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EPISODE DESCRIPTION

While communication is a critical skill for anyone serving in the military, it can often become a challenge for Veterans living with a traumatic stress injury. Veterans and their Family members can face unexpected barriers that impede the open, safe communication that every relationship thrives on.

In this episode, Brian and Laryssa draw from their own experiences to share strategies and resources that have been helpful in cultivating healthy, effective communication in their relationships with their spouses, children, service providers, and others in their day-to-day lives.

Resources

Families and Friends | Atlas Institute for Veterans and Families

Tip sheets on communication in healthy relationships | Canadian Forces Morale and Welfare Services

Stories of military members and their families | Canadian Forces Morale and Welfare Services

Can Praxis | equine-assisted therapy for operational stress injuries

Couples Overcoming PTSD Everyday (COPE) | Wounded Warriors Canada

Strongest Families Institute | mental health services for youth and adults

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Mind Beyond the Mission Episode 4: Why is communication so hard?

Laryssa

Communication is essential for the success of military operations. It’s embedded at every step of the way. Drills, routine orders, briefing notes, O groups. There are even hot washes and AAR’s for after something has occurred. So it seems ironic that in preparation for this episode in communication, Brian and I both had the same response: Communication? I suck at it!

In this episode, we will try to communicate about why communication for a person with a traumatic stress injury – and the Family members – is so hard.

Brian

In some ways, when we first started talking about this, I was thinking, “Can we talk about something else? Something a little more comfortable, something easier?”

In a lot of ways I would rather talk about some really, really nasty things than talk about why it’s hard to communicate. Even now, when the conversations come up at home of, “We need to talk…” man, that’s an ominous thing to hear. And it can be just something really benign, but it puts me in threat zone, puts me in, “What bomb is about to land?!” mode. I would rather a real bomb did land. And all those pressures are going on in my mind when it’s, “Honey, let’s sit down and talk.”

So in that regard, the military has communication, but when I communicate up, it’s a back brief. I’m responding to something they’ve told me to do and I’m showing them how I plan on doing it.

Laryssa

Right.

Brian

When I communicate down, it’s orders. I’m not really concerned about how you feel about the patrol you’re about to do. “You are going, do you have any questions?” And when I’m communicating laterally, it’s because I’m going to move my men through this, and you are going to move yours through that one. And we need to plan so we don’t bump into each other and ruin each other’s business.

Nowhere in there am I communicating in the way you and I communicate when we figure out how do we meet our needs, how we are going to do this project.

Laryssa

Right.

Brian

And it certainly has nothing to do with how I communicate with my wife. So yeah, I have courses in communication, but the communication you are looking for scares the hell out of me sometimes.

Laryssa

Yeah, because the communication you’re talking about is one way communication. You’re providing the information, or you’re on the receiving end, and that’s it. And something that you’ve said before is that part of the training that you’ve taken is using the least amount of syllables as possible to communicate on something.

You and I have chatted about that, where in a relationship, more is required. It’s supposed to be two-way communication. You’re supposed to be receptive to the other person. You have to do reflective listening, all that kind of stuff. Because I think I’d asked you before, if the military relies so much on communication and you’re schooled in it, why is it so difficult for so many Veterans to communicate within that Family?

Brian

There was one mission I was on where my call sign – because we have those. A lot of people laugh at them when they watch Top Gun or something bad happens in the news, this has happened recently in our community, in the world of call signs – I was called “33 Pronto” for one of the tours I was on, which means “the third company,” Charlie company, the third platoon within it. So 33, 9 platoon, and Pronto was the person that is the platoon signaler. So that was my job for that mission. So why I’m called that – it’s not a cool name or we don’t get to sling it around in the bar and impress people – it’s meant to be deceptive. It’s meant that if you didn’t know what I just said to you, you won’t know what the heck 33 pronto is. So built into our communication is deception of anyone other than the specific person I intended to tell and what I intended to tell them.

Laryssa

Mhm, interesting.

Brian

So it is entirely fine for someone to ask the military version of, “Where are you right now?” They’d say, “Send locstat,” and I would give them an encoded grid more than likely if we were actively being pursued. And I would certainly give them a grid, not a location. I would not say, “I’m at the top of this mountain.”

Laryssa

Right, of course.

Brian

Because everyone would know where that is. I would give them a grid based on our mapping system. So it is designed to not tell you anything.

Laryssa

Okay, which means to me, the other person has to be in the know of the code

Brian

Yes.

Laryssa

And so, let me ask you then, do you have the same challenges communicating with your Veteran friends as you do with your Family?

Brian

No. They have the code book, right?

And that’s a lot of why it is easier, but there’s also the intimidation factor. Like I told you, my friends might come to me for advice. They might come to me just to socialize. Generally when the “Honey, we have to talk” conversation comes up, that means there’s a bit of a problem and it’s probably in the emotional sector. And you probably won’t like it, even if it’s like, “What do you want to do tomorrow?” Even if it’s something you will like, the “Let’s sit down and talk…” man, that’s an intimidating conversation. I would rather have just about any other conversation, so, yeah. Yeah. We’re skilled in communication, alright. Not the kind you’re looking for, though.

Laryssa

Which obviously creates a huge barrier. And we talked before about how for any relationships, from any couples or Family members, there are challenges to communication. I mean, there’s umpteen million communication courses that you can take just for personal interactions, or for your work environment. It’s challenging for most people. So let’s add on top of that a, traumatic injury. So, have you been able to ever identify how your specific PTSD puts another layer of barriers on communication?

Brian
Yeah. So I went to an incident once where there was an exploded bus and it was really, really bad. But for me, there were other incidents that were also really bad. It took me three years working with my doctor to be able to answer the question to him of what was bad about it. So in those three years, other people are asking me the same questions, like, “How are you? What’s bugging you? What can we do to help?” and I really didn’t have the answer, right.

So I’m not lying to you when I say I don’t know. I didn’t know. And then even for a while where I thought I did know, I was wrong. So we get into a situation where I don’t have the answer or what I told you is not true. You might call that lying, but in the process of my doctor and me working for years to get to what the truth was, that’s what I told.

Because that’s what I thought. So in this circumstance, what actually bothered me was that I’d stepped in the purse of one of the people that was deceased in the vehicle. It’s a purse. I didn’t say rucksack, right? Well, soldiers have rucksacks, but women have purses. This is a different situation.

So stepping in that purse bothered me more than what was inside that vehicle. That’s weird. That’s not normal. That’s not how it’s supposed to go. I’m a dad, I’m a husband, I’m a neighbour, I’m all those things. I’m supposed to be concerned about loss of life, but I got into such a place where the loss of life was so relatively common that it bothered me more, that I’d stepped in someone’s purse.

Laryssa

Because it was then personal. There was someone attached.

Brian

How do I tell you that? And what will get better when I tell you that? And the truth is, as we’re sitting here together, there’s a couple people in the room helping us with the sound here, they’re listening to this too, and I can see their faces, I can see yours. You don’t know how to help me with that, right? So why did I just tell you? What’s the value in me telling you that? What are you going to do to help me?

Laryssa

And I think that’s hard for Family members to accept, because again, we were chatting about this earlier, that I’m going to talk specifically about about a couple’s relationship – when we use the term ‘Family’ in regards to Atlas or the podcast, that could be parents or siblings or friends – but in this case, I want to talk about couples. For many couples, your significant other is supposed to be your best friend. They’re supposed to be the one that you provide that shoulder, they can lean on you through tough times with mutual support.

So it’s really hard for Family members when we ask, “What’s the matter, what’s wrong?” and their response is, “I don’t know,” it feels like we’re being shut out or shut down, or like we won’t get it. And in many cases maybe we don’t get it, but I think in light of communication, if Family members understood what you just said, that sometimes I haven’t been able to process it on my own.

And there’s that other component too, which we’ve touched on before about that protective piece. You want to protect us from what you’ve been through. If you’ve got those movies going on in your head, why do you want to put those movies in my head? Like you said, what’s the benefit of that?

So I think it’s helpful if the Family members understand that too, and can provide some space or more understanding in that.

Brian

And I think from our perspective that we have to maybe be reminded or be willing to accept being reminded that there is more to communication than just the relaying of facts.

And we know this. There are cases where we’ll put stuff in a report and the emotion that we’re trying to put in the report, like, “I drove through this town and they hated us, but they didn’t hate us last week. Something’s changed.” I remember reporting that and also reporting the standard things of how much gas we used and all this, and the only thing that got into the communication that went was the facts, the gas, the numbers.

And so I remember being frustrated by what I think you’re frustrated by, which is that you took all the heart out of it. So there are circumstances in how we do business where the situational awareness or the feel, the atmospherics, are part of what we do.

I think it might be helpful to remind soldiers that the conversation with your spouse is probably more about situational awareness than it is about facts and figures. That’s language we would understand. I don’t know if that helps anything, but it’s one of the few places in our background where we can be reminded, okay, you do this in part of your communication as well at times, and you need to bring that talent back home.

Laryssa

Alright. I want to touch on something else that you said, too. You said so much of communication is not the hard facts. So we were talking about barriers and what barriers might be impacted by let’s say post-traumatic stress or depression or whatever. And so some of my experiences were as a family member, when my spouse maybe was really triggered and just trying to get himself grounded. And I am complaining about taking the garbage out. And I feel like he’s not present. He’s not listening, he doesn’t care.

But there’s – maybe he’s trying to manage symptoms, so that can be an additional barrier. Um, as well, he used to explain that. after his injury, he needed more time to process and compute. So I would be communicating with him. And then there’s this, again, this space and time. Um, but he was really processing what I’d said.

Um, wanted to formulate his response. So that was something we had to adapt. Um, let’s face it. sometimes along with mental health injuries comes, uh, substance use that can be an additional barrier. Um, if you and I were in a really crowded Tim Horton’s and there’s a lot of things going on that you’re trying to maintain situational awareness.

And, um, and I’m delving into something that I think is really important. So I just, I just think there’s so many different layers and I might be reading things, your body language or such, which is not factual, not verbal. And as a family member, I’m interpreting that they must be about me. So I just think there’s that additional layer, that comes along with the injury.

Brian

Yeah, I think for a lot of us, when I look at barriers, often our communication that we work with is, “I need to take this thing that’s wrong to the person who can help me with that thing”. And that’s it. I don’t go talk to a mechanic about what’s wrong with the radio and vice versa.

So a lot of it is a version of us protecting you. And you’re a grown-up; you can handle it. But do you need to handle it? But at the end of the day, the biggest barrier for me in communication is often, “what can this person actually do to help me out?” And it is just looking at yourself in some regard, but I think a relationship is more than just the sum of the parts.

There is another entity in the room between a husband and wife, other than the two people, which is the relationship. And the communication that we work with doesn’t care about that. So we have to kind of change the mode we’re in. It’s not easy. It’s not easy even now.

And I feel like, if I have a problem with Tim Horton’s, does that mean you have to have a problem with Tim Horton’s? By the way, Tim Horton’s people: love your chili. And I’m an apple fritter guy, right? So just putting that out there. But if it wasn’t my place, now it’s not your place if we’re in a relationship.

In fact, you might even not know five years from now why you don’t go to Tim Horton’s anymore.

Laryssa

Exactly.

Brian

And it could be because I’ve conditioned you that way. I don’t want to condition you.

Laryssa

Exactly. I think that’s a whole other area of conversation because I think that’s pretty insidious.
And when we’re emotionally connected to someone, you can’t, kind of, taking on those things, I guess, in some certain ways. You talked about wanting to talk to people who can help you. Tell me more about communication with your therapist. Is that different than with your buddies? Different than with your family?

Is that something you had to adapt? How does that go?

Brian

So I built a 20-year history of lying to doctors. You know, you get into the military, you’re going to get an assessment. I think it’s pretty easy to tell when they’re asking you questions at the entry point that the answers of “yes, I have a problem” or “yeah, that bothers me” are not going to be good for you to get in. You want to go on a deployment and, let’s face it, this is one of the communication problems actually between soldiers and the country: the country doesn’t understand often that we like these jobs and we want to do them. I’ve had people come up to me before like, “Oh, it’s so bad you had to go.” No, it’s not. That’s what, like, you have to hold me back from going.

Laryssa

Right.

Brian

So there’s a communication problem just there, right? But I think that’s kind of how this stuff pans out in the end is, you just get this feeling like the only people that really thoroughly get me are my buddies.

Laryssa

Okay.

Brian

And this person I’m married to wants to do everything for me that’s possible. But, um, that’s pretty limited. So in terms of the doctor, I look at the doctor, like every other doctor that I had to get through to get the thing I wanted.

Laryssa

Okay.

Brian

I want to take the Combat After Capture course. I know that you can’t allow someone on there that’s got a problem. So guess what? I don’t have a problem. And then you finally get to a point where that catches up to you. It takes a while. So if you think you build rapport with me in one session, good luck.

Laryssa

Right.

Brian

Good luck with that. It takes a while. So yeah, unfortunately, through no fault of their own, I put the medical practitioners through the ringer before I get a sense that they are actually here for me.

Laryssa

It’s a sniff test?

Brian

Hell yeah. I mean, when I reported that I had a problem to the military, quite rightfully, their biggest instance of dealing with me is to see what threat I am to the department. And they should do that. A disturbed soldier can cause a lot of damage within the system. They must protect the people in the system. But on the receiving end, you really feel like that, like you’re just being tested to see what you could damage, not administered from a health perspective.

Laryssa

So, it never felt legitimate to you? Like, you didn’t feel that those people that were there to help you were invested. It sounds like you felt misunderstood. There was a disconnection.

Brian

Yeah. Well, I also had one doctor ask me, “if you got blown up that day, why’d you go back out the next day?” Well, if you think wars are fought in shift work, this isn’t going to be a healing place for me. Next? And so I wound up maybe being overly critical, but I was certainly critiquing whether they had even the slightest clue of who I was. And in Vancouver, where I’m from, there aren’t too many soldiers around. It’s a different society out there. It’s difficult to find a doctor that has a clue as to who you really are as a person.

Laryssa

Okay. So that’s what I wanted to kind of ask a little bit was, I guess, from both sides of it. What would you offer service providers who are working with a Veteran community? What can you offer to them to help them build that rapport and help them communicate with the veterans that they’re supporting and working with in their practice?

Brian

I would say simple Plan A stuff. And what I mean by that is, if you think you are going to be getting a client coming into you who has just come back from Latvia and has an issue, well, maybe read a bit about Latvia then. And Defence is actually pretty good at putting stuff out there, mission updates as to what the mission is doing.

Don’t dare see him without reading that first, you know?

Laryssa

Right.

Brian

I mean, do some homework as to who we are, and then if you have a couple of clients from our background, start trying to figure out what we have in common, because what a lot of us feel like is that you’re trying to fix the soldier in me.

I don’t want you to fix that. I don’t work in the military anymore, and I still consider myself to be a soldier. And I organize my life that way. I plan that way. I function that way. I’m speaking to you now while you’re probably trying to get to the Brian, but the one I prefer to show you is the soldier.

And I think you’ve got to understand that. That’s the person who’s sitting on your couch. Don’t try to get the military out of the way I do business. And when I get the sense that you aren’t hostile to the soldier in me, then I can talk to you.

Laryssa

Okay. So, there’s maybe a little bit in there to speak to other Veterans, because that was going to be the other side of my question: what would you offer Veterans who might be going to service providers? And what recommendations would you give them in how to make communication flow better? And really, because I think you get out of therapy what you put into it, you have to invest in it. So if you were shut down for all of those and you’re taking nine sessions to do the sniff test and see if this person understands you, it’s not benefiting anybody. So, what could you offer to veterans about communication with their therapist?

Brian

They’re a specialist; approach them like they are. If you’re getting a weird noise out of your turret when it tries to move to the right, but not when it goes left, you would say that. You would say exactly that. You wouldn’t hide some of that, right? You have to treat this person like they need to know the truth to do their job. So if someone tells you, for example, that drinking more than four beer a week is bad for you, and you drink way more than that, this isn’t a sniff test to see if you’re obeying the rule. The doctor needs to know how much you’re taking in.

Laryssa

Right.

Brian

Because they’re going to prescribe things, potentially; they’re going to work on therapies; they’re going to pick options that are best suited to you. So they need to know the truth about you. And that took me a while to come to terms with.

Um, and I know that’s pretty common. So, if you ever intend on leaving that room in any shape or form that’s better than when you entered it, truth only—as best  as you know how to say it.

Laryssa

So, your analogy is so military centric. Because what I would say to family members who oftentimes need their own support, and therapy is, take all the lint out of, like, take everything out of your pocket, including the lint. Take the lint out of your pocket as well. The therapist needs to see that, too. So, reach down into the deepest, darkest corners and put it all on the table. So that’s the Laryssa side of your analogy: the turret.

Brian

Yeah, but I do I think that I have a doctor right now who’s done a lot for me. But the first thing he had to do was get me in a place to tell him the truth. Like, “What are you really thinking? Suicidal ideation?” I didn’t have that problem, right? But I did. And it took me a while to believe that this was the place to table that. And this stuff isn’t easy, but you will not fix it, in my opinion, by giving him 60% of what you think he needs to know.

Laryssa

Right.

Brian

How would you know? And that’s it. It is a craft. And you’re probably not going to get a cut-and-dried answer, like if you sprained a wrist. Those are pretty defined. It’s going to bump and wiggle for a bit. You’re going to go through a process that may feel like they’re guessing and testing, but that’s because the mind is so complicated, and you have to trust that this is a specialist who knows what they’re doing.

I’m going to get you to accept my precursor at the end, which is: fire him if it doesn’t work. You can’t keep working with the same doctor if you know that that relationship isn’t working. You owe it to yourself, the taxpayer who’s funding the bill, and that doctor, to be using that session in a good way.
If it’s dead in the water, if that relationship is soiled, go to a different one.

Laryssa

I think that’s really valuable. I appreciate you bringing that to light because my observation in working with Veterans and families and in my personal life with my spouse is that I believe that maybe there was at some point that you didn’t feel that you could do that.

I mean, in the military, you are assigned a clinician or whoever is at the MIR. That’s who’s treating you. And that’s it. You didn’t have those options that you couldn’t advocate for yourself, that you weren’t in charge of your own recovery. And I think it’s important for some folks to hear that if it’s not meshing, if it’s not fitting, then you can advocate for yourself and go a different route. You are not stuck with that one person or even that one treatment modality. So I really appreciate you speaking about that.

Brian

Yeah, and you know, rank does come into this, no matter how much people want to say it doesn’t. They’re saying that from the end of the conversation that it doesn’t matter. From the patient’s point of view, it does. I felt, as a warrant officer that I could come back to the system and say, “That practitioner doesn’t work for me.”

Laryssa

Okay.

Brian

I have troops that told me they didn’t feel that same flexibility, even though it’s told to them, even though they say you can bring this up.

Yeah, well, it’s a different conversation. You know, it absolutely is a different conversation. And that’s where leadership can actually play a role, is to remind people that they have rights, that they’re a patient here, not just a soldier. So I think that stuff matters.

Laryssa

Okay, I’m throwing it at you, Brian. We’re talking about communication. We’ve chatted a little bit about working with service providers, chatted a bit about family, which we might come back to, before we’re done here today. But tell me about communicating with others who provide service to you, like VAC.

Brian

Sure. How about the Canucks?

Laryssa

Okay. [laughs]

Brian

Right.

Laryssa

That was subtle.

Brian

So I ran into a problem a couple years ago. And I’m fairly meticulous with my paperwork. The problem I had was that I hadn’t opened up a very benign letter from Canada Revenue Agency, the tax office, that was telling me I had to do something; I had to provide them with a document. Easy to do, but I hadn’t responded in about 14 months. Now I have a problem. Well, the whole reason that happened is that brown envelopes from the government for a number of years were always bringing me bad news. They were normally, “you don’t qualify for this” or “you need to go get reassessed for that”.

It was normally some painful answer written in seven pages of legalese that, by the time you got it interpreted, it was bad news. It got me to a point where everything that looked like that got treated the same way. So yeah, I had a tax problem. I had a tax problem because I was sick and tired of the written communication that was coming to me, and it would set me off.

And the next thing you know, the pile of things that looked like that on the desk were piling up. There was even a reimbursement cheque in there, by the time I finally cracked it open. There was literally good news in one envelope, but I didn’t ever get to celebrate that $54 cheque in my favour because it sat there like everything else. That’s part of it. And I’ll admit that I’m the guy that wants to still talk to somebody. I don’t want to talk to a wall or plexiglass or someone that says you have to make an appointment. You know, we have problems now.

Laryssa

Right.

Brian

So, go and ask to have an appointment through this computer program, and then that person will respond to you and maybe book something a week down the road—that’s not what I’m looking for when I have a problem. And maybe the answer is, well, don’t look for help here, but then you better own that answer, right?

So there’s a lot of trickiness in this communication question. I know people who deal with the government in their business every day, multiple lines of communication to various departments. But there’s one they don’t want to speak to. And it’s because it’s raw conversation.

We’re not talking about a business opportunity through, you know, Science Canada or something to that effect. We’re not talking about, you know, you want to export a product. We’re talking about what’s your coverage going to look like and how many more times do you have to revisit this story to convince that other person on the other end that you qualify for something.

Laryssa

Right. Because veterans’ interactions with VAC is around an illness or an injury, service-related obviously. So there’s a vulnerability in that, whether it’s a physical injury I’m guessing, or a mental health injury where you have to go back and revisit that and delve into some of those things, whether how it came about, how it’s impacted you in the past, it might be a reminder of changes, maybe, in who you are now: that you’re not as capable; you don’t have the capacity; you’re not as well as you were before. So there might be other layers to what that envelope represents. And then the necessity: I’m not full; I’m not fit; I’m not who I was before. So, there might be more represented in that.

Brian

Yeah. And a lot of the stuff – and we’ve mentioned this before – is that the gateway to getting something that will help you is quite often a designation that doesn’t sound all that nice. You have to need to be rehabilitated before you qualify for things in the world of rehabilitation.
Now, I understand, from a bureaucratic point of view, why that has to happen. But I don’t like being told that I am in need of rehabilitation or that my status is diminished.

Laryssa

Right.

Brian

So in their defense, there probably isn’t a good way of doing this, but there are bad and worse ways. And it’s a pretty harsh exterior when you’re trying to communicate to it sometimes.

Laryssa

Right.

Brian

So, one thing I’d like to say is, and this will put you on the spot, but I think it’s kind of the point. I want to drag you back to my purse conversation. How can you help me with that?

Laryssa

Wow. Okay, yeah. Putting me on the spot. Well, first I guess I can’t help you with that if I don’t understand what’s happening for you.

And that’s not to say that I need to know the nitty gritty details. So we’re talking about communication. It’s not that I want my spouse, or for you as my colleague, to delve into those, but maybe how I can help you with that is by you telling me how that impacts you.

Brian

Yeah.

Laryssa

So, as an example, I’ll use my spouse as an example.

He, for the longest time, had troubles driving through a drive-thru. I don’t know exactly what happened for him. I’ve been around the military long enough that I can probably speculate. There’s the building itself, there’s usually a fence on the other side, you’ve got vehicles in front of you and behind you, your movement is limited, etc. I can pick up on that. So I didn’t need to know the details of what happened. What I needed to know was that going through a drive-thru was difficult for him.

Brian

Yeah.

Laryssa

So, I either needed to accept that when we go to a restaurant, we’re going in to get our order, rather than going through a drive-thru or, on one occasion, the first time we went through a drive-thru together, I was like, wow, this is really cool! I’m really proud of him! And I thought it was going to help. So what I did was, I started chatting with him, chatty, chatty, chatty, chatty, because I wanted to distract him from being triggered.

So we’re moving through the drive-thru, and I’m chatting the whole time. We get through the drive-thru, and the first thing he does is pull over and looked at me and he said, “Don’t ever do that again!”

Brian

Yeah.

Laryssa

Because I distracted him from the grounding techniques that he wanted to employ, that he talked to his therapist about. He was trying to do all of that. I was distracting him in the wrong ways. But again, that all needed to be communicated.

So I guess that, to go back to your question, how I can help you with that is for you to ex.., if we’re ever in a situation or how can I be sensitive to it, supportive.

Brian

So, this drive-thru thing. I’m happy you brought this up.

So you’re in a car. You can’t escape to the front because the car in front of you is there, probably arguing about if they want cheese on their burger or not.

Laryssa

Apparently ordering way too many sandwiches. Drive-thrus are not supposed to be for ordering full meals.

Brian

Well yeah. and then you’ve got the person behind you, so you’re trapped there. You can’t escape left because that’s where the restaurant is, which will be on the driver’s side. He can’t go out right because you’ll be caught in there. How would you not know what’s wrong with a drive-thru? It’s just common sense, right? Well, it’s common sense around my peers because going through a drive-thru is what we, if I was doing that to the enemy, we’d call it channeling. I don’t just have bad things for them. I have to get them into a position for that bad thing to do. It’s business to them.

Likewise, the enemy doesn’t just put bombs all over the world and hope I step on one. They have to create a scenario that drives me towards that point.

Laryssa

Right.

Brian

Maybe they even need to get my vehicle 18 inches, no closer and no further, for it to have effect. And the way they would do that would be to create a zone that you have no choice but to go through that one zone.
Also, you add talking over this radio, so you get the metallic comms voice, very similar to talking over a military radio. You add that this is very similar to going in and going out of a camp, which is where you’re going to have this massive emotional change, like you’re happy to get back or you’re trepidatious about what’s out there as you’re leaving.

Yeah. Hell yeah. I don’t want to go to that drive-thru. But I bet that my kids even today don’t understand why I don’t want to go through that drive-thru.

Laryssa

So what would prevent you from telling them what you just told me?

Brian

Because I don’t want to turn them into a pack of weirdos. I don’t want four people in my house to now hate drive-thrus.

Laryssa

Interesting.

Brian

Go ahead. It is more efficient. I understand why you want to do it. You don’t have to get out of the car. Things show up. It’s quick. Got it. Hate it. Not going. And that’s exactly it.

So let me roll this back and talk about the bus. It took me years to understand what I’m going to tell you. What bothered me about the bus was the purse, and what bothered me about the purse was that’s the last remaining items of this person in the world. I felt like I’d stepped on her tombstone.

Now if I had known for the first couple of years that I was suffering through this, that what I just told you was actually what’s bothering me, you probably could help me as my friend. My wife probably could help me as my spouse. My doctor would’ve saved himself three years.

So I can have that conversation now because I know what the conversation is about now.

Laryssa

Got it.

Brian

Right? I’m aware now that it’s actually my emotional connection to that moment of thinking that I disrespected somebody.

That bothered me more than what had gone on. That took a while. And you’re not going to get any of that unless I tell you. So yeah, the onus is on me to do the communicating. But I want people out there listening to this to realize just how intimidating of a conversation that can be.

Laryssa

Yeah, because it’s not superficial. The word that came to my mind a couple of times was “vulnerable”, even as you were describing the drive-thru. That’s putting the military member, the veteran in their mind, in a vulnerable position. And you disclosing what that person represents, meaning putting yourself in a vulnerable position again, which yeah can be extremely difficult.

Brian

So here’s something else to try on, though, And this, I mean, it’s a communication episode, but it might as well be called the bus story. There was another camp in that country, in Afghanistan, where people had taken half of a blown-up bus and used it as a coffee bar. They were literally serving their equivalent of Starbucks through the window of this blown-up bus.

I didn’t have any problem with that. Now I wonder why I didn’t have a problem with that. I’ve had a problem getting on buses here. Perfect bus here; no one on it is going to cause me any problems. This is not green roots in Afghanistan with a bus blown up, flipped over, two kids trapped under it. That’s what I experienced there. That’s what I’m reminded of when I get on buses here.

But amongst my friends and my peers, I could drink a coffee served to me through a blown-up bus, right? I don’t know why. I’m not all that sure that that’s okay, actually. But it just goes to show that, when I’m around the people that I know get me, it just takes all that unnecessary pressure away.

And you can see the humor in some of these things. You can see the humanity in it too, and we just get it. So yeah, I have problems here with things that are way more benign than if I was experiencing them with other veterans.

Laryssa

Right. And how do you communicate that with your family?

Brian

How do I communicate that to my family without making them feel that they’re lesser than my mates?

Laryssa

Yes. Yes. And that was something that I had to accept, I think, in my relationship was that my spouse has relationships that have different bonds, just as close and maybe even tighter bonds than he has with me for different reasons.

There are folks that he served with that literally they held each other’s lives in their hands. And I think I had to resign myself to the fact that it wasn’t a competition. That it’s just a different type of relationship that I wouldn’t understand. And it doesn’t mean he loves me less. It means it’s just very much in a different context.

I want to touch a little bit more back about families, because we’ve been chatting a lot about communication challenges, barriers for the veteran. Now, when you and I were prepping for this, I had the same reaction as you did: I suck at communication and I felt hypocritical that I’m recording this podcast on communication when I know that, in my home life, I’m no guru, that there’s a lot of places that, as a family member, I can improve. And we can dissect those reasons and rationales for that. Some of it is because of my relationship with a veteran and not sure how to approach things or the questions to ask.

Some of it is my own poor coping skills on shutting down. I think a lot of family members shut down, especially if they’re not getting a desired response from the veteran or, as I said, maybe they’re misinterpreting the veteran’s symptoms, behaviours, not making eye contact, whatever the case is.

Brian

Well, we don’t actually know what you go through. And to some degree, you’ve taught me that. I was part of a military Family. I was one. It’s actually a sticking point of mine sometimes that, when people try and engage the Family, sometimes they try to engage the Family other than the Veterans.

Laryssa

Yes.

Brian

I’m here too, guys. But all the way back to the founding of this institute, why did we ask that Families were parallel to us through this? And it’s because we knew that there were problems, but it certainly isn’t because I knew what they were, right?

Even in just the two years we’ve worked together, I have learned more about perspective and what you guys are going through. I found myself frustrated sometimes when people have either a glorified picture of war or a completely tragic picture of it.

I played a lot of volleyball overseas. I played a lot of poker, too. That’s not the conversation that normally happens.

There’s five days on my worst tour that were really bad for me. The rest of them were an absolute blast. I wish that you could experience the camaraderie and the excitement and just the fun of being around a platoon. And I’m sad that other people don’t get that. But for the average soldier, if you told him that there’s no one within a kilometer that wants to hurt him, that’s amazing news. That’s worthy of breaking out a poker tournament.

If you tell the average spouse that, outside of a kilometer, there’s someone that really wants to kill your husband, this is bad news, right? So the very same thing from two different perspectives is a tough conversation to have. Now add eight time zones in the middle, and we’re talking over Zoom at best, right?
Um, so Laryssa, we honestly don’t know what you go through.

Laryssa

I want to share kind of an exercise that I participated in a few years ago.  And this is specific to, again, a mental health injury, but it might give folks some insight and maybe use some insight in relation to that. Because then we could talk about what I experienced during a deployment as a military family member during that time.
But, but I want to, kind of, go back to the experience of supporting a loved one with an injury, a mental health injury. So this exercise was during a couple’s retreat. We had all of the veterans with a mental health injury go into one room, all the family members went into another room, and did the same exercise in both rooms.

So around the room, we put different posters with headings on them: psychological, spiritual, financial, physical, and asked the participants to write down on the lists how the injury impacted them in those different areas. So for me as a family member, how was I impacted physically, etc.

So, at the end of it, we brought the two groups together and put the signs side by side. And what we found was that the experiences of the family members were the same as the veteran. So a lot of the things that you’re experiencing with your injury, the family members are experiencing as well.

So I guess all of that to say, since we’re talking about communication today, it sounds so cliché. Talk to your family members, talk to your veteran, listen to what their experiences are because I’m guessing that maybe you have more in common and you’re more on the same team as you are adversaries in going through the journey.

Brian

So, in the world of shop talk on our way through something here, one thing I find is that when I go to a doctor, I’m spending an hour speaking to him about some things that are obviously pretty personal, heavy stuff. I really have to focus on my drive home in order to focus on the drive home and not on the conversation. How do you want me to walk through that door and say, “I don’t want to talk to you right now”?

Laryssa

I think I want you to tell me before you leave through the door to say, “Listen, I have a session today and when I come home, I really need some time to decompress and process what was going on for me. So if you can give me that hour, if you can let the kids know, etc.” So again, coming back to communication, letting me know prior, so that I’m not in your face saying, “How’d the session go? What are you thinking? How…”  So that we can respect what you need and vice versa. If the family member is going to a therapy session or if they work full-time and the veteran is at home, ask the family member, “what do you need when you come in through the door?” But ask it prior.

Brian

One thing we’ve had a bit of success with in that regard is, if you want something to not happen, it’s helpful to then designate when it will happen. So, if my session is over at 1:00, I’ll be home by 1:15. If I don’t want to get bombarded with questions at 1:15, one of the ways to do that is, after dinner I can talk about that. Or “I’m going to walk the dog. I’ll probably be back at 2:00, then we can get into it.” I find that if we designate how and when we are going to chat, then it creates the space to be able to come into the house, put my coat down, pet the dog, and just drop my tools a little bit. And drop my defenses a little bit, right?

So designating when we are going to talk helps create the space of when I need to not talk. Now that’s just a Brian answer. I don’t know if that works for anyone else out there, but we’ve had some success with that.

Laryssa

Okay.

Brian

Well, are you going do it then? Are you going take my advice? Or are you just going to ignore me?

Laryssa

Yeah, I’ll get back to you. I’ll get back to you.

Brian

So this is communication. This is why it’s hard. Honestly, it scares me sometimes.

Laryssa

I think it’s continual. I mean, as we sat down here, I disclosed I was no expert on communication, and I think it ebbs and flows. So, I think the important thing is to be aware, have conversations, and continue to put effort in.

Brian

And be willing and open to revisit stuff. It might be, “No, I can’t talk to you”, but it also might be, “No, I can’t talk to you right now, today, about that incident, but maybe in a week I can”. And both sides have to see that as like: “no” doesn’t mean “no ever”. We can, and probably need to, communicate about these things, but I may also need five minutes.

Laryssa

Exactly. Well, it was good having the conversation with you, communicating about communication.

Brian

We’ll communicate later about how we communicated about this communication.

Laryssa

[laughs] Roger, over.

EPISODE DESCRIPTION

“It often comes down to a decision that a person has to make in the moment and then they’re second guessing that decision for the rest of their life with the disadvantage of having hindsight.”

Moral injury is a relatively new term in the mental health research sphere, but one that countless Veterans can relate to from lived experience. Moral injury refers to the psychological, social, and spiritual impact of events or acts that a person performs, witnesses or fails to prevent, which conflict with one’s own deeply held moral beliefs and values.

It is not uncommon for Veterans to experience events that cause moral injury during their service. Moral injuries can continue to impact Veterans in their lives post-service. In this episode of Mind Beyond the Mission, the Atlas Institute’s President and CEO Fardous Hosseiny joins Brian and Laryssa for an in-depth conversation about moral injury, exploring:

  • What is moral injury? How does it differ from PTSD?
  • What kinds of events can result in moral injury?
  • What are the symptoms of moral injury? What can I do if I’m worried my loved one is experiencing a moral injury?
  • How moral injuries can impact Veteran Families
  • At what point after a potentially morally injurious event takes place should one consult with a family physician about symptoms?
  • Moral frustration vs. moral injury
  • The Moral Injury Outcome Scale
  • How to support peers experiencing symptoms of moral injury
  • What resources are available for Veterans and/or Veteran Family members who want to learn more about the subject?

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MIND BEYOND THE MISSION EPISODE 3: “MORAL INJURY WITH FARDOUS HOSSEINY”

Laryssa

Betrayal, guilt and shame are the hallmarks of moral injury. Moral injury refers to the psychological, social, and spiritual impact of events or acts that a person performs, witnesses or fails to prevent, which conflict with their own deeply held moral beliefs and values. Attention to moral injury has grown over the past few years, and yet many Veterans and Families are unfamiliar with the term, how the injury manifests or how it differs from PTSD.

Many Veterans struggle in isolation to make sense of what they experienced. Whether intentional or otherwise, Veterans who struggle with their own darker concepts of self seem to push loved ones away. And the stark lack of information and education on moral injury available to Veterans and Families perpetuates the problem.

Brian

Sometimes Laryssa, when people talk about moral injury, to me, what I really am looking at is what’s actually bugging you about a situation. And I think there’s a number of times in my own history where people would make assumptions, i.e. “You went to this incident, it was bad on paper, therefore that’s what’s bugging you.” And that almost ticks me off more because it’s completely sometimes missing what’s actually going on with me. And so, there’s textbook definitions of everything out there, but for me, what moral injury really speaks to is, what’s the backbone of the problem here? Because it’s not always trauma, it’s often disappointment. It’s feeling isolated from this organization that promised that you’d never feel isolated.

And when I first started working here, a number of different projects were put in front of me joining the Atlas Institute. And the first one that I put my finger on, I told my boss at the time, “I want to be on this file one way or another,” it was moral injury, but it still took someone to explain to me what they meant, and I’ve been at this for a while.

So in that regard, we’re joined today by our guest Fardous Hosseiny. Fardous is the CEO of the Atlas Institute, but he has also got some background in working on the moral injury case, and so we figured what a great time to introduce you, because you got a background in the file, but you’re also the guy that’s running the Atlas Institute for Veterans and Families. So we’re talking moral injury, but you’ve got a pretty big responsibility on your lap. You’re running a new organization and it’s an important one.

Fardous

Well, yeah, thank you for having me on. And to your point, Brian, even when we first started the organization back about three years ago, pre-COVID, we had a chance to do some in person consultation. So we went out to Vancouver, we met with some Veterans and their Families, and many of them were describing something that at the time, folks thought it was PTSD, but when you broke it down a little bit more, you heard the shame, you heard the guilt, the betrayal, then we identified: that’s moral injury, that’s not PTSD. So there are discussions that moral injury is not different than PTSD, but if you actually sit down with the Veteran who describes their symptoms or what they witnessed or what they went through, they’ll tell you that’s a reality.

Brian

A common refrain when military people are asking questions about their planning is, “So what?” You know, like, “This is happening,” or “This is different” or “You need to know that.” Okay. Why? What would be different for a patient when someone hones in on the fact they have moral injury versus PTSD? Are the prescriptions different? Are the treatments different? What’s actually different about it?

Fardous

Well, moral injury’s still not recognized in the DSM, right? It’s not a diagnosis as of yet. So the fact that we’re having this conversation, our hope is with research, we can actually say that this is a diagnosis of its own. So then when you do get treatment and you get care, the clinicians are prepared to offer you supports that make more sense, that address the shame, guilt, betrayal, versus PTSD which is fear and anxiety.

So unfortunately right now, it’s still not a diagnosis, but the fact that we’re having this conversation, that we’re putting a spotlight on it, our hope and through the work of Atlas, our vision is that eventually we’ll get to a place where we have this scale where we can say, “Okay, this person is showing symptoms of moral injury, another person is showing symptoms of PTSD. Let’s run them through a brain imaging scan, and then we can actually show different areas of the brain that are lighting up.” And once we have that under our belts, then that’s when treatment options can be discussed. But yeah, we’re still unfortunately in preliminary days, many other researchers will say, no, we’re far ahead, but unfortunately we still have a ways to go to get it to a formal diagnosis.

Laryssa

That would be pretty exciting if we could get to a point to be able to separately diagnose or identify PTSD versus moral injury. Could you go in a little bit more to describe what is moral injury? I think we’ve touched on it a little bit, but could you explain to folks what is a moral injury?

Fardous

Yeah, so it starts with talking about the history, right? So moral injury, Brian and Laryssa, you’ve mentioned that it’s in the discourse now. And the fact is because healthcare workers have come out and said that they’re struggling with moral distress or moral injury because they’re put in positions to make these calls. But if you look at Dr. Jonathan Shay, a clinical psychologist, back in 1994, he coined the term “moral injury.” And that’s because he saw a lot of Vietnam War Veterans coming back and describing their symptoms and he’s like, “This is not PTSD.” So he’s the one who coined the term “moral injury.” And as a result, as of right now, you talk about looking at the literature, there’s actually 17 different definitions of moral injury, all with slight variations, right? So Shay talked about authority, someone betrayed by someone who has an authoritative position, you feel institutional betrayal. You feel like someone who has put you in a position where you have to make a call, but you’re not equipped to make that call… so Shay started that.

Then it built to other psychologists and other researchers. And recently Dr. Brett Litz, who’s out of Boston University and who we’ve been working with on a moral injury outcome scale, he’s actually kind of the pioneer. And he has the most recent definition, which is, “the psychological, spiritual, and biological consequences of facing or seeing something that violates your moral beliefs.” And then we can talk about potentially morally injurious events. Those are transgressions. Either you conduct a transgression yourself, or you witness a transgression. So that’s the current definition of moral injury.

Brian

For me, it was a new term. You speak of the first kind of light bulb in the community going off in 1994… that light bulb didn’t go off for me until about five years ago, which was the first time I’d really heard of it. What I do know is that quite often in our world, it’s actually our spouses that are the first person to put up their hand and go, “Something’s going on here, something’s being missed.” What did you hear when you first heard the term? Like, did it make sense on its own or did you need to hear a little bit more to it?

Laryssa

I think I wanted to hear a little bit more to it because it validated it for me. I have a background in peer support, for 15 years, so I was very familiar with the term post-traumatic stress disorder, PTSD. My spouse was diagnosed with PTSD and so I was familiar with the behaviours, the symptoms. We developed strategies. I developed strategies on how to support him, but I found that sometimes those strategies didn’t work. I found there were different kind of things occurring. So I knew that withdrawal was a cluster of symptoms of PTSD. I knew that hypervigilance was a cluster of symptoms, but those weren’t the things that were keeping my husband up at night.

And so, once I was introduced to the term “moral injury,” I was like, “Wait a minute here.” I wanted to learn more and pieces started to fall into place for me. It was more about the sense of guilt that he had. Guilt was huge, and still is. That’s something that he has to work on, and the negative self-perceptions, I guess. So those things to me weren’t fitting for PTSD, but it made sense that he’s experienced a moral injury.

Brian

What I found kind of tough in this space was, if I’m ever talking to someone about moral injury, I undoubtedly have to say words like “I feel” or “I felt” or “it felt like.” And we’re already getting into the tricky parts of the conversation that I generally don’t want to have. It’s not easy to talk about trauma, but in a lot of ways, it makes more sense. The average person can understand when you describe a terrible event, what’s terrible about it, right? But to explain to them how you might feel abandoned… you know, “I feel,” I don’t like that all the time. Abandoned: not good. Not a good army feeling, that’s for sure. And so this is kind of what it did for me was all those things that I never really found a way to put my finger on. And it always went against what other people’s assessment was. So what I mean by that is people would look at, “You went to this event. That was bad.” But I’m actually more bothered about what I drove past on the way there, you know?

I have seen situations where I’ve watched… women being hurt is the only way I can really describe how they were being treated. But that was on the way to something else that we had a mandate to deal with. We didn’t have a mandate to deal with how women were being treated on a side street. Even if we did, we had 3000 people in a 50 million person country. You couldn’t do something if you wanted to. And so, you had to drive by. And so, it’s easier amongst a lot of people to describe what happened to me when I got where I was going, but what keeps me up at night is what I drove past. We tell people this: that what you drive by, you accept. That what you ignore, you accept. Well, I understand why I drove by it. I did the right thing. But somewhere in there, the dad, the Brian… it feels like he accepted that.

Laryssa

That feels like part of moral injury, the second guessing of your own actions or, like you said, Fardous, of someone else’s, what you’re observing. I have a couple questions. I’m wondering, can PTSD and moral injury happen at the same time? And are there differences that you can help us out with?

Fardous

Absolutely, yeah. So I think to Brian’s point, we mentioned potentially morally injurious events, right? So that’s one that violates your own core moral beliefs, or you witness something where you can’t intervene, right? You know that your moral code tells you that I should probably intervene. I could probably do something here. But the rules of conduct or rules of engagement say you can’t. So that is an experience of a potentially morally injurious event. And the second was to Laryssa’s point. You may witness someone else doing a transgression, and again, just witnessing it and not being able to engage to do something that you would do differently, again, impacts you. And you might be marked by the experience. As soon as you’re marked by the experience, that’s when it becomes a moral injury.

But yeah, to Laryssa’s point around PTSD, I think the discussion is that they’re very, very similar, unfortunately, right? So, they’re both trauma based, right? So they both start the same. But when you look at the differences – and this is where the conversation gets interesting – is you have to look at the origin of it first, okay? So PTSD, as we mentioned, is usually fear and anxiety based. Sure, there might be some shame and guilt, but for moral injury, that’s central. That’s the central symptoms of moral injury. The second is looking at attributions, right? So in PTSD, there’s more sense of horridness, helplessness. And in moral injury, someone will say that, “I actually witnessed this or I conducted this and I should be feeling bad about that.”

You know, it’s not that sense of helplessness. So you accept that, “I might actually be a bad person because I didn’t do anything.” So the attributions are very different, right. And then when you look at treatments, I think that’s also something that we have to still look at because if someone is dealing with PTSD – and prolonged exposure therapy is the gold standard for PTSD – but if someone is feeling guilty and shameful of what they do, and you tell them, “Relive that, relive that, relive that,” how helpful is that? Right? I don’t think it helps someone make sense of their situation. So there are some differences and I think that’s where the discussion needs to continue being is because we have to distinguish between the two. And once we’ve distinguished between the two, then we can look at treatment options.

Brian

Well, and one conversation we’d had before was kind of about the flash to bang or the timeframe. And we were talking specifically about the withdrawal from Afghanistan, which is, for me, a tricky situation to watch. And by that I mean it was awful, right? Watching that was not pleasant. But we spoke about how those are natural things. You’re going to be bothered by things that are bothersome. But is there a point or a timeframe down the road where if you’re still being kept up by that or it’s still impacting your relationships, if today, a full calendar year and counting later, that incident is causing large amounts of grief, do we have a ballpark of what that time is? And then what? So what? What do we do about it?

Fardous

So what you’re describing there is a bit of a continuum, right? At any given moment, you may see something, you may do something that challenges your moral codes, and if it just challenges it at the minimum level, that’s more moral frustration, right? So it’s just moral frustration. When it gets a bit more to the milder degree, then you’re dealing with moral challenges and moral distress. And then the third is when it’s more extreme and it actually violates your core moral beliefs, and as I mentioned, you’re marked by the experience, then that’s moral injury. So it is a continuum. There might be moments where something occurs that ticks you off, and that’s moral frustration, right? And then you might deal with that. You might say, okay, that’s not a big deal. You’re not marked by it. You move on, you’re onto the next thing.

But if that builds and the next time you see something and it’s even more significant, you’re like, okay, now it’s a moral challenge, it’s moral distress. And then you see, okay, now this has violated completely my core beliefs and I can’t move forward with it because I’m marked by that experience.

Brian

It’s so tough too, because you’ve got rules, you’ve got realities, they all come into play. If you take the medical circumstance, our medics in the Forces are phenomenal. They can keep people alive today that had no chance decades ago. And they can do that for anybody. And so there’s a number of circumstances where wounded would call into the base because they know that we’ve got first notch kind of care.
The capability there is incredible. It rivals an ER here in Toronto. But you can’t be the doctor of the town because if you do, tomorrow you’re going to have 10,000 people lining up outside your gate with your coughs and your sprained ankles that you can’t handle. And they have to get used to going to their own system to demand that it serves them.

So the bottom line is, in a lot of our missions, we cannot medically help people in a lot of circumstances. That feels awful for our medics, for our doctors and our nurses. They’re trained, they want to help, they’ll take any patient. But we could set off a humanitarian catastrophe in that town if we get seen as the medical experts, so we can’t. That happens.

And for me, I had a situation actually in the former Yugoslavia where we had a case where we could feed people – as in we could, we had food – but we couldn’t, because we would’ve done the exact same thing as just described. So the answer was, instead we secured the area that they were at, we did not feed them and we made them go to the aid agencies that were there to feed them.

That feels like garbage. I still am bothered by that. And when a lot of people hear that, what shocks them about it is that they expected to hear a war story. They expected to hear some big tragic tale with a huge body count – and those are out there – but what bothers me is I’m a dad. You would feed kids that are starving when you’re a dad. You look after people. I’m a good person. You would want me as your neighbour. But those don’t feel like really neighbourly ways of conducting yourself. I don’t know, does that fit? Is that moral injury? That’s I think what a lot of people in my situation are [wondering] is, is this the thing you’re talking about?

Fardous

Oh, 100%. I think you just described really well what a potentially morally injurious event is. And I think a few other examples on the battlefield is similar to what you just said, witnessing a situation where you know what the right thing is to do, you want to do the right thing, but you’re not allowed to do the right thing.

Another is using deadly force or combat, where you feel like the individual in front of you may not be the individual that deserves that or needs to take that. But you have to, again as a result of the rules of engagement, you have to do that. So, using deadly force is that. Giving orders that may result in the wrong decision, that may result in civilian deaths as a result of the call that you make, that could be moral injury. Failing to report knowledge of a situation, like saying again, you have intel on something, but again, you may not be able to share with someone and as a result, that leads to something catastrophic happening. That’s, again, a potentially morally injurious event. So these are examples of the war field where you talk about fighting and combat, but these other calls that are being made behind the scenes, these other calls where folks might think it’s not significant because you’ve gone there to do one thing, but it’s not just the only thing that you’re doing when you’re on the battlefield. There’s other decisions that you have to make on a regular basis that as a result of them, something bad can occur and then you have to live with that.

Brian

And then this plays out in the home. When someone asks me, “What’s bothering you?” or “Let’s talk” or “How’s it going?” like, do you really want to hear about when I didn’t feed kids? I don’t think I want to tell you that.

Laryssa

Yeah, I think a lot of Family members think they want to know. We’ve talked before how Families want to support each other. Families want to support the Veteran. And for spouses or significant partners in particular, we’re supposed to be the sounding board, the supporting person, right? We think we want to know, like, “Let’s talk about it. Tell me what happened, get it off your chest and I won’t judge you,” and I think we like to think that won’t happen.

I think that makes it difficult for the Veteran because what I’ve heard from some Veterans who are living with moral injuries, they can’t even look at themselves in the mirror. Fardous even talking about- I think a key that you said was decision. It sounds to me like a lot of times it comes down to a decision that a person has to make in the moment and then they’re second guessing that decision for the rest of their life with the disadvantage of having hindsight.

So later you’re going back going, “Oh, I should have, I could have, I saw… I have this information now,” and second guessing the decision that they made. And so as I was saying, a lot of Veterans are staring at themselves in the mirror, or maybe not because they can’t look at themselves trying to rectify decisions they made or maybe things that they observed.

And they don’t feel – because of that shame and guilt you talked about – they don’t feel worthy of love. They don’t even love themselves. And so what I’ve observed within Families is the Veteran, whether conscious or not, pushing their loved ones away thinking “I don’t deserve to be loved by you” and the Family member is completely not understanding what moral injury is, they may not have even heard the term before, and so they might take that personally and think it’s a reflection of the strength of the relationship, or maybe I’m not good enough to be loved. Maybe there’s something wrong with me. And so it becomes very complex just to scratch the surface on how Families are impacted by it.

Brian

And I think one thing that Veterans want to hear is that people really get the scenarios that they’ve dealt with. It doesn’t mean you’ve got to go into them all, but we often talk about things you couldn’t help, things you couldn’t do. But it goes both ways.

Sometimes I could fix this town if you would just let me take out that guy. If we could just arrest this guy that we all know is causing the problem. He’s the mastermind. He’s the bomb trainer. He’s right there. We’ll grab him. You can’t. And so you’re subjecting this town to more and more and more, and it’s done for a reason. It’s not that the people making these decisions don’t know what they’re doing, but at the coalface, where you’ve got to be the implementation tool of those decisions, it’s tough. I know from my circumstance, there were cases where you could feel that the person on the other end of the phone 10 kilometres from you, who is a military person who understands your circumstance, doesn’t understand enough to make good decisions for this.

Well then, what happens when that decision is being made in Brussels or New York or Ottawa by someone that is completely not from your background? And even if it’s not true that there’s disconnect, there is a sense of disconnect. And I found that particularly tough to stomach sometimes.

Laryssa

So can I ask you, Fardous, a little bit of what Brian is talking about, to the best that you understand, is that a moral injury that occurred someplace other than here impact a Veteran’s perception of the world here and now as they see it, their perception of people in Canada where maybe those types of events didn’t happen or we would hope wouldn’t happen? So does it change their perception of humanity or the “greater than?”

Fardous

Yeah, some of the work that we were doing with Dr. Brett Litz at Boston University was, as I mentioned, the development of the moral injury outcome scale. So to your point earlier, it’s not even events-based, it’s that outcome, the decision that was made, right. So it’s the outcome, and that’s what we’re measuring right now.

And then when we developed that scale, there were six domains that came up, that rose to the top. The first was what you just spoke to: alters in self-perception. So that’s, “I feel like I’m a bad person.” So that’s what the sense is and that’s huge. That’s at the core.

The second was around alterations of moral thinking. So, “I’ve lost faith in the goodness of others, or in the faith and the goodness of the world.” So that’s, to Brian’s point, when you come back, you may have lost faith in the folks that were making some calls in the local neighbourhood.

Don’t know your background that made decisions that you know, you don’t agree with. So, you’ve lost faith now in the goodness of others. The third is looking at social impacts and that’s your disconnection from people. So now I feel like I’m disconnected from people. So that’s the third domain.

The fourth is self-harming and self-sabotaging behavior. So, you get in the way of your own success, because you don’t think you deserve that success. You don’t think you deserve goodness because of these calls that you’ve made. You try to get in the way of becoming a better person or being successful in your life.

The fifth domain is emotional aftermath, so that’s when you think, the shame. I’m ashamed, I’m guilty. I feel betrayed. So that’s the emotional aftermath.

And then the last one you’re looking at is beliefs about life, meaning, and purpose. And that I’ve lost a sense of meaning of life. It’s different than the other one where it’s about being disconnected or feeling like you’ve lost faith in goodness, but it’s because you now lost, in general, the meaning of life. Like you don’t even have that sense of purpose.

And we know within the military population, especially with our Veterans, when they come back, they’re struggling with transition. It’s the purpose that they’re usually feeling like they’re missing. And so now imagine that at your core, you’ve also lost meaning to life. So that’s someone who’s really struggling.
So that’s the outcome scale we developed, and we have 17 items now. It’s been validated in the research context, and we now need to validate it in the clinical setting. So when you say that there’s 17 items that have achieved validation, does that mean that there is a meter stick for this?

Brian

At the research level, there is. So it’s been validated at the research level, right? So because our paper recently got released in Frontier Psychiatry, that means it’s been accepted into the research world. The next step is to take that scale and run it at the real life in the clinical setting. So working with physicians and clinicians to say, “Okay, ask these questions.” You rate the scale and then you’ll see. When someone rates at four or five on 11 of the 17 items, then we – again, these are hypothetical numbers – but then you can say, “Okay, this person is struggling with a moral injury,” but we’re not there yet.

Brian

So in the military environment, new ideas are almost automatically greeted by resistance and people that don’t want to hop on board. Is that true in science? Do you see that, even though you feel you’re making this forward progress, these achievements, that there’s people going, “Eh, I don’t know?”

Fardous

Oh, absolutely. There’s still a strong discourse within the research community and the science community around is moral injury even distinct enough from PTSD. That’s happening to this day, to this moment. So there are folks that will say that it’s a subset of moral of PTSD, moral injury is a subset of PTSD, that it should be captured under that umbrella, and others are saying that it should be distinct. So there are two camps, and there are conversations happening where one is convinced trying to convince the other. So yeah, even at that level there are conversations.

Brian

And do you find then that when there’s different camps and some are for and some are against, does that persuade some other folks in the community to go, “Ooh, I don’t want to touch this, this is controversy”?

Fardous

Yeah, it does. It can skew folks’ feedback, because there’s some strong researchers in there who have long years of experience and credentials and they’ve rightfully done some excellent work and so they might be taking the floor with their loud voices.

But we need those others, the up-and-coming researchers to say, okay, sure, there’s a healthy conversation happening, but as a result of that healthy conversation, together we need to move the agenda forward. So yeah, folks are reluctant, but I think there’s also a huge core, at least in Canada, of some strong researchers on moral injury and I’m really looking forward to them because they’re thinking outside of the box. And some of them are in the Ottawa area and are based in our own network. So I’m excited to see what they come up with.

Brian

I’m always trying to look at this from, what would the Army, Air Force, Navy do if this was fully accepted and everything we ever put forward on this, yes, they agree? Okay, so what would they do about it? When we come up with something that could happen in a traumatic scenario, take a mind strike.

We build acronyms, we run you through drills. We’ll buy equipment that handles that thing as best we can. We’ll send you to Spain if Spain’s better at it than we are. We’ll do a lot of things based on trying to show you a little bit of that traumatic moment, so it’s somewhat familiar when you find your way in it.
What would we ever do to prepare someone for moral injury, considering it’s just so wide and so open as to what could be morally injurious?

Fardous

That’s an excellent question. I don’t know if you can really prevent moral injury, and I know I’ve had a conversation with a few colleagues where the job that you sign up for, you know that there’s going to be trauma. You know that there’s going to be moments where you’re going to be experiencing things that are quite distressing. So we can’t prevent that. Well, what’s the secondary level? So now let’s say we’ve told you like, hey, you’re going to get hit by a bus. How are we then going to prepare you as a result of being hit? We may not be able to control the fact that you’ve been hit, because of the circumstances of war, the fact that you’re going to be witnessing these situations, but our job is now to prepare you. Once we know that you’ve witnessed this, how can we support you at that level? And then that’s where at the organizational level I think there’s large conversations we need to have where folks need to prepare the community, especially those folks that are being deployed, that this is what you may see, and as a result of seeing this, these are the things that you should be doing once it occurs. So that’s from a preventative metric. At the team level I think we have to look at leaders within organizations as well to say, okay, your job knowing that you’re going to be putting your staff or your platoon in ways of doing this kind of stuff or witnessing this, how are you then preparing them when they come back from a circumstance like that? Are you making sure there’s enough time for a debrief?

Brian

I think actually we’ve made a lot of progress and one of the areas I think there was progress is every leader that I ever dealt with by the end of my time in the Forces realized that their door had to be relatively open. Can’t be as open as a lot as you think, by the way. You can’t open it to every crazy idea someone can come up with. So it’s somewhat open, but it’s certainly open to people coming in and talking to you about something going on. But as the person inside that office where someone else might come darken that door, there were things I was a little afraid about.

If someone comes up and doesn’t know what’s going on with their career, I’m good. I can coach that person through that. But if they come up to me and they’ve got something more on the domestic side, I’m not so sure I’m prepared for that. And even now as we discuss this and I kind of do some work in the space, I don’t actually know what I would do all that much as the leader saying my door’s open, and someone comes in it with a morally injurious event. Because it’s all in the background, it’s all in the experience, it’s all in that person handled and felt it that way, and I wonder what we can do about that down the road. And my gut is, we’ve just got to talk about it some more.

Fardous

That’s the place to start. As you mentioned, the fact that your door was open, the fact that folks could come in and have that conversation with you, you’d be surprised how far that goes. Just the idea that I know I have a leader in place who’s willing to hear. He might not have all the answers, he might not even be prepared to take in this information, but the fact that he has his door open and I can walk in and share what I witnessed or what I just had to go through… that goes a long way. The second is, I think we’re learning within even the health care community, because we can apply research right here at home is having a cohesive team is key. It helps with team morale, you know?

So as a leader, your job is to ensure that your unit, your team, is as cohesive as possible because then they can rely on one another, and then we can have a full conversation around the power of peer support within that, right? So if your team’s feeling like they can support one another, they’re going to turn to each other when they’re struggling. So that cohesive unit is really important.

The second as a leader, again, I think it goes without saying, but it’s encouraging self-care. So, you have to ensure that your team has the time that if they do, again, witness something, or as a result of making a choice that violated their core moral beliefs, that they have that time for self-care, that they have that time to themself to be able to debrief, to be able to try to make sense of it. So you have to make that space and that time for it. And as a leader, it starts there because we can’t – I think what we’re learning, a lot of folks are saying is that, let’s put it back on the individual, right? And that’s not fair. What are they going to do? What’s that person going to do? They’re the one who’s now struggling with the moral injury and now you’re also saying, “Go make yourself better. Go get help.”

Brian

So, Laryssa, one of the things I think that I really want to get to here is, these are the things that I’m least likely to want to talk about.

Mm-hmm. , I actually do have an easier time talking about trauma, traumatic events and the things that I know you’ll understand what’s bothersome about it. So you’ve been the military spouse, but you also worked with a lot of Families, are still working with a lot of Families. How much does this ring a bell from that perspective?

Laryssa

In that the Veteran doesn’t want to disclose and talk about it?

Brian

Yes.

Laryssa

As I said before, I think it’s hard for Families to understand. They interpret it as a disconnect in their relationship. And I can’t think of many things much more, I’m going to use the word intimate, than a moral injury. I think the person’s trying to come to terms with things that they don’t fully understand. And so I think it would be really hard to disclose it to Family members. So yeah, I think there’s often a disconnect there.

But if I can, I’m going to shift it a little bit because I wanted to explore with you a little bit more, Fardous, about what you might have observed as far as the impact of moral injuries on Family members. And I’m hearing you say that the conversation and exploration research around moral injury in itself is just so new, but are you seeing Families included in that exploration?

Fardous

Yeah, it’s an excellent question, Laryssa. We talk about moral injury research being new, but then when you add the Family component into it, it’s quite novel. So outside of anecdotally hearing these conversations where Brian just said that this is something I’m not willing or I wouldn’t want to share, it’s very difficult for me to share. So then the Family member’s left to say, “Okay, why is my companion, my most trusted individual, my trusted ally not willing to share anything with me?”

So there’s that sense of, “Am I not good enough?” as well. So there’s that secondary trauma that’s coming as a result of this person trying to protect you, but you’re feeling like, “Oh, I’m not the person that they can trust anymore. We share everything. Right? And they’re not willing to share this with me.”

So that’s also additional pressure. And then when they do share, so imagine then, as Brian said, do you want me to share with you that I left children that weren’t being fed? I’m a father, or I’m a mother, or I have someone that I take care of, and now do you also want to know that information about me? How are you going to now perceive me? So it makes you start doubting again, like the person that I’m sitting across from.

Laryssa

And I think in addition to that, you talked, Brian, about some of the Families that I supported. Some of the observations were not just then about the dynamic of, okay, I’m seeing you in a different light, you as the Veteran, I’m seeing you in a different light than the person, the woman, the man that I married. But if the Veteran chooses to disclose, you can’t unring the bell. So now the Family members hear about humanity’s inhumanity. They hear about things that we can’t even dream about.

We see them in movies, just the incomprehensible things that happen on this planet. And so, the Family members are left to question their own moral compass. “I thought the planet worked in a different way than this.” And so now in some ways I’m curious to know if Family members can have moral injuries in their own experiences. And it’s strange because it’s through the lens of what the Veteran is disclosing. And then even beyond that, how are children impacted? They’re brought up in a household where usually their moral schema are developed by their parents, it’s a generational thing, our values or ethics, that kind of stuff. So when you have a Veteran whose moral compass is skewed, how is that experienced by the children? So the next generation kind of thing.

Fardous

So I think of vicarious trauma, right? I think you’re, as a result of hearing someone else’s experience, it might not be your direct experience, but hearing an experience from your partner, the Veteran, and then hearing, because I’m sure they’ll share it multiple times with you, so you’re reliving it as well. You weren’t there per se, but you are reliving it through your partner. And as a result, knowing also that your partner went through that, that additional pressure is now put on you. Like, “Wow, this is my loved one and I know they’ve gone through this and they had to make this decision. I feel for them. But I also am wondering why they made that decision.” Because you might not know the rules of engagement. As Brian mentioned, there’s certain things, calls we make, the door – I want to leave the door open as much as I can, but sometimes I can’t leave it open for you because of my job, the inherent nature of the job, I can’t share everything. Right? So you would question, why did this individual do this? But that individual will have some reason for it, right? But they can’t share that with you.

Brian

And it does get reversed though sometimes, like in any relationship, you’ll have these moments where something’s on the other person’s mind and they don’t want to talk to you about it right now. That sucks. That doesn’t feel good. When someone close to me says something to the effect of, “I don’t want to talk to you about this,” I hate that. It makes me – well, I’m obviously guilty of something. I’ve done something wrong, and you start walking down this path, so I get why the person on the other side doesn’t want to hear that.

On the other hand, I’m not so sure that they get where we’re coming from. I think the other thing, too, that’s really common in my mind with this is you may not communicate what’s important, but you are going to communicate something. I came home once to a grouping of people close to me that basically thought that I was on a European vacation.

Well, some of that’s my fault. Some of that’s because the only things I showed them of my deployment was an R&R in Budapest, or this is when I went on leave in Germany. So basically I showed them this three week snippet of me having a blast, and that was the only thing they really had to figure out what I was doing.

So they treated me when I got back like I’d been on holiday, and I have to look back at that now and go, yeah, but my lack of communication built that reaction. So I own some of it. And to me, that’s all related. Moral injury impacts communication, communication impacts the relationship. So an incident that bothered me from 20 years ago can affect my kids independently today? Yes. Yes, it can.

Fardous

And so, having that open communication, as you just mentioned, Brian, so you understand the side of the Family member, as you mentioned. So you understand that this person is saying, “Wow, is it because of it says something that I did, that you’re not trusting me with this information?”

So you understand that, and it’s important for the Family member to also understand that at some days, in some moments, the individual may not want to share, right? So allow that space, allow that safety. Don’t take it personal, right? And that’s where I think, if we had that education and we had that conversation, as the Veteran, as the Veteran Family member, don’t you feel like that would go a long way if you had some education or some training to know that the reason why my partner is not sharing is because it’s this reason and it’s not something personal. Don’t you think that training and education could go a long way?

Brian

And we all work in this space from different angles, but you just found out within this last hour that you work with someone who hasn’t fed kids when they could have, and I worry about how you’ll react when you hear that. And I know how you’ll react. You’ll react positively because you’re my friends, my colleagues, and it’s your job to know this, but still that trepidation is there. Well, what do you think that trepidation is like when it’s my neighbour or someone who really has no stake in our relationship?
Or the other way where burning that relationship – wife, kids – is so risky that it’s like, well, would I want to risk alienating a kid off telling them what I just told you? No, I’m bearing that one. I’m absolutely bearing that one. And I did for years, and for me that’s part of it. I’m protecting you, but I’m really protecting how I think you might react to me.

Laryssa

So I think, kind of in relation to that, maybe is if folks understood it better, and something you just mentioned, Fardous, was about training and education. So is there some place for people to go to educate themselves more about moral injury, whether they be a Veteran who might be suspecting that they’ve experienced a morally injurious event, whether it’s Family members, or even service providers that might want to learn more about it?

Fardous

Yeah, I think it is shameful self plug of Atlas, in our work that we’re doing.

Laryssa

That was not set up by the way. No, it wasn’t (laughs).

Brian

Well done!

Fardous

So yeah, of course on our website, where as Brian mentioned, as I mentioned early on, that this has been a priority. When we started the organization, we put the stake in the ground and said moral injury is going to be one of our priority areas. And you’ll see us continue doing work in this space until we feel like we get to a place where it’s recognized as a formal diagnosis, which will then be a potentially huge win because then hopefully Veterans Affairs Canada will start covering it. But yeah, to Laryssa’s point, there are others who are doing great work in this space. Canadian researchers, international researchers out of the US, Australia, the UK, Denmark, Israel, everyone is.

It’s impacting everyone, all the different service members, right? So we have to make sure that we’re all coordinated and consolidating this information so people have that one stop shop. And that’s what we’re trying to do. That’s Atlas’s mandate, is that regardless if it’s two, three in the morning, if you’re scouring Google, we don’t want you to be struggling to find information.

We want you to have it all in one place. So that’s why, for Veterans and their Family members and service members, I think we’re looking to offer trainings where we’re working with other clinicians who have that real life experience at the ground level, let’s say, okay, as a clinician, what did you wish you knew? And I think Brian can speak to this, I’ll be interested from his perspective, is if you walked in and a clinician said, “Actually, you might not be struggling with PTSD. This doesn’t sound like PTSD. This sounds like something else.” How many years of stress and that weight on your shoulder do you think you would’ve saved if someone had shared that information with you from the get-go?

Brian

Well, I think there’s a lot of grace and space that you get mentally when someone knows what’s wrong with you. And even if they don’t know what you’re going to do, when they turn and say you have an X, you tore this, you broke that, or this is what you’re suffering through, that helps. And I think we should to some degree shamelessly plug this because when I talk about being bold and brave, bold and brave as a firefighter is doing one set of things, but bold and brave in this space… it is a space of controversy. It is not a space where everything is ironed out and the path is lit.

It’s also not a space where everybody agrees. But Veterans and their Families have said to us that these resonate with them. These things ring a bell. This is what they’re struggling with. So for me, I’m really proud that we’re working on it. And I tell people that. I’ve presented something to you guys, though, and I think at the very beginning, it didn’t go over like a lead balloon, but it went over as a bit of a shock.
I illustrated to my colleagues what it’s like to come down the escalator. A good friend who works with us as well, he’s described a time where he came back and just lost two mates from overseas, but the main argument in the city is are they keeping their hockey team? And that’s a real argument, I don’t want to lose my hockey team either, it’d be great if they won something for once, but I don’t want them to go away… that said, it is tough when you’re coming back from these real moments, and part of it is this. If you look at World War I, World War II, conflicts like that, the whole country was at war. The whole country is saving butter and turning in extra pots. The war effort was coast to coast.

Now, with these conflicts that we’re involved in are a lot smaller and just the military is going, it can feel like we’re going to war and you guys are going to the store. We’re coming back from something traumatic. Down the escalator is a bunch of people figuring out which iPhone they want to buy next. And that is a… I’m compartmentalizing everyone, but it feels like you’re coming home sometimes to a country who hasn’t a clue what you were up to. Not a clue. That is a struggle. Is that a moral injury though?

Fardous

Yeah, I think, I don’t know on the continuum where it lies. But I feel like, again, the experience that you’re sharing is your experience, right? So again, if you’re feeling a sense of betrayal from the community that you’re coming back to because you’ve sacrificed – you and your colleagues, your mates, you’ve sacrificed at a highest degree, and folks are not recognizing that, or folks are not even addressing it, they’re going by their lives, I think there is a sense of betrayal, right? There’s like, you have no idea what I went through for us to keep the freedoms here. So yeah, I think that could be considered – again, I think it’s still an area that we have to research, but institutional betrayal is something that we’ve discussed and I think we need to discuss a bit more, but there could be betrayal from the community.

Brian

Well, there’s also tough spots about handling response time, right? Like, if you look at it this way, if an incident happened, we’re sending a quick reaction force out within minutes. We’re going, the government wants action, and we’re the guys. Off we go. That same person comes back and hears, “Well, you’re going to wait 18 months for that, or that takes 16 weeks to process that file.” You know how horrible that feels because we’re comparing it sometimes to the response time you expected out of us when you needed something. Well now I need a medical assessment and I’m sorry, I don’t want to wait. I don’t think I really ought to wait like that. But not only is it the waiting, I’m comparing it to when you needed something and I was Johnny on the spot as good as I could be. And man, that just doesn’t sit when you’re comparing it to what you get.

Fardous

You had our back, right? And it’s appropriate for the country and others in there to have your back when you come back. So yeah, it’s a fair assessment to say I was able to drop everything, I was able to do this as quickly as necessary for our country. And now when I come back, I do feel like I may have been forgotten. So you know that again, these are components of moral injury that you’re describing at the very minute level, but it’s important to capture that because I’m sure your experience is not only unique to you, so others might be hearing this and saying, wow, what Brian just described there is something that I’ve felt. I may not have known that that is a potentially morally injurious event.

Brian

Well, and I think as well, military sexual trauma, for example, is a massive problem. If you’ve got one circumstance of it, it’s awful, let alone the amount of circumstances that we have. So it’s a significant problem that’s happened. And I look at a lot of these incidents though, and sometimes I look at some of my friends who have been hurt in service – so while doing the job I signed up to do, this bad thing happened to me – and then I look at others that were hurt by the service and I get the sense that the moral injuries tend to happen more. Where you think you were hurt by the service, you were let down that team that said it was there for you was actually your perpetrator, is it a fair assessment to say that those hurt by the service injuries tend to be on the morally injurious side, or is it maybe just how it’s playing out as I’m looking at it?

Fardous

I don’t think definitively we can say one is more morally injurious than the other. But yeah, institutional betrayal is high up on the impacts of the potentially morally injurious events. So as you mentioned, when being betrayed by the institution as a result of, you agree to take this up, you agree to do all this, and then you find that the folks that you agree to do this work for have now put you in a position for something horrible to occur to you, there is for sure moral injury, but I don’t think it’s definitive that we can say one is more than the other.

And sometimes it might be a compounding effect, right? So let’s say you get hurt in service and then by the service. Imagine you get both of that, then we know that person is going to be in a very rough situation. So, I don’t think it’s been researched, I don’t think it’s been actually identified as which one is more than the other, but you do open a conversation that needs to be further explored.

Brian

So where are we going next? What do you think’s happening in the world of moral injury in the next one to two years that’s reasonable that we would get there?

Fardous

Well, I think the scale that just came out, right, the moral injury outcome scale that was in partnership with all these different countries. My hope and my vision is that we take that scale and run it at the clinical level, right? So if we can actually validate this at the clinical level, and then we start using it, and then we can start diagnosing folks that might be showing higher symptoms of moral injury.
If we get to that place, we’re ready to go. I think that’s the next step. The other is, the conversation we’re having. I don’t think we can lose sight of – even Brian just shared, someone who works in this space, who’s been an advocate for many, many years, even feeling some trepidation to share this information.
So imagine someone like yourself who you know is in a good place in his recovery journey and has his colleagues around who understand the space, but still feels a reluctance to be able to share. There are others that aren’t even close to that already. So I think we need to make sure that the conversation continues occurring and that we don’t lose sight of the importance of that, the power of that. And I think we all can speak to, when we sit down with some stakeholders, especially RCMP Veterans, we talk about what moral injury is and they’ll be like, “Wow, that’s the first time I’m hearing that.”

Brian

That is what I get all the time! I first get, “What is that?” and then, “Absolutely. That’s what I’ve been talking about for X amount of years.” And they didn’t have a word for it. Hey, is there a vicarious side to this? Like, can you spread it? Can I have moral injury and now my wife’s affected down the road and my kids are?

Fardous

So I think that was the conversation we had earlier. That’s why folks might feel like, a Veteran might feel like, “I don’t want to share with my Family member because then they might be impacted by it.” But if you share and then we walk away, then yes, that can cause some impact. But if we share and then we talk about, “Okay, how are we going to address this together? How are we going to make sure that we have the supports around us to be able to get through this? When do we need to seek professional help?”
If you have that conversation, then you’ll be in a lot better position versus just sharing and then walking away, right? Because then you’re like, okay, now I’ve maybe dropped something on this person. Then now they’re starting to make doubt a lot of things, and I’m not going to support them, then that’s harmful. And I think we’ve always had that conversation in mental health, unfortunately.

Laryssa

I have a big question I’m going to drop on you. It might be hard for you to answer.

Brian

These are the best kind! (laughs)

Laryssa

There you go, the last minute nth hour to drop it!

You kind of talked about where things will be advancing with moral injury as far as the moral injury outcome scale and things like that. But for an individual, for someone who’s listening, this is where it may be hard to answer… what’s on the other side of moral injury?

Fardous

Moral growth. Moral resilience.

Brian

That’s a thing?

Fardous

Yeah. I think we didn’t get into it a little bit today, but there is the positive moral growth as well. So certain situations that you may deal with and then there’s the result of that, because you’ve had the supports around you and you’ve been- you’ve had the conversations that you need, you may be able to grow from that. To say in a circumstance following that, “I may have acted differently” or “I may act differently. I made sense of that situation, but now I know where my compass lies and what I’m not willing to sacrifice.”

So on the other side of it, there is moral growth, and it is a journey. I think someone, even if anyone’s struggling with PTSD, you get the supports and it’s recoverable, someone could get better from it. Moral injury is the same way. So if you put the right supports around an individual and they have professional support, then there’s moral growth, there’s moral resilience.

Brian

I smell a follow-up podcast coming here! Moral growth, there you go. I think this is a unique episode for us. First of all, this is front and center with me. These are the things I want to work on. But it’s almost like people are watching a really small internal staff meeting. This is how stuff gets done here is it starts with the conversation. And I think of when we go to the community, and it’s actually one of the things we’re doing tomorrow – it’s why we’re all in town here – is we’re having a get-together of the main folks that are advising us. What do you guys want to talk about? And the very things that you think are too hot for a conversation are probably where we need to go. I’m really excited that we can be brave and bold enough to have this conversation, particularly in a space where we’re asking you questions and you’re coming forward saying, well, we don’t know that yet. We’ve still got more to do there. That’s brave, but that’s where I want us to keep going.

Laryssa

That’s great. Next mini staff meeting, someone’s got to bring the donuts and coffee. But, thank you so much for joining us today, Fardous.

Fardous

Of course. Thank you for having me. I hope that was helpful.

Brian

So as we wrap up, again, we’ve got Laryssa Lamrock here, Brian McKenna, and Courtney is of course our… what would you go with? I would go with director, producer, all things that make it work.

Laryssa

The glue, I think.

Brian

And we’re fortunate enough to be joined by the boss, the CEO, by Fardous Hosseiny, to speak to us about moral injuries.
So I really appreciate you making the time and coming here today.

Fardous

Of course. Yeah. Thank you.

In this second episode of Mind Beyond the Mission, Brian and Laryssa are joined by Polly Maher, Lived Experience Lead – Families at the Atlas Institute, to discuss how Veteran Family members are impacted by mental health and operational stress injuries.

The spouse of a Veteran living with PTSD, Polly shares personal experiences of balancing motherhood, work life, her own well-being, and her spouse’s diagnosis. Polly, Brian and Laryssa reflect on their experiences and struggles with compassion fatigue, communication self-care, living in “survival mode” and managing expectations. They’ll share resources and strategies that have helped them in their journeys.

This podcast was recorded in English. French transcripts are available for each episode.

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MIND BEYOND THE MISSION EPISODE 2: “AND THEIR FAMILIES”

 

Brian

Welcome to Mind Beyond the Mission, a podcast for and by Veterans and Veteran Family members. I’m one of your hosts, Brian McKenna, and I’m a strategic advisor at the Atlas Institute and a retired Canadian soldier.

Laryssa

And I’m Laryssa Lamrock, strategic advisor at the Atlas Institute and a proud military Family member. In this podcast, we’ll be diving into the real issues experienced by Veterans, former RCMP members, and their Families.

Brian

We won’t promise you that we’ll do everything perfectly, but we can assure you that we’ll be getting real about the experiences that so many of us have in common but don’t always talk about, or don’t necessarily know where or how to talk about it.

Laryssa

We hope you find solidarity in our words and experiences, and more importantly, that you find a sense of hope that things can truly get better, and that you can live present in the moment and live life authentically.

Brian

 Let’s get into it.

Yeah, it’s interesting. You know, I’ve worked here for 23 months, and I met you for the first time, what. three nights ago. And we’re not alone, we’re joined by Polliann Maher, and so she’s joining us here today. One of the things that we’re going to be talking about today, certainly in regards to Families, it’s still the saying of, “and their Families,” and we’re finding throughout the Veteran world, we are getting some more traction, but we’re still having to remind people, you know, there’s this group of people that come with me, they are part of what I experience, and actually, they’re part of what I used to experience, because when I re-experience it with nightmares, I’m sleeping next to someone. When I’m having a brutal day, unfortunately, that spreads around to other people. And we’re all in this together, but we’re still kind of on the “and of their Families” thing. And there was always the saying of, “if the military wanted you to have a family, they’d have issued you one,” and it gets a little snicker, but that’s not a completely made up point. That was kind of the way things were done. And I can remember going to briefings where our spouses would all go into this room, because they were getting the family briefing, and we would get the operational briefing over here, and that was progress. Right? At the time it was, so, “and their Families.” That’s kind of where we’re at.

Laryssa:

Right. So I mean, we know that Veteran Families are core sources of support for Veterans who have physical injuries, but also mental health injuries. So Polly and I are going have a little bit of a chat today about how Families are impacted supporting a Veteran with mental health injuries. So Polly, why don’t you tell us a little bit more about you?

Polly:

Yeah, so it’s great to be here in Ottawa and meet you guys. I got to meet Brian in Vancouver, so I got to meet him before you. I am the spouse of a retired Veteran with PTSD, and he’s been diagnosed since 1999. I have well over 20 years of experience of going through this roller coaster with him, and we have two sons. I used to say kids, they’re not kids anymore. They’re 29 and 27, so they’re young men, and they’ve been along this ride with us. So I’m happy to be here with you guys today.

Laryssa:

So we really want to talk about how Families are impacted. So much of the education that’s available or conversations are about Veterans. So today, let’s really kind of focus on Family impacts. And we want to keep in mind, and something Brian reminded us of, is there has been a separation between Veteran and Family. And Brian’s reminding us that the Veteran is part of the Family unit, we shouldn’t be separating them. They are not mutually exclusive. The health of the Veteran impacts the health of the family unit, the health of the family unit impacts the Veteran, so we’ll explore some of that as well. So let’s just get into it. How and why are Families impacted by operational stress injuries, like PTSD, anxiety, other mental health conditions?

Polly:

How are they not? The person goes through this enormous change in their mental health. And I know for us it crept up somewhat slowly after he released, but it was about six months and the nightmares started and the smell triggers. You know, “Do you smell this?” And I knew nothing. It was the 90’s. I was totally in the dark. We wrote letters back and forth. There was no Internet, right. So I really never clued in that they were connected. He was out of the military, right?

So the unhealthy coping skills came into play with drugs and alcohol and avoidance and isolation, and so that made me feel like a single parent. I mean, that was probably one of the first sort of impacts on us as a couple, right? There was me and the kids, and then there was him. And I didn’t know who was getting out of bed, Dr. Jekyll or Mr. Hyde, right? So that impacts you, you live in this survival mode, you become hypervigilant for your kids. So as a spouse, again, I couldn’t put my finger on all that back then. I was just doing the best I could with what I had. So when he got diagnosed, it was like it was a sigh of relief.

Laryssa:

You and I have talked about this before, Polly. I mean, I think it’s getting much better but it used to be not uncommon for there to be like a 10 year period before military members are diagnosed or post-release diagnosed. So not understanding what’s happening in your family for 10 years. And I think not only the military member of the Veteran can come up with negative coping strategies, but families very much as well.

And just as you’re talking, I remember my experiences and not knowing anything about mental health. We weren’t educated as family members on what to look for, what to expect, what might be coming. I really thought it was about me, the isolation, that withdrawal. I explored what rationally would have made sense to me in the moment, which meant it must be me. So what were your experiences when you were seeing those things happening? How were you processing it?

Polly:

I wasn’t processing them. And like you said, you take everything personally. So it was like, “What can I do better? How can I keep the kids quiet? Or how can I not put the pressure financially on him? What other tasks can I take on?” So it was just trying to do more and more and more, until there was a point where I crashed and burned, and that smacked me in the face. That wasn’t… it was gradual, but when it happened, I realized that the only person that could help me was me.

Laryssa:

So tell me more about that crash and tell me where you went from there.

Polly:

So the crash itself was, it was just little things that had piled up. He had been diagnosed, so I had those rose-coloured glasses that the psychologists were going to fix him.

Brian:

Like with physical injuries.

Polly:

Yeah, exactly. Totally. It was like, “Yeah, I’m good to go.” You go to therapy every week, and you talk it out, and you come home, and you’re going to be “normal,” whatever that looks like, right. So, but yeah, that didn’t happen. And as I took more on and I was trying to work and raise two kids, and the silence, the infighting, the arguments that we were having and stuff, and me taking everything on, so it was my fault. I wasn’t doing a good job. I wasn’t being a good spouse. I wasn’t being a good mom. And one day, I took a bottle of pills. And for me, that was my call for help. It was a bit drastic. My sister met us at the hospital. I mean, it wasn’t… I didn’t take pills that would kill me. So obviously, it was a call for help. But it was out of desperation. Because I think it was about, “what about me?”

Brian:

Yeah, so you’re a patient too, right? Do you feel people get that?

Polly:

No, no, because on the outside, I present really well. I put that mask on every day.

Brian:

Well, it seems pretty apparent to me that what happens is a lot of people approach the spouses, the children, the caregivers, as “What’s your capacity to help this person?” So the Veteran looks after the Veteran situation, the spouse looks after the Veteran situation. The kids are, “What’s Dad up to?” All this stuff is somewhat geared towards how you can help your spouse and somewhere in that we’ve got to figure out that you’re human, you’re a patient. And I think that’s where we need to go. Yeah, you know, that’s the blue sky of this, like, let’s walk there. How do we start looking at people like they are?

Polly:

I was the advocate wife back then with Veterans Affairs. The office in our city knew us quite well. I wrote to many ministers over the years. I did get letters back, so I feel like I hopefully paved the way for other Families. I was always trying to be proactive with getting my kids help and stuff. But actually, the first counselor that really sort of got the situation and helped was through an EAP program through the company that my husband was working for at the time. You know, it wasn’t VAC at the time, and for me, she talked about grief and loss.

And so we went down that road a little bit, but she really talked to me about self care and how am I going to manage my depression? When things get overwhelming, what do I need to do? What do I need to create around me? So it was really sort of an awareness. And I really dove into self help books and books on trauma and stuff. So it was, it was me educating me at the time, with a little bit of help from a social worker, to sort of help me process those feelings. Because to be honest with you, you know, I didn’t get admitted to the hospital. Basically, I went in, felt humiliated, and basically, the doctors said, “Oh, well, you guys have a psychologist that you’re seeing,” because I was, at the time sort of going in sporadically with my spouse to his psychologist visits. So it was a checkbox, right.

Brian:

Was there any feeling for you there that you had to hide your problem? Because we’re busy with this other one?

Polly:

Totally. I’ll be honest, I was in charge of finances. And I’m not a financier. I’m not great at it, but I was doing the best I could. But again, how much did I want to put on my hubby, right?

Brian:

So I want to ask you both, then, actually, Laryssa, maybe take a stab at this one. I’ve explained to people, the difference, as I see it, between capability and capacity. And where that becomes apparent to me is, there’s been a lot of forms put in front of me that I’ve had to fill out, I’m sure you know exactly what I’m talking about. In fact, even the site of the government envelope, that brown that looks like someone spilled coffee on it, I hate watching those letters. It doesn’t even matter where it comes from. It could be a tax form. But I see that and I think, oh God, here, I’m back filling out more of these things. And as you’re filling them out, one of the things that asks you is, can you shop? Can you prepare meals?

Yes, I can. I am capable of that. But if I’m being honest with you, my wife does 80% of that stuff. I can drive the kids to school, I actually do more of that. Because that’s in our house, kind of how we do our little rebalancing. But that was always apparent is you’re asking me the wrong question. If you’re asking how my house works, yeah, I can do every single thing in there. But I probably don’t. And then if it’s outside the house, especially when you’re suffering, the weight is all on that other person. So what’s your sense of that is like, where do you figure that person is capable? But can they actually do this? And do they actually do this?

Laryssa:

There’s so many layers to that. I think in many cases, the Veteran wants to contribute and participate and be part of the family unit. So they might do their best and soldier on to contribute and participate in grocery shopping or getting errands done, or whatever the case may be, taking the kids here and there. But that in itself, if the Veteran is taking every ounce of everything they have to get through that task, the Family members, often it’s hard on us, it’s hard on us. And it puts extra requirements on us to kind of manage that task as well and make sure the kids are ready to go in the car. But then try and manage the symptoms of the Veteran. And so we often end up taking those things on just on our own, because it’s just easier.

Brian:

And so we’re in the spot where you know, I can do the shopping, but I go do it, you also know I’m going to come back from there having smelled what it smells like in the butcher section, the noise, the aggravation, and I’m probably going to come back in such an aggravated state, that it would just be easier if you just do it, right. And then you do it.

 Polly:

Exactly. And it just becomes second nature, you don’t even realize that you’re taking over that sort of control piece. Because that’s the environment as a spouse that you’re able to control. So you’re keeping the symptoms at a minimum, the triggers that aggravate the symptoms to a minimum. So it’s like, no, no, I’ll just run there. I’ll do this. I’ll do that. Right, even though you’ve got six other things that you have to do and get the kids where they need to go.

And I think, Brian, you brought up a really great point. When I look back on my life, there were times where I was doing 100% of the stuff, and then it was a 90/10 scenario. I like to say now we’re in it over 20 years and it’s usually a 60/40. Very few times is it a 50/50 and he’ll agree with you, I’m not telling you anything that he doesn’t recognize as well. But if the Veteran’s working, like in our case when my spouse was working, he was putting all his energy into soldiering on and going to work. And then we took the brunt of it when he came home, because there were consequences at work if he acted out, or didn’t do his job properly.

Brian:

Direct and bold consequences.

Polly:

Exactly, right. And so when he came home, all of that came off, and he was angry, or, he didn’t want to be around people. So he isolated and went into bunker mode, and then his psychologist basically said “it’s your job or your family.” And we did separate a couple times. I mean, I look at myself as one of the lucky ones, that we were able to work through things. But we were basically signing a Separation Agreement. And we decided to give it one more try. And I’m happy to say that we did that. Sometimes I look at my kids and say, was it the best decision? I don’t know. But I made it at the time with the information that I had, and the heart that I had, because it was never about love. It was about the behaviour. I always loved him. And I had to separate that. Once I separated that it was easier to say he’s not a bad person. His behavior is unruly today, or his behavior is not nice, you know?

Laryssa:

And so you could kind of tie the behaviour to the fact that he had a diagnosis, that okay, there’s that behavior again, that’s related to the symptoms of PTSD. Your husband has PTSD, so you were able to kind of identify that. We talked about watching the Veteran become triggered or symptomatic doing errands. You talked about your husband coming home from work and having anger and he was isolating. What’s the impact on the family member? I think we, as family members, often get to pick up on real subtleties and in our own sense, develop hypervigilance, develop some of those other things that kind of sometimes almost look like PTSD itself. But so all of those things at that time, what’s the impact on you? What are you experiencing?

Polly:

So I think, again, just becoming hypervigilant and losing my sense of self a little bit too, right? Because work was my social piece, right? So I liked when I could keep a job. I left quite a few jobs, depending on where he was in his mental health. So I would have to go on stress leave, or I would quit the job altogether, so that was an impact because you have a lot of different job things on your resume, right? Why can’t you keep a job, right? It’s not really about me, it’s about my situation, my home life, right? And you take a job that works, that has flexibility, maybe that might not be the career that you wanted, or what you were able to do.

I think, with the isolation and stuff, it became sort of the boys and I… and him. So there was a little bit of that divide, even though that’s not what we wanted, the kids always came to me for everything, because they didn’t know how he was going to react. Like still to this day. I mean, my kids are in their 20s, and they won’t wake their dad up when he’s sleeping. That’s only because when they were little when they tried to do that, and he woke up and grabbed them, or was aggressive. He’s not like that anymore. But that’s their memory. Right?

Laryssa:

Tell me more about that. We’ve talked about impact on the spouse, we’ve talked a little bit about the dynamic in the relationship as the couple. Let’s talk more about impact on kids.

Brian:

I wanted to mention something there. In that regard, my kids had to learn how to wake me up properly. And they had to learn that you can wake someone else up by poking their shoulder, or just coming up to the bed and like, “Hey!” and start talking really loud. They learned real quickly that that doesn’t work with Dad. You know, I’ve never kicked a person, but you might get kicked if you’re in the wrong spot and you wake me up at the wrong time. And what’s your sense with that of like, how the kids have to learn things that kids really shouldn’t have to learn?

Polly:

Yeah, yeah. It’s a great point, Brian. I think that’s true. I mean, I know I had to learn how to wake my husband up, whether it was out of a nightmare, or whether it was, you know, in the morning to get up to go to an appointment or whatever. And I got it down pretty good. It would be like, I would put my hand gently on maybe his shoulder or his chest or depending on how he was sleeping and say, “Hey, Sean, it’s Polly. We’re in bed. You’re safe.” Nobody taught me to do that. There was no guide, there was no doctor, no nothing. I just figured that out, that it worked.

Brian:

Yeah. But interestingly enough, I’ve been in doctor’s offices, where they’re getting paid quite a significant amount of money to do what you just did. They’ve sat with me and said, “You need to see the colours in the room and actually pay attention.” You know, like, that’s a red clock there. And there’s that yellow wifi sign across the room. And those, like you’re doing grounding techniques.

Polly:

Totally, but maybe Sean was learning those, but I wasn’t learning those with him, right. And I have to say, I was lucky in that I kind of pushed my way into a lot of his treatment. And he willingly allowed me to participate and I feel blessed. And I think that’s made more success with our relationship and our life, and how we’ve had to trudge through things because he’s been open to, hey, I read about a different treatment, or, hey, maybe we should try this modality, or different things. So, that’s been really successful for us, it just depends where the Veteran is and how open they are to those things, right. So looking at it as a team rather than individual, right.

But back when you talk about impacts on the kids and that’s a big one. I mean, I think we could do a whole episode on guilt. Because I, I’ve been, in the last few years, my therapy sessions are all about guilt. And the guilt is about my kids. And I love them to death. And they’ve grown into great young men. But I have a lot of guilt of what they went through. And I know in my heart that I did the best I could with the tools that I had at the time. You can’t shield your kids. I think my kids are more aware of mental health. And our house ended up being a gathering house, which to me was a success. If friends had mental health issues, they could talk to us, like we talked openly about it more in their teen years. And to be honest, I mean, I don’t know what the boys think. We’ve never had really in-depth conversations, because I think at some point, I don’t know if I want to hear it.

Brian:

Yeah, one thing that comes to mind as you’re speaking here is, I remember when I had a four and a two year old, and I was going overseas again. For them, it was their first experience of me going away, but for me, it was the third time. As we’re getting dropped off at the airport in Vancouver, that first trip away, my kids had no concept of what I was explaining to them. So I was telling them the truth. You’ve been used to dad being gone for a bit. Now Dad’s going for a long time. And you tell them the truth, but they have no concept of it. The next tour after that, my five year old – a year has passed – said to me as I was getting my stuff out of the car, “Don’t let the Taliban kill you, Dad.” And I still have those words carved into my mind. Because five year olds shouldn’t know that Dad could die. They certainly shouldn’t know how to name terrorist groups in the world. And the fact that my career choices put them at a level of understanding that, let’s be fair, that’s too much. That’s too high of an understanding.

But that I had a group of about 1000 people that were doing the same thing. So we had this kind of idea like, yeah, this is hard on our families, but we’re all in this together. But when you come back and you have a problem, and these four guys don’t, you’re not in it together anymore. And now I’m the patient and I’m putting this additional pain on the family. Man, is there ever a lot of inspiration there to just hide it, bury it, yell it away. Because anger is better than pain, you know? Well, it certainly feels like it is. And we know we’re the source of the problem a lot of times. We’re not missing that. But we don’t know what the heck to do about it.

Laryssa:

There is no handbook, there is no guidebook. We do the best we can at the time and kind of in retrospect looking back, there’s some things I would change. There’s things we can’t undo. I do think sometimes there’s opportunity too and I guess it’s about having some insight somehow. You know, my oldest son’s a paramedic now and he’s at risk for moral injury, for mental health injury, and having lived the life before I’m very aware of the risk. So we have the conversations and his response often is, “Mom, we’ve talked about mental health in the house, I’ve seen it, I’ve lived it, I’ve supported someone through it. Maybe I’m better prepared than some others.”

So it’s really hard because that tenacity and awareness comes through that adversity. It’s hard sometimes that we’ve seen our kids go through those difficult times. I guess I’m an optimist, that I try to take some of those opportunities as teaching points. Talk to my kids that anger is normal. How you handle that anger is what makes the difference. You know, I would kind of joke around and say, oh, even the cats are fighting. So, that happens. So I tried to look at that, like I said, as teaching opportunities. But it is really hard, because there isn’t a lot of guidance, we have to kind of figure it out on our own.

Brian:

Polly, you mentioned something to me the other day when you said it’s different when the kids become adults or something to that effect. And I thought about that for a while, as I’m not there yet. My kids are still teenagers, they’re still developing how their thoughts work. So what does that actually look like? And what do I need to be scared about here?

Polly:

Well, it happens overnight, let me tell you. You blink, and all of a sudden, they’re taller than you.

Brian:

They’re there. We’re there. (laughs)

Polly:

(laughs) And they’re on their way, doing their thing. And I would say, my oldest son struggles with depression and anxiety. And it’s difficult to not do that push-pull constantly, you want to fix them. You think you know what’s best for them. But they’re adults, and they have to make their own choices. So, one of my lines that I think he’s sick of hearing right now is, “It’s all about choices.” So you can make healthy choices, you can make not healthy choices, you can make bad decisions, good decisions, but they’re yours. So you do have to play your cards, right? How you choose to do that is yours. Dad and I are here to support you no matter what, right?

Because I think sometimes pushing them too much just pushes them away, and then they shut down. Don’t get me wrong. I’ve been the mom that if my son doesn’t answer me for a couple of days, I’ll drive to wherever he’s living to make sure that he’s okay, and to tell him that I love him. And I’m here to support them. And what does he need from me? Because I don’t know, right? And I can say what worked for me, but I don’t know what worked for him. Like they grew up in a totally different era. I think a lot of how I handled things goes back to my family of origin and how things were handled, right. Like, we don’t think about those things. But what I’ve learned going through PTSD is a lot of times with the Veterans, how they handle stress, how they handle their symptoms, sometimes is from family of origin stuff. If their family never talked about feelings, they’re certainly not going to talk about feelings with PTSD, right?

Brian:

Yeah.

Polly:

And I want to say we were a little bit more of a touchy-feely family, hugging and that, and I think I had rose-coloured glasses on. I was the last of four kids. So in my life, everything was blissful. And then I got married at 21 and moved to Germany. And that was a culture shock and the whole thing, right, I was in a military family then. But I think that plays a part. So my awareness of that has really helped, actually. And then my husband’s awareness of that has helped. So he feels like he’s kind of broken a little bit of a cycle. It’s nothing for him to tell the kids he loves them at the end of a phone call, to give them a hug when he sees them and stuff. Not something he grew up with, so I’m really proud of that piece. Like, I think Laryssa, we talk a lot about it, it’s about, let’s be optimistic. There’s some really good things that have come out of this. I’m not saying we have the greatest family relationship all the time. But we can have some great moments to hang on to, so that I can outweigh now all the shit that we went through in the past, right?

Brian:

Yeah, and one of the things we look at as we’re producing stuff that’s going out to the public and Veteran family community is let’s have the truth, let’s have it bold, but there’s got to be some hope in there too, right? And we don’t want to be faking it. We don’t want to be pretending it’s there. But where it is there, we want to be looking at it and going, okay, there’s a moment there that we can work with.

Polly:

I think, Laryssa, you asked me a question before about what I did, what helps and stuff and I think another big piece for me was managing my expectations. So what was Sean capable of doing today based on where he was at in his journey, right?

Brian:

And what if that doesn’t match what you need today? Like, he can’t do Home Depot today but you really need a Home Depot run?

Polly:

]You adapt. Or does Home Depot really need to be done today?

Brian:

Yeah.

Polly:

Because I think as a society, we’ve got this quick fix, everything’s got to be done now everything, whatever. And so, I describe myself as a super gray person, I’m not black and white, although my husband’s a black and white thinker. And so I’m a little bit more easygoing, he’s coming along, but if it doesn’t happen, it doesn’t happen. And for a while, yeah, it’s a hard thing and you’ve got to always weigh those pros and cons. Because if you give in too much, and I’m not – give in might not be the right word, but if you accommodate too much, then there’s that codependency that comes in. And again, we could do a whole thing about codependency, right – ah, planting the seeds for further podcasts (laughs). But if you always accommodate having a bad day, instead of now, what will happen is…

I can think of just a couple months ago, we woke up, it was a Saturday morning, I’m throwing some laundry in and tidying up the house or whatever, and he gets up, and he’s not in a good mood. And he starts ranting and raving about, we got to get rid of this, and we got to take this to the dump, because my son didn’t do what he wanted him to do. And so it’s no good anymore because it’s not put together properly. And so this whole catastrophizing thing goes on. And I just looked at him, and I said, “So we’re going to have one of these days?” and I walked away. Now, 10 years ago, I would have never done that. But I was like, I don’t want to have that kind of day. So I’m going to go and do my own thing. And he went and did his own thing. And he meditates a lot now, and does a lot of grounding things. And he came back to me about an hour later, and he goes, “Babe, I’m sorry, it’s, it’s me. It’s not you.” And he goes, “I don’t want to have one of those days.”

Laryssa:

There’s a few things I just want to pull out that you’ve talked about that I wonder if would be helpful to other Families and other couples. It sounds like communication is a huge part of what has brought you guys to this point of having a fulfilling and happy and fun relationship that sometimes has bumps and bruises along the way. It sounds like through that communication, you and Sean have both kind of agreed to be honest. Sometimes we need to be honest and humble and just put shit out there, even when we’re not proud of what it looks like. It sounds like through that you guys have developed different strategies. And through that have kind of created a sense of trust. You’ve done a hell of a lot of work. Both of you have had to do that to get to a point where you can say to him, “Oh, we’re having one of those days” and walking away. So all of that, I just wanted to identify that it’s a work in progress. It sounds like you guys have done a lot of work and steps to get to this point. And yeah, just didn’t know if you had anything you wanted to add to that.

Polly:

Well, thank you for that! (laughs) That perspective, it sounds pretty positive.

Brian:

The smile on my face when you’re talking about that is I’m thinking back to, the Army does teach you communication. And it teaches you to throw in the garbage every single syllable that is not absolutely necessary to explain date and time and what and when and what are we doing? And the rest of it is gone. And I do wonder sometimes, are we setting ourselves up for a really, really good piece of brief communication over a radio, and a really terrible way of like, talking to your kids?

I look at it, like, we have this thing they teach people, whether you’re in the military or policing, where they look at the use of force continuum, right. And it’s this onion, basically. And there’s the outside layers and whatnot. But suffice it to say, when you’re dealing with a problem, what you’re trained to do is come in just one level above that, right? Someone someone’s being loud and boisterous, well, you just show up with presence, and you one by one ratchet your way up. But the theme of how you handle that is that you always come in one level above what’s being put in your face. Really, really good for handling a riot. What happens if all I know to do in communicating with you is to always come in one level above, right? I’ve literally been trained to have a really bad home. But pretty effective for work, gets stuff done.

Polly:

Right? Makes total sense, Brian, makes total sense.

Brian:

Well, yeah. And then we come home and we deal with you like that, because it worked at work. And then it’s about to not work anymore. But we learned that the hard way. You’re laughing.

Polly:

(laughs) Oh, yeah. Yeah, I mean, anger was a big piece in our household, right? My husband has a nice deep voice, he has a radio voice. So it can be all calm and zen and all that kind of stuff. But it can be pretty friggin’ loud and can be pretty friggin’ scary. And that’s the voice we got for many, many years when the kids were young, because anger was his go-to emotion. Like, there was no other emotion. I think if he was sad, it came through in anger, because that’s where he felt he had control, right, and that’s his stuff. And he dealt with it and I’m glad about it. But Laryssa, getting back to you and talking about the communication and all that and it does take work and one of the things we have in our house is progress not perfection, because it is constantly progressing, we’re never done on this journey.

There’s always another level that you can accomplish for yourself first and then for the family as well because when I when I realized that I needed to take care of myself first, so put that oxygen mask on first, we’re told that all the friggin’ time but we never do it other than when the plane’s going down. So, not that I want to say that my life was constantly going down. But I needed to focus on Polly. Who was Polly? I don’t even sometimes know. I look at it and I’m 52 years old now and I’m like, “What do I want my life to look like?” I’ve got all these opportunities, and again, the positive for me is I was able to take a not-so-great part of my life and help others with that in a career, and I feel super grateful for that. And I want to make that road less bumpy for others. But you’ve got to walk that road. We can walk it alongside you.

There’s so many more programs out there than there was 22 years ago. So many more. So, Brian, it still is “and Families.” However, the plus is there are programs out there, and when you talk about communication, one of the programs that helped us, I mean, we tried couples counseling, my hubby did not like couples counseling, I could go into a lot of stories about couples counseling, but he walked out of couples counseling, like it just didn’t work. And his therapist was like, “He’s not ready.” My question was, “When is he going to be ready?” I’m ready, right, because this is not working at home. I’m glad you see him once a week for an hour, but I have him the other how many hours a week, right? So what do I need? What do we need to better communicate?

And in 2013, we were given the opportunity to go to Can Praxis, which was equine. My husband does not like horses, he’s scared of horses, he got kicked off a horse apparently when he was younger. But you know what, he went and we had a couple moments. But we came home from that with some really great foundation pieces. One for him was, model the behaviour you wish to see in others. And he’s like, “I’m not modeling good behaviour for the boys. But I’m expecting good behavior from the boys.” Right? Because that’s the military. That’s the respect piece, right? And so he came back, and even though the boys didn’t go on that with us, there was a real success with the relationship with the boys. So I think it was good timing. When I think about it, their relationship that they have with their dad now is better, because he was able to sort of take that step back and look through a different lens, about what his expectations were of the boys and how he had set this standard of being an asshole. Sorry, I’m not sure if I’m allowed to say that. But you know, and that it was okay. We were always going to forgive him, because we loved him. Right? We loved him. So yeah, we might be upset with him, but we’re always going to – we have that unconditional love, we’re always going to take him back in the fold. And the other piece was learning how horses, when you drive them away, they’ve got to come back on their own. And so that analogy of when you drive your family away, just because you come and say, “Sorry, sorry, babe. I was an asshole” doesn’t mean that I’m going to – I might say thank you.

Brian:

Yeah, I’m better now. So we’re good, right?

Polly:

I’m not good, right? I’ve still got that splatter all over me. You vomited on me or whatever, right? Even though it wasn’t physical or anything. I’m feeling the residual effect. And so now, years later, I can say, you scared away the horse and the horse wasn’t ready to come back. Or he’ll say it to me, because he knows that I’m quieter, or I’m puttering or I’m whatever. And then I can go and take a bath or I can call a girlfriend or go for a walk or whatever. And he doesn’t take it personally, like before it was like if I tried to do any of that and I didn’t accept that apology, then it was another fight, right? Or it was, “You don’t love me.” You know, he was catastrophizing things, like “You’re gonna leave me,” and all of these things, right? And so it’s just it really helped us. It wasn’t the golden ticket. It’s a piece of the puzzle that we needed at the time.

Brian:

Right. So without giving me a doctor’s answer, what’s compassion fatigue like within a relationship?

Laryssa:

I think because we love our spouses – we love them, we’re proud of them, we see them suffer – and whether it’s a mom thing or a parent thing or a spouse thing, we want to fix them. And so for me, it was almost gradual, I was willing to give pieces of me to try and help him be better, and over time, that chipping away and not replenishing those pieces wears at you, and I found for me, I also relinquished my boundaries a bit by a bit by bit because I loved him and because I wanted to help. So not taking care of myself, not being at that point that I potentially could be impacted by this as well, I ended up with compassion fatigue, and because I didn’t address that either, actually ended up with my own diagnosis of depression, which is another way that family members can be impacted. So Polly, just wonder if you can relate to any of that, and if you’ve had experiences with compassion fatigue, vicarious trauma, any of your own impacts.

Brian:

I guess, like, the other way of saying it is when do you get sick and tired of us?

 Polly:

Well, I mean, I did get sick and tired of my husband and that was earlier on. You know, in the early 2000s, he had gone, he was in therapy. He had a lot of unhealthy coping skills still. He went to Bellwood for the inpatient program, I did the family program, I was always involved in any family program that I could be involved in, when he was in a facility. And, you know, that was a tough time for us because prior to him going to Bellwood, he was in the psychiatric ward for six weeks for a suicide attempt. So there were so many things swirling and stuff like that. And so for about a year after Bellwood, things were – our Friday night was, he went down one hallway of the church to AA and I went down the other hallway to Al Anon. And that was our Friday night date night, and it worked. But then some unhealthy coping skills started to rear its head. Financially, we weren’t, you know, in a great place. But I think behaviour wise, I just wasn’t willing to go back down that road again.

And so I was like, this is, this is a boundary, I’m going to draw a line in the sand. It was very literal. And it was super hard. Thankfully, we were somewhat amicable. I know he hated me during that time. And I moved somewhere with the boys and he moved back in with his parents. He went back to Bellwood again, I did the family program again, even though we weren’t technically together, but I was still supporting him, we had to co-parent, right, so we had to have some kind of relationship. And it was weird for our family, because I would still like, I think we split in November, and in December, I still went to his family’s Christmas, like at his aunt and uncle’s, because we wanted to keep it normal for the kids. And I mean, it might have been awkward for everybody. We thought we were doing the best we could, but so that was one time where that was a real boundary in the sand. People that know me know I elasticize boundaries. So I try to keep them, but I, again, manage my expectations of where he’s at today, is he capable? Can I keep that boundary? Or do I need to sort of lessen my expectation of that boundary today?

Brian:

When I started this job,I went to talk to a local police chief in my community, they’re pretty advanced in the way they handle mental health. Well, that’s my take on it. And we’re having a chat, and I wanted to talk about a completely different issue. And he said, you know, if you want to talk about policing, we need to talk about compassion fatigue. And so he explained it to me what his sense of it was, and he had a unique insight, which was, he starts to get concerned about a person when he sees loss of empathy. And to him, that’s the start point. Does that make any sense? Is there a family version of that?

Polly:

I would say so. You kind of get to the point where you’re like, what the F, right? Like, if this happens, okay, if that happens, I don’t really care. You know what I mean? I think for me, I was the family planner of everything for my extended family, and I just was like, yeah, that can go by the wayside. But when I look back, I think we lost sort of some closeness there. And I think, you know, for me, it was resentment. For me, it was a lot of resentment. And I was carrying, not necessarily vicious anger, but I was just really resentful that it was always about him and it was never about me or the kids. And everything revolved around him and every benefit that we could get for me and the kids revolved around him. So then you’re resentful not only to him, but to the system. So I think for me, yeah, probably burnout, compassion fatigue was somewhat like that.

I think the other thing that we have to look at is, you’re slowly building your resiliency or you’re slowly building your cup up again with self care stuff, and then something totally unrelated to PTSD happens, because life happens, right? Could be loss of a parent, loss of a family member. For me, it was just an event that happened. I’m not, you know, I don’t feel comfortable talking about that piece, but it was an event in 2018 that really threw me for a loop. And I think I hit a wall again, right? And I was like, okay, I don’t want to go through that unhealthy piece. I already had been on medication in the past for depression over the years, but wasn’t on it, and so the first thing I did was, I have to walk the walk that I tell everybody to walk, right, which is hard to do. And I went to my doctor’s and I talked to her and she’s like, well, I can put you off work. And I was like, no, no, work is my saving grace. I need purpose. Plus, I don’t want to be at home with my husband 24/7, right, let’s be honest. So we came to a compromise of working four days a week, and going back on medication, and seeking a new counselor. So it was like putting those building blocks back in place. And it was a whole year before I went back to work full time again. If you would’ve asked me 10 years ago, I would have just boom, gone back to work, right?

Brian:

Well, I look at this and I think there’s an operational side of this, and we’re not going to talk about military operations too much, but in a deployment, you can go over to a place with an idea of, here’s how it is. This is the aggressor, this is the group of people dealing with aggression, and soldiers, we’re here to help the little guy. By the end of that tour, though, it’s really easy for you to look at it and go, you’re the maker of your own misery to some degree. You’re contributing to part of this problem. I went through that when I watched the withdrawal from Afghanistan last year. You know, there’s this huge part of me thinking, I’m fighting for your country. Could you get on board with that? And that’s related to compassion fatigue. You know, to some degree, I can get there in a six month tour. Well, if I compare that to what my kids have been through dealing with me, can they get compassion fatigue after 11 years of dealing with this? Well, if I can get there in six months, do the math. But that’s only a recent thought that I’ve had, as in the last two years.

Polly:

I’m glad you’re having the thoughts, Brian.

Laryssa:

I’d say that it’s important for Families to consider this part of the conversation. To me, if you’ve come to the part where you have no empathy, that’s too late.

Brian:

Yeah, but how do you know you’re there?

Laryssa:

I think there are signs. I think the resentment is part of building up to that, I think the physical exhaustion, I think you need to just be real and have a look at yourself. And it is hard supporting someone with PTSD. But man, I love my husband, he’s a great guy, and he’s not the PTSD. So every day, I have to get up and say, am I in or am I out? And if I choose to be in, then there’s certain things I have to accept. I have to accept that I need to take care of myself. I have to accept that I need to teach my children how to set their own boundaries. It means I have to accept that I’m not going to fireworks with my spouse. Those are choices that you said, Polly, life is about choices. So those are choices I have to make as a family member.

Brian:

See, we’ve talked before about the five minutes I need, right? So if you look at it this way, say I come home from work, stress. Every little bit of driving, trust me, stress. I’m the kind of guy sometimes, like, if it’s a song I like, or I’m stressed, I’ll just sit in the driveway for a little bit and just find myself a couple of minutes. You know, because I know if I walk through that door, as soon as the kids see me, they’re going to come and do what kids do. “Dad, here’s what’s going on in my life” and I’ve got to this place of one way or the other, finding that I need that five minutes and I’m gonna steal it in the driveway, I’m gonna go talk to my neighbor, even if we don’t have anything to talk about. It took me years to realize the simplest of concepts of, I need that five minutes, and then I can hear about what’s going on in your life. But if I walk in that door, and am like “Yeah, honey, how’s your day going?” I may have said those words, but I’m not listening to a damn thing, because I’m not there yet. Yeah, I’m not ready.

Polly:

You bring up such a great point for me, Brian. It was probably around 2007. Sean had gone to Homewood. The kids were in counseling while he was in Homewood. And so when he got out, we did family counseling. And so one day, the counselor looked at me and he said, “So Polly, what do you need?” and I looked at him, “What do you mean, ‘What do I need’?” And he goes, “What do you need? You’re talking about this stress, so what can Sean and the boys do to help you out with that?” And I was like a deer in the headlights. I was like, “No one ever asked me that.” Right? And he’s like, “How about 20 to 30 minutes when you walk through that door?” So like you said, you need that. And I was already probably giving that to Sean, because I could read his thing. But nobody was reading mom. Right?

So at first, it was really foreign, right? And the kids would be like… I would walk in the door, and everybody would want to, like, kind of come to me, and then I would see them walk away. Oh, you know, I’ll give you your 20 minutes or whatever. And so then, maybe I’d change or whatever. Because it was just like, you walk in, it’s like, “What’s for dinner? Oh, I’ve got hockey practice tonight, I got to finish homework.” And then my spouse wasn’t working, so he was alone all day, and he just wanted to give me a hug and a kiss, which is lovely, but I just needed to like, wash off my day kind of thing before I got bombarded being mom, right. And so now to this day, my family will walk in and they will read me now, which is so lovely. And they’ll be like “Mom, do you need your 20 minutes?” Alright, so I don’t need it all the time now, because I’m much better at keeping my cup half full, instead of totally empty.

Brian:

But if they’ve got the question, they’ve given you the space to say yes.

Polly:

Yes, exactly. And they’re okay with it. Right? Because it was a conversation we had together. It was explained to them why I needed it. And then I can say that to them now. Like I can read them and instead of bombarding them, like how was your day and whatever, because it’s a normal thing, right? Maybe they’re not ready to tell me how their day was. So let’s talk about it later.

Brian:

A big thing in our house is, you wind up doing the caregiver role. It’s just how it is. Going back to what I’m saying about errands and jobs around the house, like it is not 50/50. I can’t even lie and say it’s 60/40, it’s not. She does the vast majority of those things. And that puts them in the caregiver role, puts them in the ‘making it all work’ role. And does that drag you out of the wife role? Is it hard to be the wife, when you’re the caregiver?

Laryssa:

We can have a whole conversation about caregiver, because for me, even using the term ‘caregiver’ puts an expectation on the family, right? So I am a huge advocate for using the term ‘supporter’ and it is actually a conversation I had with my spouse when I first met him knowing that PTSD saying, “I’m not going to be your caregiver, I can’t do it.” But even so, you slip into that. And absolutely, of course it does, because and the reason I don’t like using the term ‘caregiver’ is that there’s a power differential, like, a caregiver to me is an early childhood educator who is taking care of a child, or it’s a nursing assistant taking care of an elderly frail person, there’s this differential, and so how can you be in an intimate relationship with someone who’s supposed to be an equal when there’s this power differential?

Brian:

Yeah, and you know what a lot of us don’t like about it is, I don’t want my house to be like a doctor’s office. And I don’t want you to try to be my doctor. And I don’t want to feel like I’m being pathologized at the kitchen table and stuff like that, it’s frustrating. But I look at it like, I’ve left the doctor’s office a number of times, and I’ve come straight home. And the first thing that happens is, “What’d you talk about? How’d it go?” And what’s going on in my mind is, I just did an hour of hell. And I don’t want to talk about the talking. I just did. I’m done talking. But here’s this person that loves you, and they’re also there sniff testing the rest of the day. They’re doing what you did, right? They’re trying to figure out, “Is this the kind of day we’re going to have?” They’re just doing the basics, but to us sometimes they can feel like, yeah, okay, you’re you’re trying to be my doctor, and it’s like, no, I have a doctor. Be my wife. But is that possible?

Polly:

I think the lines get blurred, definitely. I mean, for a while there, we were having good communication, but my spouse was looking to me for advice or just feedback on things that now I’ve been able to say, you need to take that one to your psychologist, right. So that’s me again setting a boundary and being more in that wife/partner role, right? And less in that fix-it, caregiver role. But again, it took a lot of education, knowledge, understanding, and just some self-awareness to know that I was even doing it and to know now, because I slip into it sometimes, right? It’s normal, I love him, and I want him to have the best quality of life he can. But I want to have a good quality of life too. And I think, Laryssa, I just wanted to go back to a point that you were talking about. Because I think what I’ve learned along the years with it was in peer support for 10 years, prior to coming to Atlas. And one of the things that I find with spouses is we take on the mood that our loved one is in for the day, right? So now I can say, and I can sort of have that, that individual boundary, what kind of day are we going to have?

Brian:

And are you snowplowing? For me here, like, when you’re doing that, are you trying to get the problems out of the way?

Laryssa:

For sure, for sure. That’s where the hypervigilance comes in. We are so attuned to our loved one, like, really, you walk in the house, we can’t even see you, and we know what kind of –

Polly:

We can feel you.

Laryssa:

And so we’re anticipating your triggers, we’re trying to minimize your triggers so you don’t walk into the kitchen and get triggered. We are trying to remove all the things that could set you off. So it puts us into this state of hypervigilance or hyperarousal and that’s what we kind of touched on before, that sometimes as a result of that, we also experience isolation, we shut down sometimes. So it’s really interesting. But absolutely, we’re snowplowing to try and make your day better.

Brian:

So this is the thing is like, when you’re snow plowing – I like to use that term of trying to make the problem go away before we walk through it – that can make us feel like we’re one of the kids.

Polly:

Very true. Very true. I think it depends on how you do it. Eventually you get to a point where you can kind of communicate it. So I’ll just give you an example. The other day, we were making – it was Monday before we came here – and we were making steak and baked potatoes and stuff, but don’t have my barbecue ready yet, so we were doing it on the stove and the oven. And the potatoes, I had put garlic butter on, and it leaked on the oven. Well, my husband has smell triggers. And they were pretty good, but I’d say the stuff with the Ukraine has heightened some of his symptoms lately, and so we’re all aware of that. So he was on his way home, and so I called him and I said, “Hey babe, the house is a bit smokey. Stuff was on the bottom of the oven. There’s a smell, I got the fan on, I got the windows open. But I just wanted to let you know before you walked in the house,” and he said, “Thanks, I really appreciate that.” Because then he could set himself up, right? Because what happens to him with smell triggers is he would get triggered, he would get the smell and he would get angry. And then he would get a headache. And then he would be miserable. And it’s just a downward thing. But because I was able to sort of give him that heads-up, the smell still bothered him, but it was gone as best as we could. But then we could all mitigate and we sat down and had dinner, and I mean, so it works for us. I’m not saying it works for everybody. But that works for us.

But getting back to sort of that detachment piece. It’s really – I mean again, we probably could have a whole podcast on how to do that, but it’s really about, you know, how do you detach? How do you not take on that mood? And I think it’s almost harder for – like Brian, you said the people that don’t maybe get diagnosed until years and years and years later, right? And it’s just so difficult because you love your spouse so much and you want them to have a good quality of life and you’re just anticipating all of those negative things that have happened in the past. What’s worked for me is not going so far back in the past. And understanding that this is a blip, we call them blips now. And so what we say is he still has blips, but we all bounce back. We all bounce back much quicker. So what used to take place, when he had a bad day, it would go into a bad week, it would go into a bad month, right. And now, we could have a bad 10 minutes.

Laryssa:

And you have the skills to recover.

Polly:

And then we have a great rest of the day.

Laryssa:

I know we’re coming close to the end of our time. You talked, Polly, about sometimes you need 20 minutes, and you have mentioned that you have a lot of experience providing peer support to other Families. I know you were great at what you did, and had your heart fully in it. So I kind of want to ask about the broader picture from that experience, from your own experience. What do Families need?

Polly:

Like I said earlier, the resources have improved. Navigating those resources is difficult. So unless you have someone and that was one of the roles I loved about peer support, was I really helped people navigate the big system, the bigger systems, whether it was the Department of National Defence if they were still in, or it was Veterans Affairs, you know, what are the benefits available? Or it was the community resources. That was my job, right? I needed to know those things to help them. You know, resources in Windsor would be different than resources in Niagara, right. I think the virtual world has opened up broader resources in the fact that you don’t have to live in your area, maybe you could take certain workshops and stuff.

For me, the biggest piece is really planting seeds. And that psychoeducation that awareness of, you know, I think when we first talked about psychoeducation, and stuff, it really was always focused on how can you best support your Veteran, right? And now I think it’s really about, how can you put that oxygen mask on yourself first? Because if you don’t do that, you’re going to be no good to your Veteran. And you might fake it for a long time. And it might feel like it’s good. But really focusing on what can you do for yourself, learning about boundaries, learning about expectations, and learning about the signs and symptoms of PTSD? And what needs to be clinically worked on? And how can you help your spouse navigate that world? But how can you take care of yourself while you’re doing that? I would say that’s one of the biggest things for me,

 Laryssa:

 So I’m not sure if you can answer this, maybe you partially answered this question already. But you disclosed that you’re in your 50s, now your boys are more grown, you and Sean are in a great place and have great strategies for when you’re not in such a great place. But some of the listeners might be younger Families, couples, and I just want to put out there that Families doesn’t have to be a spouse and kids, it could be parents, we haven’t even touched on parents, could be siblings, could be – maybe it was your fireteam partner, then that’s who you’re leaning on now as a Veteran. But if you could go back and talk to 25 year old Polly, what would you tell her?

Polly:

Are you trying to make me cry? Um, I, wow.

Brian:

You didn’t prepare for that question? You don’t have that one all ready to go?

Polly:

(laughs) I did not! No, no, no, no, no. I think I would just say, put yourself first. Take care of you. And use any and all resources that are given to you. Even if you don’t think that it’s going to be a good fit, make that call, try that. And don’t be discouraged when the first or the second or the third are not what you thought they’d be, you know, it’s really about managing your expectations, because there’s no quick fix to PTSD. It’s not going to be fixed. You’re going to live with symptoms for the rest of your life. The Veteran is, and you are as their family member.

So how can you have the best quality of life? And how can you put the best tools in your toolbox that work for you? And those tools are going to change over the years. Because I’m assuming that as we age, and Sean’s memory gets worse, we’re going to have to get some more memory aids in here, right, that aren’t part of our support package now, but they might be later, right. So I don’t know if I answered your question totally, but I really think I would tell myself that I matter. Not to lose myself in the situation. And that I’m doing the best I can with what I have.

Laryssa:

Thank you very much.

Polly:

Thank you.