Overcoming Moral injuries

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Translator: Reviewer: Emma Gon
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Hola, Santo Domingo!
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In April of 2007, during the war in Iraq,
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my unit was conducting a dismounted patrol in eastern Baghdad,
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when we were engaged by an enemy sniper.
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The type of weapon system that they used was called a dishka,
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which is normally an anti-aircraft weapon
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that Hezbollah converted into a sniper rifle.
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The bullet ripped through the left arm of one of my senior solders,
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staff sergeant Marilyn Harper, severed his aorta,
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exited out of his chest and then ricocheted into my upper right thigh
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and severed my femoral artery.
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I didn't know that I was shot at first but I did feel that something was wrong.
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I could only hear the muted shots of the sniper rifle
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and my own voice calling for a medic.
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I could watch in slow motion as staff sergeant Harper's body
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slowly fell to the ground.
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And as I was dragging him into safety
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to perform aid on him in an effort to save his life,
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the slow motion time actually converted into a sense of fast motion time.
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My medic arrived a few seconds later
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and I'd like to point out that my medic that day was only 19 years old.
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And this was the point in time that a 19-year-old kid had to make
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a conscious choice between who he was going to try to save
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and who he was going to let die.
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He couldn't save both of us.
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Now from an objective medical standpoint the medic made the right decision
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in trying to save me,
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because my injury was slightly less severe.
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But it is still that 19-year-old kid that is going to have to live
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with this moral weight of that injury for the rest of his life.
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My men then dragged me into the vehicle
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to transport me to the nearest medical aid station
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in an effort to save my life.
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As I was in the vehicle, I started to become very weak.
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Nausea.
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And it felt like I was going to pass out.
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But I made it my only objective to stay conscious for the ride to that aid station
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because I knew I would be in good hands with the medical team.
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A few minutes later we arrived
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and I was greeted by a team of eight expert medical personnel.
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Every single person knew their specific job.
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They were calm, cool and collective under pressure.
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I was inspired by the work that they did
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and it gave me an enormous sense of comfort
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knowing that I was in such great hands.
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But in spite of that, as I was on the operating table
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I could feel myself starting to die.
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In a catastrophic injury such as this, your body will actually pull blood
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to the chest cavity in order to protect the vital organs.
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And I could actually feel that happening.
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The blood would creep up from my extremities
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and as all the blood would leave, they would cramp up and become numb.
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And then that blood creeping sensation moved up through my quads
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and they became numb.
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And when that feeling hit my stomach,
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I knew the injury was getting out of control.
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It felt as if I was running wind sprints around a 400 meter track
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and couldn't stop.
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And then when that blood creeping sensation hit my chest
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I consciously knew that that was it.
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I took my last breath, I said my last thought and I died.
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I woke up approximately two days later in the Green Zone to learn
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that I flat-lined for 15 minutes straight.
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The surgical team that saved my life throughout all forms of utility
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in an effort to do so.
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And as a result of that I continued the medical evacuation process
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back to the United States, recovered for about four months
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and then volunteer to redeploy to Baghdad to finish the mission with my team.
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(Applause)
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Thank you.
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Now a few years later in 2009, the Department of Defence in the US
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was starting to take very seriously
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the behavioural health challenges that our solders were facing
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when they returned from combat.
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Suicide rates were astronomical,
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families were being ripped apart
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and quality of life was being destroyed.
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In an effort to combat that, the Department of Defence asked me
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to use my story and go on a national speaking circuit with the objective
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of reducing or eliminating stigma associated with help-seeking behaviour.
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And I did that.
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But it didn't take me long to realize
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that our society has drastically oversimplified post traumatic stress.
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That it has very little to do with seeing violence on the battlefield
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and much more to do with the deeper, moral injuries
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associated with traumatic experiences.
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Shame, powerlessness, betrayal and guilt.
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When those emotions are aloud to manifest
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they can do so in a catastrophic fashion,
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that has devastating consequences on your personal life, your families,
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your friends and your loved ones.
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The challenges faced by the behavioural health system across the world
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and in the United States are enormous.
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At any given time in the United States 1 in 5 adults is experiencing
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some type of behavioural health condition.
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And at the same time, the cost of mental health care in the United States
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ranks among the top five costliest medical conditions in the country,
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spending over 300 billion dollars a year in care.
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And when you look internationally that number jumps in to the trillions.
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But that being said, my instinct tells me
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that the scope of the problem is far greater than that.
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Moral injuries have the capacity to shake the very foundation of who you are.
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And we as human beings tend to focus on decisions that we make in microseconds.
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We tend to fault ourselves for those things.
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We allow that to continue to spiral downward
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and we forget about all the extenuating circumstances
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that were surrounding the event
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that lead to that decision.
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When that seed is planted and is allowed to grow,
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that idea can spiral downward very quickly
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and develop into one of the most devastating
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and destructive things that the human mind can endure.
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Leading to an enormous sense of isolation and hopelessness.
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It happened to me.
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Several years ago, I found myself standing in the corner of...
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(Nervously stops talking)
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(Applause) (Cheers)
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Several years ago, I found myself standing
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in the corner of my hotel room in Washington, D.C.
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not having a clue who I was anymore.
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I felt completely hopeless and completely alone.
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Despite being on the national speaking circuit,
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despite being a national advocate on this topic,
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and despite having a near clinical understanding of this subject,
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I still failed to recognise the moral injuries within myself.
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And during that moment in time, somehow I found the strength
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to call one of my closest friends in a final act of desperation
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and ask for help.
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And much to my surprise even though I admittedly believed
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that nobody could possibly understand the weight of what I was experiencing,
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he proved me wrong.
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Because a couple of minutes later during that phone call,
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he resonated with me in a way I didn't think it was possible.
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And he immediately connected me
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with one of the best clinical providers in the country.
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And this lady dropped everything that she was doing, cleared her calendar
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and talked to me for four hours straight.
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Now even though that experience completely turned my life around
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and sent me down the path to healing, I went on from that point
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feeling extremely concerned and even guilty
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that many of the people that I knew, and worked with and other people,
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who experienced other conditions across the country and across the world
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did not have access to that level of care.
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Our behavioural health system is overwhelmed.
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And especially when we talk about moral injury,
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identifying a moral injury and uncovering it
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starts first and foremost with developing
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a powerful sense of trust between the patient and the provider.
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Some clinicians will strive for weeks, months or even years
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to try to get to that point with the patient.
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And again, when we have 1 in 5 people
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who might be in need of that care
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we can easily see how overwhelmed that system is
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and that we can't exclusively relay on the behavioural health community
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to solve this massive problem.
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But I am here to tell you today that everyone of us in this room
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has the capacity to change that.
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Now it takes a great deal of moral courage to do so.
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But if you are willing with your friends and loved ones who might be struggling
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to dive deep into the emotional state that they are in,
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truly and inherently understand what they are going through,
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walk through the depths of hell with them,
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and grab them by their hand and say, you're not alone anymore,
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I am going to get you out of this,
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you can have the most life-changing effect on somebody that you can possibly imagine.
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Giving somebody the feeling that they are not alone anymore
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is possibly the most selfless and courageous act you can give
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to another human being in this lifetime.
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Now, as a way to compound that effect
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many comunities in the United States
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have started to develop holistic, integrative retreats
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that leveraged the power of group dynamics
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and assets that are embedded within a local communities to help remove
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the sense of hopelessness and act as a gateway to further care.
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In a span of one week,
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we combine the traditional therapeutic approaches
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such as group, couples and individual therapies
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with all of the emerging modalities:
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yoga, reiki, massage, acupuncture, equine therapy, drama therapy,
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dance therapy and spiritual healing exercises.
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Now mind you, the people who attend this retreat
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through the nature of their traumatic experiences
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have seen the very worst side of humanity,
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but these retreats show them the very best side.
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And within a few days, we had people talking
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about the depths of their experiences for the very first time in their lives
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despite trying traditional therapy for years in some cases.
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So I'd like to leave you with one thought.
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As a public speaker and being involved
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in a behavioural health field for a very long time,
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I have often modified and changed my viewpoint
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as I continued to learn more about this subject.
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But there is one central truth that has never changed for me
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and that I truly believe never will.
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And that is, that the only force of nature,
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powerful enough to overcome the moral injuries
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that are inherent to traumatic experiences
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is the strong sense of community and human connection.
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Thank you.
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(Applause)