Moral Injury Support Network Podcast

The Unique Challenges of Moral Injury Among Female Veterans: A Conversation with Dr. Rita Nakashima Brock

• Dr. Daniel Roberts

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What if the journey to recovery for servicewomen is more intricate than we thought? Join us for an extraordinary conversation with Dr. Rita Nakashima Brock, a prominent authority on moral injury, as we uncover the deeply personal and unique experiences of female veterans dealing with moral injury. Through powerful storytelling, Dr. Brock illustrates the implicit biases that can hinder effective support, sharing a moving example of a veteran who, despite losing her legs, yearned to wear high heels. This episode shines a spotlight on the need to address gender-specific experiences to foster genuine healing and recovery.

Explore the profound impact of unresolved moral conflicts on one's conscience and how these can lead to moral distress and injury. Dr. Brock provides a nuanced differentiation between moral injury and PTSD, sparking a debate on whether moral injury should be medically diagnosed. We also delve into alternative cultural approaches to moral suffering and discuss protocols tailored for veterans that focus on acceptance and processing rather than attempting to erase the past. Learn about the therapeutic benefits of group support, as highlighted by a pilot program for female veterans, and how it adapted during the pandemic to continue aiding those in need.

Gain insights into the pioneering work of the Soul Repair Center and its diverse, religiously-informed approaches to moral injury and recovery. We discuss the center's comprehensive program for professionals and share stories that underline the complexities of moral injury. From the transformative journey of a chaplain at a psychiatric hospital to the life-long influence of compassionate religious leaders, this episode is a testament to the resilience and profound change that can come from addressing moral injury. Don't miss out on our preview of the upcoming Comprehensive Moral Injury Conference, featuring an array of exceptional speakers and the invaluable contributions of Dr. Brock and Volunteers of America.

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Learn about the 2024 Comprehensive Moral Injury Conference  

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Jamie Peer (LTC-Ret.):

Okay, hello, and welcome everyone to today's edition of the Moral Injury Support Network podcast. I'm your host, us Army retired Lieutenant Colonel Jamie Peer, and I'm joined by my co-host and the founder and president of the Moral Injury Support Network for Service Women, dr Dan Roberts. Today we have the privilege of welcoming a very distinguished guest to us, dr Rita Nakashima Brock.

Jamie Peer (LTC-Ret.):

Dr Brock, it's an absolute pleasure to have you on our podcast today and we want to welcome a true luminary in the field of moral injury. In the field of moral injury, today we are getting to highlight the impactful work that has left an indelible mark on the lives of those affected by moral injury. Dr Brock is the Senior Vice President of Volunteers of America for the Moral Injury Programming. Her dedication to addressing moral injury is exemplified through her remarkable contributions, including the establishment of the Soul Repair Center, and her extensive experience conducting trainings for professionals of diverse backgrounds. Her expertise has empowered countless individuals to navigate the complex terrain of moral injury, providing them with invaluable strategies and resources for healing and recovery. So again, dr Brock, thank you so much for joining us today and to our audience, buckle up, because we're about to embark on a journey of understanding, healing and support, under the expert guidance of Dr Brock Dan.

Dr. Daniel L. Roberts:

Hey, Dr Brock, thanks so much for coming on our podcast. We've been kind of watching your work and the work of VOA and the Shea Center for some time now and you all are very, very much leading the way in moral injury research, moral injury education, support, all those kind of things, and I know you're doing a lot to help others who want to work in this space. So we really appreciate you coming on and look forward to just hearing from you and talking about things that can really help people that are listening. So thank you very much. I'm a big fan and I appreciate you taking the time today.

Dr. Rita Brock:

Oh, thank you. It's really a pleasure to be with you, and I also think that normally when people start talking about veterans, they gender it as masculine veterans they gender it as masculine, and I think there's more emerging research around service women and service women veterans. That is important to understand that gender is a factor in how moral injury operates.

Jamie Peer (LTC-Ret.):

Yeah, yeah.

Dr. Rita Brock:

Absolutely moral injury operates. Yeah, yeah.

Jamie Peer (LTC-Ret.):

Absolutely. I think I appreciate you saying that because that is a big passion of mine is just the nuances of the gender experience in the military.

Dr. Rita Brock:

And how it's not very well equipped to deal with this Right. It's great on some things and on other things, it just needs to. It's got a long way to go. Let's put it that way, yeah.

Jamie Peer (LTC-Ret.):

And that is a big part of why we exist. And and again, I appreciate you saying that, because I have often encountered people who don't, who don't understand the military experience and it's not their fault, right, but they don't understand military experience first, off off, and then layering the complexities of being a woman in the military, just a woman in our culture in general, yes, right and then they have the military right. Yeah, um, and there are.

Dr. Rita Brock:

There are definitely very specific uh things that yeah military service is kind of a gender bending occupation, as it was for a woman, right it's. You enter a culture that's. That's strongly mascul, that people don't think about women as a separate group. It's the way some VAs don't have an OBGYN on staff, things like that. Those are things that administrators might not even think of because a lot of them are male.

Jamie Peer (LTC-Ret.):

That you know, administrators might not even think of because most, a lot of them are male.

Dr. Rita Brock:

Yeah, so, and it's not. You know, it's what is called implicit bias. It isn't deliberate, it isn't. It isn't ill-intended, if necessarily it's, it's just an implicit bias.

Jamie Peer (LTC-Ret.):

Yes, yeah, I feel like we could do a whole series of podcasts with you well, yeah, I've worked.

Dr. Rita Brock:

when I worked in Fort Worth Texas with when I started the Soul Repair Center in 2012 in Fort Worth Texas, there was a Air Force fighter pilot named Kim Olson who was just retired and she was advocating for women veterans and she told me this very simple example of a woman who had lost both her legs and she was in a hospital in San Antonio and she was physically recovering but was clearly depressed and the staff in the hospital really liked her a lot and were really concerned about how depressed she was in the hospital, really liked her a lot and were really concerned about how depressed she was, and so some at some points, someone tried to talk to her and married might have even been him and she and what she said was will I ever be pretty again, which is, you know, that's a serious like transitioning back to civilian society as a female.

Dr. Rita Brock:

For a a lot of women, that's an issue how to become more like, how they think a woman should be like, and so when they sort of pressed on that a little bit, it was that she wanted to wear high heels and there were no prosthetics for that high heels and there were no prosthetics for that. So they asked the guy at the hospital who made the prosthetics if he could make a foot on a prosthetic that could wear high heels. And the guy said I've never tried but let me see. And he was able to make her feet that would fit in high heels. So the staff bought her a pair of Prada shoes so she could walk out of the hospital in high heels.

Dr. Rita Brock:

oh, my god right, but but no one ever who would have thought of that, right? Um, that women's feet they're not generic feet, right so, and not all women want to wear high heels, but in her case, she wanted to and, um, uh, and they, they, they made that possible for her, and I know that that they understood they hadn't, hadn't considered what she wanted to in terms of what she needed to feel.

Jamie Peer (LTC-Ret.):

Okay, yeah, that's yeah, it's very interesting. And yes, I mean, I think there's so many. That's extremely nuanced, nuanced example. I personally try to stay out of high heels as often as possible to break an ankle, but but from the moments where you know I go to a with my husband, who's six five, I can wear high heels and you know I I will do that for that. But to think that I would never be able to do that again, yeah, unless I had advocated for myself and asked for it. But that's another challenge that you know, culturally and societally, women are often reluctant to ask for what they want because we've been trained to wait to be asked to the prom, wait to be asked to be married, to be asked to the prom, wait to be asked to be married.

Dr. Rita Brock:

It's very forward. So yeah, that's very interesting.

Jamie Peer (LTC-Ret.):

There's a book about women and salaries in corporate America called Women.

Dr. Rita Brock:

Don't.

Dr. Daniel L. Roberts:

Ask Yep. I've read it and part of it.

Dr. Rita Brock:

Yes, exactly, yeah. We just hope that people will notice that we're good and offer us better pay. Yep.

Jamie Peer (LTC-Ret.):

If they just work harder, they'll see me. Doesn't normally work that way. Yeah, yeah, okay, so I'm going to launch into some of the questions that I had prepared, but if this is a completely different track, that is absolutely okay, no, but there's gender differences with moral injury as well.

Jamie Peer (LTC-Ret.):

Yes, yes, Okay, so we know that this, you know, the study of moral injury has been being conducted for several decades and you, as we discussed, have been working in this field for about a decade and a half yeah, field, for about a decade and a half. But as we talk to individuals, we, you know, we know that this is still a very new concept for many of our listeners and so and there's lots of definitions, People have different definitions for this. So, you know, as one of the leading experts, we would love to hear you know your definition of the concept of moral injury. The leading experts, we would love to hear you know your definition of the concept of moral injury. And and then we'll dive a little bit deeper into what you've learned about impact on combat, veterans and other populations. So, for starters, you know what is your, what is your definition of moral injury?

Dr. Rita Brock:

Well, let me begin by saying anybody with a conscience will have a moral conflict, sometimes several a day. If you have a conscience and things bother you, you try to figure out how to deal with them and often if it's something wrong you've done, you apologize or you try to make it right. And the same if people do that to you, they try to make it right. That's how we establish normal, healthy relationships is our conscience guides us and so that's not an unusual thing. But sometimes you hit a moral conflict you can't fix Like it's. The damage is done. You have to figure out, maybe you can make recompense or do something to write or receive an apology or something. But sometimes the unfixability of something or a whole lot of moral conflicts that pile up that you can't deal with, can cause you moral distress so you may actually start losing sleep or it can affect the quality of your life.

Dr. Rita Brock:

Those are all normal, regular things that happen to human beings. But if you get too much of that or something catastrophic happens like one huge thing. Like I've talked to a group of people who have killed someone in a car accident, how terrible they feel about it. In a car accident, how terrible they feel about it, you can get to the point where you doubt your own goodness, where you wonder who you are as a decent person. You would think maybe what you used to believe doesn't work for you anymore. That's moral injury, where you're in an identity crisis, your meanings and values are challenged and threatened, and it's painful, it's very painful.

Dr. Rita Brock:

You can have feelings of guilt or shame or outrage, that anger at something out that was morally violated, that makes you really angry, and to deal with those feelings is hard work, and so a lot of people just try to set them aside and keep going. But, as one person said, if you bury those feelings, they don't die. They just sit in there and stew. And that's what I would call moral injury is that sense that you're carrying something pretty horrible and you haven't figured out how to deal with it, and it's weighing you down to the point that you may avoid it by overworking, drinking too much, taking drugs, thinking about killing yourself, avoiding relationships that remind you of things that might provoke you to have to address those things. So it's a serious suffering, but it's not a disorder, because you're actually responding to a real thing, right? So there's a sort of dispute going on in people who work on this. Whether it should get a diagnosis and a protocol so it can be treated is whether it should get a diagnosis and a protocol so it can be treated.

Dr. Rita Brock:

And because it often occurs with trauma or with PTSD or other things, I think it gets confused with them. But you can have moral injury and not have any of those things Right and suffer a lot. But the crazy thing, I think think in terms of that is if you're suffering that way because of some devastating experience, it actually means a good part of you wants back out. So so it's not that you're broken or disordered, it's that you. You just suffer and suffering is awful. But the only way to get past the burden of that suffering it's not like you can erase what happened. It's not going to go away if you feel better. So you have to figure out how to process it and accept it in a way that it doesn't run your life. It doesn't run your life and that takes time. It takes trusting someone else or trusting in some way that helps you process it.

Dr. Rita Brock:

And so we've developed Jonathan Shea, who coined the term in 1994, moral injury. He actually worked with us along with seven other experts to create a moral injury processing program that we developed before the pandemic. It ran a two-year pilot. Then we had to shut it down because of the pandemic because it was in person. Um but uh. But what we did was create small groups with veterans, facilitating the groups to help people process moral injury, and we got pretty good results.

Dr. Rita Brock:

And by the way, our first group was all women.

Dr. Daniel L. Roberts:

Oh, yes, yeah, I appreciate the conflict between DSM or not DSM and I can see the benefits of both, but for me it's like, as soon as you put something in enough context and enough things and enough people, and the other thing is well, what do you do with all the other people?

Dr. Rita Brock:

that don't meet the criteria, that are still suffering. That's right.

Dr. Daniel L. Roberts:

Yeah, yeah. So I'm not a fan of putting in the DSM, but I do see, I do understand where people are coming from. You know it's the chance to like, from a VA perspective, get a rating, get some funding, get some specific support. But I, but you know, I think the cost in terms of the human cost or the the you know, outweighs that. Yeah.

Dr. Rita Brock:

And that's also true that I think moral suffering is an ancient affliction and there are actually other cultures that have ways of dealing with it that that aren't the medicalized Western model, which is one model, right. And I actually appreciate the VA clinicians, like this woman, shira McGann she actually studies gender issues for veterans, right but also like the Brett's LITS team, where they've actually suggested a protocol, where they've actually suggested a protocol, sort of a protocol, sort of a treatment program for clinicians who are already treating veterans who have like PTSD or an actual mental health diagnosis, that you can help them deal with the impact of killing or the affliction of conscience by using a different method embedded in the therapy process. But it isn't the prescribed therapy for PTSD, for example. So in McGinn's impact of killing protocol she suggests to clinicians if you have a combat veteran who's talking about having killed, you can assume they might have some moral injury around that because they have double the suicide rates of other veterans. So they know that's a major suffering. So she says so you aren't going to fix it, you aren't going to take back what happened, so you have to treat it in terms of like accepting it. And so she has a 10 step protocol that includes things like writing a letter of apology To put the harm you did and things like that, which which I, you know it's like that's really helpful if you if you are a psychiatrist or a clinician and you don't understand what this is going necessarily going on with your veteran, if you're treating them, that this might be an issue and then you can explore it with them.

Dr. Rita Brock:

But someone who just has is this experiencing moral injury, feeling miserable about something that happened. They may benefit from something else. So I have a colleague that I met at a humanities seminar on veterans. He was an Iraq veteran who was treated by the VA for PTSD. He said that PTSD treatments were really helpful for managing his symptoms but he still felt miserable, that something in him felt utterly miserable and he couldn't figure out why. And somebody told him about this Lakota sweat lodge process and that there were some Lakota leaders who were willing to have non-Lakota veterans in their program. So he went to that and that process is what finally got to that sense of how miserable he felt. He felt so much better after going through that because it was in a group with other veterans. It was just a very different process than the PTSD treatment, and I think that there are cultures and ways of being that sometimes can supplement or replace what the Western medicalized model tries to do.

Dr. Rita Brock:

And when we work with moral injury, we try to attend to all these multiplicities. And a lot of the people we train are social workers and chaplains, so we like to give them a good, as it were, arsenal of things to try, because not everything works for everyone. Someone else might go to a sweat lodge and not experience it as all that helpful, but so it's not a one size fits all. I had an argument once with a psychiatrist about you know the way we were trying to do this sort of multidisciplinary approach, and he said and I said, we use some ritual things. And he said, well, ritual doesn't work for everyone. And I said, well, maybe it's psychotherapy. And then he said, well, yeah, that's true, right? So even though the ones that are evidence-based, don't they're? They're statistical and they're the it's, it's, it's the middle that you get. With the statistics you don't get the miracle stories or the failures.

Jamie Peer (LTC-Ret.):

Right, right.

Dr. Rita Brock:

Right yeah, so so yeah.

Jamie Peer (LTC-Ret.):

I appreciate that a lot because you know, just in my own experience, um, when I retired, I I had already done, you know, clinical type psychotherapy and cognitive based therapy and I and in some ways it was triggering for me to go do that again with somebody new because I I didn't want to have to share my story again and go and I, you know, it's just that that experience is really hard.

Jamie Peer (LTC-Ret.):

But the things that I went and pursued, first of all, I went with an open mind and an open heart, which helps. You know when you're going into a situation that you don't really want to put yourself in, you know when you're going into a situation that you don't really want. That was very healing for me. And so Dan and I have extensive conversations about how can we pull in as many modalities as possible and basically offer a smorgasbord to anybody who comes to us to say you know, this is what this is, you can try it. If it helps, that's great. If it doesn't, we've got other options. We don't want to just be a one-size-fits-all solution, because that's just not yeah yeah veterans have so many different ways they recover from from their experiences.

Dr. Rita Brock:

It's there, isn't. I mean there's different cultures, different personality type. I mean it's just there's, it's. Human suffering is a complex thing.

Jamie Peer (LTC-Ret.):

It's very unique to every single individual, that's, everybody's got a lens by which they perceive.

Dr. Rita Brock:

The thing we found is, especially with veterans who shared military culture, they have some sense of a shared past experience. Where they will if they're with people who shared that, they are more willing to trust a group of other veterans without a civilian or a fix it person in the room. And so we do all of our programs as peer facilitated and we just train the veterans on how to run the program. And I think there's something magical about going through a horrifying process of coughing up your moral injury and trying to process it and tell the story and all of that when you're in a group that believes you, doesn't think you're bad, doesn't judge you but really empathizes. And that process with the group somehow has this capacity to help people get better without the individual having to do it themselves.

Jamie Peer (LTC-Ret.):

Yeah.

Dr. Rita Brock:

Yeah, you actually feel the whole group shifting and you shift with the group, which is really different from therapy. Yeah, yeah. And I know we had a veteran go through our program who had been under psychiatric care for 27 years.

Dr. Rita Brock:

This is what he told us. And he said you did in five days what 27 years of psychotherapy wasn't able to do. He said I feel like myself again. He said how did you do that? I didn't want to explain to him, but I said well, we didn't do it. Your group did it for you. Right, it carried you until you could get there.

Jamie Peer (LTC-Ret.):

Yeah, right, yeah. So could you share some other examples of initiatives that your organization is undertaking, specifically your recovery programs?

Dr. Rita Brock:

We have. We have several. We're in the process of trying to restart our what I call Cadillac, or flagship program that we did the pilot on for two years. It's an extensive, retreat-based, 50-hour program and I think that's especially effective for people who are carrying other traumas. So when we so with the first, when we ran that pilot, our, as I said, our first group was female.

Dr. Rita Brock:

Everyone was um female and um, I think most of I think they were in an affordable housing system that Volunteers of America ran where they uh it was for uh veterans with children, um, and so some of them have been recently unhoused, living in their cars and things. So they were struggling with a lot of issues. It wasn't just, well, I wouldn't say just moral injury, but that was one of the things they were struggling with. And we didn't expect our first group to be all women. It just happened to turn out that way and we didn't expect our first group to be all women. It just happened to turn out that way and we had trained a male and female to facilitate the group. And then we got nervous about the possibilities of military sexual trauma and whether those women would be comfortable talking about that with a male facilitator, and so we told them it's fine if you don't want him to be in the group. He won't take that personally. We want you to be comfortable and safe sharing. If he's okay now but later on you decide you don't want him there for a certain part of the time, that's okay too. So so that they would feel okay around. If they had military sexual trauma and and there were stories, that of military sexual trauma that surfaced in the group, but they never asked him to leave and in fact they liked him just fine so. So that was kind of heartening to me that it was okay.

Dr. Rita Brock:

And at the end of the week they asked if they could have a session in the evening to burn all the things they needed to let go of, which was a wonderful ritual they helped us design where each one wrote the list in the afternoon and they came to the ritual with a piece of paper with everything written so they could put it in the fire and watch it burn away. And one of the startling things was that a member of the group read the letter she wrote to her rapist forgiving him, and it was really powerful. Not every woman in the group felt that they needed to forgive, but that that was what she needed to do and she was able to accomplish that. In the group Another woman shared and this wasn't confidential in the group, it was at the burn and we were all invited to be there but she also shared about the traumas from her own childhood, which were pretty severe, and what she said and she also included in that what happened to her in the military, which she was sexually assaulted in the military and also went to prison.

Dr. Rita Brock:

So I mean, this was a list of traumas that I couldn't believe one person had survived. And what she said was I realized this week that I have had so much pain in my life that I did not feel like myself if I wasn't in pain. Yeah, and she said, I realized this week I do not have to be in pain, so I am burning my pain.

Dr. Daniel L. Roberts:

That's awesome.

Dr. Rita Brock:

So there were things like that, right, and I and you know we had high hopes for this program. They were our very first group. What they did was so amazing to me. It made me believe that this really would help. And so, and it won't. And we, but we had a science, you know. We did the evidence-based piece as well. They filled out surveys and the results were really quite, were actually better than my expectations for the program. Yeah, so, so that may be, that sense of being in a group, being believed to the point that you would share the most awful things from your life and be able to unload some of that and process it in a way that it no longer, as it were, caused you to live in a constant state of pain, is a really powerful gift they gave each other.

Dr. Rita Brock:

Yeah, the retreat programming and creating the intentional space and time we're working on restarting that, but we do have spaces online because when the pandemic started, we realized we needed to do something, but we also knew that people weren't going to have 50 hours, so we actually created a one hour program based on what the facilitators for our huge programs that if you only had people for an hour, how would you help them and so they gave us some advice and we put together a one hour processing program called Resilient Strength Time and it's REST R-E-S-T is the short term for it. It's called REST and it's free and it's online and we have meetings for veterans only every week and if a group of women wanted to go and sign up for a group together, they could create their own group and it's facilitated by veterans. That sounds wonderful and there's been some interesting relative like last year, some research published around moral injury and some of the ways that gender impacts moral injury, and you know, jonathan Shea was the one that defined moral injury as being betrayed by someone in authority who violates what's right in a high stakes situation, and you could consider military sexual trauma also a kind of betrayal by when it's somebody in your unit. You're supposed to be able to trust them to have your back and protect your life, and so when they assault you, it's devastating. This is a devastating betrayal, and it turns out that women veterans have a pretty complicated relationship to betrayal, as moral injury that relates partly to experiences of military sexual trauma and and partly the genderized nature of military experience can be hard on women sometimes too, um so uh in.

Dr. Rita Brock:

In terms of men, evidently the form of moral injury that's most devastating is perpetration. Where they do something like kill someone or do something, they have a very strong reaction to perpetration, more so than betrayal, Sort of flip gender-wise that women have a stronger relationship to betrayal. They also have higher rates of attempting to die by suicide than men do. So those are all all gendered factors in the way moral injury works.

Jamie Peer (LTC-Ret.):

Yeah, okay. So my next question is with regard to the soul repair center, which you founded, focused on research and education related to moral injury and recovery. What were some of, what are some, or what were some of the most significant findings and insights that emerged from that center's work?

Dr. Rita Brock:

um. Well, the research we did was on the piece that I just talked about, the the um. So we're um, we, we all. But we also try to stay on top of the literature. There's just a huge amount of literature out there. So we created at our website a resources page that is curated and updated all the time as new research is published on moral injury and we bring that material into the certificate program we offer.

Dr. Rita Brock:

We have a 50-hour, 10-week certificate program in moral injury work and so we get chaplains and social workers and clinicians and clergy and college professors. There's been an interesting array of people who've come in to take that certificate program and so what we provide them with is the research we've done on what's current in moral injury work and we have lectures provided by various experts in areas that help inform them in that multidisciplinary way, in areas that help inform them in that multidisciplinary way. So we have Buddhist approaches to moral injury, we have Muslim approaches to moral injury, jewish approaches to moral injury lectures. We have stuff that's more clinically oriented, we have stuff that's more religiously oriented so that people can get that array of a sense of what's out there. So that people can get that array of a sense of what's out there.

Dr. Rita Brock:

So our research is around what's out there, as well as the research we did, and we're also trying to create a new research project to test several versions of that program that we created originally.

Dr. Rita Brock:

But the thing that's also awesome is in that certificate program the people come in, they do their own research and then they create a capstone project that they want to take back and try out in their workplace based on their own research. Like, for example this was a thing I would never have thought of is that a woman who was a chaplain at a psychiatric hospital noticed that people who got better, who were getting ready to be discharged so now they've been helped from their mental health diagnosis, they've gotten better she said they started to get moral injury as they were leaving because they started to feel terrible about what they had done to their families, and so she thought she thought maybe I should have a moral injury program for people being discharged so she set up a small group process, um, that that people could do for a few weeks as they were getting ready to leave the hospital, so that they would understand what the experience of feeling miserable after you've gotten better is.

Dr. Rita Brock:

And it also made me wonder sometimes how you hear about when people are deeply depressed. As they take antidepressants, they start to feel better, that's, they're more likely to die by suicide at that point, and I it that made me wonder. Well, maybe it's because they have the energy to feel terrible and guilty about things all right before they're too depressed, they're just flat. But as they emerge from that, um, so that that was such a creep, you know, like it was a way of thinking about getting better from a mental illness. I had never even considered that you might actually suffer from getting better.

Jamie Peer (LTC-Ret.):

Yeah I love that.

Dr. Rita Brock:

I mean it works with, with um. Often with know in AA people have to face into the harm they've done.

Dr. Daniel L. Roberts:

Right.

Dr. Rita Brock:

So I think that there's those kind of paradoxes that come out of this certificate program, but also just we have military chaplains who are trying to set up programs to help military chaplains with moral injury, because we don't. It's like chaplainsains supposed to help everybody else but you can also experience it yourself. So there's lots of things like that that I think are really important dimensions of understanding moral injury, that people who seem strong and competent may have serious cases of it.

Jamie Peer (LTC-Ret.):

Absolutely as a way of overcompensating for their guilt and shame, they try to work harder. Yeah, yeah, I, I can relate to that.

Dr. Rita Brock:

The other one that's awful is that toxic anger, yeah, that sense of being outraged and not trust, being able to trust anybody, and, uh, and living in a state of stewing and anger. It's just really bad for you, physically as well as emotionally, for sure. Yeah.

Dr. Daniel L. Roberts:

And the thing about what's interesting about anger is as someone who in the past struggled a lot with toxic anger is it energizes you, right? So you can get this sense of high and power from your anger and once you experience that, it's very difficult to let go of it and so people start talking about loving and forgiving and caring about people. That sounds soft and weak and like you're giving up the thing that empowers you to do, especially since you can succeed and achieve a lot with that anger. Eventually it's going to get you. Eventually it's going to exhaust you, it's going to spiritually. You know it's like it's gonna. It's like, you know, having a credit card with a big, a big, you know you have a big limit on it and you're spending, spending, spending. Eventually you're going to run out of limit and then you're going to be in trouble, you're not going to be able to pay whatever. So that that kind of anger, you know, can be very helpful at a certain period of your life, especially if you come out of a period maybe of disempowerment, like for kids, like leaving home maybe they were at home very disempowered and then you joined the military right, thinking you're going to get to be your own person or whatever, but you develop this anger and that anger serves you well.

Dr. Daniel L. Roberts:

As someone who spent many years in the infantry, I like to say we hated everybody, we were angry at everybody and everything all the time. But that's not totally true. But even our esprit de corps was often anger-based, right. So, like that, anger can really serve you well, but at some point it just depletes your soul, your spirit. However, you want to think about it mentally, and then where do you go now? Especially if you leave that organization or that place where the anger is so useful and you want to try to go do something else or have good relationships, a good marriage and all that kind of thing, then it doesn't serve you very well, but it's can be difficult to let go of because you've used it as an empowerment mechanism for so long. So so that's a little bit of a sidebar, but it's just no it's that anger.

Dr. Daniel L. Roberts:

It's a good point to mention that people don't think about you know dad.

Dr. Rita Brock:

It certainly affected me and my family. My father came home from vietnam after a second tour dramatically changed in a way that I didn't. He was mean and controlling and I didn't want to be around him. Um and um and so and I was angry at him for the way he was treating me. So I decided not to live at home again because I was just started college when he came home from Vietnam and it took me years to realize how alienated I was from the rest of my family because I wouldn't live at home anymore. Yeah, because I didn't want to be around him. And he actually died of a heart attack eight years after he returned from Vietnam and we never had a conversation about any of this. He just years after he returned from Vietnam and we never had a conversation about any of this. He just died.

Dr. Rita Brock:

I was in Switzerland. I went as far as going all the way to Europe to get away from him. I don't think I was consciously thinking in those terms, but I you know it was a person I was with at the time got a postdoc in Switzerland. So I went with him, didn't think for a minute what it meant to leave my family for two years or to leave the US for two years. So yeah, it's that kind of I think he I realized he had moral injury.

Dr. Rita Brock:

It took me a long time to figure that out. One of the reasons I work on moral injury is it so impacted my life and family. Because I had a veteran for a father who was deeply impacted by a terrible war. He also fought at Normandy as an automatic rifleman, but when he met my mother he'd come home. He he made it through the end of the war. They sent him home to Walter Reed and gave him electroshock and so then they sent him home to Mississippi and he was there uh, I think it kind of catatonic for about six months and then he slowly recovered. So by the time he came to Japan and met my mother he was as recovered as you could be from that kind of an experience. He was fine I'm not fine, but he was functioning and managed to have a good life with my mom. And then Vietnam two tours there just wrecked him again.

Jamie Peer (LTC-Ret.):

Yeah, yeah, and thank you for sharing that, because that was my next question, you know, and I realized it was a little bit more personal, so I'm glad that you brought that up. But I have found, as we discussed earlier, you know, the incredible people that find themselves in this work typically have a big reason why you know people that end up being cancer doctors it's because somebody in their family had you know that was very important to them died of cancer or, you know, struggled. So you, sharing your father's story about him, I'm sure had something to do with it. I'm also curious, as a theologian how does your background and expertise in that and your own culture inform your understanding of moral injury and its potential?

Dr. Rita Brock:

It's an interesting question. I've had to think about that a lot because it's a sort of odd thing for me to have wandered into a PhD in theology after I went to college to be a neurosurgeon. I was a pre-med oh wow, that's so interesting. But I think partly it was the influence of a Japanese grandfather who was really deeply part of my life. I lived with my mother and I lived with my grandparents and my grandfather was a Buddhist priest, and I think that how I was treated by my grandparents with kindness and care made coming to the United States, to Fort Riley Kansas, a bit of a culture shock. I went to Fort Riley, kansas and so American culture was just very different. But I remember going to Sunday school and the base chapel because my stepfather was Protestant if you didn't believe that Jesus died for you, you'd go to hell and whatever, and that only the people who believed in Jesus would get to heaven. And I thought I remember thinking, oh, I'd just rather be with my grandparents wherever they were. And so Christianity didn't make a lot of sense to me as anything I wanted to be part of for a long time and I had a really great Baptist minister in high school. That was different. He was very loving and kind and anyway I wound up getting baptized.

Dr. Rita Brock:

But I wasn't what you would call particularly pious or religious and I wasn't that interested in continuing with that until I got to college and the intellectual study of the Bible and the history and the theological questions were interesting to me, enough that and I was involved in the civil rights movement also in college and that. So there was a convergence of the justice and mercy traditions around Jesus and Judaism that hooked me to realize, oh, this kind of concern for the well-being of other people and human suffering is a very old tradition, that working to stop the Vietnam War, working for racial justice, wasn't something ephemeral and new, it was really grounded in a very, very long human history of care. So I got interested in religion. That way I had a great professor talk me into grad school in religion. That's how I got into religion.

Dr. Rita Brock:

But my project from the time I entered seminary to the time well to still, is to challenge the whole idea that God is the kind of God that would require torture and murder for people to be saved. Yeah, and that idea that the crucifixion of Jesus Christ was some kind of saving event sanctifies violence, and so my project has been to challenge that idea, and the last theological book I wrote in 2008, called Saving Paradise, was that I discovered that for the first thousand years of Christian history they really didn't believe that, that that got imposed as an ideology by penalty of death during the Crusades as a kind of war propaganda, and that was such a relief, because I kept trying to decide could I really be a Christian and hang in there? It was a really difficult struggle. I was in and luckily I belonged to a church that thought that struggle was fine.

Dr. Rita Brock:

That's made you Christian, didn't make you not Christian. The doubt is good because it leads you to think about things and not just accept them pro forma. But so, yeah, I have, I have. So for me, it's been this core moral question Is it, is God a moral being? If God has to do that?

Jamie Peer (LTC-Ret.):

We need we need two or three more podcasts, obviously, because that's, that's, that's what I would love to.

Dr. Daniel L. Roberts:

I would love to do a whole I have a well, so yeah, a whole bunch of conversations about that, because I love that idea and that's something I, you know, some readings I've been doing and thinking about it too. That has totally changed my old view, which I grew up in a very conservative Christian background and a lot of good people in that background. But that theological question, which we, you know, don't have time to go into today, but it's huge, my Baptist minister in high school certainly believed that and wanted me to get baptized and he stayed my friend until he died.

Dr. Rita Brock:

But you know, just because he was the kind of minister who was loving and accepting regardless. And so for me, that core heart that he had was about love, not about punishment. And in fact, as he was dying he said, he said to me, I have a question, I need to ask you. And he said I'm going to not be around much longer and I want to make sure that everybody I love is going to be in heaven with me and I, so I. He said do you still have your faith? And I said you know. He said cause I know you've been educated and you've, you've got. You know you've moved far. And I said I have moved far, but you know you, being in your church and having you baptize me grounded me in my faith in God. That has never failed. So I'll see you in heaven. I didn't tell him.

Dr. Rita Brock:

I believed everybody was going to heaven. That's called universalism, that there's no heaven.

Jamie Peer (LTC-Ret.):

Whatever?

Dr. Rita Brock:

we go in the afterlife, we're all going to be there, and if we don't get along here, we're going to have to figure it out there next. He might have struggled with that a little bit. Yeah, he. But I, but you know, I don't know that he would have. I mean, I think he, I, I, I sincerely meant that, I, that he established this relationship to a loving god for me in a way that was, um, no one else had done, and I appreciated that.

Dr. Rita Brock:

So uh yeah, but I did want my grandparents, my Japanese grandparents wherever I'm going, I want them to to come along. I think they're there to welcome me wherever I'm going. Let's put it that way yeah, Um, but that's, you know, that is a I've now learned all of that is very Christian.

Dr. Rita Brock:

They, uh, the um, the early church believed that the resurrection of Jesus was what validated his life and ministry and that the crucifixion was tragic and horrible, but it didn't defeat their movement and it didn't erase them, that he returned and that he brought life. And they actually believed that the relationship between the living and the dead was a close relationship that the dead visited, and jesus was part of that. So, so this idea that there was this hard deadline of separation after death and you would never see anybody again until you died they didn't have that view of death, um, and so they, they uh, also believe that the earthly paradise was actually here, that Genesis really meant it. They said that creation was blessed and there was a special world for human beings to take care of each other. And the second century theologians said the church is planted as the paradise in this world. That's the mission of the church. Yeah, is to help humans flourish, but anyway, I don't want to get that that. No, but it's, it's. You know, this is a.

Jamie Peer (LTC-Ret.):

This is a. It's an interesting thing to discuss because, on the topic of moral injury, as you know, a lot of people fall away from their faith because of some of these hard line you know all nothing mentalities within religious spaces and yeah, um it's, you know, people can't even receive the good parts of it anymore because it has anything to do with with church or you know, the word God or any of those things. And so, um, again, like in your work, in your work as a theologian, um, helping people even navigate that part, um what, what are some of the things that you've you've seen out there that have been able to help people come back to the good parts of religion?

Dr. Rita Brock:

or faith. One of my students at Bright Divinity School, who's now a senior minister, has a PhD in theology from Emory, was an Iraq vet who had moral injury serious enough that it threatened his life. He really grappled with these questions as a Christian theologian and one of his heroes was a World War II German soldier who was a prisoner of war in England, who was utterly humiliated as a German when they lost the war and he found out all the things that Germany had done and he went through. This theologian went through horrible suffering and went back and became a powerful theologian. He's a major figure in the 20th century.

Dr. Rita Brock:

I think this is a really important piece of understanding what the crucifixion means, if it isn't a thing that saves everybody, if it isn't necessary for salvation. Embodiment of divinity and humanity. In other words, his divinity is also our humanity. That's the gift we become aware of in knowing who he is, that his crucifixion, what he claimed was in the crucifixion God also died, died. That. In other words, there is nowhere a human being can go that God does not go with us. And so this theologian wrote a book called the Crucified God, which just freaked everybody out. They kept trying to say well, the human part of him died, but the divine part of him didn't, because God is immortal and he just said you can't do that to Jesus. How he suffered was awful, and did he get through it? Yes, because God went through the whole process, even dying.

Dr. Rita Brock:

And that meant a lot to my student.

Jamie Peer (LTC-Ret.):

I see it as a very like the most powerful example of forgiveness yeah, well, what it's interesting.

Dr. Rita Brock:

He didn't actually forgive the people who killed him.

Dr. Rita Brock:

He asked God to forgive them yeah, that's true he says, he says I really would like this to pass, I would like not to go through this, and eventually he says forgive them, they don't know what they're doing, right, and so that's very like. It gives you space to think about when you should forgive and maybe when you need to turn that over to God. Or I mean, there's um, because I don't I don't think you can prescribe it um, people have to get to it, my friend. Oh right, you definitely can't shoot somebody you can't say you should.

Jamie Peer (LTC-Ret.):

You don't have to do anything you don't want to do, and it's a, it's a process and it's.

Dr. Rita Brock:

It is a process and it may not be the end product of the process. Um, that my friend who was sexually abused when she was four we wrote a, we wrote a book together and she describes this and it's called proverbs of ashes. She said that she finally got six years of therapy. In her when she was like 40 she got to a place of remembering the terror she felt that caused her to be in a state of suspended trauma for her her whole life until that moment. And, um, and how horrible when she came to that she was finally able to grapple with it. And um, so somebody asked her about, I think at a book reading, asked her about, I think at a book reading, asked her about forgiveness and she said it's not a concept she related to in what happened. She's learned to accept it, it's part of what, but she didn't really know that she was four years old, yeah, and the person died a long time ago. And the person died a long time ago and so she said I don't think about it as forgiveness.

Dr. Rita Brock:

And an Iraq veteran friend of mine said I don't think about what I did as being forgiven because I didn't know the person. I have no one to apologize to. That I know and I think I wouldn't be a moral person if I forgave myself for killing someone. That's his approach. I mean, not everybody comes to that conclusion. But that's the last time I talked to him, which has been a while. He might have changed his mind. He might have decided forgiveness fits now, but at the time I talked to him he just been a while. He might've changed his mind. He might've decided forgiveness fits now, but uh, but at the time I talked to him he just said I don't, I don't want to forgive myself. I should feel terrible. I killed someone. Yeah, I said it just doesn't have to run my life.

Dr. Rita Brock:

But, I, but when I think about it, I always feel terrible about it. Yeah, yeah.

Dr. Daniel L. Roberts:

So okay.

Dr. Rita Brock:

Well, there's no, there's no like one. As I said, no one thing that works and no one answer at the end of the process that helps you continue to want to live and restores you to the. What I think of as recovery is that you are able again to feel joy and pleasure and curiosity and gratitude and wonder.

Jamie Peer (LTC-Ret.):

And curiosity and gratitude and wonder, those are the heart, the feelings that you lose when you're in a state of suffering moral injury Exactly, and that's why we're you know the comprehensive moral injury conference that's coming up. You know these are. This is the space to really take the time to have these sorts of conversations and build those strategic synergistic partnerships that will have long lasting and far reaching impacts. Excited about is just creating the intentional time and space for the sharing of the research and to have some of these very deep, very existential conversations to better inform our work, and we're so humbled and thrilled for the Volunteers of America and the Shea Learning Center's sponsorship this year. I'm curious what you are most looking forward to about the conference and what outcomes you're most hoping for.

Dr. Rita Brock:

I'm hoping that people will understand that moral injury is evidence of the goodness in you, is evidence of the goodness in you that you wouldn't be suffering like that if there wasn't that core heart, and that living with a broken heart is awful. And so the process is trying to figure out how to heal a broken heart. That's one thing. I hope that you're not a bad person, you're not mentally ill necessarily. That kind of moral suffering is how we know we're a good person when awful things happen Right, and that you don't have to stay in that state of suffering if you can find a way to tell your story, to be with others who believe you and will help carry you as you recover. That's really, really important. But the thing I look forward to is meeting all the amazing people that I get to meet doing this work, doing this work. Really, it just astonishes me when people realize what moral injury is and they start to examine it and come to terms with it. Um, what amazing people show up out of that process.

Jamie Peer (LTC-Ret.):

Yeah, that's definitely. That's another thing that we're looking forward to is we already have this incredible lineup of people I could listen to for days on end, but then the people that are interested in it and wanting to learn more and their curiosity and their questions that will just continue to stir the conversation and the research is. I can already I get goosebumps when I think about it so very, very excited, and again, thank you so much for contributing to the success of this event. We're looking forward to working with you and your organization for years to come.

Jamie Peer (LTC-Ret.):

And yeah, it really has been such a pleasure. So before I, you know, officially wrap up the conversation for our podcast today, Dan, did you have anything else that you would like to state or to share with Dr Brock or with our audience?

Dr. Daniel L. Roberts:

Yeah, thanks again, dr Brock, for coming, and what a great conversation. You know, one of the things I love about doing these podcasts is I always learn something, I always feel better about myself and my own life or take something away that I go, I can, you know, and and I always come away thinking need a couple more hours. So with you it's been a great, a great conversation, some, some really deep ideas that I hope people will really sit with, like listen to this, pause it, sit with it, think about it. You know, and really you know you mentioned a couple of great books that I people, I hope people really go out and get, hope they go to your website, voa and uh, vo right and just see all the great stuff that's available.

Dr. Daniel L. Roberts:

I'm super excited about the conference and your sponsorship of it and just the continuing conversations and relationships and how we can work together as organizations, as people, to really the number one thing you said it like help people feel better, restore that place of joy, find that place of joy If they never had it. Some people have never really had real joy in their life because from the very beginning of childhood it's been, it's been traumatic, but my, my own spiritual belief is we have that spark of God there. God is in us, and it's sometimes just a matter of uncovering the fog and getting to that place of divinity, and so there are many ways to go about that. Your organization and you personally are doing some amazing work, and I'm just super thankful that you joined us today.

Dr. Daniel L. Roberts:

Well, it was a pleasure to be with you and we look forward to seeing you in September and everything.

Dr. Rita Brock:

It's a pleasure, thank you. I enjoyed the conversation.

Jamie Peer (LTC-Ret.):

Yes, thank you so much. So, for those that are listening, the information about our upcoming Comprehensive Moral Injury Conference, september 17th through the 20th at the St St Ignatius House, will be in the notes following the podcast, as well as links to the VOAorg website, volunteers of America and Dr Brock's work there, and we just want to thank everybody once again for joining us for another edition of our podcast. And again, dr Brock, thank you so much. It's been an absolute pleasure, thank you.

People on this episode

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Dr. Daniel L. Roberts

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Jamie Peer

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