Cleveringa Dallaire Critical Conversations #4 - 2021-10-13
3:13AM Oct 14, 2021
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, 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.
Hello, and welcome, or welcome back. My name is Dr. Eric Vermetten. I'm a psychiatrist and a professor at Leiden University in the Netherlands, and a military officer in the Dutch Armed Forces. I'm joined by my co-host, Dr. Suzette Bremault-Phillips, an occupational therapist and associate professor at University of Alberta. How are you, Suzette?
I'm doing well, Eric. Thank you. I hope you are likewise well.
Absolutely. I hope you had a great Thanksgiving there.
It is a great pleasure to welcome you to the fourth of the Cleveringa Dallaire Critical Conversation sessions. We were pleased with the overwhelmingly positive reviews of the first three sessions. We are, again, so excited that people from more than 33 different countries and walks of life have joined us for today's webinar. And I'll just mention a couple of countries that are with us: Australia, Belgium, Belize, Brazil, Malaysia, Mali, Mexico, the Netherlands, Sierra Leone, South Africa, Spain, Sweden, Turkey, Ukraine, the United Kingdom... and I'm skipping on a few, as the list would otherwise be too long. But it's delightful to see that so many countries have also signed up for this session. This session is about Intergenerational Trauma and Moral Injury. This webinar is the fourth of eight conversations honoring the Cleveringa Chair that was awarded to General Romeo Dallaire in November 2020, in the Netherlands. He was 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 will reflect with us 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 are truly inspired to actualize transformative culture change. This series aims to provide a context for such a conference. Eric?
Before we start a couple of things, General Dallaire's experience is the thread that weaves these sessions together, and the conversation will often come back to the themes of his experience. We're grateful that General Dallaire will be joining us -- a little bit later -- for these sessions. These sessions will continue through November the 10th in honor of Remembrance Day. Each session is 90 minutes long. You registered and you received a livestream link for this specific session. If you wish to follow all of the conversations, you'll need to register for each separate event. Please, also share this event with colleagues, with friends, and post it on social media if you like.
We're also aware that some of the content of the conversations may be difficult to hear, or trigger past experiences and memories for some. 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 your comments. You can share your thoughts by using the Questions or Remarks box on the Leiden events page. We'll also do our best to address questions that are posted. Finally, the sessions will be recorded and made available following the event on the Leiden University events page.
We now look forward to engaging with the panelists, and our moderator, about the ideas that we have. The conversation will be moderated by Andy Greenshaw, who is a professor in Psychiatry in the Faculty of Medicine and Dentistry at the University of Alberta. He is the Scientific Director of the APEC Digital Hub for Mental Health. Please, Andy, you may take it away, and offer your introductory remarks, and then introduce the speakers. I look forward to a very interesting conversation.
Thank you very much, Eric and Suzette, for your invitation, and for convening this wonderful series. It's a great privilege to be the moderator of this panel. I'd like to say a little bit about the makeup of the panel before I introduce the speakers, in turn. One of the things that we want to achieve today is to have a real conversation -- rather than a series of presentations for you -- so we get the richness of the great experience and vision of each of these people.
The first person I'll ask to speak is Professor Rachel Yehuda, who is a Professor and Vice Chair of Psychiatry for Veterans Affairs, and is a Professor of Neuroscience at the School of Medicine at Mount Sinai. Rachel's research is really comprehensive when it comes to this subject, in terms of biological underpinnings, clinical work, and considering the overall impact of intergenerational trauma, both in the context of veterans and the population in general, particularly in terms of developing trends in society.
Then we'll go to Professor Gerlinde Metz, one of my colleagues in Alberta, who is at the Center for Behavioral Neuroscience at the University of Lethbridge, which is a remarkable center for leading research in behavioral neuroscience. Although a small location, the people in that center have made tremendous contributions to neuroscience, including epigenetics, which is Gerlinde's area of specialization. And Gerlinde will be asked to comment, and give us some ideas about the current understanding and future implications of epigenetics research, in this context.
And then we'll move to Shelly Whitman, who is Executive Director of the Dallaire Institute. Shelly has had a remarkable and rich career, leading an international team, an Afro-Canadian team -- Canada, Rwanda and South Sudan -- working as Head of Research under the direction of the former Botswana President [Sir Ketumile Masire] on the inter-Congolese dialogue. And working as a Research Consultant at UNICEF in New York, on the OAU Rwanda Genocide Report. Shelly is also acting as a Professor in a number of universities in the Maritimes, in Canada, teaching in areas that relate to intergenerational trauma and impact on the social fabric.
And, last but not least, we have a professor who specializes in children’s rights law at Addis Ababa University, Dr. Benyam Mezmur. Benyam is a lawyer who really, I think, integrates the conversation for us, in terms of the implications of what we'll talk about, in relation to rights and welfare of people, but particularly the rights and welfare of the child. And he Chairs the United Nations Committee on the Rights of the Child. He is Associate Professor of Law at the Dullah Omar Institute for Constitutional Law, Governance and Human Rights at the University of the Western Cape in South Africa, where he coordinates the Children Rights Project.
So, we have a rich group of people all pointed in the direction of the impact of their research and activities for the public good. I'm going to start with Rachel, who has a tremendous wealth of experience in the area of intergenerational trauma and the impact, in relation to moral injury and post-traumatic stress disorder. Rachel, this may be a tough question, but what are your hopes for the future, based on what we know today, and what we think we may know, going forward in this era?
Thank you, Andy, for that. That's a really wonderful question to ask me. My hope for the future is that we take the information that we have obtained about the intergenerational effects of trauma, and use it to harness resilience. Now that we have a very clear understanding of some of the mechanisms that are involved -- and we know the most important thing, which is that our environments can really shape us, and our environments help us produce enduring and transformational changes that are designed to help us cope -- we can really harness this information, so that we can develop ways of building solutions to the enduring effects of trauma, towards transformative change in a positive direction.
I think one of the things that follows from what you said, Rachel, is the shifting perception and understanding of people who are charged with caring for people, and trying to assist people with their problems. Because with that greater understanding of mechanisms, comes an understanding of the origin of the problem. Going back to even the 20th century, where there was some moralizing about whether people were strong enough, or why they would suffer from some of these problems, going back to the early days of understanding shellshock, and problems of moral injury, in a combat situation. I think the shift in the understanding, from a mental health caring perspective, is something that's caring for it informed by that new information about the impact of traumatic experience, and then intergenerational problems. Do you see that the understanding of intergenerational change is having an impact, in terms of approaches to mental health and supporting individuals who suffer from moral injury but post-traumatic stress injury, particularly?
Most definitely that there is an impact of this information in a clinical setting, because I think one of the things that has always been very mystifying for people is why people react so differently to very similar events. And especially in the context of soldiers and combat. I mean, you can really have such a diverse reaction. Some people, really, almost seem energized by going into battle, and some people are very terrified. Some people really rise to the occasion, and really become their 'best selves' when people are shooting at them, and other people don't. And I think in terms of the aftermath, there are people that say things like, "I did what I had to do," and there are people that look back and say, "How could I have done that?" I think that there's a very big range, and I think, if we understand that we are the sum total of not only our experiences but also the experiences of, perhaps, our parents and our culture and our environments, we begin to have a really fleshed out picture of why there can be such diversity in response to the environment. What I think the biggest impact that epigenetics has had on clinical practice is to highlight how profound clinical work can be. One of the things that we have demonstrated in our lab is that, not only are there epigenetic effects in relation to the intergenerational effects, but there are epigenetic changes that are associated with recovery from trauma that are induced by psychotherapy. So, what happens matters. And it's not just that negative events imprint on us negatively, it's that positive events can also imprint on us. The idea that we can change and transform -- no matter what the circumstance -- is a very powerful message that should make everyone understand that the effort that they put into healing environments, and the therapeutic process, will end up having gains for their psychology and their biology, and perhaps even to the next generations.
I think that's a really important point. In general, people have associated epigenetic work to 'the scars of experience', if you like. And the idea that looking at individual differences in relation to resilience is really important, like the message that you're highlighting now about having some plastic change that may be enduring. And so, the improvement that we have -- the positive influences of interventions like psychotherapy -- will have a benefit, transgenerationally, is super-positive. I think many of the audience will wonder about epigenetics, generally, Gerlinde. And it's a gloriously technical subject. But I'm hoping you'll be able to unzip this for us, in terms of talking about, let's say DNA methylation, in terms that we can understand for intergenerational change and impact on individuals as they go through their life and respond to trauma. And perhaps, in relation to Rachel's very positive comment, there are positive potential effects of epigenetics.
Thank you very much. Especially, also, thank you very much to the organizers, Eric and Suzette, for bringing us together for this very important conversation today. I think it's a really timely topic that we're talking about, epigenetics. So, what is epigenetics? I think Rachel has already very comprehensively described how we are applying epigenetics in research, and in our lives, to understand where certain health complications or risks -- and also opportunities -- are coming from. Epigenetics literally means that we're talking about a layer that is above the genome, above genetics. The genes housed in our DNA are encompassing the 'instruction manual' for how cells and organs and tissues work and function. This is like the blueprint for our bodies. But you may be wondering why we have different types of cells in our body, whereas all cells have the same DNA that's given to us by our parents. We have kidney cells, liver cells, skin cells, nerve cells, and all these cells have the same DNA makeup, but epigenetics is what makes them very unique. The interesting part is that DNA is not our destiny. I would like to refer to the DNA, or the genome, as a library. This encompasses all our information that our body has. If you go to a library, you have a number of books on the shelf, a large number of books, a large amount of information, a large body of information. We're not reading all of those books at the same time. You might decide, based on our instructions, to pull out a number of books that we want to read, and open, particularly. So this would be what epigenetics would be doing. It is giving us the decision, which books we're pulling out and reading. Which pieces of information are important at this particular time. So we're switching the reading of a book, on and off, basically. Epigenetics is usually involving chemicals, like a methyl group that attaches to the DNA, or a micro RNA molecule, and that can decide if we're reading this particular gene, or gene sequence, or not. It's basically the window to the outer world. This is how signals from the outer world communicate constantly with our inner world. And they give us information about what is important, to switch on our gene information right now. Not every experience will lead to an epigenetic mark, but it would be more of the severe or enduring experiences, or traumatic experiences, and moral injury, that have a higher chance of leaving an epigenetic memory behind. These epigenetic changes might not necessarily be negative, as Rachel, you pointed out already, but they're simply changes. What is really interesting is when these changes also become heritable. So if we have, for example, a child exposed to trauma or moral injury, the epigenetic memory from this very severe event might leave a mark behind, might generate this memory that eventually might influence this child's personality and health trajectory, but also potentially become heritable, and be passed on to subsequent generations. This is actually thought of as an adaptive change. For example, we're passing on information to our children that tells the children, or the baby in the womb, that this is a dangerous environment out there, it's a stressful environment, so you'd better be prepared. Get your metabolism prepared, change your personality and your behavior so that you have a higher chance of survival in this very dangerous world out there. It's thought by mother nature to be an adaptive change, but at some time it might also come at an expense, and lead to certain health risks. But the opportunity that we have here, is that while, in the first place, we are adapted, we have this biological signature in us that might predict if we are vulnerable, and at particular risk of a health condition further down the line. Or our children or grandchildren might be, eventually. But it doesn't have to be that way. If that happens, and we can identify those biological signatures, the epigenetic pieces of memory, then we have an opportunity to predict who is at risk, and also to develop interventions that will target those epigenetic marks, or a certain trait that--
Gerlinde, I wonder if I can pick up on the 'stress' piece, in terms of the context of General Romeo Dallaire, the whole piece about terrible trauma, and turmoil of war, and death, and those things. One of the key things, as I recall, is -- in understanding epigenetics in relation to behavior and mind -- is the understanding of the impact of changes in stress on our hormonal systems. Something we call the HPA Axis -- the hypothalamic-pituitary-adrenal axis. And some of us will know Michael J. Meaney, who did some foundational work in this, years ago, looking at mother/infant interactions in rats. That's given us a window into actually looking at these mechanisms. In this context, I see stress as a particularly important focal point, and mediator, that we can all relate to, in terms of the things we'll talk about today. Whether it's the experience of people in combat, the experience of people under hard conditions, refugees, people who are abused and oppressed, and even when it comes to the training and exploitation of children, particularly in war situations. So, I like to move on, and we'll come back to this. We're going to continue with the conversation, but taking that epigenetic piece, and the idea about stress... I wonder, Shelly, if you can pick up on that, in terms of the bio-psycho piece, the change in somebody's -- what we call their phenotype, or the way the way they grow up as an individual in the world -- and its impact on how they affect the societal mechanisms, and what happens, which is an area of great interest.
Absolutely. Thank you so much, Andy. And thank you, also, to my previous two esteemed colleagues, and their really insightful remarks, that were making me think about some of the points that I'm about to convey. Just to set a little bit of the context in terms of the Dallaire Institute. We were founded out of General Dallaire's experience in Rwanda in 1994, and one of the areas in which he had great trauma, was interacting with children who were being recruited, and used as soldiers, to commit the genocide in 1994. And so, in our work, we also work very much to improve the interactions between security forces, professional forces, military, police, peacekeepers, and their interactions with children, who may be recruited and used as soldiers in the context in which they are facing. So in that context, you've got two different sets of individuals who have, potentially, dynamics related to stress and trauma that have created this opportunity for their interaction in another stressful environment. And I was thinking about the very dynamics of General Dallaire, being someone who was born to a father, who was a soldier, who also had PTSD, and then was in a situation where he was also put in morally-compromising situations. In addition to that -- thinking from this perspective of the children -- what I wanted to say is that, I think often times, we don't understand that the military who may be in the situations of interacting with the children -- whether they're leaders in a country, whether they are peacekeepers on a particular battlefield -- they, too have trauma from their childhood that will impact the way they're going to interact in those particular instances. And it affects the way that they may react positively or negatively to that situation. Much like Rachel was saying, why people react so differently to the same situations, and yet may have similar training and approaches and missions to achieve. We don't understand enough about how much those dynamics are important. And I was recalling being in conditions... let me take, for example, a situation in the Democratic Republic of Congo, just a couple of years ago, and having a conversation with a General within what is the National Defense Forces of the Congo. He was relaying, as we were talking about our work and our training with the forces, about how this was his experience. He was a child soldier himself. And now, as an adult, he is an adult soldier. And so that dynamic of having those conversations with them is very important, because it can be an opportunity, right? When we're thinking about the positive elements, it can be an opportunity to understand that, in fact, your lived history is also going to impact the decisions you are making today. And maybe what we could do to break some of these cycles of endemic conflict.
Those are really interesting comments. I think Dr. Shelly Whitman's work touches on something that most of us don't really think about. And that is... we think about it in psychiatry, when people are not functioning properly, and they come into our area of interest and interaction to be helpful. But when we think about leaders in the world, and what their history is, in the extreme case, somebody who has been a child soldier, who is going to have had the imprint of that difficulty, carrying that forward into the mechanisms that they have taken onboard to protect and defend themselves, and their attitudes and ideas around leadership. Typically, we don't analyze and criticize leaders from that perspective. I'm really mindful of some of the work of one of the foundations that is seated here in Alberta -- the Norlien Foundation, originally, now the Palix Foundation -- have been doing interactions in high school situations for children who have a history of trauma. And the consequence of maladaptive behaviors typically in city schools and vulnerable populations. And they have found that, by talking to these children about the mechanisms of what it takes to build a healthy brain, and the problems of early trauma and intergenerational trauma, these kids have actually reframed their ideas about being failures, or being damaged, to understanding that, actually, something happened to them, and the validation of that story. I'm curious, Shelly, about what you think about the possibility of offering information that may give insight to leaders who may actually be moving forward based on what they don't have insight into, and what drives them in terms of their moral injury.
Yeah, I think it's really important, what you've said here. And I think it's so overlooked in our country. It's overlooked, as well, in terms of thinking through why we have some of the difficult situations that we deal with. Maybe what I would do, Andy -- because this is probably the strongest thing that I can do -- is to give you an example. There are young people in Canada, who have been child soldiers, and then they have immigrated to our country. And I had been doing some research, a few years back now, and interviewing some of those young people about their experiences, and what it was like to now live in Canada. And they would often say things like, "We would love to share our stories, but we're not sure Canadians want to hear it." Or they would say things like, "Well, you know, my interaction in that particular context," -- like joining a gang in the negative sense, thinking about some of the negative opportunities that presented themselves -- they would say, "That experience, in that inner-city dynamic in Canada, is so much less volatile than the situation I experienced in that conflict zone, that anything that was ever done here could never match that. So, in terms of understanding how to react to it, though, I was reacting to it thinking I was still in a conflict zone." I was thinking about that time, and doing that work with those young people, and just the lack of resources and understanding, even from the service providers in Canada. So, in terms of thinking this through, from a leadership perspective. When we're thinking on how we expend our resources and how we think about decision-making on particular dynamics of government programming, et cetera, these are all things we're not thinking about -- or our education system, and how to approach that. Maybe now, if we can start to understand from a truth and reconciliation perspective, and from that Canadian lived experience that we're starting to actually vocalize -- and we can think about this in terms of larger implications in our communities -- we might have a better understanding of what this might do in terms of our future, and our leadership, and our approaches.
I think these are real gems to bring forward, because they are, as you say, Shelly, areas that are not well-discussed, and they're not prominent in the landscape of this area. Benyam, in asking you for your thoughts and reflections, I'll say, by way of introduction to this, that I'm a person of Afro-European descent, and part of my family has its origins in South Africa. So, one of the questions that arises in this whole area is one of culpability and responsibility. When we look at the mechanisms that were first brought in before -- and in the conversation by Rachel -- in terms of epigenetics and individual differences, whether resilience or damage, moving through the mechanisms, with Gerlinde's comments, to Shelly's comments about this seen at the level of developing people and leaders who may have been through these difficult times. I see things like the whole Truth and Reconciliation piece, as it came out in the days of Nelson Mandela, to be quite remarkable in terms of what might have happened, in a not terribly-troubled space. But, as a lawyer, Benyam, I wonder what you think about how society might view these things? We don't want to say that people do things because they don't have a choice, because everybody does, but these epigenetic effects -- to use a convenient religious comment 'the sins of the fathers being visited on the sons'. What can we do in the future in terms of how we frame this? And how we approach the idea of looking at people's culpability, and looking at mechanisms, and trying to reach a place where we really can achieve what we might hope to achieve with Truth and Reconciliation?
Thank you very much, Andrew, for that question. Thank you for having me. In fact, as a member of the UN Committee on the Rights of the Child, what we do is, we engage with 196 states and parties at the Convention on the Rights of the Child. They come before the committee, they highlight some of the progress that they've made in relation to children's rights, some of the challenges that they're facing, but also the manner in which they plan to address some of those challenges that they are facing. The reason why I'm mentioning this, I've been sitting there, in that Committee, for the last nine years. And I'll be very honest with you that concepts like epigenetics -- even the word trauma -- are not issues that have come before the Committee. They don't necessarily make themselves easily accessible to lawyers like myself, even though there are a couple of colleagues -- more than a couple of colleagues -- that are non-lawyers. Now, as lawyers, as you rightly said, capability, accountability, it's right up our alley. It's something that we actually emphasize.
One of the biggest challenges -- from the point of accountability and making the link with intergenerational trauma and epigenetics, and so forth -- is recognition, actually. Because with recognition comes bridging the silos. So, recognition, for instance, that I'll be very honest with you, I worked on a project many years ago. It's a project on torture. And even though 10% of the funding actually went to supporting children that have been a subject of torture, there was always that sense that actually said, "You know, children are apolitical. They don't get involved in politics. So there is a link between politics and torture. So they wouldn't really be beneficiaries, or they wouldn't even be subject to trauma." So, the starting point is the recognition that children are significantly -- and increasingly -- subjected to these experiences. That recognition is the starting point. The second one is to break the silos. That the implementation of the Convention on the Rights of the Child, I understand it's a legal document, yes. But it actually requires getting the circle bigger. We need to be able to speak to psychiatric psychologists, Child Development people working in neuroscience, and so on and so forth, so that getting the circle bigger should also mean leading to a situation where our interventions are informed by the evidence -- not only the legal evidence, but also the evidence that is actually coming from interdisciplinary research -- but it also means that we have to be able to use it for programming.
Now, let me come to culpability and accountability. Something that we are actually very proud of, as the Committee on the Rights of the Child. A couple of years ago, we adopted what is called a General Comment on child justice. This is about giving guidance to states on how their Penal Law, their criminal law, pertaining to diversion on account of -- the minimum age of criminal responsibility, for example. At what age should children be held criminally accountable? They can be held accountable below a certain age, but not criminally accountable. And we said to states that it should be safe at age 14. One of the reasoning that we actually provided for that, is because there is documented evidence -- in the fields of child development in neuroscience -- which indicates that maturity, and the capacity for abstract reasoning, is still evolving in children that are aged 12 to 13 years, due to the fact that their frontal cortex is still developing. So, we actually landed at the number 14, but even said that the states have to move up to 15 or 16 years of age. We urged them to move in that direction. Also taking into account the development in neuroscience. Now, why do I mention this? It's one occasion where I believe we've been very brave, taken the bull by the horns, and actually drove from interdisciplinary research in the science out there, because it would have implications in terms of accountability. The Truth and Reconciliation Commissions, or any processes that have actually been put in place... I am reminded of conversations that happened in Rwanda during the genocide -- and the General would probably reflect on this very clearly, and would remember. There were conversations that actually said, "If a child could differentiate between a Hutu and Tutsi, if a child could even differentiate between a Hutu and a moderate Hutu, then that child is no longer a child. That child should actually be held accountable in the same manner we actually hold adults accountable." That's the wrong approach. Because, if we're looking at the science, if we're looking at intergenerational trauma, if we're looking at epigenetics, then it should actually guide us in a direction where accountability takes into account these attendant circumstances, and it has to fit the purpose. It has to be child-friendly. Indeed, it has to bring about accountability, but it shouldn't go beyond the level of accountability that should be accorded to a child in the circumstance.
Let me throw out a few more points, and then I'll leave it at that. Our education system, our immigration policy, our criminal justice system, the interventions that we actually put in place -- we have conversations about European countries that are actually refusing to repatriate children that have been born to ISIS fighters in camps in Syria. But a number of those policies are actually... they are either not reading, or they're not reading the right sources. If they were actually reading the right sources, if they were indeed, trying to approach this in a holistic, community approach -- because this is an approach that we're using in the context of the Sustainable Development Goals (SDGs), it's an approach we're using the context of migration refugee supports -- if they were taking this into a whole of government, a whole of society approach, then they would actually bring about an accountability that takes into account the attendant circumstances of these children. And that would definitely include epigenetics, but also intergenerational trauma.
Thank you, Benyam. We can move on from this and use this, richly, in the conversation. At this point, I would like to welcome and acknowledge General Romeo Dallaire. Romeo, it's delightful to see you. I know you had some live interviews that precluded you joining earlier on. Just to say, we have just really begun the richness of this conversation. Everybody has come out and made some, some basic comments, and I know that you'd like to make some summative comments at the end. I wonder, sir, if you'd like to say anything at the moment, just as we move on with our discussion.
Very, very succinctly, just saying that I've been told that the moderator is doing a magnificent job. And that the evolution of the panel is very positive. And so, I look very much forward to saying just a couple of words at the end. And thank you all for taking this session, with such significant importance, to heart. So, well done.
Thank you. Thank you so much. I must reflect that, whenever you speak to us in a group, your leadership shows, because you're always reinforcing and encouraging, and moving us on in a really good direction. So, on behalf of everybody, thank you for those comments. It's very kind. We've laid the groundwork for this discussion, and I would say that we have many different levels. Benyam, your comments really speak to the work we have to do as public activists, scientists, clinicians, to try and push all this together to inform the mechanisms that lead to the decision-making that is reflected in the law. Interpretation of law is, of course, everything. And when people do not understand the finer points, they may go in one direction or another, which may be well-intentioned, but can be disastrous. I'm going to move back down to Shelly. Benyam's has pointed out that we need to inform people, basically. There's a rich body of information that we'll go into in more depth, while we do some work on the developing mind in the clinical space, and one of the key issues we always discuss is: What is a child? What is an adolescent? And what is an adult? And through that period, you have this exquisite set of, what I would call, critical periods as reflected in some of the work that our panelists have done, where you can have greater or lesser impact. And you can also expect greater or lesser responsibility. Because the mind of a child is very different from the mind of a young adult. I'm always amused when I'm teaching -- I teach a course on maternal adult and maternal child and adult mental health -- and my students in University are always slightly upset with the idea that somebody under the age of 25 might not be an adult, in terms of where their brain is. I wonder if you have any comments on that, based on the workspace that you're in, Shelly.
Yeah, it's really interesting, because I can say that also, when I have those conversations with young people in university settings, they are uncomfortable with that whole idea, potentially, that their brain hasn't fully developed well into their early 20s. I would also say, interestingly, I've had conversations with children who are 12 and 13, who would tell you they're not children anymore, but that a child, to them, is someone between the ages of 5 and 11. So the perception from the children themselves is a very interesting dynamic to understand. And at the same time, what's really also very interesting is, from the perspective of when I was explaining some of our work, and I was reflecting on Benyam's comments in particular, when it comes to thinking about refugees and policies, and children who are born into armed conflict. That is exceptionally challenging for us, because oftentimes, the children are tainted by the decisions of their parents, for which the children have no capability of being able to influence those decisions. And so, we need to think about that a little bit more clearly, because it has huge ramifications on the politics of this world, without a doubt. We witnessed some of these issues -- with reference to cases like the Omar Khadr case, and the divisiveness that that created in our country -- it is quite an incredible thing to witness. And, at the same time, comparing his condition to, say, children who may be child soldiers in an African context, carries a very different perception in our country. We have to question. Why is that? Why would we feel that way? And I wanted to highlight one key point here, Andy -- that I was reflecting on before coming in -- oftentimes, there is this blurring about when children join armed groups, whether it's abduction, or whether it's volunteering, that line in reality is not very clear. But somehow in our judgment of values, we make a distinction that, if a child somehow -- and we say, in quotations, 'volunteer', because it's volunteering under pressure -- that somehow they are less worthy of our empathy than those who have been abducted. And that is a problem, because in any of those contexts, the adults who use and recruit them are the ones to blame. As well, to think about it from the perspective of the systems that haven't protected the children, or haven't provided the education, or haven't provided the opportunities, as well. I just wanted to highlight that. I think there's so much for us to unpack in terms of those implications for policy and approaches that marry some of the points we've talked about earlier today.
Thank you so much. Gerlinde, one of the things that comes out of this, is that you have a terrible burden as a scientist working on epigenetics. Because, apparently, it's your responsibility to very clearly and succinctly communicate to a broad population what the implications of these mechanisms are, without going into the details that will lead them to be confused and lost. It's that issue of responsibility and science. I wonder what you think, based on what you've heard all the other panelists so far.
This is a great discussion. It resonates with me very well, because talking about the brain, it is our most complex organ, and it does develop for much longer than we previously thought. And I think your idea of 25 years is very correct. It might even be a few more years, according to the latest findings. But also, we have those critical periods of development, and those periods are quite early in life, and they leave an open window for opportunity to change the brain. And those experiences will be pre-imprinted on the brain, and will last a lifetime. And they cannot be erased, in terms of brain developmental changes that some experiences might leave behind. On the other hand, I'd also like to look at the brain as a continuously plastic organ, that changes throughout the lifetime and into old age, and is always receptive to negative -- but especially also positive -- experiences. I like Benyam's idea of breaking the silos and bringing together scientists from different disciplines to communicate this, and sit around a table talking about these implications, because we need to learn from each other, and communicate the implications this might have not only on our brain, but also on decision-making and moral thinking and ethics. It's a very timely topic. In general, what I am very interested in is this aspect of social support. And I think that is one of the most important influences on our brain. And we are incorporating that now into our studies. And that really resonated in this discussion very well, that we're putting all these different aspects of social support together to help our weakest members of our society.
Thank you. It comes back full circle to the statement that had very high impact on me at the beginning, from Rachel. You can have positive epigenetic effects, too. And the idea that the environmental impact of negative events can lay the foundations for difficulty, but positive events, psychotherapy done well -- and we probably don't have time to get into that, Rachel, but I know it's one of your areas of interest these days, among your broad set of activities -- the idea that we can use drugs and psychotherapy to engender brain plasticity, and accelerate or increase that process. Before we go to questions -- we have some very interesting questions -- and before we ask General Dallaire, to make a few comments, I want to ask you, Rachel, what you think about both the natural cycle of how we get out of the epigenetic cycle problem, and how much we can we can undo with time. My Indigenous friends, living in North America now -- the peoples that have lived here for thousands of years -- in their oral history, they tell me that, after a disaster -- and I suppose colonization would be one disaster they're dealing with quite loudly at the moment -- but let's say natural disasters: Famine, great fires, or floods. That in their oral histories, they talk about it needing seven generations to wash out of the system. And that resonates, in terms of a potential biological mechanism in the background. I wonder what you think about two things, the natural cycle of how things may regress towards the mean, if you like, in terms of getting away from bad experiences, if they are related to a particular event? And how hopeful are we that psychotherapy, and supportive intervention, and social support may be able to offset that within one generation? Thanks.
I think we're expecting too much from the concept of epigenetics, in terms of asking it to solve problems that it just doesn't solve. Epigenetics is the study of how genes are regulated. And what's gotten everybody excited is the fact that, in part, genes are regulated by environmental stimuli. Which we've always known. But the thing that's a little bit new here is that the environment can produce changes that are potentially more enduring than we thought. You talked before about the stress response, the HPA Axis, those reactions are meant to be very short-lived. In response to a challenge, your body makes a stress response, and then -- we've always believed that when the stressor is no longer there -- your body comes back to normal. And what epigenetics has done is taught us that, well, not so fast. There are some rather enduring changes. It's not like there are good changes and bad changes. They're just changes. It's the way you live your life, and the context in which those changes occur, that will determine whether these changes work for you or not. So the cycle of violence and intergenerational trauma, this isn't a biologic problem. The problem here is that we're torn, as individuals, between wanting a certain fidelity to our culture and community, and wanting to be part of something from the past, and also wanting to do our own thing. Or maybe wanting to be free to lead a different life. There's very little biologic determinism in that. I think there are cultural pulls and societal pulls. In people that see a lot of opportunity, or see a lot of lifestyle choices that are possible, they may be more inclined to say, "You know what, I don't have to keep living this way, even though my people have been doing things this way for a long time." But in people that don't see other choices, or don't see other options, these trends can be perpetuated. All epigenetics does is provide a language for explaining processes that we have always known are true, from a molecular and cellular perspective. That's all it does. When you do a study and show that there are epigenetic changes in association with something like intergenerational trauma, you don't know very much about what those epigenetic changes mean. You don't know if those changes are adaptive, or maladaptive, or whether they work well for someone's environment. All you know is that changes can be made that are the result of environmental exposures. And then policymakers -- such as Benyam, lawyers, people who are dealing with how to look at things and deal with adverse circumstances as they arise -- have to just understand that these environmental exposures can confer enduring changes that aren't so easy to get rid of. But it's still all about healing environments. I mean, the idea -- we're so intrigued by making epigenetic and biologic changes, but what we've really learned about all of this, is the importance of making changes in our social environments. And those are the things... [laughter] It sounds like it should be harder to make a biologic change than a social change, but it isn't. But that's where really, the important work needs to be done.
You know, Rachel, I agree with you in many ways, but one of the things I'd like to emphasize here -- and maybe this would resonate with Benyam's comments about being informed -- this has implications for what we think about free will and adaptive behavior. Because there are these forces that push people in a way that constrain their choices. Somebody looking at the work that Shelly has been doing, somebody that had these experiences, there are biological impacts that will move them down -- we are biopsychosocial beings, right? So the biological loading that we have will shift us, in a way, we see this with adverse childhood experience and the health trajectories of individuals who look at
But it's not the biologic loading, it's the experience.
They're together. You cannot take them apart. I'll be a bit challenging here and say -- and I don't believe you're saying this, but -- one of the simple and probably fallacious consequences of extrapolating your argument would be to say, "Everybody is the author of their own destiny." But for somebody who's been a child soldier and become a leader, who doesn't have insight, and has been led down the path of psychopathology, of course their choices are bound in, but some people are resilient and some people aren't. And therein lies the rub, in terms of the moral decisions about right and wrong and culpability, which is where Benyam lives. I understand that it's the environment that is overriding, but you have some pretty big forces that are difficult to beat, unless you have the information that comes out, from understanding epigenetics, and understanding the consequences.
One example I give is... using Canada -- as a Canadian, I'll fall on my own sword here and say, in terms of impressions of Indigenous people and the way they live, in the history of Canada, there has been a lot of discrimination and a lot of blaming about: Why do people live this way? Why do they do these things? And an understanding of epigenetics and the effects of cultural oppression has led people to a better understanding of why there might be increased rates of psychopathology related to drug misuse, and that kind of thing. It's not simply that these people have a choice. They have choices. The comment that Gerlinde made, about social support. With the right social supports and the right environment, people can recover and do okay, but society has to appreciate that. And the power of science is really important because without that explanation, one can be moralizing about a group, and actually discriminate simply based on their choices. So that's--
To defend what Rachel is saying -- and at the same time hearing what you're saying, Andy -- I do think aspects of our understanding of resilience from the social/ecological perspective are really important for us, in thinking through support, as well as policy implications. And those could be at a very micro, community level, but also to a more global standard we could think about. When it comes to children who are growing up in conflict zones, there's a really interesting study that I've often referenced from northern Nigeria, which was looking at children who evaded being a part of the Boko Haram insurgency, and -- some of the factors that are so incredibly important to look at there -- it's not about the poverty or the unemployment conditions in which they were exposed to, but had far more to do with access to power. State mistreatment of communities, or injustice, that they felt. A sense of purpose and social ties and belonging. Understanding those elements are also really important, setting the social conditions that can make a difference in whether or not someone makes a choice in what might be deemed a positive or negative realm. And so I just wanted to highlight that from our perspective, also.
I think that's very helpful. Perhaps we can move to questions for about 15 minutes, and then I'll ask General Dallaire to make some comments. And please, Romeo, if you want to get involved in answering the questions, of course, we'd love to hear comments. Ken Hoffer wrote--
Can I come in for a minute?
Andrew, can I come in for a minute?
Yes, please, Benyam. Yes.
Thank you. I know you say to us that we can--
Yeah, so let me come to two or three points. One is... from where I sit, looking at the implementation of the Convention of the Rights of the Child in 190-something countries, one of the biggest challenges -- and I agree with Rachel, when she said that, it seems like the biggest challenge that we're actually facing is changing our social environment. It seems to be the way. The way we behave. The way political leadership is going to be provided. You know, there are a number of countries that keep on saying that, you know, "We have very advanced legislation in Parliament that will be coming out soon." But that legislation has been there for 15, 16 years. Now, for children who were actually born at the time that legislation was introduced in Parliament, they're about to be adults. So they're not going to benefit from that legislation. When we talk about leadership, and when we talk about changing the social environment, one of the biggest challenges that we face, in relation to the conversation that we're having, is the manner in which mental health is undermined -- left, right and center. Let's be honest about it. Because the way mental health gets attention -- we can talk about stunting, malnutrition, and a whole range of other things. In the part of the world that I am from, they get the financial support as much as possible. But if you're actually talking about mental health, the possibility of getting funding -- from DANIDA, FILIDA, CIDA, USAID, and a whole range of other stakeholders -- is usually closer to zero than closer to one. So unless you have those resources, and of course, states have to be able to provide that. And in many instances, states themselves do not provide that. That's the first point. The second point: When we talk about 'breaking the silos'. Earlier, I talked about this differentiation that we make between disciplines and how one is not relating to the other intercourse. It's not just only those silos. It's also the silos that we're actually facing in relation to those that are working in human rights, those that are working in emergencies, and those that are actually working in development. There are huge silos in that category. I'll give you a simple example. Since we have the General here, I will come to an example from Zaire. There was a disturbing trend in Zaire, in ranking recipient's rights to aid on criteria other than needs, at that point in time. With different refugee groups deemed worthy and other refugee groups unworthy of humanitarian assistance. That was a clear indication how those that are working on human rights, those that are working on emergencies, and those that are actually working in development, were making that differentiation. And there is a tension there. In many instances when we talk about accountability -- whether it's in relation to intergenerational trauma, whether it's as a result of eugenics -- that division, and those silos that we have between the different service providers, seems to exacerbate. And add COVID-19 to it, and it's the best combination for disaster.
Oh, thank you so much for bringing up eugenics, because that's sort of what I was trying to say before. We don't want to put too much weight on the biology and on the epigenetics. We really don't. We've been down that road before. We've made that mistake before. We have to be different this time. Basically, the epigenetic and biologic work helps. For some people, it's very reassuring that there are biologic changes in response to experience. It may help understand, I think, individual differences, most of all. But, you know, the kind of intergenerational effects of horrible lives and communities and traumas, it's not something that is going to be solved in a molecular laboratory. It's just not.
Yes, clearly. Clearly. It's informative. It's useful. But social action is where things have to change. Absolutely.
That's where things have to change. Now, I'm not sure to what extent the biologic work can impact on social policy. If it does, terrific. But the hard work is the realization that, you know, biology explains certain things that might make certain choices more difficult. It might make certain things put in some obstacles. But I really reject this idea that trauma confers a biologic determinism that makes it very difficult, or makes it impossible, for people to get out of this cycle. I think why people don't get out of this cycle is because, from generation to generation, bad things keep happening. And nobody makes them better. And so, there isn't really something for people to hang on to. There isn't some template. There isn't some model for somebody to say, "You know what? Maybe I can live a different way."
You know, Benyam particularly has mentioned General Dallaire a couple of times, and we do have questions. But I'd like to weave the questions into the conversation. Romeo, I wonder if you'd like to step in now and make some statements that would indicate what your reflections are so far. And we'll continue, and we'll add some questions from the listeners also.
You were doing so well! [laughs] I'm glad to see Shelly there as part of this panel, for the depth of the work that's being done on child soldiers. And in fact, looking at the social action, to change the way people look at children in societies. Without just training soldiers to know the tactics and the methodologies of potentially making children ineffective as a weapon of war, but also of preventing the recruitment. But it's going deeper than that. It's actually attacking the cultural framework in which the children are growing up, that the adults have imposed upon them. And part of that is, in fact, showing that these children, at 13, are 13 with an AK-47. And that they are not a person that can be held to conduct war, where adults themselves are not even doing. So I think the social dimension is a critical aspect of the work of not only training people to do things, but also to change their mindsets on what they're looking at. And that often attacks, directly, the cultural framework in which they're in. And those cultural frameworks have got to be, at times, broken in order to reduce the impact that we're seeing on children.
The other thing is, I remember sitting on the Aboriginal committee in the Senate, and we were discussing the different aspects, and one of them was Aboriginal youth, and how they're seeing the future and so on. And we had an ex-Prime Minister who was a witness, who had been working on Aboriginal matters. And I asked him bluntly, I said, "Is it possible that Aboriginal youth -- with more being educated and the social communications that they have now, which permits them to coalesce, to be able to exchange far more than at any time in the past -- is it possible that they could become a security risk in the nation? Because of what they've seen, what their parents have seen, and what society has done to their culture and their framework?" And it was interesting that the prime minister said, "Yes, they can, in fact, become a security risk." And so, the social frameworks in which these youth are growing up in, are lining then up to become activists? Fine. Well, activists with a dimension that I consider to be extremist, and in so doing, is curtailing or preventing them from taking a balanced look at the future, and is setting them up, in fact, to become elements that might in fact, regress, ultimately, the future of their society.
And lastly, Shelly mentioned Omar Khadr. You know, it was beyond me why we couldn't understand, at 15, at 11, 15, being indoctrinated, the way they were. As I saw the Interahamwe being an indoctrinated militia, who conducted the slaughter in Rwanda. They were youths. That Omar Khadr was never wanting to be... having... letting people -- or, people were against him being recognized as a 'child soldier', because they kept calling him a 'terrorist'. That we created, in fact, another set of parameters of assessment, that went beyond any of the biological or social references that we have. It overrode everything, and turned the individual from a child soldier to a terrorist. And because of that -- it's interesting. 50% of the country did not ever believe that he was a child soldier, even though--
Romeo, that speaks directly to one of the points that Benyam made earlier, about the position of the child as a person with moral judgments. One of the people in the audience asked, "Do children have a moral compass?" And, "Are the impacts on children and individuals in conflict situations in any way analogous to the impact on somebody who would be in the armed forces carrying out their orders, and so on?" So, two questions there. They relate to the issue of accountability and culpability. Benyam, and Romeo, too, and the entire panel: Society has an obligation to try and be fair in its assessments of things, but too often we are dragged this way or that by common beliefs that are not based on real evidence. Whether it's societal evidence with some biological information thrown in, or not. And in the case of Omar Khadr, Romeo as you put it out there, he was a child. But people viewed him as an entity that was engaged in terrorism. I think most people who did were not considering his state of moral development, and development as an individual moving to adulthood. Benyam, I wonder if you could comment on that, to start.
Thank you very much. Very briefly. It's interesting when, when it is about children's voices, children's participation, children's issues that actually directly affect them. Children being able to bring a case before the court of law, children being able to give consent in relation to sexual and reproductive health rights, and so on and so forth. We often make the argument that they don't have the moral compass, they don't have the capacity, they don't have the know-how, they don't necessarily differentiate right from wrong. We make those arguments. And on the other hand, when it's about accountability, and culpability, and labeling, and so forth, we automatically jump the gun and want to actually attribute responsibility to children. What happened with Omar Khadr is a very clear example of this approach that we often deploy, when it's about accountability and responsibility. Many countries, a number of countries, Andrew, that are actually lowering their minimum age for criminal responsibility. That, as I said earlier, is the minimum age below which children should not be held accountable. They are making all sorts of these arguments. I know one African country where a 15 year-old in a 12 year-old raped a 10 year-old girl, and they pushed her off the third floor. Parliamentarians actually latched onto this, to make strong arguments why they need to lower the minimum age of criminal responsibility, from 14 to 10. Because they want to use that as an example. We've seen it in the Philippines. We've seen it in Maldives. We've seen it in a whole range of other countries, where specific incidents are actually taken to actually lower the minimum age. That approach that we saw in the context of Omar Khadr, is very much the same approach. That we want to downplay the capacity of children, when it comes to issues that actually matter to them, that they need to have a say on, that their views should be taken into account. That whole attitude that says 'Children are to be seen and not to be heard'. That approach, we often inculcate that and incorporate that in our legislation, in our lawmaking processes, in our policies, but also in our programs. But when it comes to accountability, that goes out of the way. And again, as I said, one of the positive things that we did as the Committee on the Rights of the Child was to actually look at the neuroscience in child development, and say to states that the minimum age that we had, which is the age 12, is not really coping with the science that is out there. And we actually need to raise that. And depending on where that science will lead us, that possibility to raise it might be coming in the foreseeable future, too. Over to you.
This is such an interesting area. We started out with -- I think it may have been you, Benyam -- people talking about the stages of dealing with this area, and one of them is recognizing the basic issues. And I go back to General Dallaire. The great impact of a senior leader in a western armed forces context, coming out and talking about moral injury, and talking about personal impact, and being able to start that conversation. That's the very beginning of the recognition. And I think that resonates, whether you're talking about children who have done things because of the environment they're in, that led them -- or coupled to those choices in that dance between biology and social choice -- or whether it's a soldier or a person acting in a conflict situation. Getting over stigma and recognizing in the beginning. But Romeo, there's a great price there, right? Because you come out and identify this. Society is not necessarily going to go, "Oh, thank you. Yeah, we'd like to understand." Because it's not the status quo. And so, we have to somehow move forward to deal with these issues and recognize them. Shelly made the comment that -- privately in a conversation before this, but again, in this conversation -- that there were leaders who'd had traumatic, early childhood experiences that led them, perhaps, to be in a position where they're likely to make choices that won't be optimal. Because those choices are governed by the attitudes and beliefs, partly because of the defense mechanisms that allowed them to continue. Romeo, you've been through that process of coming out and saying, "I've been damaged by this. People need to recognize that people need help." Having seeded that conversation. I wonder what you think about the way forward, and the balance of accountability and culpability. And thinking about helping people, whether it's rehabilitation for people who've done bad things, or therapeutic intervention, social support for people who are suffering damage from being placed in impossible situations.
There is so much to be said about people who work in a 'uniformed environment', be they military, or police, or firemen, or first responders. That is, based on a Darwinian perspective of performance and of expected capabilities, of their being nearly as Supermen, in regards to the extremes they could be faced with. There is no tolerance for what we can't *see* as an injury, and because of that, the whole dimension of moral injury, let alone PTSD as a starting point, was just not acceptable in the social structure of these organizations. And because of that, and it's incredible, that young soldiers -- who have not served, have not gone overseas, and are still in training or they're just new into the regiments -- are looking at these veterans and saying, "I will not be injured like that. I'm stronger. I'm not a wimp," as they would like to term. And not realizing that it's got nothing to do with whether you're a strong soldier, a weak soldier, or so on. It's got to do with the scenarios you are facing, and the ability to sustain the pressures of these ethical, moral, and often legal dilemmas that will simply wear you down and force you to even have to leave the environment, because you simply can't sustain the pressures of these fundamental stressors on you. When I went public -- first of all, I had to realize that I was, myself, injured and that came from a specific incident -- but I went public because there was a fundamental refusal, by legal and medical staff in the military, that the 11 suicides that we had had, among soldiers who had served -- particularly in Rwanda, but also in another mission -- that they refused to say that the suicides were due to the traumas and the experiences that they had lived in these operations. They would say "It's only one factor amongst the others." Not realizing, in fact, that this experience threw them over the edge. This experience went far beyond whatever predisposition might have existed there. And so, we refused to take care of them. And that's when I went public, and said that, "No. They killed themselves because of what they lived." And because of that, I believe that many of my colleagues continue, probably still today, to debate whether or not I should have gone public with that statement. And I, fundamentally, am convinced that unless we had looked at the injury of the mind with the same urgency as we did the other physical injuries -- because of course, the mind is physically affected too, like somebody losing an arm or leg or something -- we didn't create a M*A*S*H, as we do to save soldiers physically. If we don't create a M*A*S*H, and a sense of urgency to get at the mind of the ones who are injured psychologically, we will continue to sustain worsening psychological impact. And more casualties, because the scenarios which we're in are far more complex and far, far more obtuse and ambiguous than we've ever had before, and create these dilemmas that wear you down in your moral fiber.
Thank you so much. I reflect on the fact that, without your actions back in those days, we would not be having this conversation today. It was a pivotal moment in your life, sir. But it was a pivotal moment in our whole approach to moral injury, and looking at what happens in complex situations. And that has fed forward through the Dallaire Institute, and engagement with all of us, and lawyers like Benyam, around how do we go forward? And what do we do? [crosstalk] Please? Yes?
I think the research work that's ongoing, by the Dallaire Institute, supported -- finally -- by Veterans Canada, that we've recognized that it is a significant element of the operational capability of forces, to be able to face these challenging times and into the future. And that, unless we are far more knowledgeable on the impacts and how to attenuate those impacts, we are going to see more and more lasting casualties. And those casualties affect their families, and their families become casualties. And we're now at a time where we see psychologically affected soldiers, their families... teenagers in those families committing suicide, because they cannot live in that environment. And so, the Institute taking a strong lead in pursuing that need to reduce moral casualties is to me, a great step forward, and an essential one.
Thank you. We just have a few minutes left. And Rachel, I hope you forgive me for doing this, but I think the balance of information going forward -- we've talked about intergenerational trauma. We've talked about epigenetics. We've gone right up to the political level and talked about accountability and culpability. I wonder if you can maybe try and paint for us a picture or a message that you hope would come out of this conversation, around the way forward. And what people can hope for, taking into account the information that science brings forward. But the great importance of how we deal with this, socially, in terms of our social responsibilities. Those of us who are relatively well, those of us who are typical, and those of us who have suffered injury, could you make a summative statement for us?
I think the gentleman said it really well. That we don't have M*A*S*H units for people who have a psychological injury, or have a moral injury, in response to combat. And I think coming out and saying -- especially if you're a leader, and a General -- coming out and saying, "This affected me," really provides a tremendous amount of inspiration and reduces stigma, and gives a lot of people permission to understand that this is not a problem just for the weak. This is a problem. And that, because it is a problem, it requires a solution. Now what science can do, it can help us find a better, more efficient path towards solutions that might actually work. We can agree that we need a mental health response, but we may not necessarily understand what the proper mental health response is. And that's where our science comes in. Our science can come in to teach us about mechanisms of healing, how it is achieved. You mentioned before my new interest in combining psychotherapy with medicine, actually, through the use of psychedelic assisted psychotherapy. Because the science is offering us the ability to see novel mechanisms of action in the brain that might be relevant for healing moral injury. It might not be about just suppressing neuro-chemicals, which is the way that most people have spent decades, being prescribed by pharmacologists antidepressants and other medicines. And after all those years, maybe they feel a little numb. The pain is a little bit dulled. But they haven't felt like they have completely gone on the other side of their moral injury. That's what science is going to help us do. Science is going to help us identify novel healing mechanisms. And epigenetics and molecular psychiatry are really at the forefront of trying to teach us that healing isn't just about suppressing our symptoms -- our very natural symptoms, our very natural reactions to experiences -- it's about trying to find a way over to the other side, through mechanisms of neuroplasticity, of building something new from the ashes, literally from the ashes. And I think that's the purpose of having a dialogue that includes an interdisciplinary group. That we can begin to understand more concretely, what solutions can be like, after they're identified by leadership, by people who've served in traumatic situations, by people who have seen the dilemmas that are involved in these enmeshed and systemic, I would say, generational traumas. Really, you give us our marching orders.
Thank you so much, Rachel, that's very eloquent. You've covered all of this stuff we've talked about. It's been an honor to be here, moving around in this conversation. I thank you all for your wonderful, wonderful contributions. You're all very busy people. You're doing wonderful things for the public good. General Dallaire, it's always a pleasure to have you here. Thank you for all you do, and all you stand for. I'm going to pass it on for the last 30 seconds to Eric and Suzette. Thank you so much for giving us this opportunity. It's been wonderful. We look forward to the next piece of this series. Over to you, Eric.
Thank you. Eric?
I'll unmute myself, too. Here we go.
Yeah. Thank you all for your contribution. Andy, for facilitating, for moderating such a rich conversation. Rachel, for your contribution. Gerlinde. Benyam. Certainly, Shelly. The General. Thank you all for your insights. I just want to flag a few of the key words that we captured in the course of the conversation, starting off with harnessing new understandings of trauma to foster resilience and transformative change. A very powerful statement of what we can look forward to and in the seed-planting of hope for the future. The question of why people respond differently to various events, no matter what they're confronted with. DNA, not being our destiny, but our library. An opportunity, through science and biological signatures, to really predict who's more at risk, and what kinds of ways science can inform some of the interventions going forward. Looking at things from a biopsychosocial spiritual perspective. How we might be able to weave those pieces together and really look at it from not just an individual, but a bio, psycho, sociological, psychological kind of perspective that might be able to help inform things going forward. Really needing to look at culpability, responsibility. We heard about 'breaking silos'. Needing to be informed very strongly and squarely, from an interdisciplinary perspective, in order to be able to address larger societal changes in multiple countries from multiple different perspectives, and really break the epigenetic cycle and to move things forward. Looking at the social environment, the imperative to really look at the social environment and the important work that needs to be done in that domain. So 'breaking silos', interdisciplinary perspectives, but really the social dimension. I can't accentuate enough from all of you being really critical to understand where children come from, the different perspectives, the ways that adults have shaped the worlds and cultures that children grow up in, and how there's a lot of work to be done to really break the cycle in and through social constructs. Looking at leaders who are currently involved in different missions. Looking at the intensity of the ambiguity, the obtuseness of people who are being worn down in their moral fiber at times from being in these different kinds of contexts. Leaders speaking out. The imperative of that highlighted, General, about the importance of how your model, your witness has really broken down some stigma, given some permission for people to be able to address these situations and really change. But also to look at the imperative of looking at a variety of different kinds of injuries that people sustained. Not solely the more obvious ones are the visible injuries, but the invisible injuries that can have such dire consequences on individuals and families and societies and communities. That can actually impact children as well. And to see how that needs to also be shaped and revisioned. I'm going to ask Eric if there's any further things that you want to add.
Well, you summarized it well. Two things that I'd like to highlight, because they're sitting in my brain. That thing that Benyam said, "How is neuroscience going to inform the decision about accountability of children?" That is something that, wow, is it 10? 14? Where are we in this? And the other thing that Rachel set the stage for. The healing, and how can neuroscience contribute to an understanding of healing, and where that intergenerational information about trauma and stress has helped us to understand how that can be informative of healing. And many more. I think this is needed, this interdisciplinary approach, to complex, deep questions that we're dealing with. And the General summarized some beautiful cases that will keep us thinking.
Just one last comment. This is going to be followed, tomorrow, by a Critical Conversation about Moral Injury itself. And we will have four panelists. I'm just going to read their names. Dr. Jacky June ter Heide is a therapist and a senior member of Amsterdam's ARQ Centrum ’45, the National Center of Trauma Care for patients suffering from complex trauma in the Netherlands. We have Dr. Capt. (ret) William Nash, a clinical research psychiatrist from the VA Greater Los Angeles Healthcare System, and he's worked for the United Nations recently. We've got Dr. Tzeggai Berhe, the Chief of Psychiatry in Grande Prairie and the Interim Medical Director of the Queen Elizabeth II Hospital and an Associate Clinical Professor of Psychiatry, University of Alberta. And, last but not least, who set the stage initially years ago for moral injuries. Dr. Joseph Currier, a professor of psychology at University of South Alabama (USA) and clinical director of Veterans Recovery Resources. That's a mouthful. Again, also from my perspective, I do like to, with Suzette, thank the panelists again -- Shelly Whitman and Benyam Mezmur and Gerlinde Metz and Rachel Yehuda. And of course, it's delightful to have you always with us, General Romeo Dallaire, with your brilliance and your comments. And also thank you for your excellent moderatorship, Andy. Andy Greenshaw. Good to have you with us. We've gone over five minutes. Sorry about that. So I'd like to close this session. It is going to be recorded, and can be livestreamed or can be viewed back, I think it's going to be 24 hours, from the Leiden University website where you can watch this. Send a link to everybody who may be interested in this webinar. Suzette, was that okay? Do you want to close, here?
Just in closing, I look forward to joining Dr. Alexandra Heber tomorrow, who moderates the session with-- [crosstalk] Yeah, so Dr. Alexandra Heber, the chief psychiatrist for Veterans Affairs Canada and an associate clinical professor at McMaster University. So we'll join her tomorrow. We'll see everybody then. Have a good rest of the day. And, again, thank you earnestly to our moderators, to our panelists, and dear General.
Thank you all.
Well done. Well done, all. Thank you ever so much.