Cleveringa Dallaire Critical Conversations #5 - 2021-10-14
3:08PM Oct 15, 2021
Jackie June ter Heide
When Canadian Lieutenant-General Roméo Dallaire commanded United Nations forces during the Rwandan genocide, few beyond the military were aware of the severe psychological damage that witnessing such moral atrocities can cause. Dallaire's revelation that he suffered from PTSD and Moral Injury in the Rwandan conflict helped de-stigmatize these potentially devastating mental conditions among military veterans. It also helped us understand how all of us can experience Moral Injury in our daily lives. As we live through the aftershocks of a global pandemic, racial injustice, and the rise of extremist violence around the world, there's no better time to have a conversation about trauma, recovery, and moral courage. How do we build resilience? Collective hope. How can we embrace humanity and human connection? Join the conversation as we work together to build upon General Dallaire's call for transformative change, and an engaged approach to leadership in the face of moral dilemmas.
Hello, and welcome, or Welcome back. My name is Dr. Eric Vermetten. I'm a psychiatrist and professor in Leiden University in the Netherlands, and I'm a military officer in the Dutch armed forces. I am joined by my co-host, Dr. Suzette Bremault-Phillips, an Occupational Therapist and associate professor at the University of Alberta. Hey, Suzette, how are you?
I'm doing great, Eric, thanks. Great to see you again.
Every time, we're 8 time-zones away, and it's very early morning there. So, good morning to you.
And a good evening to you, sir.
Thank you. It is, again, our great pleasure to welcome you to the fifth of the Cleveringa Dallaire Critical Conversation sessions. We are pleased, and we were pleased with the overwhelming positive reviews on the first four sessions. And this is already the fifth one. And again, I'd like to share with you that we're very excited that people from over 33 different countries and walks of life have signed up. And I'll mention just a few. I'll just list them, because this is a wonderful, wide, dissemination of material that we are sharing with Australia, Belgium, Belize, Brazil, Cameroon, people are watching from Canada of course, Cape Verde, La Côte d'Ivoire, Croatia, Finland, Germany, India, Ireland, Israel, Italy, also from Japan, and welcome Kenya, Malaysia, Mali, Mexico, the Netherlands of course and New Zealand and Nigeria, Philippines, Rwanda of course, welcome Rwanda. And Sierra Leone, South Africa, Spain, Sweden, Turkey, Ukraine, United Kingdom, and welcome, United States. So, this webinar is the fifth, as I said, of eight conversations honoring the Cleveringa Chair that was awarded to General Romeo Dallaire in November 2020. At Leiden University. Born in the Netherlands, General Dallaire is a celebrated Canadian who has exemplified moral courage, the key focus of the Cleveringa professorship.
During this series, General Dallaire and esteemed colleagues who we have with us today we'll reflect on issues related to complex ambiguous moral and ethical dilemmas. These times -- overshadowed by issues associated with a global pandemic, climate change, gender-based violence, racialization and threats of terror -- are a call for Truth and Reconciliation. They also highlight the need for engaged leaders, who embrace humanity and can truly inspire and actualize transformative culture change. And this series aims to provide a context for such a conversation. Eric?
And, as you note, we're doing this out of Leiden University co-hosted with the University of Alberta in Edmonton, Canada, and the Dallaire Institute at Dalhousie University in Halifax, Canada. So, these are three institutions that are celebrating the Cleveringa Dallaire professorship. But before we start a few things that we'd like to note. General Dallaire's experience really is the thread that weaves all these sessions together. The conversation will often come back to the themes prior life experiences. We're grateful that he will be joining us -- just a little bit later -- in this session. And the sessions will continue throughout November 10, in honor of Remembrance Day. We have another sixth, seventh and eighth session to go. Each session also tonight will be -- or today I should say -- we'll be 90 minutes long. And sometimes we've gone over a little bit, given the richness of the conversation. You registered and you received a livestream link for this specific session. If you wish to follow all of these conversations, you need to register for each separate event. And please share the event, or the information, or the link about the events, to your friends, colleagues, or post them on social media, if you like.
We're also aware that some of the contents of the conversations may be difficult to hear, or trigger past experiences or memories. We encourage you to honor you, and your experience, and seek local supports and services if needed. We'd also love to hear your questions and comments. You can share your thoughts by using the Questions or Remarks box on the Leiden events page. We'll do our best to address questions that are posted. Finally, the sessions will be recorded and made available following the events on the Leiden University events page. We're going to now turn to the start of the session, beginning first with a land acknowledgement from Dr. Tammy Hopper.
Hello, I am Tammy Hopper, Interim Dean of the Faculty of Rehabilitation Medicine, home to HiMARC at the University of Alberta, in Edmonton, Alberta, Canada. When we acknowledge territory, such as we do at the beginning of a meeting like this one, it is a small but important act of reconciliation and thus, on this day, I would like to acknowledge that the University of Alberta is located on the traditional territory of Cree, Blackfoot, Métis, Nakota Sioux, Iroquois, Dene, and Ojibway / Saulteaux / Anishinaabe nations; lands that are now known as part of Treaties 6, 7, and 8, and homeland of the Métis. The University of Alberta respects the sovereignty, lands, histories, languages, knowledge systems, and cultures of First Nations, Métis and Inuit nations. Thank you for listening, and joining me in this moment of reflection.
Today, we'll be talking about the Repair of Moral Injury. And this is at the heart, maybe, of the Cleveringa Critical Conversations that's -- at the bottom, maybe, of the heart -- and I'm looking forward to listening in to what's going to be unfolding as a beautiful conversation. We will hear from the panelists, but let me introduce the moderator of this panel, and that is Dr. Alexandra Heber. Hi, Alexandra. Hi, Alex. [Alex is] Chief Psychiatrist of Veterans Affairs Canada, a retired Lieutenant Colonel and Associate Clinical Professor at McMaster University in Canada. Dear Alex, may I offer you your introductory remarks, and set the stage and engage everybody in a delightful conversation about this difficult and important topic.
Thanks very much, Eric. So, how we're going to organize this today is we are going to -- I'm going to start with some opening questions, and then I will, in turn, introduce each of our four discussants, and they will have a few minutes to make an opening statement, and then we will have kind of a conversation among all of us, looking at different issues around moral repair. Here are the opening questions. The first one is, how can we understand Moral Injury from a biopsychosocial spiritual perspective? The second question is, how does Moral Injury differ from other struggles and conditions? Third, what approaches can we take to repair Moral Injury? And finally, what are some emerging treatments for Moral Injury?
First, I will turn to our opening discussions. Jacky June ter Heide is a therapist and senior researcher at Amsterdam's ARQ Centrum ’45, an Institute for patients suffering from complex psychotrauma. She has published on trauma-focused treatments for refugees, Complex PTSD, and the relationship between Moral Injury and empathy. She is head researcher for a study on Moral Injury in military veterans, supported by the Dutch Ministry of Defense, as well as Chair of a project developing treatment guidelines for Moral Injury in Dutch treatment-seeking veterans. Jackie.
Thank you, Alexandra. Today's session is on the Repair of Moral Injury. But how can you 'repair' an injury? That's not a very common thing to say. You go to a garage to ask if they can repair your car. But as far as I know, it's not -- English is not my first language -- but you don't go to a hospital to ask if they can repair your wound. So, what is it, exactly, that needs reparation in Moral Injury? I would like to invite you to think of Moral Injury as the tearing of a fabric, and of the repair of Moral Injury as repairing, or mending, that fabric. Please let me explain. Human beings are moral beings. It is as important to us to live in a world that is safe, as it is to live in a world that is just. A world where we respect each other, and take care of each other, so that we can flourish together as a species. In order to do that, we have an amazing capacity, the capacity to know what someone else is feeling. Not to know what someone else is thinking, because that capacity we lack. But to actually feel what someone else is feeling. And this capacity is called empathy.
Empathy is what motivates us to stop hurting someone who is in pain, or to start helping someone who is in pain. Empathy is like a cloth that connects us to each other, a cloth woven out of feeling. Empathy is our social fabric. Now in situations that are morally injurious, we are often prevented from acting empathetically. We are too distressed to feel any empathy, or something or someone is preventing us from acting. And at that moment, the social fabric gets torn. Someone else is in pain, and we caused that pain, or we were unable to do something about it. What follows are tremendous feelings of guilt and shame and anger. What we call Moral Injury. Now, in order to deal with the Moral Injury, we need to repair the social fabric. That is, we need to restore empathy. In people with Moral Injury, empathy is often an issue. They may be overly empathetic towards those who have been hurt -- they will think of that person suffering night and day. On the other hand, they may lack all empathy for themselves, for the situation they were in, when they acted or failed to act, or how young they were at the time. Also, they may fail to receive empathy. They may withdraw and not tell anyone how they feel, or they may come home to a society that is quick to judge and lacks empathy for what they have been through. My proposal is that those interventions that aim at restoring empathy are the most powerful. Empathy may be restored individually through imaginal exposure or cognitive therapy, where you help a person to acknowledge the context of the events, and their own feelings and needs at the time. It may be restored through helping a person talk to important others about what's happened, and what it means to them. Or through helping somebody to listen, and to apologize, and to ask for forgiveness. And it may be restored outside of the treatment room, through replacing societal condemnation by societal recognition. When we try to help someone who suffers from Moral Injury, we need to look carefully where there is a lack of empathy for oneself, for others, or from others, and try and supplement it. When empathy is restored, the feelings will follow suit, and the guilt and shame and anger will usually abate. Moral Injury involves the tearing of social fabric, and is healed through the reformation of social fabric that is, through restoring empathy.
Thank you very much, Jackie June. Next, I'm going to call on Dr. Tzeggai Berhe. Dr. Berhe, originally from Eritrea, is the Chief of Psychiatry in Grand Prairie, Alberta, and the Interim Medical Director of the Queen Elizabeth II Hospital. He is Associate Clinical Professor of Psychiatry at the University of Alberta, and he comes with considerable experience in transcultural psychiatry, and has participated in a number of global mental health initiatives. Tzeggai, please.
Tzeggai, I think you're muted.
You're on mute, Tzeggai.
Sorry. Sorry. Thank you for having me. And for the introduction by Jackie June, thank you so much. I will use this opportunity, probably, to give voice to millions of girls and boys in the world. Because I have been in that situation, myself, as a kid.
Sometime in 1974, a young boy was standing in the corner of a neighbourhood
called Edaga-Hamus, North Eastern Asmara, Eritrea, with a self-made soccer ball
underneath his right foot, waiting for friends to come out to play. For some reason,
it was oddly quiet this time. There were only older people strolling around; then,
there suddenly occurred a strange, persistent noise that the boy had never heard
before. The noise got louder and scarier. Any reasonable boy would have run
away; instead, a mixture of curiosity and puzzlement mesmerized this boy. On the
right, nothing to see, from the left some things were moving slowly onwards, and a
lady out of the nearby abandoned shop calling with a fearful and fidgety voice:
"Run, little boy, go home, please go!" The boy was awestruck by a caravan of
combat vehicles with big, intimidating men dressed in dark green and armed from
tooth to nail atop. "Ah, everybody is hiding from you guys" the boy thought. "How
did they know?" he wondered while pinching his upper thighs through his shorts'
pockets; it was not a dream. He quickly pulled his hands out and started
pretending to play soccer, so he did not draw their attention. He felt as if each of
these men was staring at him, shivers down his spine. The nightmare caravan, with
some never-seen shiny dark-green tanks in between, was finally gone, leaving some
burning rubber smell and new vast holes on the already old rugged asphalt street
behind. Right there was the escalating warfare, and the ensuing life was never to
be the same. The boy had friends who were feeding just on nuts, who were all born
into the war. They were tiny but matured fast to understand that the unfolding
scorching fire in front of their eyes was getting oxygen from far away.
The boy and his Family heard every day about Nixon, Vietnam and the Middle
East in the BBC World News. However, nobody talked about Eritrea when more
and more sophisticated weapons were taking over the grounds and high up in the
Even little boys knew this was a proxy war. There was nowhere to turn; all he saw
was depredation and hunger. Young adults are targets of the security forces and
the military, and they either live in fear, have left, or were in prisons, or gone.
People would crowd around the radio to listen to the News. Beautiful UN speeches
about peace negotiations in the Middle East and Vietnam, no mentioning of Eritrea
or Ethiopia, over and over. Parents are demoralized; they have only the boy and
his little sister left; the five older siblings were gone, one by one, as they grew
beyond the earlier teenage years.
Growing in all the wrong times and places, and by now taller than his petite mom,
all his parents could do was praying for their boy not to grow fast, so he did not
become a target as well. Too late. Five or six or so years moving forward, they sold
whatever significant assets they had, and entrusted him to a stranger to get him safely
out of the country and over to neighbouring Sudan.
The boys' group of ten was fleeing by night. He disliked the night but had an
unshakable faith in the sun, [it] being the connection to everything that had meaning to
his being, especially his mom and her smile. And where there was nothing good to
be anticipated, he looked forward to the coming of a bright morning. And for the
rest of his life, Hope has become inextricably linked to the sun/sunrise.
The teenage boy arrived in Germany as a refugee with the help of his oldest sister
overseas. "Wow, what a different world!" Home felt so far and remote. Germany
was still processing The Third Reich; The boy was learning a new language. He
felt like an odd duckling in the classroom, grade 9. His classmates talked about
their issues with parents or siblings; that felt so unreal to him, as he would have
given everything to spend just a few minutes with his.
The boy lived in the basement studio of a very kind German family, who later
accepted him as an informal foster kid. Peaceful, safe and prosperous during the
day, living back in his war-torn country by night. No matter how hard he tried to
avoid sleep, he had, in the few hours of rest, the same dream every night for two
long years: A person finding him in his hiding and telling the soldiers, the boy
constantly waking up in sweats just before they shot at him.
One day, he met a Jewish gentleman who was kept hidden by the German Foster
Family's relatives and survived the Nazi era. His Family's story appeared so
immeasurably horrifying compared to his, and he felt ashamed of his emotions.
The gentleman said, "Don't feel that way, son. There is no weighing-scale for
suffering; we humans are hard on each other, but don't be harder on yourself." This
was too deep for the boy. The gentleman explained: "Any evil person or group of
people can only abuse your body, but never the real you." He did not understand.
"The body can get hurt and die, but the more important part of you, the soul, is
eternal." Many of the Holocaust survivors no longer feared the terror, nor the
death, so he told him. The man never talked about the Nazis, he spoke about
people in general. Not seeing the world from a 'them-and-us' perspective makes it
easier to understand human vulnerabilities, and forgive. The boy lost his fear too,
and the nightmares disappeared; he was now in Germany day and night, made
friends, started playing soccer again.
The gentleman taught the boy that the Nazis killed 6 million Jewish people, and
66 million perished in World War II in total. "More than 20 times the size of the
population back home," the boy calculated. The gentleman was trying to explain to
the boy that insane people in power have no respect for life. The feelings of guilt
and shame in the self no longer made sense to the boy.
A few years later, a young man and a medical student accidentally found Henri Tajfel's book "Human Groups and Social Categories" in the library. Tajfel was a
Jewish social psychologist who volunteered to serve in the French army in World War II.
He was taken prisoner of war by the German military and survived because he was
considered a French citizen.
The nightmares were gone, but the young man was still recovering and looking for
answers for the war rampage he witnessed as a kid, and the continued agony back
home. Tajfel inspired him with his social-psychological studies, that categorization
was the foundation of prejudice and hatred. Tajfel had seen too many people
without peculiar personalities holding extreme views of the Jewish people. He saw
that Hitler would have been impossible without the support of 'ordinary' Germans
also. He found that the conditioning and categorization directly affected
judgements, independently of the Germany, UK or France groups. This was
published in his article, "Cognitive Aspects of Prejudice," in 1969. Now, this was a
big clue for the young man, because he saw what Tajfel described. People were
engaging in atrocities not because they were Germans or, in his case, Ethiopians,
but because of our human vulnerability to falling into the trap of random
categorizations and shallow identities. In the absence of sabre-toothed tigers, our
limbic system 'otherizing' fellow humans who look or call themselves differently, or
happen to be in a different place. Forgiveness became much easier for the young
man, and resentment made way for true healing and moral repair. Thank you.
Thank you, Tzeggai, for that very, very moving account. I'm going to move on now and introduce Joe Currier. Dr. Currier is Professor of Psychology at the University of South Alabama, and Clinical Director of Veterans Recovery Resources. A clinical psychologist by training, he researches and publishes on trauma and Moral Injury, spiritually-integrated mental health care, and other topics related to Applied Psychology of Religion and Spirituality. He has co-authored two books with the American Psychological Association, 'Trauma, Meaning and Spirituality', and 'Translating Research into Clinical Practice and Addressing Moral Injury in Clinical Practice'. Joe.
Thank you for that introduction, Alex. I also want to thank Suzette, Eric, and General Dallaire, for the opportunity to serve in this inspiring Critical Conversation series. I'm also honored to serve alongside such distinguished panelists today. Thank you, Jackie June and Tzeggai, for your comments. It feels like a lifetime ago, but my first encounter -- or clear encounter -- with the concepts of Moral Injury and moral repair occurred about a dozen years ago. I remember sitting in my sparsely-decorated office as a brand-new Assistant Professor, reading a review article authored by Brett Litz, Bill Nash, and their colleagues. At the time, I was coming to terms with spending three years working with the first wave of our Iraq and Afghanistan veterans, to enter our VA healthcare system. I was still reckoning with the disappointing resolution of many of my cases, in which my veterans faithfully journeyed with me through the protocols of our best psychotherapies for PTSD at the time, only to continue to experience a deep sense of shame, disconnection, and a void of meaning.
Like the familiar scenes in movies, when a detective stumbles onto the missing clue that puts the whole story together, within Bill's and his colleagues' article, I saw a possible key, or Rosetta Stone of sorts, that might reorient my work to more fully address the biological, social, spiritual and psychological consequences of events which deeply violate our deeply-held moral beliefs and values. And I still hold this conviction today. Flashing forward, we now know, from a pretty convincing research base, that morally-injurious events, like needing to take the life of a child, being sexually assaulted, or being a child in a warzone community. All of these events are clearly linked with greater risk for severe and complex issues that often warrant our clinical expertise. I'm also confident that clinicians will soon have Best Practices for conceptualizing, assessing and treating Moral Injury. Yes, as Jackie June and Tzeggai have both already highlighted, the longer that time goes on, the more I come to see that, for the vast majority of my patients, Moral Injury is more than a cognitive, an emotional, or a larger psychological process. There are inherent social, spiritual, and possible religious dimensions that should not be minimized or overlooked in our clinical care. Let's focus on forgiveness is just one example. Most of our empirically-supported treatments offer guidance for transforming painful states of anger, shame and guilt into more adaptive ones. Yet, for many persons around the world, forgiveness is intricately tied with spiritual beliefs, practices, and relationships. For example, many persons believe in a God, or gods, who are involved in human affairs, and serve as the ultimate arbiter of justice for acts of betrayal and moral transgression. As a perpetrator of a morally-injurious event, forgiveness might not, then, be viewed as something that a patient can give or offer to themselves. It might only be received or transmitted from the victim, or the divine, possibly in the context of cleansing rituals, repentance, reconciliation, or other attempts at amends-making.
I first learned these lessons from an Army veteran who encountered a number of perpetration-based traumas, in the early years of the Iraq war. At the time that he came to treatment, he felt profound shame and alienation from God and humanity, for taking the lives of about a dozen persons as a sniper, and giving orders to open fire on a vehicle that was filled with children while he was guarding a checkpoint. On the one hand, his identity wounds would not have been so painful if he had not internalized certain beliefs about God and morality. On the other hand, these very same convictions also restrained his desire to act on suicidal thoughts and impulses, fueled his courage to pursue forgiveness, and mapped out practices and pathways for transformation that transcended my psychological interventions. Without attending to layers of spirituality and religion, in many people's cultural identity, we risk oversimplifying the nature of our patients' suffering, and risk excluding sources of resilience and strength that could be needed for moral repair to truly occur.
I just want to make one final comment to this first question, that morality is more than wrong, it cuts to the deepest aspects of meaning and identity. At its core, the purpose or function of morality is to promote shared values and cohesions within social groups and communities. As such, as Jackie June has already highlighted, Moral Injury always ensues when someone has lost a basic sense of their humanity, and feels a painful absence of belonging and connection in life. Why wouldn't we then, as clinicians and organizations, seek to ensure that patients have 'communities of concern', in which they can carry on the journey of more repair when our clinical care might not be feasible any longer, or might not be immediately accessible for them? Just as mental health professionals too often exclude spiritual components of culture and intersectionality, systemic barriers to this type of community engagement too often limit our ability to address social and communal dimensions of moral repair. Too often, communities are simply the places where we gather our data, implement our programs, or generate referrals for our clinics and practices. We are at a point now where we need to better understand, access, and possibly enhance the healing potential of our patients' social environments, and communities of choice. Without doing so, we risk perpetuating Moral Injury and not being as helpful as we possibly could be, as clinicians and researchers.
Thanks very much, Joe. And now, for our final presentation, I would like to introduce Dr. Bill Nash. Bill Nash leads a program of treatment and research for veterans with Moral Injury at the VA Greater Los Angeles Healthcare System. Previously, he served as the Director of Psychological Health in the US Marine Corps, and while on active duty in the US Navy, as a Combat Stress Control Psychiatrist embedded in the 1st Marine Division in Iraq. 'The Doctrine for Maintaining Psychological Health in Military Operations', written by Captain Nash in 2009 still informs leadership training throughout the US Navy and Marine Corps. His research with marine infantrymen was the first to document PTSD in service members as a direct result of violations of moral expectations. Dr. Nash has co-authored two books, 'Combat Stress Injury Theory: Research and Management' and 'Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury'. Bill.
Thank you, Alex. And thank you, my fellow panelists, for those amazing comments. It's such a rich conversation already; I'm so delighted to be part of this. I want to add to what's been said already by quickly focusing on four concepts. Four ideas that, for me, are really foundational for my work with Moral Injury, both treatment and prevention. The first one is that Moral Injury is not some little thing, off in the corner somewhere. It's not something we have to hunt for, because it is very central to life. And it always has been. Some of my colleagues in theology have written a book called 'Moral Injury and Sacred Texts', and there's one chapter for every sacred text in the world, just to show how Moral Injury stories are central to our common life experience. And, if I had the money and the time, I think if I were to conduct an ethnography, or a cultural study of popular media -- of movies, of television, of books -- I think all the major themes of Moral Injury, of betrayal, of atonement, of redemption, [of] forgiveness. It's all there. Because that is our challenge, as human beings. How do we maintain this moral fabric? That is, as Jackie June said, so essential for our moral safety, which is far more important for our well-being than physical safety. So that's the first thing. This is central to life.
The second thing is Moral Injury, I think, it's only possible because morality is hardwired. Morality is inherently biological. And Jackie June and Joe really hit on one of the central proofs of that concept, which is that emotions are hardwired. No one teaches you how to feel joy, or happiness, or sorrow, or grief, or anger, or shame or guilt. Those are all pre-wired. So, they're brought out in life by different situations .We can do certain things to try to deny those emotions or manage them in some way. But we couldn't be damaged by life, broken by life, unless morality was something that's firm and stuck in the ground. This image I just had, while I was listening to you speak, was of a bullfighter, who's stuck in the ground and unable to get out of the way -- he's going to get creamed, right? And that's the case with morality. It is stuck in the ground. It is not, as many people think, in the eyes of the beholder. One proof of this is, in the US and I think many countries in the world, justice in the courts is meted out by juries of 12 ordinary people. And it doesn't matter how much education they've had, what race, age, gender, because our ability to understand right from wrong is inherent and innate. So, that's, that's central.
The [third] point is that because of the biological, social and spiritual components of Moral Injury, the treatments have to embrace all those things. The worst symptoms, the worst life problems, this destruction in individual well-being and families and communities, are due to the long-term consequences of chronic stress, of allostatic load, chronic inflammation of the whole organism, which causes this progressive deterioration in your ability to manage your emotions, to manage your impulses, to be able to interact with human beings in a constructive way. So, it's the biological chronic stress that causes that deterioration, and all of the comorbidities of Moral Injury, PTSD -- which is Complex PTSD, I believe -- that's the end state.
I guess the next point is that, as I already just said, I have become convinced in the last three years, working at the VA in Los Angeles with veterans -- all of whom have Moral Injury, and the vast majority of whom have Complex PTSD -- it is clear to me that the the end state, the outcome of severe Moral Injury, whether it's in early childhood, or during a deployment, or a rape during adulthood, or whatever, at any point in life, if the injury is severe enough and progresses, the end state is Complex PTSD. Now Complex PTSD is recognized in the International Classification of Diseases, 11th Revision (ICD-11), the World Health Organization system, but not the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), which is a very crucial distinction. Because the American Psychiatric Association has not recognized Complex PTSD, we've not been able to do the important research to prove the connection, for example, between a deployment on a peace or combat operation with subsequent Complex PTSD. And without that research, without being able to study that, many people are allowed to hold the belief -- the false belief, I believe -- that the only way to get Complex PTSD is early-childhood trauma. Because some people believe that adult personality is fixed, once you get through adolescence. But that ignores development which goes on throughout a lifespan. And development is always a two-way street. So, I can become more mature, more responsible, more driven by my prefrontal cortex, but under stress, the balance of resources in my brain shift, and my emotional centers, my deep impulses become stronger, and my ability to control those impulses gets weaker. So, that's crucial. I talked more than I wanted to.
I just want to say one last thing about repair. I agree with Jackie June, it is kind of a funny way to talk about recovery. And I don't believe any of us have any magic capability to repair a wound, you know, put your hands on the wound, and it goes away. It's something the individual themself has to navigate, negotiate, with the help of social-spiritual resources. I believe that forgiveness is an outcome, not a predictor of an outcome, that forgiveness is not something you can decide to do, any more than you can decide not to feel ashamed after having been assaulted. Even though it makes no sense that I should feel bad about myself because somebody did something to me that I had nothing to do with. But that's hardwired. In terms of treatment, in terms of recovery. Given that I also believe the organ that is damaged in Moral Injury is the core self, the social self, which is important to maintain our social self-esteem. Given that Moral Injury is damaged to that social identity, core self. And just like the Complex PTSD symptoms of low self-esteem and difficulties regulating emotions, and difficulties with trust, and sustaining relationships, that the only way to build, to recover -- to mend the fabric, as Jackie June said -- is to create goodness, where the badness was. To create good. To plant the flag of goodness where evil existed. Because that's the only thing we can do. If I feel bad about myself because I did A, B, and C, I cannot un-ring that bell. I cannot undo that. So, it is now my mission -- and that's another thing about Moral Injury, it's a mission, it gives everyone a mission, and that's why we're having this conversation -- the mission is to make me a better person and the world a better place, because that's the only way I can sleep better at night. So, thank you for that.
Thanks. Thanks so much, Bill. So, I'm wondering. Is there anybody who'd like to respond to anything that was said? I can give you a minute. There's a few things I'd like to pick out from what was talked about, but certainly please raise your hand or jump right in if there's something that twigs for you, and you'd like to talk. For Jackie June, I think was very important, this analogy she created of the fabric and the tearing of that fabric of empathy. And I think that sense of that, actually -- there was a thread of that, if you like -- to all four speakers. For Tzeggai, the first thing that he said that really struck me was when he talks about that nightmare caravan that was rolling down the streets in Eritrea. That picture of that was such a strong and frightening kind of picture. But the other thing that struck me a great deal from his story was what the Holocaust survivor told him, when he said to him, "There is no weighing-scale for suffering." And I thought, you know, in terms of what Bill was just talking about, what a beautiful way to help somebody, perhaps, start repairing that sense of shame that they have in terms of, you know, "My injury is not as severe as these other people's injuries." I thought that was very striking.
From Joe. Joe, you mentioned, early on, cleansing rituals, and that really struck me. And I thought to myself, as you were talking, "Is that what we've tried to do -- and maybe not very well -- with our modern psychotherapies for PTSD and Moral Injury?" We've tried to create a cleansing ritual, because I think you're right, what we need is probably much closer to that. I think we've used certain parts, and maybe it's been the parts that we in first-world North America feel more comfortable with. Like the cognitive parts, right? "Let's think ourselves out of this." But that really struck me. Then, of course, you talk later about the idea of community and creating communities of concern. Which, again, reminds me a bit of something like a group therapy, perhaps, and how a lot of that, it seems to me, in our work in mental health -- and particularly, I think, in trauma work -- has kind of fallen by the wayside in many places. And I'm wondering why that has happened. And then, Bill, I think what you said about Moral Injury, being central to life, that this isn't something -- again, it's not this cognitive challenge that we can separate out -- you said, this is really part of life. And I think that was so important. And that, like emotions, the idea of morality and Moral Injury is hardwired into us. And that we cannot just, again, talk ourselves out of it. And then the other thing I want to highlight that you mentioned, when you said this idea of, perhaps, in the APA world, and the North American world of diagnosis, we've somehow decided Complex PTSD only occurs in children, and it can only happen in childhood. And you're really challenging that. And it reminded me of something else that reminded me of how when Attachment Theory was first developed, it was thought that those issues of attachment only applied to children, right? That's all people studied or talked about. And of course, we know now that isn't true at all. Attachment needs are there for us throughout our lives. And in fact, we need to be paying attention to them. So, those are my initial thoughts. Sure. Go ahead, Bill.
I want to say two things. First of all, I want to comment on Tzeggai's narrative, because he highlighted two different contexts in which a whole community was morally injured. The first context, of course, was when he was in Eritrea from the perspective of an Eritrean. Listening to the news and seeing how we're being ignored by the world. What a profound Moral Injury that is, all by itself. But then he also talked about the German national Moral Injury from the Third Reich and how, when he moved Germany, he experienced that attempt at moral repair among the German community because of that Moral Injury. So, I think those are really great examples of the way in which community identities, racial identities, can also be morally injured, just as individual identities can be. And the processes of recovery are probably analogous. That's definitely one thing I wanted to say. And what was the other thing you were just talking about Alex? The, uhhm... I'm sorry, you're muted.
I made that comparison between Attachment Theory and Complex PTSD.
Thank you. Thank you. I just wanted to say something about that. I am also working on a model to understand the nature of Moral Injury, and loss, because one of the central common denominators is, we've known forever that loss and trauma can lead to a similar outcome. So, I am now convinced that the actual nature of the injury in an individual, or in a community, from Moral Injury is losing sustaining attachments. Whether internal or external. So, if one of my sustaining attachments is admiring, for example, the Marine Corps. I love the Marine Corps, because to a person they try their best to live by their moral code. But if they betrayed my trust, massively, and they betrayed it in little ways, of course, because they're human, but if they betrayed massively, then I lose everything that that attachment gives me. And I lose the ability to feel better about myself just because of my relationship with the Marine Corps. That's, you know, and Heinz Kohut, self-psychologist, highlighted three different types of sustaining attachments. There's the kind where you value something else, someone or something, or someone or something values you, which explains to me why dogs and pets can be such good adjuncts to the treatment for trauma and Moral Injury, because they really do love us, they have the same hardwired morality and love that we do. I think attachments are central to the process. Losing attachments. Internal attachments. If I fail my own expectations, if I fail to meet my own standards, then I have lost some self-respect. I've lost some trust in my own strength, my own capacity. And that is -- whew -- that is central to Moral Injury, as well. So, attachments are key.
Thank you, Bill. Yes, Jackie June.
I think this link between Moral Injury and how it relates to the trauma of children is really interesting. I think you can also reverse it. We never use the term Moral Injury when it comes to traumatic experiences in children. And I think we should, because the worst trauma that children suffer from is interpersonal and I think it is usually moral. Somebody takes advantage of them, somebody feels to protect them. And I think it is a new field that we could explore and maybe help progress, thinking about that in that way.
Anyone else? I'll give you a minute. I want to -- we have some very interesting comments coming in from the participants who are watching. I'd like to read one of them. She writes, "Forgiveness built a devastated Rwandan society after the 1994 genocide. No medicine or reimbursement was equivalent to the loss of the genocide survivors. Forgiving didn't only act as a unifying factor, but a process of self-healing for these traumatic, horrific, and sustained moral injuries." So, I think she's emphasizing with another example, how important and how powerful this is, and that many other things that are done in terms of reparation, really just don't cut it.
I totally agree. I think it's also a warning that we should be careful that we don't pull more injury into the treatment room too much. I think that's also what he's referring to. Yeah.
That's a good point.
I think what I hear in that statement, is the reality that true forgiveness really costs something. It takes the willingness to really feel the full emotional and spiritual weight of the wrong that was done. That there's always a debt that needs to be paid in forgiveness. And we can't go back and reverse the past. So, what I heard in those words, is that it's paradoxical, because it requires us to find the willingness to lean into the pain of injustice. But then, paradoxically, we find that also holds the key to transformation and healing. It's almost like we find that by no longer sort of drinking from the cup of resentment, out of a desire that the perpetrator would suffer as much as we are, that we find that it was us who was consuming the poison.
I agree. So, I think resentment hurts the person that was affected actually more than the person who never cared for them. That, for one, recognizing that these things did not happen only to you, was, for me, pivotal in my healing. But I, without knowing that there was such a thing as therapy, where I was raised, without knowing that I can vent my emotions. Suddenly coming across a gentleman who had experienced more than I had. And telling me what more atrocities, more pervasive ones, had occurred in the place that I had happened to arrive by chance, basically. By chance, bumping into the family by chance, being in a household where this Jewish gentleman was to be. I mean, I was just thinking was that happening just accidentally? Or was there any reason for that to happen? That was the first time ever, that I was talking about how I felt. Because he saw that I was not like any other teenager. And he opened up and talked about his family's experience, and giving you a hope that nobody can assail your soul, your deepest self. That's the core self that I think Bill was talking about. The deeper us that is unassailable. I'd never heard anything about that before. That meant also for me that the people that I had left behind, were also not assailable. So, that was a hope. And talking powerfully about the Holocaust survivors came out and never took a victim's role. They were a role model for me. If they can do this, then why not me? And I think a hope in that message. That there were people that have gone through the same things like how -- maybe even worse. Then, you know, you look up to them and try to search because I didn't really follow through on any therapy or what. I was just reading things and coming across Tajfel again, the idea of categorization. It's conditioning people in our households, certain ways without being aware of that impact on the wider society, because we call ourselves certain ways. I mean, even the name 'Eritrea' was not given to us by ourselves. It was just given by the Italians, and then we call ourselves that way. And Ethiopians call themselves that way, and Sudanese, and now we have these identities, followed by boundaries, and all those things. We are splitting. Splitting and splitting. And then we have just small units that keep to themselves and find ways of secluding each self and if they were in power, then discriminating [against] the others. It makes, really, no sense and the moment that I understood how our mind works, and this is Tajfel talking. I mean, he was n Poland, he was discriminated [against], had to leave and go to France. And he had every right to be bitter and resentful. But he didn't. He just wanted to understand the mind of people. To contribute to reconciliation. We are all one. And that's why I like, also, the culture of the Indigenous people. The oneness. When they talk about their hurts, actually, they don't have a tendency of blaming others. They still talk, you know, a lot more about reconciliation than their hurts and trauma. I admire them for that. The residential schools were exactly the antithesis to their 'oneness' culture. It destroyed their beautiful culture. They had the highest consciousness. That's what we are striving to achieve in the evolution of consciousness. They had that already, but it was torn apart. And that is the social moral fabric Jackie June was talking about. Torn apart, now we see what is happening among themselves. So, I mean, to understand the mind, the human mind, how biased it is, and even in brain-mapping, you can see which part of our brain we use when we encounter people that look different to us. It's all neuroscience. We are vulnerable. And there's no point in pointing fingers at this region, or this color, or this race. It makes no sense. We are all one. The African savanna 50,000 - 70,000 years ago, that's where we are [from]. And all studies show the genes are the same; it's a human species. How we make so many unnecessary delineations, identities, and all that. And that becomes the driving point. And I think the moment I understood that, forgiveness was much, much easier for me.
Thank you. Thank you, Tzeggai. Bill.
Yes, yes, yes. I am really struck by the parallels that Tzeggai is highlighting for me between cultural Moral Injury and individual Moral Injury. And also highlighting how, as individuals embedded in cultures -- and we're all embedded in multiple cultures, depending on your different social identities... and we're porous, we're open to the back-and-forth flow of information with those in cultural environments -- that really, the first step to comprehensive Moral Injury repair in individuals, is Moral Injury repair in cultures. Cultural transformation. We have, in just a short time, listed a number of serious moral betrayals on a massive scale -- in massive scales, involving millions of people. Until, as community -- as Tzeggai says, we're all the same. Our DNA is 99.99% something the same. That until cultures can come to terms with this, make amends, atone, apologize. You know, and in my country, the US, we're grappling with race, obviously, and some other injustices. So, individual justice depends to a huge extent, on cultural justice. And that's where moral leadership, I think, is absolutely essential, because in order to move communities toward those kinds of healing stances and actions, we need moral leaders to stand up to the flow in the other direction and say, "No, no. That's justice, in that direction." I just wanted to make that point.
I wanted to -- thank you, Bill -- I wanted to come back to something that Joe had mentioned. You mentioned 'leaning in', and you were talking about, I think it was about in a way the transgressor leaning in, to interact or to be part of that. Because you can't have a repair or healing of these moral transgressions without those who are responsible, or those who are part of the group that was responsible somehow 'leaning in', and being part of that transaction. A good example, of course, is Tzeggai talks about, you know, what did the German people do after the war? How did they come to terms with that? And I think in Canada -- forgive me for being very local for a minute -- there are two things that we're really grappling with right now. And one is the whole residential school [situation] and the crisis with our First Nations people, and being what they now call 'settlers'. You know, "What? I'm not a settler!" But how do we lean into that, or the other one -- it's both in US, and Canada -- is in the military, the issues they are grappling with around military sexual trauma. Because I meet with leadership in our military, and I see how they're really struggling to try and come to terms with, and to not just be defensive, and say, "Oh, it didn't happen on my watch." But it is really a struggle for people. I'm wondering if someone can comment on that, about how, when you're the person who has committed the injury, how do we help that person get engaged, to 'lean in'?
I can make a comment about this question. I think it's helpful to pause and reflect on the purpose and the function of emotions, like guilt and shame. And as Bill has highlighted, we don't learn to experience these emotions. I think our social relationships and culture can affect our proneness to experiencing these emotions, in addition to probably a range of other factors. But when someone has transgressed against their deeply held moral beliefs and values, potentially contributing to the tearing of social fabric, of potentially injuring a fellow human being, by what they did, or by what they failed to do. The presence of that moral pain, in itself, is motivating a responsibility-taking. It's motivating a, "Hey, yeah, I did transgress, and the presence of this pain is trying to motivate me to begin to take action." As human beings, we have a really, really, really difficult time making room for painful emotion, in general. Our primary impulse is often to push it away, to move away from it. But in mental health professions, historically, we have pathologized emotions like guilt and shame, not recognizing that -- wow, if we're going to take a full-body view of morality, we have to understand that guilt and shame are essential if we want to have cohesion within human communities. So, leaning in to guilt and shame, going through a period of potentially remorse and feeling responsibility and coming to terms with the weight of the wrong that you did, or you did not do, that's an essential part of the healing process. I think the concept of self-forgiveness is becoming kind of more and more popularized. And I think too often we have a really superficial view of how that happens. That we want to somehow help our patients to forgive themselves, while circumventing these initial steps. To really expand make room for that moral pain, recognizing that, "I'm experiencing this because I have values, I have a morality. I haven't lost it, it's there." But you're going to lose it if you don't move into the pain and come to terms with it.
I'd like to comment on that, actually. I totally agree. And something that I find fascinating is what we as psychologists and psychiatrists can learn from restorative justice practices, for example. And how we can help people to have conversations about what happened. How can you hold somebody to account? For example, somebody who did something to you, and you want to talk to them about it? Or how can you go to somebody that you hurt, and how can you really listen and apologize and so on. I think this is a technique that we don't fully [laughs] know how to do as, as psychiatrists and psychologists. And I think we can really learn from other professions.
It's a really interesting point. Thank you, Jackie June.
I could add maybe a comment on that. We have a colleague, a social worker colleague, who does a Virtues Project in our hospital, and I have learned a great deal from that. I have learned, for instance, what compassion means, since I've been listening to her. And compassion, I think we use it maybe in a limited manner. When somebody does something wrong in our family, we can actually practice compassion. But we can't when it is outside of our family. For as long as we cannot understand everybody else, as an extension of our being, as one, and seeing beyond their sometimes unacceptable behavior. That, we can do with our son or daughter, but not really with other people. So, we're really quite quick to 'otherize', and I think that is, again, our vulnerability as human beings. Because we quickly want to identify enemies, and once we have done so, it's very hard for us to actually practice compassion. Whereas with our kids -- and we see it in our practice, in therapy -- we can do it over and over and over, even to the detriment of our own ones. So, the question is, why is that so difficult for us? We've come that far, even in Western culture, where families are just living within just one family, separated from neighbors, and you can see the, "This is my territory." And they don't want to even hear any noise from the neighbor. That already bothers them. When it comes from within, no matter how much, they can take it. I mean, this is back to the roots of teaching kids the virtues at school, like A, B, C. That's what I have learned from the Virtues Project. And I think we have to start there, to teach kids, to actually learn more about self-awareness. It's more important than 1, 2, 3, A, B, C. I mean, Indigenous people were living perfectly in harmony with each other, and that's what [Carl] Jung says, and with the nature, too, now, we have no compassion for anything but just our family. That's a fundamental issue that we are dealing with, even from within. The unit that has the same identity, outwardly, can protect themselves with military, when somebody comes from outside. But, still from within, they are split and don't know how to do compassion, and other virtues. And I think that is for little kids, to consider to teach.
Thank you. I wanted to respond to something that Joe said that was very impactful for me. And that's being able to tolerate the negative emotions, the painful emotions, and the tendency we all have to deny them, and to move away from them, to distract ourselves from them, just to maintain our equilibrium. The point I want to make about that process, which I believe also is central to recovering and healing from moral entry, [is that] you'd have to begin by sitting with yourself and allowing those emotions to wash over you. I think mindfulness, acceptance, Commitment Therapy, are very useful, because that's the starting point. This, "Let me just experience where I'm at," and then try to figure out what to do with that. But the one thing that doesn't work, that we've been trying to do in therapy for the last 40 years, is, in a clinical setting, tell your story, and somehow that's going to make you better. Narrative Therapy. And that's based on the belief that the main impediment to healing, the main obstacle to experiencing those emotions, is fear. That's the one word [laughs] no-one has mentioned here, because it's not about fear. It's about moral betrayal. It's about trust in self and others. That's one thing that, to me, is an indication that it is not therapeutic for me to ever push someone to tell any part of their story. Because I don't know, at any given moment, how ready they are to accept those truths about themselves and others? Or, do they have enough social/spiritual support, to be able to tolerate that truth? That's why communities, families, are so much more powerful and effective in moral repair than clinicians. And there is no such thing as a 12-session fix for Moral Injury. It doesn't exist. But thank you.
Sometimes, Bill, I think you need to be a bridge, right? A clinician has to be a bridge between the person and their family, or their community, because you will be like a safe person that they can talk to.
You know, I don't want to minimize the impact of a compassionate, empathic clinician. And I think of [that role] as, "I am going to be your greatest cheerleader, I am going to be a valuing attachment for you, because that's the thing that's most missing. With the inflation of my moral engagement in your life. I trust you're going to be able to figure out what to do next."
Yeah. And I think that's the other thing, is that sense, Bill, of that relationship that you have with the patient, and only the patient can say what that is. I mean, we may think that we have a great attachment to our patient, but it's their experience that counts in terms of what they're going to tell us, and how much they're going to share. I want to come to one -- or actually, sorry, I have one thing to say. Unfortunately, the General is not going to be able to join us today. Something has come up, and he regrets that he won't be able to make it. So, I wanted to pass on his regrets.
Here's one question that we got from the audience that I'd like to ask, as it fits with this: "The discussion highlights the concept that treatment for Moral Injury comes as much from a sufferers' community as from formal therapy. My question is, how can someone in the sufferers' community best help with repairing the Moral Injury? Is it through focused actions, or through everyday interactions? Thank you."
Well, I think it's both. I think that's the most powerful, taking action. To make the world a better place, to build a new sense of my own self-worth and identity, so action is crucial. But without the compassionate engagement on a very human level with each other, to give and receive support, none of that other stuff is possible. So, I think that my view is they are hand-in-hand.
I would think that, on a daily basis, the most important thing that you can do is really listen and not judge. And be aware that anybody could do, or fail to do, what that person did. I think that is going to be helpful to somebody who suffers from Moral Injury.
Just building on the comments. Personally, I've grown to understand the importance of humility in doing this work, and assuming that if it was me who was born in this person's shoes and experienced the trauma that they experienced, shared their DNA, that I would be suffering in the very same way, or potentially worse. I would encourage any helpers or peers out there to pursue that type of humility. And also to just keep showing up, and to check in regularly, to keep showing up. And don't underestimate the power of a compassionate, nonreactive presence in people's lives.
I agree. And I think one of the things I didn't understand when I became a therapist in [my] initial years, was that not every concept that you're taught, let's say, CBT, is going to be effective for everybody that you see, because it isn't really a fixed idea that we have. That is, again, identifying ourselves with some concept in school, and then here we go, you have schools fighting against each other, saying CBT is better, or psychoanalysis is more superior, for this and that, it's not really about certain ideas in human encounters. I like how you put it, Joe. Humility. And I think showing vulnerability, as well. You have to, you know -- I think if the gentlemen that encountered me, or I encountered by chance, initially had not told me that he'd suffered and he had nightmares, and all that still has not resolved his issues after 40 years almost, then I thought, whoa, then I'm also normal. And that's the shame and guilt part, that really dissipates when you can share, "Hey, you know, these are humanely shared experiences. We are all vulnerable." And there are things we just cannot take, especially men have it more difficult, because of the way that they are raised. And you can see in the numbers of the patients that come to us, for trauma, the majority happen to be female patients. And the reason is, we are raised and conditioned differently. We need to go beyond any concepts, because life's not about constructs and concepts. It's just about encounters. And you don't have to have gone to school to help somebody, either. There's a wisdom, a wisdom that is much more powerful than the schools. I mean, how many times do we say, "The priest can preach, but are they really going to do what they preach?" Well, not so much, most of the time. That's why residential schools occurred. It's priests that conducted the atrocious deeds, and traumatized people for generations, while holding the Bible. It doesn't really mean that somebody who's gone to the best schools, you know, I think that is where [the virtue of] detachment matters as well, being detached [from] ideas and notions, because the human being is much deeper than a school could ever, ever understand. That's why Jackie was saying, "It's not like a car, taking it to a garage and repair it." It's deeper, and I think everybody can have the courage to show up with a genuineness, be honest, and be there when the person needs you. Exactly, show up. And I think that is how trust can be built upon, from there on, the person can reach out to you. But don't have palatable answers. That's not really [how it works]. You're on the mountain, and the person -- or, you may be on the mountain, but it doesn't mean you can drag the person [by] the foot up there, just never [goes that way]. You have to go down and go up, step by step [with them], if you can, and be there when they need you.
Great, yes, thank you very much, Tzeggai. We've only got a few minutes left, so we're going to shift to our summary. And I think Eric is going to lead this.
We don't want to take it away from you, Alex. By all means, this is a rich and beautiful discussion. And Suzette and I would like to sort of, at the closing of the session, ask the panelists, that gave the best of their selves in engaging in this conversation, to highlight what they take away from a conversation like this. And then after that, Suzette and I will have some closing remarks, too. But is that okay, Alex?
Sure, yes. So, we'll go around, maybe, and do it in the same order as people made their opening remarks. So Jackie June, would you mind starting? What was your key takeaway?
I am so glad that we all stressed that morality is such a deep force within all of us. I think that's the most important thing about Moral Injury. If I can ask people one thing, if they really want to understand that you don't need any type of cognition for morality, you can watch on YouTube, you can watch the films by Francis Deval, where he conducts experiments with capuchin monkeys. And he gives them a task, but not the same reward for the [same] tasks, and you can see their response. And then immediately, you can understand that you don't need any type of real cognition for this type of morality. I think that's one thing that you could do, in addition to [laughs] listening to this conversation series.
Thank you. And Tzeggai.
I think this shows to me how far psychotherapy and psychiatry has come. Having therapists and psychiatrists talking about spirituality. I mean, a few years back it was a taboo. I remember that. And this is how far we've come. And I think that is the most neglected dimension of our being. And if anything, if there was anything that helped me most, it was talking about the soul. That's very powerful. Thank you so much.
Thanks Tzeggai. Joe.
It's interesting that we never actually got into the nitty-gritty about emerging treatments for PTSD. And personally, that was a bit refreshing. I think, at least in my field of psychology, much of the energy has focused on probably too narrowly defining Moral Injury and placing too much emphasis on psychological methods of care. One of the themes that I'm going to take away from this conversation is that our psychological interventions are important. I'm going to continue to devote a lot of my time to providing psychotherapy and supervising psychotherapists. But what I'm also hearing is that, in addition to our best psychological interventions, we also need to be addressing the spiritual and social dimensions of moral repair. So, we need to do psychotherapy in a socially and spiritually conscious manner, and that's going to be a formidable challenge, at least for my profession. This is going to need to drill down to the way that we train students and clinicians. It's going to require resources in the types of services and programs that we're able to offer. And it's widening the set of Best Practices that we truly need, to address Moral Injury.
Yeah, thanks, Joe. I love your phrase, 'the communities of concern'. I think it's a wonderful phrase. And Bill.
The thing I'm walking away from this conversation with, more than anything, is the pleasant conclusion -- the reassuring conclusion -- that we're all talking about the same thing. We all have the same image in front of us, we all understand, to a great extent the biological, social and spiritual aspects of Moral Injury and moral repair. And, to me, that's so reassuring. That we're past the head-scratching stage, at least, and we're beginning to understand the nature of this beast a little bit. And moving toward being able to do something about it. I'm delighted to be part of the conversation. Thank you.
Well, thank you all. Thank you, Alex, for moderating this session. On behalf of Suzette and myself, thank you all the panelists for shining [a light] at this really difficult, heartfelt topic of the Repair of Moral Injury. Please allow me to share, in closing, a personal reflection that came from the General.
In a Student's Session -- we've had a series of Student Sessions preparing for this conversation series -- and [General Romeo Dallaire] was asked about what he shared earlier, in a documentary, 'Shaking Hands with the Devil'. He spoke about 'the loudness of silence', and that he couldn't sleep at night because of the nightmares. And he shared with us, that for a long time he had difficulties resting his head on the pillow. And then he shared that something new came into his life, and he called it Love. He said, "I found a new love in my life, and with that woman next to me on my pillow in my bed, she's curling my hair, and then I can rest my head to my pillow." He said, "My moral repair is love." And I'll echo that also, as we had all these very important topics, but that came just from the General's personal experience. And Marie-Claude Michelle -- am I pronouncing her name correct, I hope -- will be with us, his wife, on one of the next sessions, to speak about her contribution and her leadership. And that's going to be, Suzette, when is that session with Marie-Claude Michelle?
That will be on October 28th. So, in closing, there's a number of sessions that we have coming up here. Our next ones are on October 27 and 28th, before our final session on November 10th. And I'm going to let Eric tell you a little bit about the next session, which is October 27th, that will focus on Destigmatizing the Impact of Trauma and PTSD, and some celebrated panelists that Eric will introduce.
We have Professor Captain (retired) Alexander McFarlane, the Director of the University of Adelaide’s Centre for Traumatic Stress Studies, and an international expert in the field of the impact of disasters and post-traumatic stress disorder. An esteemed colleague and a dear friend, Professor Colonel (retired) Robert Ursano, a Professor of psychiatry and neuroscience at the Uniformed Services University in Bethesda, Maryland, and a Founding Director of the Center for the Study of Traumatic Stress, an excellent panelist that we have on our next panel. And Najat Maalla M’jid, a paediatrician and assistant secretary-general and UN special representative of the secretary-general on violence against children. And lastly, we have Colonel (retired) Rakesh Jetly, an associate professor of psychiatry at Dalhousie University and the University of Ottawa, and prior senior advisor in psychiatry for the Canadian Armed Forces and head of the Centre of Excellence on Mental Health, Directorate of Mental Health in Canada, and Suzette, I will be moderating that session, and I have the great pleasure to be on the stage, for that one. You want to say the closing remarks for this one, Suzette?
I was just going to celebrate that you're going to be the esteemed moderator! It'll be fun to engage with you, and to see you engage with all of these exceptional speakers. I want to just thank all of the moderators, Dr. Heber, thank you so kindly for moderating. I'm going to give you the final word, in a moment, to see what your key takeaway is. But from our end, I just wanted to thank each of the panelists, moderators, and everyone for joining us. Alex, would you give us a final, key takeaway message from your end?
[gasps] I wasn't ready to give a key takeaway! You know what? I just... talking about that issue of attachment, and its relationship to morality and Moral Injury. I think it's something that I will take away with me from this talk. And how very much we were able, in this short time, to form some attachment bonds among the group who were discussing, so I thank you all very much for that, too.
Thank you. Thank you all. Thank you, Alex. Thank you, panelists. That was wonderful.
Eric, would you send everyone off? Thank you, everyone.
Thank you all for watching. Okay, there we go. [laughing]
Thank you, everyone.