pleasure.
Jerry (37:21):
Thank you for having me.
Yeah, thanks again forlistening.
Don't forget to rate and reviewthe show wherever you access
your podcast.
If you know someone that wouldbe great on the show, please get
a hold of our host, jerry DeanLund, through the Instagram
handles at JerryFireAndFuel orat enduring the badge podcast,
(37:44):
also by visiting the show'swebsite, enduring the badge
podcastcom for additionalmethods of contact and up to
date information regarding theshow.
Remember, the views andopinions expressed during the
show solely represent those ofour host and the current
episode's guest.
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