Soul Injury -- An Overview


Soul Injury is Not PTSD and is Beyond Moral Injury

Our Goals

Our Goals of this document is to give you a basic understanding of Soul Injury, what causes it, an overview of some of the practices for working with those with Soul Injury, and how to learn more about Soul Injury and caring for those with Soul Injury.

Introductions

Toni’s Background in Veterans Work

Though not a vet Toni’s father was an airborne combat vet with disabilities and mother who went from boot camp directly to being one of Eisenhower’s assistants in France. Eisenhower’s orders in to battle went through her and the communications from the battles also went through her. Interestingly, he confided in her that a major factor in picking him for the job of Supreme Commander of Allied Forces was because he had never seen the horrors of combat.

Brian’s Background in Veterans Work

Brian was also not a vet he did work for Northrop Aircraft and worked on both the F-5 and F-18 and was also raised by a WWII vet that saw combat in Okinawa but was supposed to have been shipped to the Battle of the Bulge. During his father’s hospice care Brian was there to listen to the stories that his father had kept bottled up in him for nearly 60 years. These few days gave Brian an inkling into the changing insight of the combat vet near death. Both his mother and grandmother passed with Alzheimer’s giving him much insight into care of dementia patients and the value of pet companions and music.

Their Continued Journey with Hospice

Brian and Toni’s journey with veterans in hospice continued by being Toni’s mother’s primary care giver using what Brian had learned about the connections with music pulled stories from her from her years under Eisenhower and before.

Toni and Brian have been hospice volunteers for 5 years with Hospice of the Valley in Santa Clara Ca and one year at Roseburg VA utilizing animals, music, nature, stories of the past, and objects to open communications with vets. They have gone through extensive and continued training in Soul Injury with a goal of running a training center teaching caregivers in working with vets and others with Soul Injury.

The History of Deborah Grassman

What we are sharing with you about Soul Injury is from the work of Deborah Grassman and her team of nurses and their 30 years at the hospice unit at Bay Pines VA in Florida.

During that time they worked with more than 10,000 dying vets and learned that many were carrying with them festering mental wounds that had prevented them from being at peace, keeping them fearful, or angry. They learned to identify the causes and how to heal those wounds.

Deborah Grassman and her nursing team all retired within a few months of each other and went to work codifying what they learned and the protocols they developed.

We will be sharing some of our training and own insights and experiences in our work with Soul Injury.

Soul Injury Is

Unmourned Grief or Loss

Have not fully cried over… - Loss of limb, senses, disfigurement, or… - Loss of time with spouse, children - Not there for a family (death of a parent, child, spouse, or some milestone big or small, good (seeing child’s birth, first step, a childs graduation) or bad, the death of a family member, a child’s run in with the law or drugs) - Loss of career - Loss of a friend in battle - Loss of…

Unforgiven Guilt or Shame (Moral Injury)

Not Able to Forgive Oneself For

Not Able to Forgive Others For

Diminished Self-Compassion

Diminished Self-Compassion may cause

Combat Vets Certainly Suffer from it But So Do Those That…

It Should Be Noted

Soldiers deal with an intensity and frequency that is only seen in combat and there is no honorable exit strategy for those in the military.

Good or Bad Memories Make Physical Changes in the Brain

Learning a Good Thing is Slow

The process to learn about good things is slow, that is necessary for survival. How long did it take you to like beer, wine, broccoli, or Mozart? Some are still working on liking broccoli and Mozart.

When a good thing happens in the brain a very delicate connection between synapses is formed. This connection is slow to pass signals (signal passes at roughly 3 mph) and easily eroded away, therefore easily and quickly forgotten. How often have you forgotten the name of a nice person you met only after a few seconds before.

To make that connection robust repeated positive experiences are required. With each connection gets more robust with a laying on of more myelin. Eating the fruit from a plant we learn from repeated modeling from our mothers what is good to eat. It takes many times of seeing the fruit picked from the tree and tasting the sweet flesh to have mastery that the apple is good to eat.

Learning a Bad Thing is Instantaneous

Survival of the species depended on learning quickly to not repeat situations that make bad things happen. We evolved to make immediate and robust connections in the brain when we feel pain or see or hear someone around us are hurt.

Cavemen Thag and Zog walk past some large distinctive tracks and dung and inadvertently walk into the personal space of a mammoth, Zog watches Thag meet his demise and Zog never forgets. He never forgets the outcome for Thag and the mammoth sharing the same space and he never forgets the track and sign of a mammoth. Even after years of therapy caveman Zog remembers every detail even though it happened only once.

We evolved so when bad things happen we do not repeat it be it drinking bad water, eating the wrong plant, walking past fresh mammoth dung, or walking back into the battle field.

Those connections will never go away even though the incident only happened once we hold those memories a lifetime.

PTSD vs Soul Injury

A person can have PTSD without Soul Injury, have Soul Injury without PTSD, or have both.

PTSD

Very simply, if sights, sounds, smells, or situations trigger panic or if those memories cause night terrors the person has PTSD. It is an acute response.

Soul Injury

If depression, addiction, inability to connect or love others or self, a fear of death, or wanting to take one’s life; if these symptoms are chronic the cause could likely be Soul Injury. The cause could be one traumatic incident. My father watched his buddy run up to him to share something with him and detonated a landmine. That one incident caused PTSD and Soul Injury. It could be many smaller events, their effect is cumulative.
Both PTSD and Soul Injury can be hidden under the surface or so profound that the patient cannot function in daily life. It is how we process those memories determines whether we can continue to thrive or not.

We are not qualified to truly address PTSD. We do have tools and protocols to properly identify Soul Injury, to process memories, to aid in the grieving process, to aid in the process of forgiving self and others, and seeing value in self and return of self-compassion. Oh, by the way, remember those that hear the stories in vivid and deep detail also can develop both PTSD and Soul Injury. If we are good at tending to hospice patients like chaplains we are good at pulling stories from these vets, listening without judgment or advice. Toni’s mother sending endless orders out then reading of the resulting carnage gave her a lifetime of Soul Injury. We all as hospice volunteers subject ourselves to both PTSD and Soul Injury through the stories we hear.

Stoicism and Its Relationship to Soul Injury

Stoicism in necessary for survival of self and others in combat, in the operating theater, and other professional high risk situations. In combat, flying a stalled airplane, in triage during a disaster, during an animal attack survival of ourselves and those around us we must stay present and continue to do our jobs. There is no time to grieve or ask for forgiveness.

Recruits are hammered with it as soon as they enter basic training. There is constant conditioning to become hardened to the carnage. There is constant shaming of that shown emotion. “Suck it up Butter Cup.”

The cost is stoicism prevents healing, effects grief, self-forgiveness, and forgiveness of others.

It is so ingrained into the combat soldier that they may have only done one tour of duty, their deployment may have lasted only a few months, their injuries may be visible but many are not.

Stoicism Is the Enemy of Healing

By burying the grief, shame, and the unforgiving of others under stoicism it cannot heal and it will fester like a gangrenes wound hidden by dirty dressings. There is pain and they may deaden it with addictions booze, drugs, sex, adrenalin, or work. The addictions mask the pain, hides the symptoms, but prevents the healing. It is insidious; the damage gets worse without anyone knowing it. Even without addictions the constant stress causes a constant flow of fight or flight hormones through the body which does its own damage.

The Goal Should Be to Break Down Stoicism Early

The sooner stoicism is broken down the sooner these memories can come to the surface. With the very first telling of their story we see a difference in their eyes and how they carry themselves. With each telling of their story it is easier to tell. With each telling of their story the negative emotions gets diminished. Smiles and laughter return. Our goal is to give them the tools to have the most happiness from that point forward. The first step in healing Soul Injury is first breaking down stoicism after the wall has started to come down then each part of their Soul Injury can be addressed.

Practice in Healing Soul Injury

There are many core routines that Deborah and her team have developed over the past 30 plus years to address key roadblocks and progress down the path of healing. There is a test to understand where they are on the spectrum of stress and if we have Soul Injury, we are all on the spectrum I have never seen a classroom of people given the test where one person was stress free. Questions are asked and can be answered for no one to see or to share that identifies what needs to be worked on. They can write their stories, Some are writing their story to be read out loud to others or not, telling their story to a person, to a dog, to a stuffed toy. They may leave their story to be read after death. We have honoring ceremonies as part of a group or alone to give thanks and closure to those who were not received back from combat with open arms, writing letters of forgiveness to the living and the dead, some to be mailed some not. The list goes on, there are many practices that we have found that work.

Once the Walls of Stoicism Fall

Once stoicism has broken down we have heard the following short sentences from our veteran hospice patients, “I am afraid to die.” “I did things I tried to forget.” “I saw things a 17 year-old-kid shouldn’t have ever seen.” “I was just following orders.” “I’ve never told anybody this”. “I don’t talk about that”. “It should have been me.” “Why was it me?”

They may have waited 70 years to say that. We have heard these if you haven’t you will. Typicly those short little statements open the flood gates and the stories come. They start to walk taller, they start to smile again, they start to laugh, they are ready to move on.

Nearing Death Effects Consciousness in Hospice

We are all here in the role relating to hospice. There is uniqueness in working with those at the end of life. What seemed important when we were teens seems trivial now as adults and our energies are put to different needs and wants, there is a shift, we have all experienced it. As people approach death and are in that state of fighting death there is a shift as to what is important they may franticly address their bucket list. When people accept that death is eminent there is another shift in awareness that will happen there is no point in fighting it and there is new insight and that buck list changes to righting wrongs.

Loss of Control Triggers Helplessness Which Triggers Soul Injury

When no longer having autonomy, when no longer being able to drive, get groceries, pay bills, go for a walk, needing help to get out of bed, needing help to get a drink of water, go to the bathroom without help, get dressed, bathe without help. These losses of autonomy trigger the same feelings of helplessness that they felt in combat, after being wounded.

Antianxiety Medicine May Paradoxically Effect the Combat Veteran

I am not a doctor but I do want you to be aware that common antianxiety medicines in many cases give the opposite effect. The person that is already triggered by a loss of control may be profoundly triggered by feelings the loss of control these drugs produce.

For More Information on Soul Injury

Opus Peace www.opuspeace.org

Books By Deborah Grassman

Peace at Last: Stories of Hope and Healing for Veterans and Their Families

The Hero Within: Redeeming the Destiny We were Born to Fulfill

Veterans and family wilderness skills class
"Just going from a war zone to civilian life—you feel totally isolated, totally alone. You feel cut off from everything. My dogs were the only 'people' that were there for me."
—Joshua when returning from Afghanistan
"Both my Mother and Father served in WWII, Dad a Paratrooper, Mom an assistant to General Eisenhower. the negative impact on Mom was profound. She took his orders and sent them to the troops, she then received the communications back from the carnage of battle which she internalized. Three days before she passed was the first she could talk about it and she cried for the men that died, only then did I understand why she was so cold to me growing up."
—Toni King