Moral Injury Support Network Podcast

Veterans' Healing Journeys: Insights from Annette Hill

• Dr. Daniel Roberts • Season 2 • Episode 6

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Can trauma from a single event create a lasting moral injury or PTSD? Join us as we explore this compelling question with Annette Hill, a licensed professional counselor and EMDR certified therapist whose dedication to trauma treatment is both professional and deeply personal. Annette shares her remarkable journey from her influential role in the Lifebook program for foster children to her creation of the Journey of Me curriculum. Her heartfelt commitment to veterans is evident through her long-term involvement with Operation Freedom Bird, and as a Gold Star mother, she brings a unique and profound perspective to her work.

Our conversation dives deep into the complexities of moral injury and its distinct impact on mental health, particularly among those in high-stress professions like the military, law enforcement, and emergency response. Annette helps us understand the nuanced differences between moral injury, PTSD, and unresolved grief. We discuss the importance of personalized treatment approaches, highlighting effective techniques such as EMDR for PTSD and the necessity of engaging with an individual's spiritual and ethical core to address moral injury. Through Annette's expert insights, we underscore the critical role of empathetic listening and the adaptation of therapeutic methods to best support those suffering from these complex forms of trauma.

As we look ahead to our upcoming Comprehensive Moral Injury Conference, we touch on the excitement surrounding innovative therapeutic techniques and the gut-brain connection. Annette's contributions and keynote speech promise to add invaluable depth to the event. We discuss the importance of diverse treatment modalities, community partnerships, and overcoming organizational barriers to enhance mental health care for veterans and first responders. Join us for this enriching episode filled with practical strategies, transformative experiences, and a heartfelt dedication to supporting veterans on their healing journeys.

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Jamie Peer:

Okay, well, everybody, thank you for joining us again today for this edition of the Moral Injury Support Network for Service Women podcast. I'm your co-host, jamie Peer. I'm a US Army veteran, having served for 23 years, and I am joined by my co-host, dr Daniel Roberts, who is also a command sergeant major in the Army Reserves. He is the president and founder of the Moral Injury Support Network for Service Women and today we are very excited. We have the privilege of introducing a truly remarkable guest, annette Hill.

Jamie Peer:

Annette is a licensed professional counselor, nationally certified and an EMDR certified therapist. With her private practice based in Scottsdale, arizona, annette brings a wealth of experience and expertise in the field of mental health and personal growth. Annette's journey in serving others began with her work as a coordinator of the Lifebook program with the Arizona Children's Children Association, where she worked with children in the foster care system. Later, as a therapist at Devereux in Arizona, she continued to support children in foster care and her experiences led her to create a comprehensive curriculum called the Journey of Me. This curriculum has empowered foster care agencies to establish and sustain their own life book programs. With a background of 10 years as a dual diagnosis therapist in residential treatment settings, including the Meadows and eight years with the Sundance Center, annette has honed her skills in assisting individuals with various diagnoses. However, her specialization lies in trauma treatment, where she has made a profound impact on the lives of her clients.

Jamie Peer:

Annette's dedication extends beyond her private practice. She passionately supports veterans through her work with Operation Freedom Bird, a nonprofit program that she has been involved with for over 27 years as a volunteer therapist and board member. She provides invaluable support to combat veterans, offering healing and guidance during their annual four-day healing journey to Washington DC over the Veterans Day holiday. In addition to her remarkable work, annette is a Gold Star mother. In addition to her remarkable work, annette is a Gold Star mother. Her son, adam Hill Gibson, served two tours in Iraq before tragically succumbing to symptoms of PTSD in 2009. Annette's personal experience further fuels her commitment to supporting servicewomen, servicemen, veterans and their families. We are deeply honored to have Annette join us on this episode today, and her extensive experience, compassionate approach and personal journey make her an invaluable resource in our collective healing process, so we would love to warmly welcome you today, annette. Thank you for joining us.

Dr. Daniel L. Roberts:

Thank you, annette. Thanks for coming on from sunny, I'm sure sunny Scottsdale, arizona, but we're very proud to have you. We're looking forward to having you at the conference in September as a keynote speaker. But it's just what I know about your work. I'm very fascinated with the work you're doing with our special operators and many of our other veterans, and you know that. I know from personal experience of one veteran how you really transformed the way she thought about her experiences into a very much a healing space. So thanks for coming and I'm eager to speak to you.

Annette Hill:

Thank you. Thank you for having me. I am speaking to you from 105 degrees so I've come very prepared. I may run downstairs and get more water. Yeah, it's getting a little sporty here. I may run downstairs and get more water. Yeah, it's getting a little sporty here. I shouldn't complain because I know you all are speaking from high humidity so I will stop whining. But I do have AC blowing everywhere. There are fans going, so if you hear background noise, that's what it is, but I appreciate your having me with you today.

Annette Hill:

I'm so looking forward to joining your conference and I've read through the documentation, the books from your previous conferences. I am enjoying just the planning committees. The whole thing is so enriching in every which way and I believe that the research that you guys are continually putting together and adding to the body of knowledge of this particular subject is going to make a difference in the lives of so many. As part of my. You read some stuff there. It's funny because I can hear things have already changed and whatever, but I have also was the original clinical director and I stood up a program in Bandera, texas, for veterans and first responders. It's a. It's a residential treatment center Warriors Heart and it is exclusively for this population and as part of that treatment, we are utilizing some of the things we're going to talk about here today and certainly at the conference in depth, utilizing some of the things we're going to talk about here today and certainly at the conference in depth.

Annette Hill:

But the idea of differentiating between things that people are suffering and calling them out by name is so important. It's hard to put words to the importance. Think of it like a medical doctor. You know, if I complain of a side ache and you're treating me for a pulled muscle but it's cancer, because I'm describing a symptom, but you're not getting more in depth to what the full presentation is and my history and listening. We're going to have trouble and I think that you know we hear the number 22 a day. We believe it's a higher number for a number of reasons. You know it doesn't count single vehicle accidents or suicide by cop or accidental overdose. You know any of that that it's a much higher and why? What are we missing? And that's, I think, what puts you guys on the cutting edge of this, of this. I know there are other entities that are working very hard to do that, but the fact that you're putting on this conference for other providers is huge.

Jamie Peer:

Thank you, thank you. Okay, so we're going to get started on our questions, and the first question is can you share specific examples of how you have witnessed moral injury manifesting in the lives of veterans or service members, and how has this understanding shaped your therapeutic interventions or strategies?

Annette Hill:

Yes, I can share. I know when you and I have chatted about this and your mission is for women veterans, because they seem to get a bit of short shrift because their population is so much smaller in our armed services, but they're also a little later to the party in that official way, it seems. So I noticed different things with the differences between the treatment of men and women. With the differences between the treatment of men and women, you know, with Operation Freedom Bird there generally seems to be just a handful of same thing with the residential treatment centers that I've worked in, just a handful of women versus men. So the way that men and women approach how they experience a trauma, how they articulate the trauma, it does fall a bit against gender lines because how we are raised in our homes of origin, our family cultures are, you know, the male-female dynamic. Then you roll into what those edicts are in the armed forces. It does alter then how I'm going to process or not process my pain. So you know, one of the most common trauma that women face is sexual trauma in the military. The unspoken trauma at a high number is that men also experience sexual trauma. You know military sexual trauma and the manner in which it plays out, how one internalizes those behaviors are obviously impacted, like all trauma, by the frequency, the duration, the intervention, who I am as I come into that moment, what was said, what was not said, you know what action am I allowed to take or not take, what's expected of me and who am I when I come home? Active duty versus veteran, and that impacts the treatment as well. Am I done with my military service or do I have to go right back into the very place of my pain and face those people? And I do, like many others, treat both when we're dealing with that specific type of and again common, sadly traumatic experience. We know, with people who experience sexual trauma, regardless of whether you're a veteran first responder or a regular citizen.

Annette Hill:

I was in my 30s when I was drugged and raped, and so I am a survivor of sexual trauma, and I think that the most common thing that we see is that we take on blame. Somehow. I brought this on. I should have been able to prevent it. What's wrong with me? Am I damaged? Now, I think when men experience sexual trauma, male to male, does this alter who I am as a man, women? If it's male to female. How will my significant other now, going forward, think of me? Who can I share this with? Am I supposed to be tough? Women walk into the military with a sort of extra load in their rucksack which is don't you damn. No, I'm sorry, I do swear. Is it bad if I swear?

Dr. Daniel L. Roberts:

No, you can't.

Annette Hill:

I think it's mostly adults listening to this.

Annette Hill:

Oh man, I think it's really, my first career was in construction, so I do swear like a truck driver. Now you work with you all and it's like you're fine, all right, I'm gonna work hard, everyone, but you're gonna see when I struggle. Um but um, you know, if I women are not allowed to shed a damn tear, please don't, because then the side you know chiding is, I knew it. You can't let those guys in here. You know they can't handle it. And so now you are suffering something that is extraordinarily to the core of who you are as a human thing, that is extraordinarily to the core of who you are as a human. You know the most stripped away thing a person can take is. You know your sexual integrity, your privacy, you know all the things that you can name. And but then you know, oftentimes it's a hierarchy, it's a supervisor, it's somebody who is of higher rank, and or it's the people my brothers, who who swore to protect me. They're doing it maybe as an initiation, maybe they're doing it as a gang rape kind of an experience, or you know just all of the different things. And then I've got to go and serve right next to you on the battlefield or in the field, hospital or whatever, and I'm supposed to act, a act like nothing happened, but also take a bullet for you. I mean it. Just the complexity of just that trauma is so grand that it takes a lot of unweaving. It takes a lot of time, I think, in the treatment of all veterans. And I'll get to a different type of trauma that is also common in the military, which results in moral injury, but also just PTSD type trauma. Is that what did I bring to the table previously? We know that people who will in later life have sexual trauma experiences very frequently statistically will have had sexual trauma in their early life, which is fascinating, and so is it. You know, some of the theory is that predators know prey, but there's something that an unresolved trauma in the sexual arena we give off in some way that leads to a subsequent. Now, that's not everyone and I think in the military that may be a lesser experience, because we see again, you have this high propensity of a more aggressive type personality, somebody who is forward driven. What combat does alter in everyone? You know, as far as just that intensity drive, the offloading, the peer pressures, the a thousand points of entry. But I always look for what is precipitating, always look for what is precipitating, because you can heal a sexual trauma from later in life and still have a total infection growing up underneath, and that's for men and women. I think that is a true statement for men and women.

Annette Hill:

I did treat a gentleman who a Vietnam LERP Long Range Reconnaissance Patrol Officer Soldier and he when I, by the time I got him and I did meet him in Operation Freedom Bird, which, by the way, actually stopped they I think they were 35 years old when they stopped serving the Arizona combat vets. But wow, if you add that in and of itself is an amazing experience. But that's how I met him and he, 70 years and change, elegant man, very spiritually inclined, a Catholic gentleman who church every day. All of that and his, his moral injury versus PTSD. He did have PTSD but but he actually had symptom resolution with the treatment he got from the VA but they didn't treat the moral injury piece. So in a private setting, what he shared was that, with great pain, that they were directed not to engage the enemy, the Viet Cong. But sometimes you know, as they're out scoping, you know, looking Viet Cong to bring information back, but sometimes the enemy would be there and they would engage. At that time the Viet Cong was mutilating the bodies of our service members when they were in combat moments with them, cutting off body parts, doing all kinds of horrifying things, and our guys would come up upon those bodies and see that. So when there was hand-to-hand combat with the LERP group patrol, they would repay that out of their rage, they would repay and mutilate bodies back and this gentleman disclosed that, he and his guys, they would cut the ears off of the deceased Viet Cong and they would wear them as a necklace strings of ears. You know his pain is what. Who does that? What kind of a person does that? You know, and the tears and the sobbing and this, the horrifying shame. I mean he wouldn't hurt anything.

Annette Hill:

Yet here we are and I think in in in to to treat all kinds of trauma, but certainly of the moral injury flavor where a person does have some sort of connection to the action. I did something that I violated my own moral code versus, you know, people who I serve with violating toward me. There are two types. You have to be able to listen to that and receive it in such a way that as the clinician, you have to deal with both ends of it. How does how does he make sense of why he would do that? Because that's a legitimate question. Does he make sense of why he would do that? Because that's a legitimate question. We always ask why, why? Why did I do this? Why? Well, the antidote to that is answer the question why did you do that? And oftentimes, in the treatment of moral injury and other things, the person does have the answer to the question about why they did it and he was able to spell out what it was like to be there.

Annette Hill:

In that, I think a vast majority of us can put ourselves in a position of having been so utterly wronged, or a family member or a loved one so wrong that you want retribution, you want revenge and when the moment is over, you think I'm not wired like that Heat of moment. Moments they matter. Now you move backwards into sexual trauma and I believe that people who commit those crimes, some people, will have a moral code and a conscience that years later, or hopefully soon, they think those things themselves. How, my God, who would do that in a gang rape type moment or a peer pressured moment or a whatever? But some people don't. They feel justified and that is really the difference between where we as clinicians are working.

Annette Hill:

This particular gentleman, he walks both. I can put myself in his position as an 18, 19, 20-year-old man who has been drafted into this horrifying moment and I don't know what I'm doing, they don't know what we're doing and we're seeing our other brothers who were also not wanting to be here, you know, and I've got to go home and talk to their family. I could put myself in that position of justification, yet it is unjustifiable justification, yet it is unjustifiable. So it's a complex treatment and you have to be able to be there in that moment with the person to walk through that sort of circuitous route to healing. And ultimately, in any of these situations, whether it's PTSD, moral injury, unresolved grief, loss, what the brain is looking for is an action. What do I do now? You have to be very clever about that and they do need a something.

Annette Hill:

In certain faith-based systems there are hungry for justice against others and we are hungry for some sort of penance in our own selves and you have to be comfortable in sitting in someone else's shame to be able to kind of prescribe an action that he can take. And I've got other examples. I can go on with this question, probably for the rest of the hour. Sure, sure you get the idea I'm gonna grab a shoe because I've got a fan blowing in my face. Yeah, you're good, nose runs um, go ahead.

Jamie Peer:

I, I wrote down. I didn't to me that was so powerful that the antidote is to face the question. I'm not sure if that's exactly what you said, but to answer the question of why, why?

Annette Hill:

why did it happen to me? Why did I do it to another? Answer the question yeah, yeah, that's really powerful.

Jamie Peer:

Okay, so thank you for that. Now, as a therapist specializing in trauma, what are some of the key insights or lessons you have learned about the unique impact of moral injury on mental health and wellbeing and is do you see a difference from other forms of trauma? Oh goodness, yes.

Annette Hill:

Um, I think that, like other trauma, it is can be cumulative and it is notable that one event can result in post-traumatic stress disorder. It can result in moral injury. It can result in, you know, catastrophic grief and unresolved, you know, looping grief for years. One event can be all three of those things. One event can be two, any combination of and I call it the dark triad so I refer to.

Annette Hill:

I needed to come up with something you know, with the residential treatment center where I could try to get the guys to understand. These are the most common things you're going to probably deal with Law enforcement, ems, er, doc. You know anyone in the military who's for sure deployed and gone out in enemy territory. You know MASH units you know just anybody in that place. And to understand what symptom you have to listen. I, you know I'm not the one that coined this, but two in one use them in that proportion. You have to listen to the person in front of you.

Annette Hill:

I think that people in my line of work we tend to like a modality or two and then we shove everybody into that modality and we try to make it fit you as a clinician, I believe if you're going to do trauma work. You need to understand the different flavors of trauma. For some people it is, you know, different flavors of trauma. For some people it is, you know, years ago, being bullied on the playground, which could be quite horrible. It could be not being, you know, watching your parents argue, witnessing, you know, not actually being the victim. Technically it can be where PTSD, by definition, that's a victim-based experience, fear-based Moral injury is shame, guilt-based. Now there's a little bit of you know with the LERP, you know it is pretty horrifying to see what he saw. So now he may have PTSD out of the fear that they're going to come for me out of the jungle, you know, or, now that I've done this, that they like there is some fear there, so there may be some shades of and and we have so many wonderful modalities for PTSD resolution. My preferred one is EMDR, but it isn't for everyone, so I I have other tricks in my kit, as everyone should. Moral injury it really goes to your soul, the core of things, your spiritual self, and I don't mean religious self which could appear, but I do mean your spiritual self, the essence of who you are. If it's done to you or you do or don't do something that is part of your sworn code.

Annette Hill:

I think that in what makes the military experience of any of those unique, is a the propensity for experience. I mean, my goodness, you know, it's the worst thing in the world. You know, one experience that a person has in the military is the worst thing in a lifetime experience for most civilians. And it's Thursday for you, you know, out there, and so you've got to untie that knot. But the idea that my job is about right and wrong. My whole job is about code, about higher level directives and hierarchy and following orders and yes and no, and even to a higher degree, if I break that law, I don't get to quit the military because I don't want to play anymore. I go to the brig. I mean it's, I don't even own me anymore.

Annette Hill:

It's so so that when you are betrayed by your own in the military, by a command by your peers, by people who are also raising their hand for that oath, it goes so deep, so deep, and then you can't. Where do't? Where do you go with it? The very place where you have as an option to go, military court, sometimes not supportive, I know, in recent times more supportive. So the layers of betrayal is the key phrase here.

Annette Hill:

I was betrayed or I betrayed. I was betrayed or I betrayed two sides of the moral injury coin run deep and we still have to answer for the why and also the do. What action do I take? And I believe that at the end of all of these things, whether it is PTSD, moral injury and grief, you are moving eventually to acceptance that it happened and forgiveness, release or reconciliation, and so the more versed you are in all of these stages. But we've got to get to. You know I use this phrase frequently. Let's lift 40,000 feet above what happened. Let's look at all of the components, not just what you're perseverating on, not just what you're fixated on. What is looping for you, what is your narrative? We have clinicians again who subscribe to a modality or two and specialize in it. They may not really be fully listening to what that person you versus, you versus him or her. You have to really know who you're treating in order to treat. You can't just make a person fit, and that is very important.

Jamie Peer:

Absolutely, Dan. Did you have anything to add?

Dr. Daniel L. Roberts:

Yeah, so as we think about from a chaplaincy perspective, you know we're used to in in a normal soldier contact, soldier engagement contact. We're used to one or two sessions with the person. Most of the time they're looking for some help at the moment and you can give them some ideas. You can help them do some problem solving or work through what I talk to chaplains about when you're talking about moral injury be prepared for a long, you know, relationship with this person and many, many sessions potentially because as you talked about, like we're getting really deep here and one counseling session with a closing prayer, that's not going to do it. Even and I agree with you giving them things to do. And I say daily, it's about rewiring their whole thought process. Rewiring their whole thought process and you have a short-term decision, like you're talking about the LERP guy that now has long-term repercussions and ramifications, but that too can be rewired, that too can be forgiven, that too you really can get a place where to a place where it's okay, you know, where you can able to let yourself off the hook, able to forgive yourself. But part of that is a daily sort of walk through that, a daily I love daily affirmations and those kind of things meditations, prayers, whatever your, whatever your flavor, whatever your word is you like. But you know this is not going to be for a chaplain. And for counselors like yourself you're probably used to many sessions, but for chaplains it's like, hey, this is not. Let's have one, two, three sessions are going to be good, move on to the next soldier. Let's have one, two, three sessions are going to be good, move on to the next soldier. This is where, if you want to be part of that care team, be prepared for many sessions of helping them through and you should love that, like I love that.

Dr. Daniel L. Roberts:

Being able to have a soldier that engages, being able to have a soldier that engages I'm seeing every week or every two weeks, whatever it is, and seeing them grow through that and work through that. And seeing a different, because moral injury often affects people's self-esteem on a really it can shatter someone's self-esteem, their identity, and you talked about that. They don't know who they are now or what they are. Am I really that evil person? No, you did. You may have done an evil thing, but you're not an evil person to help people walk through that.

Dr. Daniel L. Roberts:

But just the understanding if I'm going to be a moral injury care provider. I'm in it for the long haul with you. We're going to journey together. You may not be able to have 100 clients right. You may just be able to have a few that you're spending lots and lots of hours with, because when you're not with them they have to work through that and, like I said, giving them things to do to think about mantras, whatever it is from your angle, is super helpful, but they're still going to need somebody to come back in, to be able to visit and say, hey, I'm really struggling right now. I need an outside voice, so to speak. So that's kind of what goes through my head as I hear you talk about that work.

Jamie Peer:

Thanks, dan. So in preparation for our podcast today, annette and I talked and she had made me aware of a new book that's come out called Love Mom, and it's inspiring stories celebrating motherhood, and they're different chapters written by different women who are mothers, and I just I honed in on Annette's chapter. Obviously, I was keen to get more of your story and understand where you're coming from even better, and I think what really stood out to me is the bravery that you, with your status as a Gold Star Mother, and how has your awareness of both of those aspects influenced your approach in supporting individuals who have experienced trauma and combat-related challenges and their families?

Annette Hill:

frankly, yeah, I initially you know, because I was already a clinician when this happened, specializing in trauma, and you know the way that Adam, when he came home, he was different, you know. But he was so and he was also so young, you know. We also know that brain is growing still and it's being bathed in all this pain. So I had a level of understanding when I rewind the tape to the things that he would say only when intoxicated he wouldn't talk about his combat trauma. When sober, my uncle Al, who was a B-52 ball turret gunner in World War II he said it best when we would inquire about the war he would say you know, I'm not going to tell you those things because I went so that you would never have to know those things. So if I tell you, you're now going to know and therefore you will be there. And I thought, gosh, I do get that and I know that that is part of where I think a lot of our veterans are, my son included. But it has to come out and I would try to encourage those things. When I rewind the tape about the things that he would say while intoxicated, the defense is down I can see now the difference between the moral injury and the PTSD of which he had both.

Annette Hill:

He came out of the military with a diagnosis of PTSD and I could also see that the early life events. So it informed all of that For me personally. I thought I, who will want to be treated by me, I couldn't save my own son. Now, over the course of time I've actually had two people say that to me so I was glad that I got to that first. Yeah, it was hard to hear. One was really angry because her husband was going into sobriety and she didn't want to go into sobriety so she made that about me somehow. So I thought, okay, whatever, girlfriend, but yeah, but the point is still there, that the thought is there, and so the grace of God, the sheer grace, is that I have also awareness that I wouldn't even be invited to some of these tables in the veteran community if I hadn't had this experience, if my son was alive.

Annette Hill:

There are a lot of people that do what I do for a living, but there isn't sort of a supposed given belief in my understanding of how bad this can be In treating veterans and first responders selfishly. Hearing the horrifying things that go through their mind actually oddly helped me to understand why my son is not here that the collision of events is it's a 75, 85, 95% of the time what is leading a person into suicide. It's a sensation of trap. So in the teaching in large groups I speak around the country to law enforcement veterans in training mode to understand that with each other you need to be aware if clusters of events are happening, we all can handle things, if they happen here and there and there and there. But if I have a flat tire, an argument with my spouse I'm having, you know I'm in the month of all those bad things that happened to me. You know my unresolved grief, my, my worst pain. I got an argument with the boss. You know when you carry this level of pain PTSD, moral injury and unresolved grief you're never at a resting point of just being casual and easy going. You're always at an activated, animated up here. So it doesn't take much to put you into trapped and suicide is not a selfish act.

Annette Hill:

I really have a hard time when people believe that. I know that people listening, some people are going to think differently than I do and that's okay, I'm right and you're not. So there's that Because people, honestly, when you listen to people who have come close to suicide and then, for whatever reason, it doesn't complete. And then they're in your room talking to you. They're not thinking of you, they're not thinking, and if they are, what they're thinking most likely frequently I should say is you would be better off without me. I'm a burden to you. If you really knew what I have done, if you knew me, if you knew how much I've changed. It goes on and on and on.

Annette Hill:

Shame, shame, shame, ptsd. When you do the research, moral injury and shame are at the root of suicidal thoughts, gestures, actions, far more than the fear-based PTSD, I'm afraid, moments we are missing, we're missing it. So, when your clients are talking to you, what I learned is listen, to differentiate between what is being said, what is not being said and, kind of in your own little put it, you know, start to break it down and then help the client to break it down. This is that and this is this. Have you ever heard of this before? I mean, I, you know we have priests and we have confessional booths. That's moral injury, right, we go and we sit behind the curtain because my shame causes me to not want to look at your face. It's not new. It's not new, you know it's not new, but but but as a term it is. And again, I want, I don't. Secondary gain is another thing that that I was informed, you know. That informed me.

Annette Hill:

What do you get out of remaining stuck and needing this penance? Needing it, did not want to be off the hook, because if I get off the hook, then it'll mean that what I did was okay. It'll never mean that that, but it'll mean that the circumstances were such that I did or didn't do something and I have to reconcile who I was in that moment, and that those things are the recipe for that moment. That that's not my true character. The harder ones are when there's an attempt to justify working with the gold star community.

Annette Hill:

I became part of the gold star family. I host the. It's a national event at the end of fall every year, um, all over the united states, and so, uh, the second year, uh, since died in 2009, 2010,. I offered to have it hosted in my backyard and it was selfish. My son died October 24th. His funeral was Halloween and this event is usually then, and I thought, gosh, if I host this, I have to remain hinged. I have to. I can't spin off out into nowhere and, um, but what I, what I got, uh, this makes me want to cry that look on people's faces. You know that, the, that the, the grab for responsibility for my loved one being gone, whether it ended because of combat. So a Gold Star family is the person that has deployed, or it was enlisted but deployed, died in war or because of war. So we have Vietnam vets that die months, years, decades later of Agent Orange that's because of war.

Annette Hill:

Moral injury and PTSD are physiological injuries because the chronic looping creates neurological changes. I think, dan, you said that earlier. It is a rewiring, it can be changed and it can be put back. But listening to the families, the pain sometimes it's called carried pain, even the children carry it, and I love photography, so I'm a photographer at the event as well, and when I'm going through the photos and I make a DVD for the families after, I can see it. I can see it, the hollow stare, that, just the all of it, and and I can see, yeah, so the tenderness and the, the, the camaraderie, the words that you don't have to speak, um, the, I get it, portion of it, but in treating, uh, veterans and first responders and the treatment of them.

Annette Hill:

I think you have to be really willing to get in the weeds and you have to be able to hear pretty horrible things and you have to be able to go in the pain. It's not comfortable and shame is the thing that most of us don't want to hear from somebody else. We try to cover it. I hear clinicians doing it because I train clinicians to work, obviously, with the, and I can hear where they're starting to do this because it feels uncomfortable to sit in somebody else's bad behavior. It's easier when you realize, say you know, such as in sexual trauma. You know you didn't bring this on to yourself, but this attempt, power grab to get control of I somehow should have prevented it, kind of a thought. That's easier.

Dr. Daniel L. Roberts:

But when there is ownership, partially, you have to work through that yeah, um, you know what you're talking about earlier and one of the reasons why PTSD treatments um may not work for moral injury in the same way is because it's a spiritual thing. It's not a religious thing necessarily, but it's a spiritual thing. You talk about things like forgiveness. As you're talking about these various elements and letting off the hook and being able, like, like you said, if, if I forgive myself, if I'm able to put this behind me, let go of it, then does that mean what I did was okay? I mean, those are spiritual kind of conversations and a pill is not going to do that, it's not going to fix that right well, let me just say a pill's not going to do for any treatment.

Annette Hill:

I, you know I this is a terrible thing to say you know people will put out. You can't open your car door without hitting some veteran organization. With doing something collective, yes, there's something beneficial about doing things with people that also serve, but in a swimming with dolphins isn't going to cure PTSD, it's not going to cure moral injury. The collective sitting around together, talking together, that's going to have an impact. But I will say that with EMDR, I do use EMDR to work on moral injury, because what we're hunting for is the core belief. That's a core tenant of EMDR. You're looking for the physiological sensations, the images, all of that. Well, that's all present in moral injury. But if the thing I think is about me, which is generally what a core belief is, I can use that. And what EMDR does is that I shut up and you shut up and we let the healing start to occur through the emotional networks, which are not really necessarily what gets the airtime. Talk therapy is a matter of my logic, engages with your logic, and then, boy, I better have the right words and you better be able to think of the right words to say back but that's not where trauma lives. It lives at deeper soul level. So I do think it's a spiritual thing. But I do think that some modalities do lend themselves.

Annette Hill:

Another one that I'm a huge fan of is internal family systems, ifs, and it marries very well with EMDR. But people will say things especially with moral injury. Let's just go back to the Vietnam Lerp. A part of me understands why I would do that when we finally get to the why, answering the why, and he describes the circumstance, and a part of me is horrified by that behavior because I would never, but yet I did. A part of me feels betrayed by my country because I was put in that position. A part of me is angry with the Viet Cong and I hate them, but yet I know that they're just trying to defend their country, so I even feel some weird compassion for them. Like you've got all these parts that are all arguing internally. That is fair game for the full-on modality of internal family systems, but it does marry well with EMDR processes. And then the actions of prayer, forgiveness, you know, and I think having a clear definition with your client's patients of what forgiveness means to you versus what it means to me is a necessary step.

Dr. Daniel L. Roberts:

Right, and I think that one of the reasons why there's no such thing as a modality that works for everybody is because we are so unique. And you know one of the clients I had she would never have done group anything Like she just would never. She may, with enough individual counseling, get to a place where she might be in a group, uh, but she would never do that. And and so you know that's a modality like peer support has worked for a lot of folks. She, not her, she just because of early trauma, early child and her fierce, her need to be fiercely, fiercely independent. And then the shame that was so powerful she would never openly share that with others. You know and and so, and then I've I've heard you know, other folks, like with EMDR they just it just couldn't. So my point of that is that the need for lots of different modalities to not to not camp on one or two.

Dr. Daniel L. Roberts:

I think part of the issue that we tend to have with major organizations like the VA is there's going to be a certain number of approved modalities and that's the ones you get to use and if you have a client that doesn't work for you, just can't help them. And so you know that where the, where the community piece, the non-profits, all the different state organizations, federal organizations, that's where there's a need for community partnerships and working together, because maybe we can't do certain modalities because we don't have funding for it or authorization whatever, but you do and you can and you've had great success. So let me help get you a client. Let me, you know, refer this client here. And we have, we have too many and I don't want to get too far down this road, but just there are too many barriers at times for organizations to be able to work together rather than sort of like, hey, this is, these are the modalities we do, and if that doesn't work for you, we can't help you. Yeah.

Annette Hill:

I absolutely agree. One of the other things I think that, as you're speaking, it reminded me to say that you know when you're working with veterans and first responders and I do lump them together because the traumas are the propensity for, and oftentimes one career goes right into the other and then they go back, so you usually see the same person in both. It's a high. It's a high number in certain communities, but I do put them together. But it was part of the reason why we chose with this treatment center to not do certain things because the feedback from the veteran is that I don't want it, I didn't like it, it doesn't work. Some of these modalities, my strong way of doing therapy, is I don't want to clean a room. I don't want to clean a room, I want to clean the house. Now, if we're here to work on your car accident, that's a room. That's, you know, a 1T big T trauma. It's not. You know lots of feeder traumas or sustained traumatic events. You know all of that. But I want I always start from birth, because the foundation of who a person is affects how they perceive anything subsequent to that foundation. It's it's like building a house my walls are going to only sit plumb if the foundation is sound, and so you have to know the person.

Annette Hill:

My opinion all the way down to the bottom, um, I think to your point. With the VA, you know, uh, they were inclined to do, uh, two modalities that I I've yet to really hear a house cleaning, which is what I'm looking for. Um, they did adopt EMDR finally, which I'm very happy about, but I also want to say that two things. One is that what, if you're going to venture into this realm, you must do evidence-based treatment. Do not venture into these early development, one-off, zany things. You will hurt the people in front of you and they may not ever go back to a clinician again. Do not do that. You must be well-versed. You need to practice and be well-trained. You need resource development. To your point, Dan, you open up this can of worms and if that person cannot contain that pain when you send them out that door, you have harmed your patient. You have to do resource development before any of these things can be done, because you're wading into deep territory. And so I love group therapy, even for people who don't want to be in the group but to be in there as a listener.

Annette Hill:

There are a lot of things that we get from listening to others share their pain, especially sexual trauma. Interestingly, it's one of the benefits in all the domains. Women will share it, they will share it and it helps the men in the room share theirs. You know there's a statistic out there how many women do you think zero to 18 have sexual trauma? What percentage of women Zero to 18, 80% is the statistic. What do you think it is for men?

Jamie Peer:

60, 70.

Annette Hill:

So I need you to think about that. And, and you know we had a lot of sexual trauma in Vietnam and pre women being in the military, you know they had lots of. So the VA is learning to ask about sexual trauma with men, and who do you think is never going to want to talk about it? And it has to be talked about. It is, it is such a core violation of everything sacred to a human and it just.

Annette Hill:

The other thing I think is interesting with moral injury is that I also have a bone to pick with my higher power. The very area of my spiritual self is also injured. So when I go to a spiritual place to have my you know, my moral injury looked at, I don't know if I want to believe in a God that would allow that, and so I've got to work through all of that, the injury to even just praying or forgiving. You know it's so complex. It's not as complex, I think is what I'm trying to make it sound, but it is that complex, you know, because we are, you're working with very educated human beings. We are an educated military, very educated, and so I think some of these silly modalities that are out there, silly things that people do, especially in residential treatment centers. You know I struggle with some of that and it needs to not occur because it's insulting to who is in front of you, especially when you're moving into special forces and all of that. You better be on here. Yeah, smart people.

Jamie Peer:

Yeah, okay, so we have time for one more big question, and I do want to focus. I mean, we need to talk about the hard stuff, for sure, but I would also love to hear of a success story that you've had, or a transformative experience where you were able to maybe help somebody navigate their moral injury and regain a sense of purpose and wellbeing.

Annette Hill:

Yeah, thank you for that question, cause we do tend to focus on the other stuff and not ever say, well, gee, does anything work? I would say you know, just I was. I was a success story with EMDR. I carried PTSD, but I also carried moral injury and so with my clinician and I was not a service member I have what is called post-traumatic growth. That's a well-documented phenomenon.

Annette Hill:

At the residential treatment center there was a gentleman who was a drone pilot. Well, he worked in the drone with the other people in that area. He was not the one that actually fired the drone, but he was bringing intelligence back and forth from one room to another and all of that. And when you are a drone, when you're in the drone unit, you see very up, close and personal, the damage because you're looking straight at it with cameras. And so and this was in Iraq he comes to the treatment center with high suicidality several attempts. He's a family little kids, wife and he was under eye to eye suicide watch. We had to keep him under constant, 24 hour surveillance because he was that fragile. So we do a two hour presentation. I do a two hour presentation at that moment and then we do a breakout where the clients are to do this exercise, which actually I'm not going to share what the exercise is, because you now have to go to the conference in order to tear this right teaser teaser.

Annette Hill:

It really is so good. Um, it is so good. I didn't develop it, but I certainly uh altered it. So it's kind of an adaptation, but it is somebody else's uh brainchild. Anyways, I have everybody break into groups. Two people, um, my husband, who is a 30-year combat vet, was in the room because he just happened to be there traveling and I asked him. I knew that this man was so fragile so I sat and listened to his moral injury and then, for the second part of the exercise, I asked my husband would he please sit with him? And then he knows the exercise. So he kind of finished and walked it through.

Annette Hill:

Exercise was done, things go well, he's able to achieve this shift in his perspective, which is ultimately what we're looking for a different way of viewing it. And again, I don't have any social media, literally zero. And I got a memo from the owner of the treatment center and she said that this guy posted on their website or their Facebook page. It's been 20 days, 20 days in nine years that I have not been suicidal and he cites this exercise and he has a picture of him with his children. He looks different. There is something about when a person makes that shift. It's almost like the flu that's been invading every cell of their system has been relieved. Color is different, countenance is different. With the LERP, same kind of a thing. He was able to move into grief. He was able to move through to forgiveness of others and self. Not that it was okay and it's not necessarily an off the hook For another veteran who they would run over dogs in Iraq out of a sense of revenge. You know wild dogs everywhere. This man is a dog lover, a dog lover, and so I have him in my office and he is so horrified he's been suicidal in just the idea that he can't. Even who would do that? And it was just a point of rage. There was a betrayal with the little community that they were set to protect and one of their guys was blown up by a suicide bomber, a vest. He walked up with a suicide vest and exploded himself, killing the guy.

Annette Hill:

Anyway, so his penance, his due. After we worked through again the forgiveness and everything else, he wanted to take an action. So he again a lot of going back and forth, which is you're going to go to a local pound. You know humane society. And he rescues dogs one to three. He trains them for mobility issues, ptsd and all of that for veterans, hearing issues, all of that and then he donates them to the veteran or first responder and that is his penance, because he can't bring those dogs back. But he needs to save a veteran and he needs to save a dog, and so that is his due. So, to be clever, and he, there's no stopping him, no stopping him. I can go on and on and on, and there you will meet a woman, the one that you referred to, um, and we'll go more in depth into her story and the why we did this exercise, but she, uh, will speak on her own behalf and I'll chime in. But yeah, there are some good things out there.

Jamie Peer:

Absolutely, and you're referring to Dr Sarah Archer, who's going to be another one of our keynote speakers at the conference, and you, two amazing ladies, have been collaborating for the better part of a year on your presentation, so we're really looking forward to that. On that note, and here's your final question, what are you most looking forward to regarding your participation as a keynote and the networking opportunities that will be happening at the Comprehensive Moral Injury Conference this September?

Annette Hill:

Well, I'm looking forward to unfolding all of these topics, that is for sure. I mean, I am chomping at the bit. I'm like, how much time do I have? Like I'm really I'm excited to get in the weeds. I love, I love that I'm excited to be in the weeds. I love, I love that I'm excited to be in person and to have no interruption for several days about these subjects, about being with other providers, and I don't.

Annette Hill:

I have a hard rule I don't ever ask another provider to do something that I haven't tried myself. I ask no other patient to do anything I haven't done myself. So I'm interested in learning what other people have done that has worked and I'm interested in providing ideas of things that have worked with this population. Specifically, I'm interested in sitting in on all these other categories, the people, the not keynote people, but their presentations I mean in just the planning time, all of these other ideas, all the research about the gut and the brain, and alter one alter the other huge stuff. To invite people to join Dan in some of his stuff you know who've written amazing books and then to be able to hear more than even a book offers, to be able to make personal examples is a huge thing. You'll never forget to be able to attend this again with the CEUs you'll be providing, you know, to be able to kind of I can't capture all that, I'm just excited to be the hell out of Arizona. September is fatiguing here. Oh, got to retreat, yeah.

Jamie Peer:

Dan any any kind of closing thoughts before I I wrap this up for today. This has been awesome, annette, and I do want to say really quick the first time we met you and we got off the call with you, I called Dan and I was like I love her energy, we need her to be a part of this, and so I just want to say thank you for agreeing to serve as a keynote, for participating in so many of our conference event planning things to make it even better, and your input has been incredibly valuable, and then for today and your willingness to share more of your story and help us build anticipation for the conference. Thank you so much.

Dr. Daniel L. Roberts:

So, dan, yeah, I am really looking forward to seeing you at the conference and having some really long conversations over coffee or eggs or whatever.

Annette Hill:

I like beer. It's vodka, just kidding, it's water.

Dr. Daniel L. Roberts:

But, yeah, having some really long conversations about all these kind of things and then watching you during your talk, because we gave you lots of time and we want to. I know a lot of people there will really want to engage you and have questions and all that, and so I'm really looking forward to the really deep discussions we're going to have. And part of the reason why in the conference we built in personal time. You know, you go to these conferences and you're completely exhausted by the end of it and you go from one thing to the other, one session to the other, and I think at the end of it you're still going to be tired just from all the information and input.

Dr. Daniel L. Roberts:

But we built in personal time each day for people to be able to get together, to be able to get with presenters, to be able to hang out, have that cup of coffee or wine or whatever it is right, and really have some conversations that there's not time to have during a presentation or tell stories or share with people. There are people that come in person because this is a Jesuit retreat center. They have their own little room and their own little sanctuary and their little quiet rooms around the facility, because we'll have the entire facility. So it'll be times where people might want to just go get a quiet room and really, you know, take this in, do some meditation or whatever that they want to do. Three, four days with Annette the kind of great discussions you can have and with Jamie, and with myself and Sarah and Dr Dubé all these great folks, you know be ashamed to miss it for sure. So, thanks so much.

Annette Hill:

Thank you. Yeah, and the terrain, the pictures that you've sent of this retreat, oh my gosh.

Jamie Peer:

How can we and I'm hoping for fall color secretly, because we don't have such things here yeah, no, yeah, the the ability not just to go to like a quiet room but to go walk in nature, and it's very peaceful. It's not in the middle of downtown or by an airport or anything like that. So part of the reason I love that is, you know, the people that we're inviting do expend a lot of energy doing heavy stuff most of the year, and so just to give them these little brief moments of solitude or connecting with nature or just talking with people that really get it in person over meals and things like that is is going to be really extra.

Annette Hill:

Yeah, tough cases, like if you've got a tough case, bring a tough case where you feel stuck, like let us all conspire. I think that would be fabulous. I love that you can workshop it on site.

Jamie Peer:

Yeah, that's really good. Okay, so that concludes our podcast for today. All the information about the conference and our agenda and everything will be listed under, you know, within the podcast summary. Again, annette, can't thank you enough for all of it, every bit of what you've brought to this effort, and especially for your willingness to share today with us. So thanks again, and we say thank you to our listeners and please like and share this podcast with people that you think would be interested. And that's all we've got for today. Thanks again. Bye-bye, take care. Bye-bye.

People on this episode

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Dr. Daniel L. Roberts

Host
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Jamie Peer

Co-host