Hello everyone, it's Anthony Chadwick from the webinar vet welcoming you to another podcast, another veterinary chat podcast. Very fortunate today to have Lydia Brown and Brian Powers on the line. Lydia is a very old friend of mine, .
She actually helped get me into vet school, so I'm eternally grateful for her help of that. Lydia at the time was working, I think he's the best vets practise in the whole of the UK. It was Beth the vet, wasn't it?
He, he was set up on our, on my road in Liverpool Priory Road. And as a 12 year old, I started going over and then Lydia would come in and do locums. Lydia originally dealing more in in fish vet work but has now had a very varied career.
And is particularly interested in this new, in this new concept, I think, or new to many of us of moral injury within the veterinary profession. And we're also very fortunate to have Brian, and Brian comes from a background of the US military, so. Moral injury obviously is something that we're gonna be discussing in more detail, but you know, I know Brian, it is a new.
Concept, perhaps, introduce yourself first, but then if you can tell us a little bit about what moral injury is about and how to define it. Sure, thanks for having me, Anthony. It's an honour to be here with you.
So my name, like I said, is Brian Powers. I'm a systematic theologian at Durham University. I'm also a veteran of the United States Air Force and the conflicts in Iraq and Afghanistan.
What at Durham, I occupy essentially two posts. One is the Van Fellow in, Christianity in the Armed Forces, and the second is as executive director of the International centre for Moral injury. So as you said, what is moral injury?
That's a key part of what we do is, I think educating on that, . As we say, it's something that's difficult to define, but the best expression of it is, it refers to the sustained experience of negative moral emotions, so guilt, shame, contempt, and anger in particular. And these result from the betrayal, violation or suppression of deeply held or shared moral values.
It involves really a profound sense of broken trust both in ourselves and in our governments and our leaders, in the institutions that we expect to act in just and proper ways. And that broken trust really can have cascading effects on how we live our lives. It turns out that if we can't trust anything or anybody or ourselves to make good moral decisions, we really have a problem kind of understanding ourselves and how we operate in relationships with other people and as a larger community, and often the effects of moral injury or profound condemnation either of ourselves or of society.
And that has again, different psychological effects on us and consequences that follow on from that. It is, you know, very distinctive. We know PTSD is often spoken about as something that military veterans face, and so it's commonly understood that any military veteran who's having trouble, upon their return has post-traumatic stress disorder.
However, moral injury has many of the same symptoms, but is actually quite distinct. PTSD is essentially the the. Effects of continued exposure to fight or flight stress, extreme senses where we're forced to make decisions out of a very fundamental sense of fear for our lives.
And over time, we know our body's condition, to that, and we can both our memories of those really traumatic and stressful times, as well as our body's reactions themselves can become problematic and maladaptive when we're no longer in those really stressful environments. So that's a clinical condition that can be treated by medical teams, by psychiatrists, by psychologists very well. We, it's not easy, but we know kind of how to deal with that fairly well from a medical and clinical environment.
Moral injury involves those things that I said that comprise more existential crises, us understanding how we fit into the values of the world, what our values are. Perhaps even our own realisation that those are very Often tendentious things and that it can be easily betrayed, that we can easily violate them, that we can, they're not the solid foundations perhaps that we always assumed that they were. And so those issues are an entirely separate part of how we process our experiences from the actual physical and physiological manifestation of post-traumatic stress.
This is a more again, reflective moral evaluation and and how it works out in ourselves. Less in the fight and flight stress situation, but actually just asking deep questions of ourselves that what we did, what we were asked to do, whether we felt that morally it was the right thing for us to do. That that's it.
And I think it's experienced by, it's first observed in military veterans who are in very acute situations. One of the early definitions is that it is a betrayal of what's right by a person in a position of authority in a high stakes situation. And that idea of a high stakes situation is easily seen if we imagine combat scenarios where the consequences of our actions are either life, death.
Of other human beings or destruction of something our friends, the enemy, all the situations involve irrevocable choices. So the military is really an acute version of it. And so that's why we often see it in that way in military members.
But what's interesting is we're currently now seeing it and observing it and taking the learnings that we've had about how it operates and military members. And noticing it and recognising it in different scenarios in the healthcare setting, particularly with NHS workers in the pandemic who had to face similar high stakes situations continually in law enforcement, where again, those high stakes situations aren't hard to imagine. And also, again, in the veterinary profession for, for different, different ways, different experiences that kind of collapse our moral expectation.
Well, perhaps Brian, at that point we can bring Lydia in, cos obviously Lydia, we talk, we talk a lot and obviously this was an area that you have become more interested in in the last few years. What, what kind of got you interested in it, but perhaps before you start that. For those people who don't know you, tell us a little bit about the, the veterinary, history and the veterinary experience that you've got.
OK, thanks, thanks very much, Antony. Well, I'm, I am, as Antony said, I'm a fish vet and I spent most of my life working in research universities or the pharmaceutical industry, but mostly it was connected with aquaculture. And, on the sort of veterinary political side, I got involved in, you know, trying to give back to the profession and became a council member of the Royal College and then ultimately president in 1998, 1999, which seems like a long time ago.
Now, but then went on to, be the chairman and then of things like, that helpline. It was veterinary benevolent fund initially. I was one of the people, the founders of the veterinary surgeons Health support programme where we tried to find a way of If you like, instead of removing a vet's living, you know, at the Royal College under a disciplinary procedure, we tried to find, try to create health procedures so that the vets could be moved to one side and help to return to full professional life.
And then on the animal side, I suppose, I was chairman of U4 and Humane Slaughter Association. So that's a bit of a thumbnail about me. And I'm married to Stephen, who is an Anglican priest, he's retired and he was chaplain general for the British Army.
In fact, we were both widowed and we met each other and got married 12 years ago. And so, through Stephen's, interest in obviously chaplaincy, what chaplaincy does in the army. We met with Brian and Michael Snape, who's also at Durham University and got involved in the Van Fellowship.
And, as that was progressing, we began understanding more and more about moral injury and what it was, and I felt that it was really important that somebody who really knew what they were doing, and Brian is one such man. Should, should kind of produce a centre, an international centre for moral injury, which, which is, as I say, international because things happen differently in different parts of the world, and we can learn from each other a lot. So we were looking for a digital presence, if you like, a website based with all of the research that Brian and his colleagues are doing, but also linking with other research centres and Asking for those centres to link with us so that we can share information and it's readily available to everybody.
And, and if you like, I know that my understanding has all come from the history of the the military perspective, but we also have, if you like, silos on the website, which address blue light organisations, NHS and so on. There's a veterinary section. We're trying to build up the research of what's being talked about with with the veterinary profession.
. And, and just in, in general, you know, general life, how moral injury can affect us too. We, we don't have to be, you know, a healthcare professional to, to be affected by moral injury. And it's really interesting, Lydia, I mean, perhaps give us a couple of scenarios where you see moral injury could happen.
In the veterinary profession, which is, you know, obviously quite different from the military, but you know, I take your point that I can imagine some situations, but tell us maybe about some real life situations that you've maybe come across. Well, well, true. I mean, I think one of the important ones would be, you know, our approach to euthanasia.
killing healthy animals and sometimes a vet nurse may be asked by her boss to euthanize an animal or or to oversee euthanizing an animal, she doesn't feel or, or he doesn't feel that's right. We saw it, I think in the BSE outbreaks where vets were crumbling. And I think we now call it moral injury because they had to put down perfectly healthy animals because they were in a ring of an area where BSE had been detected.
And, and similarly with TB in cattle, probably today where and foot and mouth disease of course and mouth, yeah, we have all of these, these, these scenarios. Hm, yeah, so it, it's really interesting. Yeah, if I may there's another one as well I should talk about maybe and that's.
We've had a lot of concern, haven't we about animal abuse and, clients coming in with animals into clinics and stuff. You can just imagine scenarios where the team, the veterinary team are really worried about this animal and what they should do and and so on. So, and, and that will play right through a team, not just as individuals.
And then of course the flip side of the team is if you are a junior member of staff and you are feeling perhaps bullied, you know, if that's not too strong a term by senior colleagues, what can you do about that? And so that, you know, I, I think it's, it's ripe in the profession, but, but do we recognise it, you know, and we know that if it doesn't get treated, it's leading to a lot of mental health problems. I remember fairly early on.
Kind of being encouraged, which I obviously didn't do, to, to sign papers for a downer cow that had received antibiotics and it's the same sort of thing being asked to do something which you know is morally wrong. In, in, you know, in veterinary or in, in the military. Obviously, Brian, you were mentioning there about the .
Pandemic and the NHS workers, where does moral injury then come in, cos I can accept, post traumatic stress disorder where you're seeing, you know, lots of people dying in uncomfortable ways, but on the whole, people as NHS were trying to, Help people in that situation. I mean, what were the sort of examples where you could see people struggling because of maybe rulings or, or orders that they were getting from higher up? Was that almost coming from a government level as well, or is that very much just from the, the local hospital, if you could perhaps enlarge on that a little bit.
Sure, you know, there's certainly at a local level, one could find that just whatever some local policy they have in place, folks found it really difficult to commit their best to saving lives, given a limitation here or there, specifically at the height of the pandemic when it was severe, when you have tonnes of people in the hospital, when you have. Decisions perhaps that have to be made. I think in the UK we probably avoided the worst kind of decisions that had to be made on the kind of scale that we're seeing in, say, Italy, in certain places at the outbreak where decisions would have to be made by doctors and nurses as to where to spend the resource that they had and to make sure they saved the life or spent their time and resource treating the most savable.
People, those are the kind of decisions that could lead one simply having to make those kind of decisions, having to shoulder the burden. Of literal life and death of some of those patients, I think has a significant, could cause one, I should say, to reflect back on the systematic choices that led you to that point and really become resentful and view those as betrayals of the oath that you took, that you're being forced into morally difficult circumstances because poor moral decisions were made. Further up, and that certainly, as you alluded, goes beyond local level to the choices that were made at the beginning of the pandemic, perhaps.
People could see, and I'm not, I'm not judging this necessarily. I'm simply expressing how this might be viewed by the folks that are working there, decisions based on pandemic strategy in the early going, you know, if we hadn't say embraced an early strategy of letting it spread. To focus on herd immunity.
And then, you know, if we'd had a more protective stance from the beginning, would that have saved more lives, you know, and I think if you're somebody tending to patients having to watch them die alone on wards where they can't be visited by loved ones. And often there's so few people there in many situations, doctors and nurses were acting as chaplains, as family members, as comforters, as all of those things. And I know there were wonderful chaplains working in the hospitals in those times too.
But sometimes those burdens were all shouldered by medical staff, and simply the exposure of having to watch someone. People die in those circumstances again and again and again and again. It's just not something that I think any of us are used to, whether military, NHS and those kinds of circumstances until we're thrust into it.
And I think those cause us to really reflect on those moral situations and make it distinctively different from a situation where we just take an action and then regret that slightly later. It's one of those things that becomes much more haunting experience because of the consequences and the profound. Ways that attached to it.
That's something we're certainly looking at. At the ICMI and one of the things that we've discussed in different scenarios as we assemble different people to study this, you encounter different ways in which moral injury manifests. So as we have professionals that from with PhDs in sociology and anthropology, and when we bring together folks who chaplains and folks who have lived experience of pastoral care, as the ICMI's remit is certainly to do and to.
You know, foster collaborative research, we find a lot of different ways in which moral injury is experienced like that, and certainly some commonalities. The deal with life and death, certainly I think as Lydia is just alluding to, in having to take life as a veterinarian, that idea of shattered moral expectation, I might have come into this to save life and to do well, and find that my capacity to do so is diminished either by the decisions of others or just the situation. That are right that one finds himself in.
I, I suppose, yeah, in, in Italy there was a real shortage of ventilators and I think even in the UK we had shortages of those and oxygen and so there were choices being made, whereas in places like Germany who were perhaps a bit more prepared, they had more. Ventilators, it it meant that people didn't have to make those terrible decisions who got a ventilator and and who didn't. Absolutely, and you know, even just knowing, knowing that other countries made other choices perhaps enables that more reflection reflection to be, well, we could have done this differently.
And see that more as a moral choice and feel much more betrayed by that, if you see that the way we did it isn't necessarily the way it had to be. Mm. I liked your idea that, Brian, of bringing people from different disciplines.
And of course, as a team together everybody achieves more, you see different facets from different professions and that gives you a more rounded view on it. If it's just the military talking about this, you have a very one-sided view of things, don't you? We do, and you know, it's really interesting.
Like I said, it certainly started in the military, but as we observe moral injury and the particular ways in which it manifests in different scenarios, I think that also tells us more about how it's experienced in a military setting as well. We take, can take the learnings from all of those different ways from, you know, the experience of veterinarians and police officers and healthcare workers. You know, you see some of those common threads, and that helps us identify perhaps even what it is in the way that military members operate, the way combat, sort of distorts and changes the way we view things morally, but yet, our humanity connects us to this idea that, you know, having in our responsibility, whether it's to save a life, whether it's to take a life, whether it's You know, actually just either one of those, whichever side one falls on that boundary.
Really tends to stick with us and we tend to and causes us to reflect, I think on. Moral situations and the moral values in a very strong way that can become. Really difficult for us.
Mhm. Obviously, Brian, you're up in Durham at the centre, you know, military, NHS, anthropologists and so on. Do you think there's there's a need for vets to be involved, for somebody to perhaps be interested and to study this further, as a veterinary surgeon or as a veterinary nurse, would that be helpful for people to start, considering it as an academic discipline, even for vets to follow as well?
Oh, absolutely, Anthony. I mean, I think one of the things that we found is that the best, the best research on this comes from folks who do are rooted in a profound experience of that. Community world or moral injury itself, and kind of bring that to the study and want to interrogate that experience, find out more about that experience in order to help others in their community.
That's one of the profound ways. So certainly, if there are folks who this resonates with in any way that have experienced moral injury in the veterinary community, we would love to have you study moral injury at the university. We have links that I think will be available later on our website.
Understudy as that detail the ways in which you could do that, but certainly we'd love to be in contact and do some of that research. One of the big, big remits of the centre is certainly to produce research on moral injury, as well as to build networks that are going to collaborate and foster new research. Our conference that we held at Durham, in last April really brought together Different folks, clinicians, psychiatrists, psychologists, sociologists, we had artists, theologians, chaplains, clergy members, .
All looking at moral injury from different avenues, and it's really rare, and what I think the centre really is able to do is to bring those folks together under the banner of moral injury specifically. Moral injury gets talked about in a lot of different sectors of both academia and society, but it's very rare that it is the heading, and it is the reason for people coming together and focusing on that. So what we found, I think at that conference is a really beautiful way in which All those folks are seeing what each other is doing, noticing that, looking at their academic research.
And able to see new directions that they can take their research and new ways which we can collaborate and work together. And that's been, that's been probably the most rewarding part of this so far is just to see how those networks come about and see how that research really does become collaborative. I, I think this is such an important word.
I love that whole idea and and. Word collaboration because. I'm doing trying to facilitate a bit around sustainability in the profession and if we're trying to compete in these sort of areas, it would be complete madness because the more we collaborate and share, the quicker we come to the solution, don't we?
That's it. And I think that's, you know, the center's primary goal and the ultimate goal in which all of our research is geared toward is to, of course, improving the pastoral care and treatment of those who do experience moral injury. So that takes place through different avenues, certainly, but as you say, the collaborative one is the one that allows us, I think, to build on.
The research done by others and certainly work together for the most kind of holistic idea and way to treat it. That's something that's And again, the centres certainly wants to serve as the hub for where you go to, especially in a European context to find resources for moral injury, to understand, to work together, to find other people working on it. And I think that's a really, that's a really valuable contribution that I think it makes whether it's military members, NHS workers, veterinarians, all other forms of moral injury that we see in society, there being a central place to find research about it is an important function.
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I think it probably is fair to say, moral injury is, is as a concept is more developed in the US and is that basically come from the, The military are really investigating it and and researching it. Well, I would love to say yes, that it's the military doing that entirely, but it's certainly US . Organisations within the US that are kind of leading the research that have really pioneered it.
The definition of it was really, it was really brought into the modern lexicon by a VA psychiatrist named Jonathan Shay up in Boston who gave the definition that I noted earlier about the high stakes situations and the betrayal of what's right. . And a lot of the research, because it's so involves our moral values, how we see ourselves acting in concert with them, how we see ourselves upholding or violating general shared communal values, because a lot of that comes out of the US, it does have a very American values focused feel to it, .
And you know, I think that's we've already seen, I've had several conversations just today with others here in the UK that say that have said notice that and said, you know, this is true in an American context, but I'm not sure these You know, different aspects are true in a British one, and I think that's that's very true. So, there's brilliant research done in the US. There's two kind of centres that were partnered with there at the Shea Moral Injury centre in Washington DC and the soul repair centre in, at Bright Divinity School in in Fort Worth, Texas.
But again, those are very Does do wonderful work in that American context. One of the things the International centre for Moral injury at Durham is trying to do is really also serve as a European hub for research and look at a lot of the ways in which European values can bring so much to that conversation, how European stories of moral injury, how European narratives and perspectives on moral injury can really contribute so much to the global conversation, . You know, in one sense, to decenter that from an American focus, but also so that the US which sees so much of this in acute way, can also see and explore pathways to recovery that it may not otherwise see.
So I think bringing that international focus to it, and seeing how different cultures outside the US, outside Europe, even, do understand. Moral injury, understand moral values, reckon with difficult situations after conflict. I think that will bring a lot to the discussion.
That's certainly something the centre is very interested in. No, that's brilliant. I think, you know, I.
I'm a student of history and the whole concept of a just war, I think has changed over time, . In the 1st World War, Second World War, people would. Come home after the war and would not talk about what happened.
In those feelings of shame, possibly they didn't want to talk about it, and I always feel it's, it's ironic that the politicians put people into war, but it's often the ordinary person on the street who is often, you know, if I'd have been born at that time. There would have been a lot of similarities for me in Liverpool and somebody in Germany, you know, we probably shared, we could have been vets, we might have shared similar faith issues, and yet there we were, not even having ever met. No reason for us to fight the war first certainly the First World War was just a case of people not talking to each other and mobilising too quickly.
So I presume that that's also a big part of it where people ask the question, why am I even going to war cause I don't even understand what this was about. Yeah, that's really interesting point. Certainly, I think, as you describe, I think what's common both honestly in conflict and military members, who were somewhat at the front end and enforcing end of political decisions that they didn't make, that are made by, as you say, politicians.
The military is again the most acute example of that where they're faced with the moral consequences and often the moral trauma of having to reckon with what carrying out and implementing some of those policies is about. Certainly, we think moral injury is not something new, even though we've newly identified it. We think it's existed certainly since probably the humans first started fighting conflicts whenever that first took place.
But in a similar way in other contexts too. So I can imagine in a veterinary context, with what Lydia was just describing, the decisions about, you know, which herds to cull, what rings around different infections, if there's an outbreak of disease in animals, those are decisions made not by the person that has to go out and kill the animals. And so in the same way, I think.
In the pandemic also. There are folks who often end up for, for lack of a better term, holding the bag in moral situations, and they're not the ones who made a lot of the decisions that could have gone one way or the other. One of the things that we I find certainly very.
Worth exploring in moral injury is the ways in which our own agency, our own sense of goodness is often co-opted, in ways that we don't foresee and can't imagine. So we're We set out to do one thing. And find through a series of different events or agreements or.
Kind of decisions that flow suddenly we're doing something that we never could have imagined. We started out doing and then seeing that our own sense of honour and goodness has really been bound up in a greater one, and now it's been betrayed when there's a disconnect between what we're finally ended up doing. And the values that we hold, and I think that's true across different, Strata society, different professions, as we look at that again, that idea, especially coming down to How we deal with a lot of those high stakes situations, but certainly I think.
As as you described, I think that idea of being the person that's doing the thing at the very front edge. That person is never the same as the decision maker. In a large scale, and that's that affects us, I think.
Just probably two questions. First one, again with the sustainability hat on, I was talking to a psychiatrist who, we did a webinar with a psychiatrist for the Royal College as part of their Mind Matters initiative. And they talked about the whole concept of solostalgia, which is this existential dread.
You know, for the existence of the planet through destruction from environmental causes, and people then get to a point where they don't think they can do anything about it, so therefore they go into a state of hopelessness. Is that similar to moral injury, because obviously we all know that we're making decisions every day that are affecting the planet, you know, we drive somewhere, we heat our houses, etc. Do you see potentially moral injury becoming a bigger problem as we look at some of these really, as you say, an existential threat, which is, you know, the, the climate crisis that we're in at the moment.
Yeah, that's a really interesting comparison, I think. That experience of kind of shattered moral expectation is one way to describe moral injury. It's that I thought things were gonna go one way.
I think that sounds somewhat similar to what you're describing in that if I The reason I might feel hopeless about something is because all of the decisions that have been made that led us to this point, weren't made in the proper way that would have led us down a different path, and I think there's Can be both probably a frustration at leaders for lack of accountability in that, particularly as, as you say, as you know, I think among younger generations who are growing up with probably little expectation that things are going to turn around. So I think that is probably a form of something very similar that my expectation that My government, my global community is going to provide me a space to live that's healthy, a planet that's going to be able to allow me to have a, to use an old philosophical phrase from Aristotle a flourishing life is no longer there, and I think One of the things that Moral injury explores this kind of our expectation of justice, and I think climate justice is one of those categories. If we expect injustice, then that's a difficult world for us to live in if we don't expect.
To be able to find a way, a pathway to a just world, whether that's environmentally sustainable one that will allow me to enjoy the same kind of life that my father did, my mother did, my grandmother, my grandfather. Then we're in a place that, you know, does have a moral consequence, especially in terms of climate change. And so I think that if they're not exactly the same, they're they're cognate.
Kind of ways of understanding. Is is really difficult and perhaps to to finish off . You know, full disclosure as a practising Catholic, we we talked a lot about, you know, the, the institute as part of a theology institution as well.
Moral injury is, is not just about religion though, is it, because humanists presumably can still feel the same about these situations, or people who are not bound to a particular organisation religiously, but are nevertheless spiritual people. Right, no, that's, that's, that's a good characterization of it. Certainly, certainly, owning my own part, I'm a Christian theologian.
However, in terms of moral injury, what we know is This is not about our religious nature. What it is is perhaps you say is. We all have existential expectations.
We all have some set of values and a framework in which we view the world. And what we know is moral injury really causes us to question those, and often it's more severe cases, it kind of shatters our sense of values. One of the problems we see in military members is again that that idea that I'm not sure.
I feel like I've done something deeply wrong, but I've even lost the framework by which I can understand myself and evaluate those actions. I don't understand, I can't orient myself enough to see which way is up. And so sometimes those certainly can find, we find that a religious framework is helpful in kind of redefining and helping someone rediscover that framework, whether it's Christian, Buddhist, Jewish, Islamic, Hindu, a lot of those faiths do have some kind of framework, but it's not necessarily, it doesn't necessarily need to be a religious one.
What it is is a questioning of our values and kind of having to Find our footing again in a framework that makes the world make some kind of sense or from which we can say. OK, now I've rebuilt my own sense of what's right and wrong, and I'm gonna pursue that. I'm going to either decide that I did do something really.
Morally wrong, I'm going to try to make amends for that and put my life in a different direction. But sometimes the lack of framework to do that is really makes that really difficult for us to evaluate. So certainly it's, it's a side of us that we can either identify as existential, our need to understand and put ourselves in relationship with community, with other people.
And kind of build our own sense of shared values. And whereas religion certainly are helpful in doing that, they're not exclusively, perhaps, . They're not the only way to do that.
It, it's really interesting bringing Lydia in, because we're nattering away here, Brian, and Lydia is listening intently, and it's really interesting because I, I find, we were giving an award a year or two ago for the green vet of the year and . We couldn't really divide the two people that we wanted to give the award to, and I was saying, well, we must do, you know, we must find this, and the two ladies wanted who were on the judging board with me collaboratively, both almost at the same time, said, why don't we just share it so women leaders can be so much more collaborative than men, can't they? So it's, it's interesting.
You're the, you're the listener, Lydia, so, I, I thought it was really interesting what I feel, . I learned the whole idea of what the word religion is, which comes from Latin relijare, which means to bind, at least that's what I've been told. I'm not an expert on Latin.
I did it for about a year or two in school. And that community aspect, I think if we are able to share problems, you know, in the Catholic faith, we have the confessional box to be able to go in and be able to share our, our shame and our moral injury. With somebody else, whether that be in a sacramental way or just in any way, a problem shared is a problem halved, so presumably, People who suffer from moral injury, part of their recovery is integrating into a society or into a community where they can be accepted.
Despite what they feel they've done wrong. I don't know if you want to make a comment on that Lydia again as an active member of the Anglican community in in the UK. Well, I think you're right, but the things that I've seen that seem to help people a lot with moral injury are kind of group, sessions where people have are coming together all with different aspects of moral injury.
But are over a period of time, and it's been quoted that courses to help people can last about 50 hours. This is not the only way of doing it, but, but by sharing and by being community and then at the end of the time, by having some kind of. Not necessarily a spiritual ritual, but a ritual of perhaps, tearing up pieces of paper and burning them, you know, which symbolise that they've got, you know, can understand why they're feeling, how they're feeling.
I think that's being able to let go. And I, I think I, I did hear somebody once say, that moral injury isn't a disease, moral injury is you as a person knowing that something is wrong and it's the good in you trying to get out, which is causing the pain. I think I'm paraphrasing Rita Brock, who is a a big guru in this area and in fact, she came and gave a lecture at ICME ICMI several months ago.
Brian, perhaps to finish off, have you got a comment on that? I was just gonna note that I think that is really helpful there in that comment. I think the One of the things we know about the two different emotions, if we say guilt and shame are two different things, for example, most, or there's a decent bit of consensus that guilt actually is an emotion that drives us to repair a situation.
It tells it kind of conveys to us, hey, maybe I've done something wrong and hurt someone. And as a result of that, I need to make amends. I need to make, make things right and figure out a way to reconcile with the the people I've hurt.
Shame, however, is often described as a very isolating emotion. This is a judgement about who I am that I'm not worthy to be a part of this community, so I'm going to withdraw from it. I mean in different contexts, that sense of isolate forced isolation can be really damaging, and it can be done.
In ways that we wouldn't necessarily see. I was back in the US just a couple of weeks ago and attended a baseball game there. And there's a moment in that, for example, when between innings where.
All the veterans are asked to stand up in the stadium of about 45,000 people, to rapturous applause. And to be appreciated by the rest of the fans there. Now, if you're a veteran who doesn't feel great about the moral experiences you had or you really have a lot of moral ambiguity about some of the actions you took.
That affirmation, while well intended, can often lead people to think there's no place for me to, as you said, witness to this. There's no place for me here. To tell people that I don't know that I feel great about this.
I'm, I'm really struggling to reconcile these things I did. And you're absolutely right that sense of community is in finding someone that you can witness to is often a really important step in kind of forestalling the worst outcomes of moral injury, which certainly do include suicide and difficulty from and ultimately hopelessness and that sense of it. So.
All this is to say, yes, that sense of community is important, but it's also important to reintegrate. One of the, it's wonderful when veterans form communities where they can testify and listen, where veterinarians, for example, might be able to talk about those experiences with other people that can understand. But ultimately, if moral injury points to that break, where somebody's made a decision at a high level that People are struggling to actually kind of actually or do the actions that Cause the moral consequence.
And there also has to be an integration where their stories are told beyond those communities where the larger, broader. Civilization, nation community. Can understand, hear those narratives and re-evaluate what our values are, reevaluate and have conversations about how we want our shared values to be.
Those are a couple of the conversations if I can tag on at the very, at the end here and also note that we will be exploring at the conferences we'll hold next year both in Carlisle, Pennsylvania, in the US, and then at Durham next April 1 of the things we want to do is integrate and talk about those narratives of moral injury at the Durham conference in a European way, how those Distinctively Values oriented and different and how our different national values shape those things differently and in ways that I think we can all learn from. So those are two, just two ways that I think we're trying to in some way accomplish that sense of integrating and opening up conversations about values that may in a large scale way help to . At least change the conversation about moral injury.
It'd be great to get those links for, for the conferences, you know, both in America and in the UK so that if people are interested, they can obviously look at the conference information and obviously get in contact with you, Brian or one of your team to discuss further if this is a sensible thing for them to attend and, and similarly, if there are vets out there who want to take this to a higher level. Obviously within your institution there's, there is higher level courses that people can do, isn't it? Absolutely, and we, you know, we're really building up our resources on our website.
One of the ways we do that is through monthly webinars that we have recorded. They really feature both academic research on moral injury, as well as more practical ways of understanding it, ways of addressing it within families. And we'll have a wonderfully European narrative of moral injury to start us off in our September webinar that we're planning now.
So I think there's a lot of different resource, and I'd certainly invite anybody who's experienced that in the veterinary community and is interested, have a look at those things, certainly contact me, and we'd love to work with you, certainly. That's great. Brian, thank you so much for, doing the, the podcast with us and Lydia also for setting this up because I think it's Such an important area.
We obviously are, we're in early days of really considering this as part of the veterinary profession, but I think you gave some fantastic examples before. So I hope this is a lot of food for thought, something for people to go away and, and reflect on and, and, you know, feel free to, to come back to us with with questions and underneath the podcast there will be various ways of getting into contact with, with Brian and his co-workers. Great.
Thanks so much for for coming and speaking, both of you. Thank you. Thank you, Anthony, appreciate it.
Thanks everyone for listening, everyone. This is Anthony Chadwick, the webinar vet, and this has been vet chat. Take care, bye bye.
