I am here in a very small way to facilitate the greatness and the bigness of the individual across from me. It's very different to think about my PTSD symptoms, not as something wrong with me, but something within me that's actually functioning how it's supposed to. It's just, it doesn't fit in the context anymore. Welcome to Veteran Voices, I am your cohost, Tom Faust here with my son, Chris. And today we have with us our guest, Dr. Brian Livesey, and we're going to talk about well, a few different subjects that you want to discuss. And so I'll let you start to cover those. But I would like to get started with how you decided to join the military, a little bit about, a little bit about your service and kind of take it from there. Yeah, for sure. Well, first, thank you, Chris, Tom. Great to be here. Yeah. Thanks for joining. Looking forward to spending some time with you and getting a message out to the folks. Yeah, where am I coming from? So I think I could go all the way back to visiting my great grandfather. He was toward the end of his life and looking at his military memorabilia, the pictures he took, flying recon in the Pacific during World War II, and just having a sense of like, purpose from that, a sense of like, belonging to something very big, of course, even at that age, I had a sense of World War II, you know, watching John Wayne films, you know, enjoying the classics, right? Good, good upbringing. Yeah, exactly. Yeah, yeah. And that always kind of stuck with me. It was something that seemed like an inevitability, I suppose, what I was supposed to do. You kind of grow up feeling like that is the place you'll, you'll end up, you'll be a soldier, you'll be a warrior, you'll, you'll follow in the footsteps. Right. And yeah, I suppose it did, it really did linger. I had a bit of a sidetrack, I played high school football, and I guess I did well enough at that to get a college scholarship. And so that's my detour. I played, I guess, four years of D1 football at a university defensive end. And that was something that I think prepared me, I suppose. Well, one thing it did do is make basic training quite a bit easier, because I would eventually enlist after I finished college football. You know, it put me in sort of a, I guess, a paramilitary sort of mindset. You know, sports tends to do that. You can think about sports, and a lot of us played sports is, in some way, it's the simulation of combat or warfare, right? So I was always at home with those things. When I enlisted, I was, I suppose, still in my undergrad. And the dates are going to elude me, and I'll struggle, and folks don't want to see me struggle with trying to remember the dates. But it was sometime around year four of my undergrad, I enlisted. And I did that while simultaneously working toward my degree and a commission. And I was able to attain that. So I had about three extra years in my undergrad working toward what looked like a double major, but was really just focusing on some things that I thought were really important for how I can give back and contribute, even in the military, biology, psychology, neurophysiology, in particular. I did get that commission. I'm in the Army Reserves at this point. I'm three years in, and I'm now an officer. So I take that and extend my military career, so to speak, for another seven years or so. Along the way, I had an opportunity for a command tour. So I was able to serve as the headquarters and headquarters detachment company commander for the 172nd Med Battalion, where our role was really to support the hospital. So the cash, the mobile hospital. So we provided ambulance and blood debt and mental health support through our cost companies really kind of, again, aligned with the things that I was preparing myself and training myself to eventually be. I was working on my graduate school degree for clinical psychology during this time. And then I was also able to begin to experience the VA even before I ETS, before I finished my service as a officer in the Army Reserves. That began around 2017, and that date sticks out to me because so much is relevant as far as who I am now and what I've been up to and doing. I was able to take a perspective into the VA as a provider. So at the time I was this sort of graduate student in training, training to become a psychologist. I'd also be wearing the uniform on the weekends. And given my role as the company commander, I was doing quite a bit of work, you know, something like an AGR, kind of an active guard reservist role, though not officially speaking. But this unique perspective was one that I think put me in a position to represent both sides, to represent those of us who are consumers of the VA and who need the VA for support and for medical treatment, for health treatment, health care, mental health treatment, all of those things. But simultaneously, I was being trained to be a provider of those things. That was kind of a unique perspective. I suppose I was always going to take that perspective of wanting to do everything I can to advocate for the service members who are seeking these services from the VA and being in a position as a provider was one where I could sort of simultaneously meet those needs, knowing what they are so well. There are some added benefits, I suppose, of the folks I'm working with. You know, they find out, they either ask or they can tell, you know, at times often wearing my military boots into the VA for work, you know, while I'm wearing my cardigan, what have you. So it was a dead giveaway at times. But to be in that position of what they're receiving, what I'm being trained to provide and offer the service members as far as mental health care, I'm also very much aware of its limitations, those potential limitations. And to seek those out, to sort of suss those out, it kind of became a passion or what's the right word. It became something that I was just tenaciously seeking is how to better these things, how to find where the cracks are. And, you know, and part of this, if I back up, is that there's this general sort of understanding that the VA, as good as it is, it's not perfect. And I'm being very diplomatic when I say that. A lot of folks would say in a much stronger way that it didn't do what it needed to for me or it was never going to offer what I what my needs really were. And so I'm taking that perspective and I'm looking for where those gaps are. How can I bring how can I bring my passion, my understanding, my role as a service member into a a dynamic and better relationship as a provider? So it was research that was part of it. Part of it was pulling away from the system is and stretching it as much as I could get away with. You know, to be specific, there are ways that the VA sort of defines how in particular PTSD treatment should go. We've got evidence based practices that are identified as better or the best sort of the sort of this hierarchy of like, here are the recommended start here and work your way down. And now within that, there's always this sort of latitude to use clinical judgment. So I took that I took that little caveat and said, I'm going to use my clinical judgment. And a lot of what I was seeing is where these therapies were falling short, in particular with treating PTSD is for the service members who are experiencing more than just the fallout of a threat to life experience or the fallout of a traumatic loss. And so I begin to sort of detect something both in my one on one experience with veterans and providing care, but also begin to research it and look at it from a wider lens. And the the idea that I'm getting toward is that there is something within all of us, there's this system of morals, right? We have this component or capacity to know what's right or wrong. And it's anchored or tied to something very deep within all of us. You can, you know, don't have to go very far to find different ways of explaining this, you know, we have a soul, there's a there's a spirit within us, there's something that's more than just the some of the behaviors, some of the cognitions that seem to be so easily measured, there's more than that. And that's something I was running into, and feeling like we didn't have a good answer for when the moral system was damaged. OEF and OIF provided a lot of opportunities to see how moral injuries could show up. And so that's what I was saying, you know, and that's where I was taking my sense of what I needed to be doing, and really heading into something meaningful, something that I could really make and lay claim to, we've got to notice this more closely, and treat it more seriously, and conceptualize it as a real and dynamic thing and force of, of injury, like a threat to life would be. And so that was something I kind of took on early in my career. And that was, you know, I guess, at the time I used the designation or the date 2017. That was around the time where I had a sense of what I'd be doing next. And was it about maybe two years after that, I resigned my commission, and said, All right, I'm going to be working in the VA, and I'm going to be doing everything I can to bring something better, you know, and that's going to be, you know, whatever it needs to be, and I'm going to be a, you know, a vessel of this mission to figure out what the better is, and to make sure that I bring it in every day, every moment of my practice, and to promulgate it, to get it out there as best I can. Okay. Yeah, it kind of, we see that it really, you know, you kind of had an idea initially, like, you know, like, as you were, it goes of what you wanted to do. So, you know, we can kind of see how it shaped your path of, you know, working in the mental health thing. So at when you ended your service, you know, what was your transition out of the military? Like, like, how did, how did you handle all that? I've reflected on this a few times, there's been times where I've really had to go back and kind of face the pain of that, though, at the time, it was something I was doing my best to sort of ignore. It was like, okay, this will be okay. You know, I'll just, I'll, and granted, you know, my role wasn't, I wasn't so deep in the institution of the military, you know, my military service was one that still had me, you know, very much participating in civilian life as a reservist, you know, even if I was given 30 hours a week to my unit. But the truth is that removing myself from that, that part, that aspect, that identity, you know, that was part of who I am, you know, I still have all the stuff, all the uniforms, all the boots, all the, all the little accoutrements that we accumulate over a decade. But I wasn't interacting with it anymore. You know, and every day was just sort of like a, you know, another, you know, I guess, point of injury, in a sense of like, that's not me anymore. I'm something else now, you know, something that I had to face, you know, just, there was pain in that, certainly. And I think I'm burying, I think burying myself, really entrenching myself in my VA service was my means to cope. You know, it certainly was, you know, in a sense, it was adaptive, and, you know, probably beneficial for a lot of folks around me, and even myself. I'm not that far away from my brothers and sisters, right? You know, the service members are in the building with me, when I start the day and when I finish. And so, in a lot of ways, that was a sort of a healthy adaptation, you know, as I look back, but knowing that the pain was there, and knowing that as much as I was able to put on balance with that transition, and as far as healthy adaptation, and sort of having a way of staying connected, you know, that for so many folks, it's not like that. For so many folks, you are in the institution, and then you're out. And that contrast is so sharp. So saline, it's, you know, it slices right between the, you know, time now and time now. There we go. Completely different. So I, you know, I benefited a lot from having a community that I was already sort of building within the VA, and these relationships in a role that I could take on in the VA. And so, that transition from service member to, you know, somebody who's working in the VA, working for service members, which was always my job. You know, my job as a company commander was to serve my troops, my soldiers, and I got to continue to do that. So it is, in a way, fortunate for me to have that, in a way, also a model, you know, as I understand how that was for me, I can see the benefit of having something like that for so many folks who get out and don't, and don't have that community to plug right back into. So yeah, I mean, that's, it's a great question. It's one that maybe I don't reflect on enough, because in so many ways, I've been fortunate to be still in a community, still with my service members, still with the folks I care about. ISKRA Kind of going on that same lines of, you know, you, you knew where you wanted to go, you knew what you're doing. So what are some of the common barriers that you can see veterans running into when trying to access, you know, benefits and services? HOFFMAN Yeah, I think I see it a lot. So I think, you know, our listeners, the folks who are hearing this, they're going to notice I have a bunch of roles, and I'm not here to represent the VA per se. I'm here to represent my perspective as a prior service member and, and some of the things that I think are important for folks. So I really like this question, you know, these barriers that we run into. I'm constantly interacting with, with veterans and prior service. ISKRA Yeah, personal opinion is always, personal opinion is always better on it too. HOFFMAN Yeah, yeah. And I, and I'll give you my opinions, that's for sure. I just want, you know, if, if big, big VA's listening in, which they might not be, just know that I'm not here representing y'all. Okay. But yeah, you know, my opinion, you know, my experience working with, with service members is that those barriers are, like at every turn, you know, it's like, okay, where do I go? I'm supposed to have education benefits. Where do I go? It's like, pull up a browser tab. Good luck. It's just, it's impossible to get places in a convenient and easy way. In some sense, it's gotten easier. In some sense, there are, you know, ways you can figure that out on your own. But for the individual who tries, like, you know, in earnest to figure all this out on their own, it tends to be very frustrating. And that frustration, that barrier of frustration is one where, you know what, I'll just, I don't need this. I don't need this stress. I don't need this frustration. If they don't want to take care of me, then fine, I'll figure it out myself. And then so many other ways that we can react to that feeling of not having, you know, that same sort of supportive institution ready to catch us on the way out, to catch us when we land and say, hey, let's get you right back to where you need to be next. You know, let's find that next place for you. You know, some of those barriers are, you know, very much just navigating things on your own for the first time. How do I access my benefits? Where do I need to go next? The DOD is doing better, and this is my understanding, doing better with setting up those transition sort of, you know, training and, you know, build up the domain knowledge about what folks need to be doing next. But there's no real warm handoff, which we would, I would like to see. I would like to see a real good warm handoff. So oftentimes where I'm, you know, working with folks in my role, in my professional role, I'm finding them on college campus. I'm picking, you know, picking them up out of an outreach event and saying, hey, man, have you been enrolled with the VA? Oh, no, I just figured I, you know, that was something that wasn't for me. It's like, all right, well, let's see what's going on with that. If you don't mind, I can help you with that. So we get them plugged in. We find that there's all of these benefits they have access to that they were otherwise not using or not going to use. So having those barriers identified, you know, because there are so many, you know, that's part of what I've found has been, you know, my role and my job and what I can do well for folks. And then also seeing how that sort of translates, you know, if I am able to get somebody plugged in, how they can turn around and advocate. And it's just sort of this natural thing and help somebody else break down their barriers and get closer to the connection, the institution, the services and the benefits that they've earned. What do you think are some, maybe some steps that veterans can take that would help put them in a better position to find the, you know, to find the benefits that they've earned and feel like it's worth going after? Yeah, this is a good question because there are a lot of resources out there, like physical sort of places you could go, you know, like you could go to, you know, different organizations that will help you apply for service connection and VA benefits who will kind of help move you to maybe employment, who will maybe even plug you in with a community. And I think all of that is, all of it is good. And we need all of these, these institutions, these sort of like peripheral stakeholder, you know, entities that have a vested interest in the veteran and not the institution or not, you know, maybe the VA or the DOD, but just the individuals. I would take it a step back though, you know, where I'm thinking about, where I'm thinking about and folks listening to this is that we kind of have to start with a reflection on ourselves. So to recognize that I have something left to offer, some inherent value, even if it's not obvious anymore, even if I've been displaced from what I know and what I do well, and there's no clear, obvious, you know, analog for me in the civilian world to take a step past that and recognize that there is beneath all of those skills, beneath all of that training, beneath all of that, you know, high speed capacity to do a job well, something of deep inherent value. And we have that. We all have that. You have that. You got to tap into that and say, okay, what is this thing within me that persists, that continues to have value, even if I'm not sure exactly how to manifest it? You need to plug into that and say, okay, let me take this value as my first step, this recognition that I've got more to offer. My journey's not done and the mission's not complete. It just changed significantly. It's just very different. Okay. Now, first step, I recognize that I have all of that ahead of me. I think that's really important for folks. I think we have to have that sort of internal source of understanding of that value and that motivation and that that energy to move forward. It can't just come from without. It can't just be good organizations and good people pulling me along. It's important for me to find that. In the order that people find that is always, you know, their own journey and it's always unique. But that would be kind of my message to folks is that wherever you are now, there's something within you that needs to be checked in with. So, can we plug into that value? Can we plug into that continued journey? There's something more for me to do. What is that? Okay. Okay. Yeah. That's really good stuff there. I know you had a pre-interview with my dad and so I was just kind of reading through that transcript and everything like that just to kind of get a better idea of things. And in it, you had mentioned critical memory integration. Sure. Yeah. So, can you tell us about your work with the critical memory integration or CMI? Yeah. What it is in a nutshell? Yeah. So, I kind of left off at the beginning with, you know, where my story through the military career and getting in and getting out where all of that was heading. And it was heading a direction and it actually ends up right at this place where I'm now and this ongoing effort to develop something better for our service members. So, in 2017, that date really stands out because it was an inflection point. It was an inflection point of like, hey, there's something within me that can make an impact. I recognize that and it's not left me. And the efforts over the last, you know, eight going on nine years have been to develop something more than what currently existed through modification of what was there or to reach back, reach down, reach out, and to pull together something that would be entirely different, entirely new. And I'm kind of talking in abstraction, but really to put it into certain terms, I began working on both in research and developing a better understanding of what we are as human beings. What we are as a human being that underpins who we are as soldiers, airmen, marine, sailors, coast guard. There is something within this, you know, vessel, this flesh and blood that is deeper than the behaviors and the cognitions and all of these things that seem to be where the symptoms rely or where the symptoms sort of manifest. There's something more to our experience. And so, I really wanted to take that understanding, that truth, something I believed, of course, and say, okay, what about taking all of that and approaching the healing process from that belief set? So, understanding that we're more than just the maladaptive thoughts or the maladaptive behaviors or however they're framed in the, you know, diagnoses and the current treatment paradigms. So, there was an early effort to begin to understand these things. And it led over the course of the last eight years to where I am now and opened a lot of opportunities for me to get what my work has been over these last eight years out there and to start training folks, which has been about the last two years, to start training folks in some of these things that have been so beneficial to the folks that I'm working with in the VA. And so, now we've got a name for it. You know, before it was just, you know, these different techniques or, you know, I've got a different approach or a different style. I'm going to engage with you a little bit differently than some of the mental health experiences that you've had in the past. Now we're calling it something, and we have for a while. So, critical memory integration defines so much of this work that I've been a part of. And it's not just been me. I've kind of given you my perspective. There have been a lot of people who have contributed to this. I might come back to that as a story here in a bit. But where we are now with critical memory integration is approaching the way these, you know, quote unquote problems manifest for folks and to approach it from a bit of a different perspective. For example, if I use the word, the maladaptive thoughts and the maladaptive behaviors, you know, right away I'm labeling something that folks might be thinking or feeling or doing as, well, maladaptive. There's a problem with it. There's something corrupted or perhaps about this. It's a symptom of something that we diagnose. If I can look at that differently, if I can say, hey, maybe it's not maladaptive. Maybe all of those things that show up, that anger or that reaction, that quick reaction, that feeling of being, you know, isolated from everyone around you, all of these different things that show up, maybe they all serve a purpose. Maybe all of those things are either there to sort of represent a past or existing means or strategy or way to survive or to be effective at your job or to make sense of the world around you. What if they're all adaptive at their core, but they've just sort of persisted across time into an environment now that they don't really fit? So they create problems for you. The other thing noticing is that as these sort of adaptation persistence occur, that we try to work against them or we try to channel them or we try to suppress them or we try to not have them manifest in such a significant way. You know, so maybe if I drink, I don't get so fearful at the end of the day. Okay, there we go. Now I've got a strategy for managing this, this, you know, persistent adaptation, this persistent survival strategy. Well, we've, we've created a solution to a problem, but in so doing, created another problem. And the original problem doesn't go away either. And so it's, it's the sort of compounding effect that we see to have our best efforts to solve a problem. You know, that's awesome. It's amazing that we can do that without even really thinking it through, we can try to solve our own problems. And so many folks are doing that, but running into the sort of nature of it being ineffective and how it continues to create those issues and those problems. So that's just kind of like a frame of reference for what's going on with folks. And right away, it's very different to think about my PTSD symptoms, not as something wrong with me, but something within me that's actually functioning how it's supposed to. It's just, it doesn't fit in the context anymore. So now what? Okay, well, now we got to go in and engage with that stuff. It exists within the nervous system. It's in there within you somewhere as a sort of stored memory in parts of the autonomic nervous system, in the body, in the limbic system, in our emotion systems, in our sensory systems. It may also be a function of what we've developed as sort of evaluations of ourselves after all of that. So these cognitions where we have sort of created a narrative about who we are in the context of all of these, all of these so-called symptoms. And so we got to go and engage with all of those things. And CMI is set up to do that, not to have you think differently about all your problems, all of these difficulties, but actually to go down into the experiential domain of where these adaptations are, where these past experiences are, and to meet them on their terms from a place of deep connection with yourself, of profound agency and will to feel all of that and to engage with all of that. It's not happening to me anymore. I'm actually going back to find where it is. I'm going to find where it is, and I'm going to explore it on my terms. I'm using some, you know, kind of like these narrative motifs. In some way, something like The Hero's Journey does a very good job of describing what we do in CMI. But at the end of the day, what we're really working toward is updating and modifying existing places in the nervous system. So changing those places that are not working, that are persistent in their efforts to be adaptive and to protect us and to keep us safe. We're going to those places, those locations in the nervous system, and we're making changes there. And that's very different than trying to build something else somewhere else in the nervous system, some other habit that might out-compete it, you know, might out-compete this adaptation within us. So it's a very different approach. And with CMI, it's not that it's so unique or revolutionary in some of these broad concepts. There are other therapies that do endeavor to modify the nervous system, modify memory. Where CMI really stands out is the efficiency and the certainty of the role of both the veteran, as I work with veterans, and the mechanisms of action along the way. So we do stand out in how we deliver this kind of therapy. And it's been very effective. That's been my experience. It's been very helpful and very effective. Do you have like a particular story of, you know, anonymously, whatever, but of somebody where, you know, how that's helped a particular situation? So there's a veteran I was working with a few years back. His army, he was a helicopter pilot. I won't give much more details, but that's part of the story, his story, and it's relevant. One of the things that he was seeing me for was the diagnosis, PTSD diagnosis. And he had been through a lot of different kinds of therapies, and things weren't really moving for him, weren't really advancing or progressing in the form of like symptoms going down, or these difficulties and well-being, you know, points and measures of well-being in his life weren't really changing. Where he and I met in his life, he was, you know, kind of at a point of, I got to try this again, because everyone's telling me if I don't, you know, that'll be the end of it. You know, they're fed up with things not working for me, and for, you know, the lack of change, despite all my best efforts. So yeah, he met me in a, he's sort of in a desperate place, and that's often the case when I'm working with folks, they're in sort of a desperate place in their lives. One of the things that was very helpful for him early on was, now I'm a professional, right? I'm the doctor, you know, I'm the PhD, et cetera, et cetera. But to take on the role of I'm just Brian, you know, at the very most, I might function as a bit of a mentor, but that's only very briefly. For you, you're going to be the hero, you're going to be the tip of the spear, you're going to have the compass, and I'm going to follow your lead as you suss these things out, and work toward this healing, and work into this healing process. And that's not really something he had experienced before. It's like, usually you sit down with a professional, and they just tell you what to do. You know, they're the benevolent dictator in the room, and I just trust that, you know, I'll just trust that the, you know, the therapist has all the answers, or enough of them, that, you know, things are a little bit better at the end of the day. So right away, the relationship and the dynamic was different. And, you know, that's something that I've, you know, I've made that change early in my career that, hang on a second, I cannot be the expert of these folks' lives. Of course, you know, I don't know everything. And to take on that role of, you know, I'm the one with all of the agency, and all the control, and all the expertise, in some way, it kind of stands on their toes, or usurps their agency, usurps what they have to offer. I'm inserting myself in their journey, and in their story. That's really how I felt about it. And so, you know, that's how things start. It's like, hang on a second, you're going to do this. You're going to be the one in control and in charge. And so, part of how I am able to maintain that position, that posture, is to constantly show up with curiosity, to constantly show up with this connection that I can offer. And so, for this veteran, that's what it was. It was being curious, and being connected with where he was. And in so doing, that helped provide him a resource for his own connection, to stay connected with these parts of himself. When he's feeling all of those sort of somatic symptoms come back in, I'm there as a resource to sort of help stabilize his, you know, his heart rate, his breathing, all of these things that happen when we're, you know, moving into these more, you know, arousal symptoms associated with PTSD. So, for him, it was a matter of going back into the body, just starting with these deep, profound sensations of panic, of, you know, this crushing feeling, trying to think some of the specific words he used. But it was a matter of going back to the most difficult things that he would identify, the things that he would try to numb, things that he would try to evade and try to escape. It was starting there. And what's interesting is that as he begins to do this, as we begin to make small steps towards that which is difficult, a few things happen. The first being that those small steps are revealed as not so difficult. But the other part of that is that those small steps reveal that we have something like a strength within us. And we learn something. This is what he's doing. He's learning that there's a strength within me to continue to persist in these difficulties. And as he persists, he begins to map out and explore more of what he's feeling as a sensation in his body that transforms into these emotions, these feelings, these more complex places of experience. And he begins to map these feelings, these sensations, these emotions. And he's in all of it, and stable. He's connected. He's in control. He's agentic. And he's able to continue. And as he's doing all of this, he encounters something like a metaphoric or sort of like an episodic space. So he finds himself in this past memory. And where he finds himself is he's encountered his co-pilot. And so he's in this memory that he's shut out. I'm learning about this after the fact. But he's in this place in his experience, in his past, in his memory, where he's so ardently avoided. But he's here now of his own will, of his own sort of capacity to explore it. And he encounters his co-pilot who had passed, who had died in the crash. And there's some circumstances around that. But what's important is that he was in a place where he could have a conversation. This is very interesting, because I'm not coordinating or orchestrating any of this. Because this veteran's able to make these progressive steps and to remain stable and agentic and connected with himself, he's able to arrive at the very place where he needs to. This is kind of how I understand it. This is my understanding of what we're all able to do. We can arrive at these deepest places. And this is where the idea of critical memory comes from. We can arrive at these essential places. And then because we're in the right sort of state and frame of our capacities, you know, we're all there, we're all in, we're all engaged, something can happen, something very transformative can happen. And he had a conversation with his co-pilot who had passed, you know, I guess it was like eight or 10 years prior to these therapies sessions. So the conversation went something like this. He's like, hey, I can't talk to my family anymore. You got to go talk to them. They need you. And what you have to offer them is something like, and so I'm kind of remembering the story, but his co-pilot is saying that you have some part of me within you that they've never met, right? Or that they don't know, that they don't have access to, but you have it. It's within you. And so as he's having all this sort of internal experience and this internal dialogue, I'm on the outside sort of observing and toward the end of the session, he sort of comes back and he's like, hey, he told me all this stuff and I haven't talked to his kids since the accident, since I got back from deployment. I've completely shut them out of my life. He told me I need to stop doing that and I needed to reach out to them. I need to share with them the parts of their father that I have. And so all of this stuff is coming from this veteran. And again, I'm not orchestrating or I'm not deciding, I'm not recommending any of this stuff. That's all there and available because he was able to take on that role of the hero, to take on that role of I'm going to engage this journey and discover where these places and parts of me are that I've been ignoring or have had to shut out or have had to avoid or escape from on a daily basis. Because he did all that, he received this very valuable message and embodies that. He takes that to heart. He says, I got to go. I got to reach out. I got to call him. We had a few sessions, just a few more sessions after that. And that's what he was doing. He was reaching out. He was making calls. He was setting up visits. And things really changed for him. Things really changed. I've said metrics of well-being, these measures of well-being. The symptoms are interesting to me. How a person is thriving in life, I think is more important. How someone is strong enough to bear the burden of what we might call symptoms is also very important. And to see him grow in that process, it's his growth. It's his journey. It's his adventure. To see him make that growth and to see the ways his life was coming back together, the relationships, the connections with his kids and his wife, to see all of that and to hear all of that, it just stuck with me. It was a moment of humility for me too. It's like, again, reinforcing this idea that I've got a role, but it's very small. The role that the veteran had was massive, was huge. And that's the same sort of call to adventure we all have. Everyone listening, you've got that signal within you that's reaching out and saying, hey, there's an adventure down here. You need to have it. You need to engage with it. So again, it's really humbling to see all the folks I work with have that incredible capacity for growth and change. It blows me away every time. Yeah. Sometimes being introspective can help out a lot more than you'd realize. I know a lot of people don't like the silence. They're stuck with their own thoughts, but sometimes you just have to face those thoughts head on. And then you realize things about yourself. It's really fascinating how the brain works. Yeah. Yeah. That's a good point. That's great. And I think that part of what I heard in that is that if he's going and talking with the families of the co-pilot, he's helping bring closure to them as well. I imagine so. And it works in him to be able to deliver that. Well, it's interesting because I mentioned the hero's journey a few times. There's a part of the hero's journey. It's like the last third of the journey. It can be divided into 12 parts or three parts, but it's toward the end. And what it describes is that the hero has returned from the underworld with the thing of value, having gone through all the difficulty, returns to the community, returns to the family, returns to the village, returns to wherever they go back, and they offer that thing of value to others around them. And everyone benefits. And that's the promise of this call to adventure, this answering those voices and those feelings in our head that say, hey, I'm here to mess with you. No, no, no, no. I'm going after you. And when we do that, the promise is that the end result is we bring something of incredible value, not just for ourselves, but back to everybody who we care about, everybody whose life that we touch. It's really interesting because it's like there is, again, something very, very humbling in all of that for me, which is I am here in a very small way to facilitate the greatness and the individual across from me. I've just got a very small role, but the impact of the person who comes to see me, the impact of every veteran who I don't see and who's out there, the potential, you know, we talk about potential a lot, but there's something that I've really connected to in that because I've seen the potential manifest. Like, you know, faith moves mountains. You hear that sort of thing. It's like, to me, there's something in it. There's something within the individual. If they could believe and connect to that and recover that, they can do huge things. They can transform the geology and the topography of their lives in a really impactful way. Yeah. Sometimes all you need is to give somebody a little nudge for them to start getting on the right path. But kind of going along that too with some of the stuff that I was reading from the pre-interview is you had mentioned, you know, we all know the standard, PTSD things, you know, what could be constituted as that. One thing you had mentioned, which is kind of separate from that, but still kind of is, is the moral injury. Right. So kind of for the, you know, listeners or viewers who might not know kind of what that is, can you kind of give us a little rundown of moral injury? Yeah. So the idea around moral injury, this was something I was encountering early in my career. You know, again, that date of 2017 where I'm first working with the PTSD clinic team, you know, at the VA, I was traveling across the state, you know, across state lines to get to my externship at the VA. And, you know, all of those trips, all of that driving that I was doing was great opportunity for me to listen to another book on tape. And so it was really accumulating a lot of really good domain knowledge about the profession I was getting into. And in particular, this, this externship that I was a part of learning everything I could about trauma and look, you know, listening to all of the new stuff. And one of the things I was seeing is that this person's pain in front of me doesn't really seem related to the fact that bullets were flying at them. Right. Certainly seemed related to, you know, some of the loss that you described from their you know, other service members. I mean, that's there, that pain is there, but it doesn't really seem to be what's driving the majority of their, of their hurt, of their injury, of the, the dysfunction, that's kind of the fallout of these things. And, you know, just to kind of share and offer a, an example of, of what I was noticing, do an intake with a veteran, talks about all of these firefights, all of these threat to life experiences he had. What bothered him the most was that when, you know, he had to fire, I guess, shoulder mounted AT4 is what we call it. So it's a anti-vehicle weapon system, fired it into a building, hits the back wall, the, you know, the firefight stopped after that, they go and they clear the building. And what he discovers is that the insurgents had a family in there. Okay. So for him, the difficulty was the civilians who were killed in that incident and his role in that. Now he can justify his role in all that. You're supposed to do it. He was given it, you know, an instruction from his senior NCO to, to do exactly what he did. He followed his orders, rules of engagement, you know, everything is, you know, technically speaking, correct. And yet, and justify it. And yet the pain is still there. Okay. It turns out that there's something that's more fundamental than our rules of engagement. You know, there's something more than the sort of constructs around us. And this is that moral system I mentioned a while back. And so when this veteran sees the results of his actions and his behaviors and, and, and this engagement and the whole system is dead children, that's what stayed with him in this injury, this, this pain, this moral pain persisted. And that's what was driving everything that was difficult for him thereafter. And so I'm recognizing this early on, like, this is different than what the DSM says in diagnostic and statistics manual. This is how we diagnose folks. How we say, oh, well, this is a disorder. So what this veteran's experience is not in this book per se. It's not in there. It's not defined. And yet it seems to be what we need to focus on. It seems to be where we need to go. Okay. Well, what does the treatment say to do? Well, the treatment says in these treatments, what they say to do is that we got to let the veteran know that he's thinking about that wrong. He's got to change the way he thinks about that. And I, you know, I think about that for a bit, you know, and, you know, even offering it to somebody like, well, what if you just sort of justified all of that by saying you were following orders? It doesn't work. The, the part within us that holds those moral systems sort of rejects these, these notions, these ideas, these thinkings outright. It says, no, there's something more fundamental. Dead children is always wrong, for example. And it's like, you know, how do you escape that? That is in there. It has to be sort of encountered or it has to be engaged with in a very different way, in a way that these, these, these therapies, these evidence-based practices that are supposed to be the best that we have to offer. They just missed the mark in so many ways. And so it's up to the therapist to say, okay, we gotta, we gotta take a look at what's actually causing the pain for the individual and maybe modify things. And so for me, it was a matter of understanding what the moral injury is, you know, and just to give like a, a finer point on the moral injury idea. So I'm looking at a book over here on my shelf. We go back to Vietnam. There's a clinician, his name's Jonathan Shea, and he's working with some of these Vietnam era soldiers. And he's noticing that there's more going on than the shell shock, right? And what he was noticing is that there was a lot of difficulty folks were experiencing a lot of symptoms that were around this idea of betrayal. And so we began to like really pay more attention around what betrayals were there and how it was showing up and how people reacting to experiences of betrayal. And so we begin to develop this idea, and this is where the idea, the term moral injury first started, you know, back in the seventies, I guess it was with Jonathan Shea, Dr. Shea. And he came up with this, you know, early definition of, you know, these are, moral injuries are derived from these experiences of betrayal by authorities, you know, they hold legitimate authority and it might be something that, you know, they put me in a position that was compromised or they made it, you know, a call that was clearly the wrong one and it caused more harm than good. He also noticed that there was a lot of betrayal around the way Vietnam veterans were coming back, experiencing the rejection, the betrayal from the, you know, the culture at large, you know, the community, the civilians around these veterans. So they're experiencing betrayal from both sides. And so he's really noticing this idea of moral injury in this context. Now you go fast forward to about 2000, I think 2009, though it was sort of advancing over the years, but 2009 a paper came out by a guy named Brett Litz, a clinician, and he expanded the definition to include those violations of deeply held moral beliefs for actions that we either do or don't do. So inaction, so things that we don't do, so things that to see something happening that you know is wrong and not be able to stop it, that can create this moral pain and this moral injury to engage in a sort of a framework or a context of warfare where civilian casualties might occur, you know, that's an action of this sort of violation of a moral code or system that people have. And so we're seeing moral injury sort of advance as a concept and we're measuring it and we're seeing it show up in our service members, you know, and then it doesn't take too much longer for this to kind of spill out into the private sector, the civilian sector, and our public servants who are here, you know, working for our police department, fire department, that sort of thing. And there is a very clear evidence for moral injury showing up in their day-to-day work. And so moral injury has, as a concept, done very well at sort of spreading out and legitimizing itself and it's becoming better understood. And maybe at some point it'll be reflected more officially in some of our diagnoses and that sort of thing, you know, but that's not my concern, I suppose. Until then, I'm very much an advocate for folks understanding what moral injury is, to recognize that so much of the pain and suffering that we experience as a result of our time in the service, being in a wartime area and deployment, and how the way that maybe threat to life doesn't really impact us, but it was those other things, those other things that they can't talk about. That's legitimate, that's important to recognize, and that's important to seek help for. Yeah, sometimes it's one of those unfortunate things about being in, whether it's military or, you know, law enforcement or something with a structure like that where you have to follow orders, like there's no right thing about it. So you can try and cover what you're doing. It's like, you know, well, that's what I was told to do, but deep inside, you know how you feel and yeah, you're going to have to process that anyway. So that's why I can kind of see why maybe moral injury kind of hasn't really, you know, received as much mainstream attention just because, you know, people don't like to talk about like, you know, morals and stuff like that, because everyone's are different. So, you know, kind of like what do you think we would need to do to, you know, help change that to help even more people realize, hey, this is a real thing that we need to help people address, because it could help a lot of people. Yeah, I think it's interesting, because I think there was at a time a lot of interest and attention in just at large, you know, in society at large in, you know, some of the experiences of our, I guess, maybe you just look at it when we were in sort of these active states of, you know, OEF and OIF, they're ongoing, we're in it, right? There's a lot more interest, a lot more attention, a lot more focus on it. It seems like there's more energy around some of these concepts, a lot more books are being published, you know, I guess, in the circles that I was in, I was hearing a lot more about it. And then the energy goes somewhere else, you know, these operations close, right? You know, there comes an end to these things, you know, and we still have a diagnostic and statistics manual that has yet to accept it. So, what happens? You know, these terms just kind of fizzle out and go away. Well, they might, but the experience of them doesn't. And the pain that folks are experiencing doesn't. And so, for me, it is a sort of enduring obligation to continue to reach out to my colleagues, you know, stakeholders that are involved in the VA as, you know, mental health providers to give the presentation, let's talk about moral injury, you know, and that's something I do every year, I give a didactic to our incoming interns and externs, and they're going to learn everything about moral injury for me. And so, that's part of what we do. So, for folks who are in those positions to, you know, have something to say and have a voice that's going to be heard, to understand and to look into it, and there's a lot of really good stuff out there, you don't have to go far, you know, go to your web browser and stuff will just, you know, pop up and fill in, begin to understand what this is, and you might recognize your own experience with it. And then to, you know, let folks know, like, hey, that kind of sounds like something other than this PTSD thing, but it's real. You know, it's not just that there's something wrong with you. This is a real thing. This is a real thing that we all can experience. And so, I would really just advocate that the stakeholders who are out there, if they can, inform themselves, and to, in so doing, be better at recognizing it, and to reach out and say, hey, there's something here that I see. I think you need to take it seriously. I think it's real. So, yeah, I think that's a good start. Yeah. Yeah. And I think, for anybody, you know, anybody listening, for any veterans out there who might be going through something like this, just to understand that that might be what's going on as opposed to PTSD, and don't try to necessarily put them together into the same box. They're different things, and seek the appropriate help. Yeah, I think that's right. I think there's different ways of looking at it, and different researches have kind of come up with a way to unify all of these different things under sort of, you know, one coherent term. I think that's fine. But I think what you're saying is right on, Tom. You know, you've got to look at this as your experience, and it's specific to you. And if it doesn't fit what the, you know, maybe the Benefits Administration did their assessments, and, well, you don't have PTSD, that's not illegitimizing your experience. You know, that's real. Take that seriously. You need to honor that. And I'd really advocate that folks do. Yeah. So what would you say to a veteran out there who, you know, kind of, they're carrying this thing silently, and it's heavy on them, but they don't really know how to ask, or feel like they're ready to ask? Yeah. I think there is a lot of benefit in slowing down and listening to that place within them that's calling out. And it's that voice, that feeling, that emotion that's not shut up since day one, right? Slow down and give that internal experience, honor it, and to give it a moment to speak to you, to inform you of something that's going on. This is easier said than done. This is not an easy task. But to say, hey, there's something real about this, and it doesn't mean that I'm wrong. This is adaptive. This is something within me that I need to slow down and listen to. I mean, if we have a moral system, let's call that important, right? If that exists, you know, and we can measure it in different ways, I believe it does. If there's pain that's originating from that, it needs that moment to be honored and sort of connected with. And that's just the first step, to be... Go ahead, Chris. Yeah. No, no, no. You were going ahead. There was just a little bit of a pause in there, and I was like, oh, okay, I can jump in. You can jump in. Yeah. Well, just to take that first step is so important because what it does is it sets up the second step, which might be reaching out to a battle buddy and saying, hey, can I talk to you about some things I've been feeling, right? You know, you got to pick and choose who you talk to and who you open up to. But I think it's important to try that. You know, if you don't have a therapist, that's fine. I'll tell you the best therapies, you know, around the campfire, right? Or wherever you go, you know, wherever you find yourself, you know, good therapy is with good connection. That's what I believe. You know, I think connection is more important than, you know, the sort of technical components of therapy. I think it starts with that connection and ends with that. Find somebody you can be safe and connected with and just explore these ideas. They don't need to give anything to you. They're just a place and a resource for you to stay connected as you explore it in your own sort of internal world. That's really important. I think if folks can do that, even in a small way, they begin to sort of engage this process that will iterate and that will begin a healing and that will sort of get them on this track of, you know, wherever their journey may need to take them next. Yeah. Well, that kind of also can circle back a little bit into the whole, you know, critical mind thing is sometimes all it takes is vocalizing what's going on for it to start. Your brain is thinking, oh, okay. I didn't really think about that because once you vocalize it, it's kind of like out there in the world. So instead of like, you know, thinking about it or, you know, like you're actively saying, okay, it's out there and now you're being forced to kind of start going in the right direction too. Right. Yeah. I mean, yeah, you, you, you got it exactly right, Chris. There's, there's actually some interesting research around what you're describing. Maybe you've, you've experienced it and you don't need the research. I, you know, I, I think that's, you know, the best evidence is what we have from our experiences. And in particular, when we're talking about, you know, where we need to go next, you know, trust your, your experiences, you know, rely on those things, you know, connect with those things, connecting with our experience. Sometimes it's too big a ask, right? It's too big a task. Like whatever's going on the inside, it's going to consume me if I even list, you know, start listening to it. But what you described there, just giving it a name or a label, or, you know, sort of connecting some description or language to this internal phenomena. Yeah. We know that that's actually very important. There's a part of the brain that's trying to figure out what it is. And then as soon as we label it, as soon as we give a name that that's a, it's that feeling is like being disconnected or being isolated or being left out. Okay. So you labeled it. Now this part of the brain, isn't trying to figure out what it is anymore. You've got extra budget, extra energy, extra capacity to perhaps explore it a little bit. You've also sort of created by, by identifying it or defining it or labeling it. You've created a sort of cognitive container, linguistic container around which you can explore without too much else coming in. So you just kind of focus on what you label. It's that, it's that empty feeling or that, that isolated feeling good. Now you've, now you've given yourself a domain to explore. And that's something that CMI does very well. And it's very important. Some other therapies do something similar and similar things are done in different ways. You know, it's nothing new under the sun, right? CMI really looks at that as an important component to exploring the inner world into, into, you know, taking the subsequent steps in the journey. So I really liked hearing you say that, Chris, that's awesome. And then, so kind of like for families and friends listening, because you know, everyone's journey is different. How can, how can friends and family be more supportive of loved ones navigating, you know, post-military stress, moral injury, things like that. Yeah, well, I think it's important to always say that for our military families, like in, in one way or another, you signed up or you got involved or you got drafted into this thing too. And the, I think the honor and respect to our service members is great. I think where, if there's a lack and there's a lacking anywhere, it's honoring and respecting our, our military families. So what they go through is very much deserving of attention. And, and so I appreciate the question, Chris. So really where I think military family members, you know, children, parents, spouse, friends, right. I think we need to include everybody here, the community around our service members is that for each one of you, you have an importance too, you have something within you of an immense value that needs to be connected with. And I think that that's important. So that's like a first step is like, okay, where am I in all of this? You're not just a, a, you know, a node orbiting around the service member. You're an important piece, an important person. You have an important place in all of this. And to really anchor yourself in that intrinsic value, I think is important to be able to be anchored in that and stable in that will communicate to your service member that you have that stability and you have that connectable sort of feature within you. And I think that's, you know, of the, the many things that we can do is to be a resource for connection. And it doesn't need to be that we've got the wisdom or the answers or the advice, just connection to be a resource of, Hey, I can stay with you in this moment without becoming disrupted or destabilized or upset myself. And to be able to do that, that's no small thing. You know, we have to go on our own journeys to get to that place where we have that, that connection within ourselves and that stability within ourselves. So that's what I'm encouraging folks to do is to take their matter seriously and to take themselves as important and valuable. And in so doing, we can really create ourselves as a resource for our service members. You know, that's what they need. They need stability around them. Pretty much touched on the major topics that we intended to discuss today. Is there anything else that we haven't touched on that you would like to share? No, you guys did a great job. I think obviously the pre-podcast discussion kind of sets things up and I would kind of spend some time listening to other podcasts and going over my notes. So I think I hit the beats I was hoping to. Yeah. And I really appreciate the questions and the curiosity for me too. So I feel pretty good about it, Tom and Chris, I feel good. Great. Good. And then kind of one of the things that we've been trying to do with podcasts kind of going forward is kind of ask like a, you know, general question of, you know, of everybody that we talk to. And that is what is one way that we as a society can better support those transitioning from military service to civilian life? Yeah. Yeah. That's a good question. You know, how I'd answer this is to I suppose there's a lot of answers to this has a big question. The way I like to answer things often isn't, I mean, you got another two hours. No, I'm kidding. You kind of got at this earlier in a way, I think that we need to create a society in a very immediate proximity around each other. You know, society shouldn't be this thing that we can't reach to the left and right and grab all of it. That's kind of how I feel. I know that's not how the definition is, but in as much as it pertains to me and is important to me, the society needs to be those things that I can directly interact with and connect with. And so in some ways it's like not leaving it up to the unknown sort of mechanisms that are beyond our hope or control. It's to create that society and that community. And I guess really that's kind of the next best term, wherever we are. And you can take that and sort of iterate on it. And it's like, at some point you end up right back with the individual. So for everyone hearing this is like, you're a node in this community, in this society. And so it really is up to you. It's not up to anybody else. And that gets back to some of those big themes. Find that place within you, connect to that value that you have, that importance of your role and manifest it. Take it seriously. Connect with those things that have been difficult all your life and understand them, map them out. Become something greater than you were a moment ago, a day ago, et cetera. And when you do that, and it's like, Tom, that connection you made with my story earlier, the veteran is feeling a lot better, but what happens after that? He goes and he connects with the family of his co-pilot and he plugs into their life and he brings something of incredible value to them. I mean, who knows where it goes from there? That's how we do it. That's how we make the change. In that case, I really want to thank you for being on here and talking with us. It's very informative. And I'd like to thank our listeners as well. We really do appreciate anyone who takes the time to listen to us, watch this. Hopefully it helps either yourself or if you know somebody pass the information along, because that's exactly why we do this, is to hopefully get something out there to know that there are resources, there are people out there that have gone through things that want to help you. There's resources. So if this helps you, if you enjoy it, click like, subscribe, do what you need to get the word out. And thank you very much for taking any time that you do to help us out with this. Talk to you in the next episode. Catch you in the next one. All right. Bye.