Healing Veteran Moral Injury

Moral injury – the profound wound that occurs when one's deepest moral codes are violated – affects countless veterans yet remains largely misunderstood. This powerful episode brings together three voices at the forefront of healing this invisible wound: retired Colonel Lisa Carrington Firman, who transformed her experiences with combat and military sexual trauma into award-winning books; psychologist Dr. Pat Pernicano and retired chaplain Kerry Haynes, who developed an innovative curriculum combining psychological and spiritual approaches to moral injury healing.

Unlike PTSD, moral injury strikes at the core of identity and meaning, often manifesting as crushing shame, guilt, or a profound sense of betrayal. For women veterans like Lisa, military sexual trauma frequently becomes a source of moral injury when the systems meant to protect them fail. For combat veterans and military leaders, impossible decisions that result in harm - regardless of necessity - can create moral wounds that fester for decades.

What makes this conversation extraordinary is the insight into how healing happens. Through metaphorical storytelling, creative expression, and community support, veterans gradually process pain they've often carried silently for years. The "cracked glass bowl" exercise described by Dr. Pernicano demonstrates how veterans identify their wounds before reimagining themselves transformed through healing - not erasing trauma but integrating it into a new, whole identity.

The discussion addresses a crucial reality: isolation compounds moral injury, while connection facilitates healing. As Kerry notes, "Moral injury happens in community, so healing best happens in community." Yet many veterans, especially those in leadership positions, feel unable to reveal vulnerability. This helps explain why some traumas remain hidden for decades, as Lisa's did for forty years before she found her voice through writing.

Whether you're a veteran struggling with moral injury, someone who loves a veteran, or a provider seeking better ways to help, this episode offers concrete pathways toward healing, forgiveness, and post-traumatic growth. Discover how combining psychological and spiritual approaches can transform even the deepest moral wounds into strength and purpose.

Are you carrying a moral injury or know someone who might be? This conversation could be the first step toward a lighter, more purposeful future beyond the weight of these invisible wounds.

Chapters

• 1:10 Introduction to Moral Injury Support
• 8:55 Military Sexual Trauma and Moral Injury
• 18:25 Creating a Healing Curriculum
• 32:38 The Cracked Glass Bowl Metaphor
• 42:57 Leadership and Moral Injury
• 55:10 Hope, Healing, and Post-Traumatic Growth
• 1:02:09 Final Thoughts and Resources

Transcript

Speaker 1: 0:36

Hi everybody. Welcome to Moral Injury Support Network podcast and videocast. I'm Dr Danny Roberts, president and CEO of Moral Injury Support Network for Service Women Incorporated. Today our subject is healing veteran moral injury and we have some very special guests today that I'm excited about introducing to you, and I'll let them introduce themselves, talk about their work and how they're connected together. Let's start with you and I'll let them introduce themselves, talk about their work and how they're connected together. Let's start with you, lisa.

Speaker 2: 1:05

Sure. Thank you so much, daniel, for having us on the show. I'm a retired colonel, united States Air Force combat vet. I'm also someone who has PTSD and someone who was sexually assaulted and harassed while I was in the service. So I have taken what happened to me and kind of started my own healing journey a few years ago. And the first way I did that was to write this book called Stories from the Front Pain, resilience and, excuse me, pain Betrayal and Resilience on the MST Battlefield and Resilience on the MST Battlefield. And I'm proud to say that's an award-winning book and it contains 14 stories of MST experiences, military sexual trauma experiences. And we all know that lots of MST turns into moral injury as well, so I'm sure we'll get into that a little bit later.

Speaker 2: 1:51

And I also wrote another book. It's an autobiography told through poems, prose and art, and it's called Latino Warrior. This one is really my healing journey. This talks openly about some of my PTSD episodes, flashbacks, the harshness of combat and the realities of combat. You know, not the stuff you see on TV, but the sights, smells and sounds of combat. I was able to really articulate that in that book. Also, I talked about sexual assault, harassment, discrimination as well. But again, the leadership opportunities I had in the military were wonderful. So I cover the entire the good, the bad and the ugly right, and that's kind of how I met the folks that are going to be introduced next and we'll talk more about that, but thank you so much for having us.

Speaker 3: 2:33

Yeah, great Thanks. Hey, I'm Kerry Haynes. I'm a retired pastor, retired Army Reserve chaplain and also a retired mental health chaplain, so I'm a specialist at retirement. But I did. While I was in the VA I had the opportunity to work in mental health with mental health providers around me and one of those became Pat Pernicano and she and I developed a curriculum. Prior to that I had done a spirituality group for veterans using some case studies from scripture and that was a turnoff for some veterans. She and I took that same curriculum, played with it and turned it into a psychological and spiritual curriculum that was more loosely based spirituality, less offensive and more inclusive for all veterans, and we later on, after we retired, we turned that into a book. She'll talk more about the book, but I just love working with veterans and helping those especially who felt unforgivable along the way because of what they did or did not do, and helping them to find hope and peace and a way forward. So thanks, danny.

Speaker 4: 3:40

Appreciate you.

Speaker 1: 3:43

Okay, pat go ahead.

Speaker 4: 3:44

I'm Dr Pat Pernicano, just Pat. I'm a recently retired psychologist from the VA. I worked for the VA for about 10 years and prior to that I worked a lot with abused kids and families and in both I saw this thing. I don't know what to call it when I first saw it, but it turned out to be moral injury. And when I worked with veterans, initially I was doing disability exams and I was thinking, well, this isn't PTSD, this is different, this is some kind of a deep woundedness, a depressive guilt, very different and they were struggling with it years after what they had gone through, what they had gone through.

Speaker 4: 4:38

So I ran into Chaplain Carey my first day at that VA and I was looking for a chaplain to co-lead a moral injury group. I had been reading some of Litz's stuff and some of Shea's stuff and I said we need to do a group with veterans, something at the VA that has a spiritual component, because there's meaning making and loss, and then we need a psychological component for the kind of things they carry with them, the burdens they carry with them and what they tell themselves about what they went through. So we did that work starting in 2018. And as he retired and then I retired.

Speaker 4: 5:32

I thought you know, there's so many veterans that are out in the community that we never reach. They don't even know that they have moral injury or that there is such a thing as moral injury and we need to give them access to materials and help for what they're experiencing. So the chaplain and I always said when we retire we're going to write a book, and we got a contract for this and it was a year of writing and it's really a hard process. But the book is intended to take our model of acceptance and forgiveness out to the community, to veterans, to their loved ones, to universities, to therapists, people who may not have the resources that we had at the VA. So that's kind of how we got started.

Speaker 1: 6:36

Right, and here in a little bit we'll get into the specific curriculum. You can tell us more about it, but talk about how you, lisa, are connected with Pat and Carrie and what is the connection there, because you didn't help write the book but you participated in this curriculum, right?

Speaker 2: 7:01

you participated in this curriculum, right, I did. Actually, pat and Carrie both cited some of my work in my first two books because it's similar along similar veins of what they were doing. But I have to say, the first time I met Pat and Carrie was on a webinar about moral injury. I had no idea what moral injury was. I was writing my first book about military sexual trauma, telling my story and writing 13 other stories, but I had no idea what moral injury was. I was writing my first book about military sexual trauma, telling my story and writing 13 other stories, but I had no idea what moral injury was. And so I signed up for the webinar.

Speaker 2: 7:25

So again, I'm writing this book, interviewing people, and then I started listening to them and then I started looking up what they were saying because it resonated with me. She's right. I mean, I had tremendous guilt and shame based on what happened to me with military sexual trauma, with sexual assault, but I didn't know that. I knew I had PTSD, but I had no idea that I also suffered from some moral injury as well. And then I held some deep resentment for what happened to me and how I wasn't protected. I wasn't safe, right. So I watched the whole webinar and they had an author on the webinar who had written a book about moral injury. He interviewed a lot of combat veterans. All male never brought up MST. But I could relate too, because the combat experiences that I had and I was in the Sunni triangle in Iraq, I was a commander and my job was to build up the air base in the Sunni triangle in early 2004.

Speaker 2: 8:15

So I'm listening to them explain what moral injury is and it just it landed on me like, oh my goodness, this is. I'm experiencing this as well and I didn't know that. And I think almost everyone in the book I wrote, those 14 stories, did the same thing, some on different levels of impact. I mean deeper. Some of them were deeper because it was very horrific what happened to them, especially if it was a relative that sexually abused them or a military supervisor or something like that. I mean we still feel betrayal because it's our sister or brother who were really turning on us and doing this. So that's how I first met them. So then I think maybe they can talk a little bit more about how they got involved with me and then we can kind of go from there. How's that?

Speaker 4: 8:59

Yeah, you know, Lisa, you shot me off an email right after that presentation and it was like this is exciting, I want to learn more. This is my story. I said, well, that's what we want is to help veterans tell their stories. And then she asked me if I was related to another Pernicano. Well, he's my husband and she knew him. So these things, these tendrils right, that started bringing us together and I realized pretty soon when I read your book, that you had lived the experience that we had developed as a treatment model. You didn't know that yet because you didn't have the stories and you didn't have the model, but there it was, and it was really important then to stay connected with you, Lisa, and it was really important then to stay connected with you, lisa.

Speaker 3: 10:01

Yeah, later, pat, you knew Lisa better than I did at the time and I think you suggested we have her read a copy of the draft book. And Lisa is like, yes, this is me, this is me, this is my experience.

Speaker 2: 10:17

Yeah, I read the book and I said where was this? You know, two years ago, when I was going through it and when I was writing and I just kind of organically used their model, I didn't know it existed. I just painfully went through my. It was a way for me to heal, for me to face the pain I was going through. I went through EMDR therapy while I was writing the first book, which I'm very grateful for. I'm not sure I would have finished that book if I had not had that kind of support. And then I started learning more about moral injury and all that really helped me kind of get it all out. But I lived their model. I got it all out, you know, and it was very dark.

Speaker 2: 10:48

My first pieces of poetry I wrote were extremely dark. I used to think for a while there, daniel, that I could not write about the joys in my life because it was just dark. I realized I carried this for so long. I had never spoken about my sexual assault for 40 years. I kept it, I buried it deeply, I was successful. But I compartmentalized very well, like a lot of us do.

Speaker 2: 11:12

I wasn't ready to face what happened to me until late 2020 is when I finally got therapy, started going through therapy and writing about my experiences. And again now I know why Pat, it really resonated with her, you know, because she saw, like you said, I actually lived her and Carrie's model, I mean I carried it out and so for that model to be available in one book I think is an amazing thing, because I just kind of powered through and it was a very painful process. So imagine if you have a handbook that basically tells you, a guidebook that tells you how to do this. Our vets out there have suffered enough. They don't need to keep suffering with their head in the sand.

Speaker 1: 11:55

Yeah, there's a couple of things too. One you bring up a good point. This is going to be tough, like if you're going to and I was sharing this with a woman veteran the other day who had called for some support. We were kind of talking through some different processes and it was like this is going to be difficult no matter what, because, regardless of the modality, you have to like revisit some of those experiences. But the other thing I wanted to mention so what I love about this approach is it's interdisciplinary or multidisciplinary, whichever word you prefer, but we have a psychologist and a chaplain working from two different angles, right, kerry?

Speaker 3: 12:41

That's right and bringing my original spirituality principles and I dabbled a little bit in psychology, even though I wasn't supposed to, but Pat kind of helped me clean that up and we brought it together in one model, an integrated approach, and we found out later that the VA was very, very much in favor for this. There was some work at the national level to produce integrative approaches between mental health providers and chaplains, because they realize what you're saying, denny, that we are whole people. We've got a spiritual component to us and we've got a mental, emotional, physical component, and so the group exercises that we have delve into all those different sides of ourselves yeah, can I say.

Speaker 2: 13:23

I just want to comment on something you said earlier, daniel, about how hard this is, and I mentioned it before. Then you kind of went on top of that. Um, I have to tell you that, you know, as a military person, as an officer, as a multiple commander, I served a lot. I served 30 years and I was a commander a lot in my career. I felt like I was perfectly trained to go into combat. All right, I you know everything I learned. It was like it culminated in that environment. I was ready to do that, but no one trained me, prepared me to deal with the trauma that I experienced while there or while years later, when I finally let it come and started reflecting on my sexual assault, my harassment experiences, discrimination from my fellow, you know, airmen and soldiers. So we don't get prepared for that. If I was prepared for that, it would have been a different story completely than it was.

Speaker 3: 14:10

Yeah, that's why moral injury hurts so much when it's a sense of betrayal. It's one thing to betray ourselves. It's another thing for someone else to betray our values and hurt us in the process, and both of those are addressed in our group.

Speaker 2: 14:23

But I have to say there's outstanding professionals who serve Not everyone's a predator, not everyone takes advantage and does that.

Speaker 2: 14:29

So that's important. But the infrastructure itself, the system, sometimes doesn't do right by the survivors. We're not shown the dignity, the respect that we need as an individual, right. So I think the system's coming around, it's working hard to make some changes, but individuals I think, if they were armed with this kind of information, what this book's about the experiences I've gone through and learning that there's more than one way to treat moral injury or to treat PTSD, and each of us, as a veteran who's gone through this, what works for me may not work for someone else, right? So we need to be open to that and I'm glad the VA is more open now to a lot of these alternative ways to heal.

Speaker 1: 15:10

Right, so let's get into the curriculum a little bit. Pat, if you would Just kind of give us an overview of the different elements, if you would, of this curriculum and we can get more detail on it. But kind of give us a brief overview, if you would.

Speaker 4: 15:26

Sure, you know the process. It is a process of healing from moral injury and we maybe stand out in our program because it's based on stories, not just the stories of veterans but other stories with metaphors that guide veterans into experiencing their pain, thinking about it, processing it, even without words, in drawing, in art and I saw that, lisa, you know there's a lot of art, there's a lot of poetry, and veterans found it really helpful to have access to different ways to process moral injury. So we call a program acceptance and forgiveness. It's acceptance is kind of that radical, what I can't change. How do I learn to live with it? How do I learn to release it? Forgiveness to yourself or others. And it's not a religious forgiveness, it's a letting go of the pain you're carrying.

Speaker 4: 16:37

Some famous authors have talked about it. You've got poison inside, you've swallowed the poison. You need to be able to find an antidote, you need to be able to heal. So through this forgiveness process, some actually come in with such guilt over things they've done. They really need to be able to forgive themselves. And we do it in a group because it's very important that other veterans who have had moral injury are there as their witness, there as their support, as their compassion, because if you can have that from other veterans, you can come to get it for yourself, you can experience it through their eyes first. And so the group is a connection of individuals, human beings, that really end up getting very close and relying on each other and sharing very meaningful memories that they're kind of afraid they won't be acceptable, they won't be worthy, they won't be forgiven, and then they find this joy of oh my gosh, I'm not alone with this and I can heal it with help.

Speaker 4: 17:59

So the process, if I said, in a nutshell first there's naming the pain, experiencing the pain, and we do that in a variety of different ways, with story, with drawing, with lament, but they experience the pain and maybe for the first time they're facing it. The middle part is about processing the pain, learning about responsibility for whatever you've experienced, learning about how to forgive, learning about how to help others be, you know, be a good support for the other veterans. So there's the processing. We use some ritual. We use some ritual about telling your story. Eventually we guide them through it so that it's not too complex, it's not too much right, they can do it.

Speaker 4: 18:59

And then the last phase is a growth. It's kind of a post-traumatic growth, it's a healing and it's a feeling. It's feeling lighter, it's feeling purposeful, it's finding that meaning again, because there's quite a bit of meaning making as you work on moral injury. You need a path forward, so I dealt with this. Now, what do I do going forward? So there's lots, there's activities every week, there's homework I used to call it practice assignments, but they started calling it homework, so I said, okay, so that's the process of starting with pain, processing it and then moving forward with hope and a lighter self when you've released that pain.

Speaker 1: 19:54

Yeah. So when I'm thinking about groups, as Lisa mentioned, she talked about sexual assault and for a lot of women veterans, that is the primary context of their moral injury. Certainly, women veterans go to combat and they experience everything men do in many ways, but for a lot of women, their moral injury is is related to sexual assault. So, when you're thinking about groups, are you, are you, are these, uh, homogenous groups where there's specific types of context for moral injury, like you have combat veteran groups and a sexual assault groups, or or do you, are you just having people together? I'm wondering if, if I have, say, a veteran with moral injury related to combat and I have another veteran who is a different gender, say a female, related to sexual assault, will they want to talk about those stories in that group setting? What have you found with that?

Speaker 4: 20:57

those stories in that group setting. What have you found with that? Terry and I could both speak to that, I think, because we took the risk of saying let's do it co-ed, but let's do it in a way that when the women tell their story they have a lot of support from the group leaders and the other veterans. What we found was the men in the group became like big brothers, like protective father figures, Like I wish I had that guy here. I'd go, you know, cut him down. I'm so sorry you went through that. Is there anything I can do to help?

Speaker 4: 21:36

Right, the guys would jump in in a very compassionate, protective stance and then the women would say, wow, there are some guys I can trust. Now I feel like we have this love and acceptance in this group and I'm glad I did it. That's kind of my perception. There are a few women who would opt out. We would make sure they could do their work with women or with a woman, because they need to have access to what they can do. But what holds them back is their fear, and you don't want people to live with a fear that you can't trust anyone, you know.

Speaker 3: 22:23

Yeah, we've been doing these groups, like Pat says, since 2018. And we were really surprised. I was surprised on a number of fronts, danny. I was surprised first that metaphorical stories could even reach combat veterans, for instance, and it reaches them in an indirect way. It kind of sneaks in the point to their conscience where they can say well, I can identify with that character in the story and it's a safer way to approach the injury at first, until they're ready to share their own story. And then we were surprised that Vietnam vets and younger vets could relate to each other and that was another pleasant where they're respecting each other and the younger vets are like you're our heroes, you know, and Vietnam veterans sure need to hear that after the welcome that they got when they first got home. And then we were surprised about men and women veterans, like Pat was saying, and yeah, I know that we asked them to share one story and this is, you know, week seven and eight out of 12. So it's after they've gotten to know each other better and feel safer in the group and if they need to pass, like Pat said, they can.

Speaker 3: 23:32

And I know that sometimes one of the women in the group and women are minorities in the military and then there are minorities in our groups usually. I think we've had one group that was mostly women and that was kind of a cool vibe there. But sometimes a woman will share a military sexual trauma whereas another woman earlier has shared a combat example of moral injury, and then once the MST comes out, it gives not only other women but sometimes men in the group the safety to say, well, yeah, me too. I've actually been through that myself, and that's one of the things I love about groups is when you see the group members helping each other in a way that Pat and I could just sit back and say, wow, this is awesome. You know, we still guide the discussion, but we always set it up in a way that this is going to be supportive, this is going to be nonjudgmental and it's going to be beautiful. We're going to encourage each person after they share, and a group has never disappointed us. The veterans just rise up to it.

Speaker 4: 24:35

You know it's partly important to say we work up to the verbal sharing. The very first way they share is they hear a story of a trauma, about a cracked glass bowl and the bowl is shattered in a hurricane, and then we have them, in silence, draw themselves as a cracked glass bowl and label it with their traumatic and moral injury experiences. So in silence, they're remembering what they went through and they're drawing it and they share their drawings with each other, but without a lot of detail, and so they're getting to know each other and the pain that they're carrying without that full disclosure until we work up to that week seven where they put it in words. So you know, if you get at a point, if you want, I have a screen open, I could show you an example of how they draw. That's up to you.

Speaker 1: 25:41

Okay, sure, while you're pulling that up, let me ask you, lisa, because as a commander and I've heard from other commanders there's a feeling of isolation, loneliness. Often you have to make these difficult decisions by yourself and then, on top of that, you're carrying this trauma with you. Is that true? Did you feel like there was, that you were kind of alone in this battle, especially as you were trying to command airmen and women and make these important decisions, and did you feel burdened by that trauma? Or were you just you just had to push it away? Did you have anybody you could share it with? That kind of thing?

Speaker 2: 26:21

I think that's the difficulty of command. It's very isolating. And it's even more isolating if you're not the norm. So as a Latina, as a woman, I was not the norm. So were there any other women commanders there? Very rarely, but I had great people working for me, mostly men, and I was able to bounce issues off them not my own personal issues. But you know, when I had to make a command decision about something, I went to all, gathered all the data but then made my decision Right, but but in that environment, no, I would never had shared any of this stuff before. I didn't even share about the difficulties of command.

Speaker 2: 27:04

I heard a few of them, heard me second guess myself when we started getting casualties and my job was to fortify the base. You know, to build the base up and fortify it and make sure it was hardened and secure to withstand attacks. And of course we got attacks and people died. And then you start, I started second guessing my leadership, you know. So in that standpoint, other, other people talk to me, other men, other commanders and we and even investigators who are out there investigating.

Speaker 2: 27:32

You know, when people were killed, they talked to me and then they, they kind of tried to put my fears aside, I guess, if you want to say that because I was concerned that that I didn't do something right and I second guessedguessed myself and then they said no, they did autopsies and that kind of stuff and they said there was nothing you could have done. It didn't matter how high the sandbag wall was or how thick it was, nothing you could have done would have saved these lives. Right, but still in the back of my head I wondered. It took a long time for me to kind of reconcile all that in my head. I wondered, and took a long time for me to kind of reconcile all that in my head. So I think serving as a commander, serving in any leadership role in combat or when you're facing adversity, is a difficult role and it can be very isolating. So it helps to have a good, strong support network. You know that you can talk about these issues with people.

Speaker 3: 28:22

I think, one of the things. Sorry, I cut you off, kerry, go ahead. I was just going to say that we did see some commanders and sergeants, major or senior enlisted ranks in our groups and it was always great to have them in there and for the reasons that Lisa's describing, and also, you know, military intelligence, folks that had maybe overstepped their bounds or seen that happen in interrogations, we would see some of that, a variety of different kinds of situations in the groups, and that was part of the beauty of the learning that we can all listen and encourage each other and good would come out of that.

Speaker 1: 28:57

I think one of the things that we don't talk about enough when we talk about moral injury is just moral injury, leaders, moral injury and leaders when they have to make these decisions. Where I retired as a sergeant major in the army and there were many times, especially as a senior leader, where I felt like I was stuck between two bad decisions and, no matter what I did, somebody was going to get hurt.

Speaker 2: 29:28

Yeah, that's exactly right. How do you?

Speaker 1: 29:30

how do you like you know so that's we often don't talk about that. We often think about moral injury as what happens to others and betrayal and so on and so forth, and that absolutely is important. But even as a personnel manager, I knew I was making decisions that a family was going to be feel harmed. They were going to feel like they things were done to them. Why can't it be someone else or whatever? And it was like no, it has to be you. You're the only person that can go do this assignment, whatever the case is. But I had a lot of I had I struggle with that and these aren't even life and death decisions like in combat. But but regardless, as a commander or a leader, you're often faced especially the higher you go up in rank and position, I think you're faced with more decisions that are they just feel all of it feels bad and we just don't talk about that enough. And I'm sure for those leaders in your groups it's a way for them to unburden some of that right.

Speaker 3: 30:37

It is, and the other category I'll just mention quickly and then let Lisa talk, is the medic or corpsman. Can't bring them all home alive, and we saw some of that too in our groups.

Speaker 2: 30:48

Yeah, I think this whole concept that you're talking about, about leadership, is important because, you know, leadership as a civilian is totally different than leadership as a military member and as a person.

Speaker 2: 30:58

And leading in combat, right, so I mean truly mistakes, if they're made, could be really life and death, or you could lose a limb or something like that, or be scarred for life, literally, you know. So I think you're right and you're on to something, because us leaders, yourself included, when we're in the field or we're on the base and we're leading, we're not supposed to show weakness, we're not supposed to show any chinks in our armor, so to speak. Right, we're supposed to be tough and our troops don't know the burdens that we carry and the decisions we make, and they do impact families, they do impact their promotion. Sometimes you have to take a stripe or something that affects their livelihood, right, and their families. So these are heavy decisions that we make on a daily basis when we serve in the military and I'm not sure the average civilian can understand what we're talking about. So I think that's a whole other topic conversation, daniel, that we should be having. So I appreciate you bringing that up.

Speaker 1: 31:52

Yeah, absolutely Okay, pat. So you've got us here. I can see the picture, I can see that screen. Take us through that a little bit if you would.

Speaker 4: 32:00

You actually see the picture of the blue.

Speaker 1: 32:08

Yes oh, qualitative change glass bowl.

Speaker 4: 32:09

I see that, all right. So this was a Vietnam vet, a crusty old guy. You could hardly hear. He really struggled to show up because he didn't do much online work. But when we got to draw yourself right as a cracked glass bowl that first bowl you see it has a lot of dark spots. He labeled each place something happened and they each say something about their bowl. They describe it and he said this is my old cup.

Speaker 4: 32:44

When I came in, all kinds of scars all over my body, scars inside of me in my heart, hurt, full of scars, water coming out of it. I was going to take my life and got referred to this group. I didn't really want to be here. And so they share these with each other and they see the pain and they feel each other's pain. And then at the end of the group, at the very end, we tell them part two of the story, which is the bowl goes to a glassmaker and she experiences the heat, with the glassmaker, of melting the cracks from the inside out and making the self a new creation. They get to pick what they want to be and it's not always a bowl.

Speaker 4: 33:36

And this wonderful old, 73-year-old Vietnam vet you see his teacup. That's his recreation. He wrote complete transformation, hope, faith, love. Like something you might have at a tea party, with a rose on it, a flower on it, and he said this is my new cup, a whole new transformation Hope, faith, love. I learned that from you guys. I have hope now. I have a new outlook on life. Came so close to pulling the trigger In the Marine Corps, they said we never leave nobody behind. That ain't true. We are human and we cry, not as tough as they say we have to be. I don't want to take my life now and for once I'm spending more time with my family going to baseball games. My faith is back. I'm back with God. I'm a work in progress. So each of them has that kind of. It's a beautiful way to depict who they are right, and it's more beautiful in pictures sometimes than it is in words alone. So now I've got this and I want to see how I? How do I stop sharing? Do you know how I?

Speaker 1: 35:02

I think I can maybe click the share button at the bottom okay, let's see. I'll do it for you, so you're good. Yeah, all right.

Speaker 2: 35:16

I'm gonna get it off, but thank you. Can I jump on some of what she said? Uh?

Speaker 1: 35:20

yeah absolutely.

Speaker 2: 35:21

I um, I think the biggest for me, the whole whole journey, her process she described. I lived that process, going through the pain. I mean there was a period of time where I was so enraged and for me I think I was blessed because it was during covid and I didn't have to leave my house and be around people because I was so enraged. When I started reflecting and remembering what happened to me, I just again I didn't trust people, I don't want to be around people and I was just so, so mad and incredulous that it happened to me. And then these other people, right. So it took a while for me to deal with that pain and then I told you, I started writing poetry to deal with it. But once I started owning it I said, okay, this happened to me, I can't change it, right? So what am I going to do now? Right? And I chose to own it and move forward. And I chose, I basically traded the armor I used to wear in combat for my pin, and now my pin is my armor, right? So, as she was explaining that, I wanted to share with you.

Speaker 2: 36:20

I have a poem I called MST Warrior Military Sexual Trauma Warrior, because I don't call myself a victim. I don't even like the word survivor because I think both have such negative connotations attached to it. So I feel like I've owned what happened to me and I've been able to move beyond it. I'll never forget it, but I've been. I know where to put it now right.

Speaker 2: 36:40

So this poem I wrote called MST Warrior and it was beautifully illustrated in my latest book. But I just want to read you the first, maybe the first stanza and the last stanza, and I think you'll I believe you'll relate back to this crack bowl. I am a military sexual trauma warrior, never a victim, much more than a survivor. Owning my past jettisons me into a present and future worthy of happiness. And then I'm going to go down to the very last stanza, sharing my story and others to make a difference on the MST battlefield, not broken but beautifully crafted, to emerge stronger after trauma. For I am an MST warrior and the whole poem is about owning what happened to me and then using it to move forward, to help other people as well as myself.

Speaker 3: 37:34

I love that.

Speaker 1: 37:35

That's great. There's one of the things that we find common. We interviewed 50 women veterans who had experienced moral injuries, some kind of moral injuries event, and isolation was a really common thing. After once they left the military and they just became so isolated, some to the point they don't even talk to family. And then some of them had different ranges of that where they remain married. Many of them lost all their relationships as a result and some of them stayed married, but they still had to. As one woman said, she's, my husband knows when I'm triggered. She, he knows when I'm at a certain point and I just lock myself in the bedroom and he has to deal with the kids and they. He understands and you know.

Speaker 1: 38:29

So, this sense of isolation, but I don't think it's limited to women veterans. We see that as a result of MST, for sure, but lots of other things can can lead to this. Moral injurious experiences can lead to this isolation. Right, this, uh, this sense of, um, you know, it could be a lot of different things. I'm not redeemable, I'm just garbage now, um, I, you know a whole lot of things. So, um, I, I think that's one of the difficulties is getting veterans to try a group like this. The first because there is some level of comfort. You're miserable but at the same time you're comfortable being isolated. At least you're not facing those dangers, dangers from other people. You can't possibly be happy, right, but at the same time there's a sense of safety when I'm keeping it to myself and I'm staying away from other people. So how do you get veterans to get to want to try this?

Speaker 2: 39:44

Let me just tell you I was not ready to do group at all. Okay, when I first finally came up and spoke about my combat experiences and MST experiences, I was offered a group therapy session or CBT or EMDR. And I specifically chose EMDR because I was not ready to speak up in a group and I didn't even want to speak up if I didn't want to. And for EMDR, all you got to do is think about it and you know, they ask you the question and then you watch.

Speaker 2: 40:12

I was watching a tray of lights go by. So I chose EMDR because I wasn't ready to speak up in a group. So I have never done the groups like she's they're talking about, right, but I did. I did it alone and then I partnered with another woman combat vet who experienced something similar to me. We partnered together and then she created the art art that's in my book. So together our healing journey is kind of merged and then turbocharged each other. So I know the power of the group because of the collaborative power that we had together.

Speaker 2: 40:45

But I have never sat down in a group of a bunch of people and gone through that journey that she describes. I pushed through and I don't know what part of me would ever be comfortable in doing that. Now I can't, but then initially, no, there was comfort in my pain and, as a matter of fact, there were days I just wallowed in it, you know, and I didn't want to talk to anybody. So but the danger in that is that you could go down so far into the abyss that you'll never come out. So that's the danger. So that's why there's some security and safety in a group. But you have to be ready to be open enough in that group. So like the fact that their process you start out kind of slow, you don't have to talk about your trauma and it slowly kind of gets there to your comfortable. So that's a good thing about their process.

Speaker 4: 41:32

You know, lisa, you created a group around you in your book because you created all those chapters of other people with MST as if you're a shared unit, right, I mean, I think you kind of did it your way, but you didn't do it alone, alone. You pulled in the stories of others. I will say we now, in 2020, when COVID came, we developed a four-week educational program for moral injury and we published it through MIREC, which is best introduction to moral injury with no pain, very little pain. It was an educational for four groups, but they didn't share anything. They were fed information about moral injury and had a workbook, and then at the end of that, it was like who wants to do some work on this? You know who?

Speaker 4: 42:50

Oh yeah, that's the link from Carrie who wants to, who thinks they have moral injury and wants to pursue healing? And out of that educational group we might get six people who say I'm ready, I want to go forward. So that helped the process. We had fewer people that were scared of doing it and fewer people who dropped out. Don't you think, kerry, that that made a difference?

Speaker 3: 43:21

It was a huge, huge difference. And the other thing about that four weeks we promised them they would not have to share any personal stories in that group and so it made it safer for somebody like Lisa to come into the group and just listen and get some information. And by the time they said, yes, we're ready for the 12 week, they also had gotten over an initial fear about being in a group and it was a little safer because they knew that everybody in that 12-week group had been through the four-week like they had and it was kind of a. It was a beautiful thing that came out of COVID when we thought everything in COVID was terrible.

Speaker 3: 43:58

So very grateful for that, yeah.

Speaker 1: 44:27

Yeah, I think that I think that's a really, really good point about about, you know, get getting it, but there's no way I was going to do that while I'm still in uniform. But once I got out of uniform I said, you know what? I'm going to get some therapy, because now it doesn't matter and it's just about I'm retired, so it's about me healing, getting to a better place. But before I was willing to do that, even I thought about it many times. But it took a person, a licensed counselor, who was very compassionate, loving and invited me to get some therapy from her, and it was in a way that I really liked her, trusted her, and so the relationship was there first.

Speaker 1: 45:14

Um, and because part of it is the point I'm getting to, is that I was like there's no way I'm going to share all my shit with somebody I don't know that I don't know it's going to judge me. I have enough shame. I I'm going to share all my shit with somebody I don't know that I don't know is going to judge me. I have enough shame, I'm not going to, you know, like offer someone else the opportunity to feel ashamed of me too. That's what was going on in my head. But Annette was so loving and compassionate and kind that I felt like if I could tell my story to anybody, um, and be cared for, it would be her.

Speaker 1: 45:49

Now I I'm sure that the vast majority of therapists are really good at that, uh, and chaplains too. I worked with chaplains for many years in the army, um, but it's still. It's still that sort of thing of they don't know what I've done Right. It's still that sort of thing of they don't know what I've done right. And so I love this approach of really gradually you begin to build relationships among the group, you begin to build that trust, and then people can just kind of gently share what they're comfortable sharing and then, when they feel that that love from others, that begins to build right this environment where it's safe and it's good and people feel loved, right.

Speaker 4: 46:35

I want to pick on your word love. Because they come to group. Many of them say my heart is cold, I've shut off my emotions, I don't let anyone get close, I don't deserve to let anyone get close. We hear that and they do bond. I think healing is relational. Healing is interpersonal. Relational Healing is interpersonal. You don't heal outside relationships with others and actually moral injury comes out of broken relationships in many cases.

Speaker 4: 47:16

So you know we had a guy who he dared us. It was like you're not going to get inside me. You know it was like you're not going to get inside me. You know I'm cold and I don't have a heart and he did his work. He did it faithfully. And in the second to last group meeting he said I come bearing gifts and we said what? It was close to Christmas but he gave each group member and each leader a blue blown glass heart and he said your love has healed me and I love each of you and it's real. He said you woke my heart up for better or worse and I will never forget him because veterans are able to heal in connection with others who care.

Speaker 3: 48:11

The other thing I was going to add to the discussion about groups versus individual and Pat and I talk about how moral injury happens in a group setting or in a community setting, and so healing best happens in a community setting. But sometimes there are veterans that are not ready for groups, like Lisa described, and so part of the intent of the book that we wrote was to give some resources that a veteran could pick up and work through on her or his own and do the work and start to find some healing, or a veteran's spouse or a veteran's loved one who doesn't know how to help. So the book is designed not just for providers in the community but also for veterans and those who love veterans, and we hope that it helps somebody out there.

Speaker 4: 49:00

Lisa mentioned that the book felt like a journey through healing and we wrote it with the intention that the first half would be about learning about moral injury and about spirituality, but the second half is a journey through your own moral injury process. If someone wants to do that, they can do it using the book.

Speaker 3: 49:28

So the book is written to the reader. The second half.

Speaker 2: 49:31

Yeah, that's what I think makes it so powerful, right, because you could use that, especially if you didn't want to go in yet for a group session or whatever. You know, I think now in time, but it took me a few, you know, a couple years before I was comfortable enough to talk to a group of people. Now I do that quite a bit. But I think you might have been right, pat, when you said I organically, as I interviewed all the people that participated in my first book, even though it was one-on-one, it became like a group session because I heard about their trauma and yes, and then I realized that man, there's all the trauma is, it's a whole continuum of harm. You know, and you know there is no Olympics for trauma. You know how a person internalizes their trauma is just as significant as somebody else who maybe was completely, you know, physically assaulted or something. So I learned a lot writing that first book and the second book, that kind of my journey that followed your model.

Speaker 2: 50:24

Basically the last part of that whole section, daniel, the last part of my book, is all about the healing journey to authenticity, because I was one of those people who never showed my authentic self on active duty, I downplayed my femininity, I downplayed my being a Latina, you know, because I wanted to be like the leaders that were in charge, and they were typically white, male, you know. So it's taken me a long time to become, you know, this new creation, as Pat calls me, and scars and all wounds and all but the scar tissue. I actually said this. I said with every word I write, the scar tissue thickens, getting me further and further away from the wound itself. So for me, that's what's helped me the most.

Speaker 1: 51:09

I think there's a commonality between your work, lisa, and carrie and pat and the participants, in the sense, like you're carrying all this garbage, um, you're carrying these wounds, you're carrying this stuff, and by you writing your book and and then sharing that process, uh, with the other women's stories and and the participants in the curriculum, getting out what's in in a way and a form that is cathartic, right, it might be art for someone, it might be poetry, for someone else it might be journaling I do a lot of journaling and that's something that I'm very comfortable with but it's this process of sharing, right?

Speaker 1: 51:59

Even, lisa, in a sense, right, you're sharing your story with people you'll never meet, you don't know, they're invisible, there's this invisible wall between you and them, but there's still this human spirit of sharing your spirit with their spirit. That's connecting spirit of sharing your spirit with their spirit. That's connecting and that's where I see some commonality here, of getting my pain out in a way that is safe for me, is good for me, is cathartic for me, and then other people can see that pain, acknowledge it, affirm it, share it in a sense, and say me too, I have that too. Maybe this story is not exactly the same, but pain is pain in many ways and I feel that and maybe there's some way for me to get it out and you know, some people are going to love group because part of it's personality driven and so on. But this commonality of sharing, I think, seems very important.

Speaker 4: 52:57

So you know, Lisa, the poem you read. It mirrors that, one of the ending stories in our work. It's called the Journey and this group of people have been on their individual paths and they've been on a journey, a tough journey, and then they find themselves at a lake because they came for a treasure. They were told that if they followed the path they would find a treasure. And they all get to the lake and they start sharing their journey and their experiences. And then they say where's the treasure? Where's the treasure? And their experiences? And then they say where's the treasure? Where's the treasure? And this, this wise person, says you are the treasure, you have brought your treasure with you and you, inessential, you know you've healed yourself. But by coming together now you can share your treasure. And they're all surprised when it's them, when the treasure is in them, and they start to experience not just releasing right the pain, but finding a real treasure within that starts to. I don't say replace the pain, but seal, seal the scars, make them stronger.

Speaker 2: 54:16

And that gets you to the level of empowerment where I feel like where I'm at now Now, based on everything I've gone through and the work I do now is I am empowered and I empower others and, like you said, sharing is really important and listening without judgment is really important and finding healthy coping mechanisms, because most of us go to the unhealthy ones first.

Speaker 3: 54:39

And.

Speaker 2: 54:39

I know I did and I'll share that when I talk to some organizations and individuals, I'll share kind of what I did, because I was. I was going down a path that was not a good path when I finally started facing my demons, but it took me a while to figure it out and then I did, and then I actually wrote about that too. I think I said the demons and I, you know we went fisticuffs and all you know, because I had to beat the crap out of them for me to get them to shut up and leave me alone so I could move forward. So I am still in my post-traumatic growth, right. But the beauty of it now I have healthy coping mechanisms and one of them, like you said, is I chose to use writing to help me.

Speaker 2: 55:22

But I also try to work out as much as I can because you know, a lot of us vets walk away not as healthy as when we walked in, right. So I definitely have service-connected issues and I have to work through those. So I can only do certain things, but now I'm doing them and it's important that we do that, that we just don't wallow in our pain. And I've been there and I've done that. But that will not get you to where the empowerment is Right.

Speaker 1: 55:46

Right. So as we wrap up, I want to we're going to in the video show notes and for anybody who listens to this podcast online, we'll have all your information, how to get the book and everything like that. But for those who might be listening riding in their car or whatever, um, how can they, how can they get this book, uh, into their hands?

Speaker 4: 56:09

so this book um right now the publisher, which is rootlage, rootlage um their website. You can get it discounted right now because it's a new book. It's probably cheaper through the website than it is through amazon.

Speaker 1: 56:26

They could get it either place um so that's and if they want to reach out to you directly, they have some questions or like they'd like to find out about the group. How can they get in contact with you?

Speaker 4: 56:40

We do put our email contact in the book, and so if they want to reach us, they can reach us through our email.

Speaker 2: 56:51

I would say if people are interested in any of my books, they can find it on my website, which is lisacarringtonfermancom, or they can go to Amazon and get it there, and there's a contact sheet they can fill in if they want to talk to me and this happens to me a lot A lot of people will read one of my books and contact me and start telling me their stories. I am also a co-editor on Blue Ear Books for the Veteran Book Initiative, so I think it's very important that we share our stories, not only for ourselves and our families, but for the general public, to educate them. I think it's important to capture our stories for the historical record, so I'm doing that towards that end with my publisher, so I'm happy to help any vet out there who thinks they want to tell their story, and however method they want to do it I mean I've done documentaries, podcasts. Uh, matter of fact, my story is going to be part of a, a four women play, so it's important to get it out so that everybody becomes educated about these issues. So they know.

Speaker 2: 57:48

Number one they're not alone. Number two there is a way to move forward and live with pain and become a new creation that can live life to its fullest. I think that is real important. I was living life, but I was living life one foot in front of the other and not to its fullest. I was successful both in the military and higher education. I'm the founder of the Veteran and Military Affairs Department at the University of Texas in San Antonio. So I was having a very successful second career but I really wasn't living. So I was having a very successful second career but I really wasn't living. I am now, but it took me facing the trauma, facing the demons that I dealt with, and then acknowledging them and then putting them in perspective and finding healthy mechanisms, ways to cope.

Speaker 1: 58:32

And then, for me, one of the emerge strong is art writing, poetry writing and art.

Speaker 4: 58:36

Okay, so as we go ahead, you can connect with us too. If someone should contact you and say do you know how we can reach these people, feel free to send them forward.

Speaker 1: 58:47

Okay, so, as we finish up, what I want to do is give each one of you in turn, just a chance. Any last things you want to mention before we close this episode? Go ahead, kerry.

Speaker 3: 58:58

I was just thinking, danny, about the seriousness of moral injury and we didn't really mention the impact probably that moral injury has on suicide and, as most people in America know that suicides in the military and the veteran population they're pretty high. Most veterans out there do not get services from the VA. That made it especially special for Pat and me, I think, to speak for Pat, when a veteran did come to one of our groups and actually say I'm going to help other veterans. That was always special to like Lisa's talking about, to further the message, and so I would say, if anybody's listening out there, whether you're a veteran or someone who loves veterans, there is hope, you do not have to let this consume you and even if it's not suicide like Lisa was describing, you don't have to live life halfway. You can find meaning and purpose and you can find a better life ahead. And that's what we believe and what we've seen through hundreds and hundreds of veterans. So I really hope that they get help.

Speaker 3: 1:00:07

Our method is one way. There's lots of methods out there. Lisa's books are a way. You know there's lots of good resources out there. Thanks, lisa's books are away.

Speaker 1: 1:00:14

There's lots of good resources out there. Thanks, yeah, and I'm a firm believer that at the heart of suicide is moral injury, yes, and PTSD and homelessness and substance abuse for veterans a lot of like. Underneath all that. Those are the leaves on the tree. The root is moral injury in a lot of situations. Go ahead, dave.

Speaker 4: 1:00:38

So I think that's true that the more research they do, people are so much more at risk right of suicide, of substance abuse, when there's moral injury at the root, abuse when there's moral injury at the root. Probably my deepest hope is that for veterans that they could get help sooner, that they wouldn't have to wait till they're 60 or 70, that it could become a common issue even at the VA, across the VA, and I will say common issue even at the VA, across the VA. And I will say Congress right now is examining on mandate. What is this moral injury? They're doing a task force and what should we be offering veterans throughout the VA? So I'm excited about that, but more than that, we have to get it to be in the community, support people talking about it.

Speaker 1: 1:01:42

Absolutely.

Speaker 4: 1:01:42

You know, no stigma so that's Absolutely.

Speaker 1: 1:01:47

There's a group at Harvard working on getting moral injury in the DSM. I support that approach, but I also agree with you 100%. This is a community issue. It's not even just a military issue. Moral injury is a human problem, not just a military problem, and the more people understand about moral injury, the more we can build a better society. I mean, there's a whole lot to that, so so I agree it needs to be. It should be a term that is as common as other as the word trauma, like whatever else, so that within every industry it doesn't matter if you're talking education, military, certainly first responders, like there is trauma and a lot of it has to do with moral injury.

Speaker 4: 1:02:40

Yeah.

Speaker 1: 1:02:40

Moral trauma Lisa go ahead.

Speaker 2: 1:02:46

Take you home. Okay, I would say that there is no cookie cutter approach to dealing with moral injury or PTSD. There's a saying that if you've met one vet, you've met one vet. We are not a monolith. We have some shared experiences but we are all different and so our approaches to therapy and trauma and healing should be different and we should welcome any avenue that helps us as long as it doesn't harm us. So we need to look for the healthy ways right.

Speaker 2: 1:03:15

But I work hard now to destigmatize asking for help, because I know what it did to me, you know, as a commander, to ask for help. When I finally had to, because I was forced to, because physically I couldn't continue anymore, my brain said, you know, soldier on, but my body just wouldn't do it. So I had to get help right. But it took more guts to do that than it did to serve as a commander, you know. So I think it's we just need to destigmatize and reframe the messaging around PTSD, moral injury, mst and really work hard to do that.

Speaker 2: 1:03:47

So part of my work is to do just that. So you know I'm optimistic that in the future, that this is getting out more and more, that it will become part of the common lingo that we use, because we shouldn't shy away from these things. I mean, we ask our people to serve and then we discard them when they come home, and that's not right. We need to help them, you know, and we need to do a better job in training, preparing them for what they're going to go through. So again, no cookie cutter approach. Let's see what works for you, and no provider out there should ever assume that what worked for the guy that just left and the person coming in the door is going to be the same thing.

Speaker 1: 1:04:21

Yeah, that's right. That's right. Well, it's been a real pleasure having you on this on the show today. I'm really excited about your work and I hope that everybody out here listening gets a copy of that book and a copy of Lisa's books, because this is great information and a great way. Even if you're not a veteran, it's a great insight into veterans' minds and veterans' experiences.

Speaker 1: 1:04:52

I am presenting to the Georgia Psychological Association annual conference at the end of this month and most of the people at that conference are not military, haven't worked with military folks, but we're presenting on moral injury in military families and I think they're very interested in getting an inside look into what's happening in military families where PTSD is a factor. So so this book, this book we've been talking about healing veteran moral injury, and Lisa's two books are really, I think, important reads for people. So you know I want everybody to get that, but anyway we'll close it out here. But thanks again for being on the show and certainly I'd love to do another episode with you, lisa, to specifically talk about the book, and then Carrie and Pat be nice to circle back maybe in a few months, and if there's some additional stories or some additional stuff we'd be happy to do it again. So, to everybody out there, hope you have a good rest of your day and the rest of your week and until next time.