Moral Injury of Abandonment

Hey, everybody, and welcome to today's show on the moral injury of abandonment. I'm your host, Dr. Donnellice Snipes. In this show, we're going to define moral injury of abandonment and how it relates to soldiers and their families, medical personnel, and even parents. We'll identify the consequences of the moral injury of abandonment and explore some practical interventions to address moral injury and and specifically moral injury of abandonment. There are lots of different causes of moral injury, but today we're really going to focus on that moral injury that occurs when we feel like we have abandoned someone or something or we've been abandoned. Moral injury is defined as the profound psychological distress which results from actions or the lack of them, which violates one's moral or ethical code. These events can include acts of perpetration. We do things that go against who we are. For example, abandoning somebody in their time of need, terminating life support, putting a child in a safe haven because you can't care for them, or acts of omission. And that can be failing to do something that you think you should have done, like being next to your loved one's bedside as they were dying, but you weren't able to do that because the powers that be told you you couldn't be in the room. The doctors had to work on them, or hospital administration said there was no visitation. Whatever you can feel, person can feel like they abandoned their loved one when they failed to be there at those final moments. We can also experience moral injury because of betrayal from leaders or trusted others. We define ourselves in part based on our culture or cultures, and each culture typically has leaders. And when those leaders do things that we find morally or ethically reprehensible, they are basically committing those atrocities and it reflects poorly upon us. So it's moral injury by proxy, if you will. Moral injury is not a mental illness, although experiences of morally injurious events can also cause PTSD and, or lead to negative thoughts about oneself and, and others, as well as deep feelings of shame, guilt, disgust, regret, depression, and rage. All of which can lead to the development of health as well as mental health problems. So let's talk specifically about the moral injury of abandonment. Now, abandonment is one of those terms, when we hear, typically has a negative connotation to it. But it's important to remember that abandonment simply means leaving or giving up something or something, someone or something. Abandonment is not always a choice. Sometimes people are told they must leave. Like the example I gave of the loved one in the hospital room that wanted to be there when their loved one took their last breath and they were not able to. They had to leave so the doctors could operate or do whatever they were going to do. Or in the military, when the military mission gets suddenly terminated and the soldiers are told they must leave, they are not allowed to stay in country anymore. So sometimes abandonment is not a choice. It doesn't mean people don't feel guilty about it. It doesn't mean that it isn't morally injurious. They feel like they created a situation that they should stick around for. Sometimes people must make a devastating choice between keeping or saving something and abandoning something else. And we're going to talk about some of these examples in a minute. But think about, for example, a parent who has a child who develops wicked allergies and wicked asthma and cannot be around the family's pets. Or, you know, worse yet, the family lives on a farm and their entire income and livelihood is based on being around animals. And that child can't be around animals. So they choose. They feel like they have to abandon their. Their animals and their livelihood and do something else because they're protecting their child. So while they may love their animals, they have to choose and relinquish one. Sometimes people give up something for the right reasons, even though it causes moral conflict. People who leave their babies in safe havens, for example, there are a lot of situations where a caregiver recognizes that they are not equipped, they are not able to. Able to take care of an infant, which is one of the wonderful things about safe havens. It doesn't mean that that caregiver doesn't feel remorse, doesn't feel guilty, doesn't feel tortured about relinquishing that baby. Other words that might be used instead of abandonment or in addition to abandon include escaping or relinquishing Some examples of abandonment, which can cause moral injury. And this is not an exhaustive list, so I'm sure that you will come up with other examples. But some, some of the ones that I brainstormed. Abandoning your home and releasing your pets during a disaster. There have been multiple disasters that I have lived through. And people have had to, for example, just, you know, open the doors and let their dogs or cats go because they couldn't take them with them to the shelter or they couldn't catch them and, you know, a scared horse, a scared pig, something like that. Sometimes you're not catching it yet. You have to make the decision for self preservation. You can still feel very guilty. We can also feel the moral injury of abandonment due to unavoidable events. Sometimes Things happen, life happens. And somebody's not able to care for their pets anymore. Maybe they lost their job and they're impoverished now and they can't even feed themselves, let alone feed and care for an animal. Or as the example I gave, they have to choose. They have this dog that they've had for 14 years, and then they have a baby, and the baby has respiratory issues and cannot be around the dog. Some people will say, well, it's a dog. Other people will recognize that for some people, a dog or a cat or a horse or even a reptile is part of their family. And they choose to obviously do what's best in the. In the case of the child. But it means having to relinquish, having to abandon that animal that has been a part of their life for so many years. We already talked about leaving infants in a safe haven. And a lot of times this is a caregiver recognizing that it is in the best interest of the infant to relinquish it because they are not able to take care of it. Leaving people or pets behind in a tenuous situation. And this can happen, for example, when people escape from a domestically violent situation. A lot of domestic violence shelters will not allow pets. So they may have to leave the pets behind to protect the humans. Yet they recognize that there is a better than average chance that those pets are going to suffer harm at the hand of the abuser. During civil unrest, when people are escaping from their country of origin, for example, sometimes not everybody in the family can go. Some of the family is too ill or infirm to go. Or during extreme poverty, sometimes people leave situations, leave cities, counties, states, countries in order to create a better life. And the plan is to send money back to that family wherever they happen to be. But it still may feel devastating to abandon those people and say, trust me, I'll be sending you money and I'll help you out. Leaving a loved one's side immediately prior to death so doctors can work, or because the hospitals won't allow visitors. I know a lot of people have experienced this over the past two years, but even prior to that, if somebody you know codes while they're in the hospital, loved ones are ushered out of the room so the doctors can work, it doesn't guarantee that you will be able to go back in and say goodbye to your loved one before they cross over. Terminating life support or in the case of doctors, prioritizing medical care, this can also be a devastating choice to have to make. And people may feel like they're abandoning the Person for whom they're terminating life support, maybe your aunt Sally has been in coma for seven years and you've made the decision, you know, however it comes up, to terminate life support, that can be really challenging for a lot of people who don't believe in killing and they see this as killing, but they also see this as a humane action. So they're torn in their beliefs about what they're doing. Or maybe they feel like they have to terminate life support for some reason. And prioritizing medical care, doctors, when there is a huge crisis, when there is a mass casualty event, sometimes they have to prioritize. And soldiers in the field, same thing, have to prioritize medical care based on who, who has the greatest likelihood of surviving. And that can feel like you're abandoning the people who are still alive at that point and leaving them to die. Terminal illness. Now this is an interesting one. People who have terminal illness may have a moral injury experience, moral injury of abandonment, because they regret the choices that they made. They may feel like it's their fault that they have this terminal illness and that they will be leaving, that is abandoning their family sooner than they should. So there's a lot of shoulds, there's a lot of grief, there's a lot of regrets. Abandoning a mission, leaving supporters or confidential informants behind. This is not always military. Sometimes it's law enforcement where the people who are in charge of the mission decide to terminate it. And the people who were in the area, if you will, the supporters, the confidential informants are left to their own devices to try to protect themselves. And this can happen in gang territory. This can happen in obviously in war torn areas. But when people have helped you out, you often develop a connection with them, at least an appreciation for their service. And there is a great feeling of abandonment when you have to let them down, when you can't be there to help them out anymore. You made an agreement, you help me, I'll help you. Then all of a sudden it's like, well, you helped me. Thanks a lot, see you later. There could be betrayal experienced by those whose loved ones died in service of an abandoned mission. Now this is a little bit more abstract, but for people who made the ultimate sacrifice, their child, their husband, their father died in the course of a mission, or whether it's, you know, generally this is a military sort of thing, when that mission ends or is terminated without a successful resolution, it feels like that person's death was meaningless. And that can cause people to feel abandoned. It can cause people to question the goodness of their leaders. And again, people can experience moral injury of abandonment. When their leaders abandon the values of their culture, when they believe that their culture is one of goodness and helping and kindness and compassion, and their leaders choose a different route, then they can feel like their leaders abandoned them from for nefarious reasons. So what are the consequences? As you've seen, there are a lot of different ways that people can experience this feeling of I abandoned something, I let them down. So the consequences morally injurious experiences and the resulting guilt, shame or anger may contribute to stress reactions. Go figure. Changes in Sleep when people lay down to go to sleep, they may start thinking about what went wrong. They may start thinking about the person or situation that they abandoned and it can race through their mind. That triggers their threat response system, their HPA axis, and prevents them from getting good sleep. There can be significant and persistent negative changes in behavior or habits. People may withdraw, People may get overly engaged in activities in order to avoid any sort of downtime and even sleep. Because anytime they slow down those thoughts about what happened and that moral injury just opened wide up again. All of this results in disrupted circadian rhythms. And our circadian rhythms control just about everything in our body. It controls when cortisol secreted, when melatonin is secreted, when our hunger and satiation hormones are secreted, the levels of our gonadal hormones, our immunity. There is a lot of stuff that is tied to our circadian rhythms and all of those things impact the levels of neurotransmitters. So when those go wonky, neurotransmitters typically go wonky and we start feeling apathy, agitation, depression. People may experience reduced immunity and increases in stress related illnesses. When people feel helpless, when people feel disempowered, they feel unsafe. When people feel unsafe, they can't relax. When they can't relax, then ultimately it has a negative impact on their immunity. So they become more susceptible to viruses and colds and bacterial infections as well as stress related illnesses like cardiovascular disease. When people's neurotransmitters are out of whack because of the aforementioned issues, there is often an increase in pain. That could be because of increased muscle tension because of the stress, or it could just be because of an imbalance or an alteration in bodily chemicals like hormones and neurotransmitters that are responsible for helping us deal with pain. Stress, we also know triggers an inflammatory response and can worsen or trigger an episode of autoimmune issues. And we know that a lot of people have autoimmune issues right now, when we don't get good sleep, when we're not feeling our best, and when our neurotransmitters are out of whack, specifically dopamine and norepinephrine, we have difficulty with concentration. There's often increases in mistakes, and that can make people feel frustrated. It can cause them to feel even worse about themselves sometimes if they are seem to be able to get back on their A game. There can be isolation because people withdraw from others. They see others as potentially dangerous or unpredictable, or they feel guilty about what they did, so they fear rejection, or they don't feel like they deserve to be loved. And we also see compulsive and addictive behaviors like overworking, overeating, drinking, drug use. There can also be other reactions, like a weakened sense of empathy or compassion. And you may be scratching your head on that one. But when we experience moral injury, that feeling that we abandon somebody, that feeling that we let somebody down, is palpable. And when we empathize with others, it can be too overwhelming. It opens that wound. It allows us to feel others pain. And right now the thought of the pain that we caused others is too overwhelming, so we can't even open that door. Or we have difficulty opening it and have more difficulty with compassion. People can develop pessimism when they see that they have done something that goes against their moral code. It's like, well, if I can do it, then anybody can do it. So maybe we're not all that altruistic of a species as we thought. Depression, which is a sense of hopelessness and helplessness. Well, yeah, when you're in these situations, you may be looking back on it and feeling hopeless and helpless. You can't change the past. And you may wonder, am I going to make that same decision or have to make decisions like that in the future where I feel powerless? There can be anger and rage at yourself, at the situation, at the leaders. There's lots of dysphoria to go around. Almost inevitably when there is moral injury, there is guilt. When you do something that goes against your moral code, you often feel guilty for it and you create what we call cognitive dissonance. It's like, I am this person, I'm a good person, blah, blah. But I did this bad thing and how do I rectify that? If I see what I did as inherently bad, how is it that I as a good person could have done that? So the recovery process involves coming to an understanding and trying to reconcile that cognitive dissonance. There can Be grief. And there a lot of times is grief, especially if it resulted in a loss of life. But even if it just results, I shouldn't say just. Even if it results in a loss of self concept or a loss of your faith in others, that's something to be grieved with. When you recognize that the world isn't exactly as you thought it was, or people aren't as benevolent, there's a grieving process that goes along with the loss of that ideal. And it's important to give yourself permission to examine that, grieve it. And grief has the stages. Not everybody goes through all the stages of denial, anger, bargaining, depression and acceptance. But a lot of people at least go through anger and depression a few times before they figure out how to reconcile what happened and integrate it into their narrative of life. And finally, brief psychotic disorder. Now this doesn't happen a lot, but it does happen. When people are exposed to a trauma or extended periods of stress, it may result in them having hallucinations, seeing things, or hearing things that really aren't there. Now this can be loved ones, maybe if they feel like they abandoned somebody. You know, if they, they left a war torn country and they feel like they abandoned their, their supporters, their confidential informants, people they were close to, if they fear that that person died, they may see that person in their current presence. You know, there are certainly instances of brief psychotic disorder where the brain's trying to reconcile what's going on and is having a whole lot of difficulty doing it. And brief psychotic disorder is different than schizophrenia. Some people can have brief psychotic disorder but not go on to develop long standing schizophrenia. But, but it is important to recognize and get help if somebody is starting to experience brief psychotic disorder. There are also a lot of other things that can cause hallucinations and some of them are very treatable. So actually most of them are very treatable. So the sooner somebody gets evaluated, the better their outcomes. And finally, ptsd. Not everybody who experiences moral injury, even moral injury from abandonment, will develop ptsd. But some will, and it's important to validate that so people can get help. Because PTSD is a long standing stress reaction, a long standing protective reaction that develops as a result of directly experiencing or witnessing a traumatic event, learning of a traumatic event that occurred to a family member or close friend, or experiencing repeated or extreme exposure to aversive details of traumatic events. So they've expanded the criteria for what can trigger ptsd. And I think that is, that's awesome, because it really does encompass more of what, what can provoke chronic stress reactions. What do we do to address it now? A lot of times, moral injury will need to be addressed in the context of therapy or pastoral counseling. But let's talk about some practical things. Moral injury is traumatic and may involve the loss of a sense of self. You know, whatever happens, whether you did it intentionally, unintentionally, or you failed to do something, the person looks at themselves in the mirror and says, this is not who I am. I don't abandon people. I'm a bad person for doing this, but I'm not a bad person. So their self concept is experiencing that cognitive dissonance. They may have a loss of a sense of safety. They may feel because of the actions of others that they're not safe. Or they may feel that they will be rejected by others because of what they did, for example, if they put their child in a safe haven. Personal power is another thing that people can experience a loss of as a result of moral injury because they feel like they had no choice or no say in the matter. They really wanted to do something, but they couldn't. They were prohibited from doing it by some other force. And that can make them feel disempowered and unsafe, unable to protect themselves or others in the future. It's vital to use context and consider all of the factors at play when helping people examine and reconcile the situation. I personally believe that people do the best they can with the tools they have in that situation at that time. So it's important to really look at all the factors, not just armchair quarterback from, you know, from home or from a safe distance, but to consider all of the factors and explore why the person made that decision. And a lot of times it was choosing between two bad options. It's important to be alert to concerns about the therapist, pastor, or supporter who is trying to help the person with that is experiencing moral injury of abandonment. The person may wonder if they're being judged or if the person, the supporter, is disgusted with them. They may be thinking to themselves, is this too much for my therapist or pastor to handle? Am I giving them stuff that's just going to completely overwhelm them? So those thoughts can be going through somebody's head. And sometimes it's worth acknowledging that if you get the sense that someone is holding back because they're fearing being judged, you know, maybe talk about that or talk about, you know, if you get the feeling they're holding back because they're afraid, it's too much for you to handle. For those who believe in a higher power, their faith may be very shaken. They could be asking like, how could my higher power allow this to happen? I was doing the right thing. Those people were doing the right thing, so how could this happen? They also may wonder, am I now unlovable or unacceptable to my higher power because of what I did or what I failed to do? Was I supposed to do something different? So there are a lot of spiritual, ethical, moral questions that may come up. Moral injury may lead people to believe that they don't deserve to feel better, which could negatively affect how much they engage in and comply with self care and treatment recommendations. How do we address it? Well, physically, it's important to help people create a sleep routine and evaluate their sleep hygiene. Adequate quality sleep at about the same time every night for ideally seven to nine hours per night is really what we are striving for. Now, there's been a lot of research that has shown that people who have post traumatic stress are at a much higher risk for developing obstructive sleep apnea, regardless of whether they've got PTSD or not. If they snore like a freight train, it's worth getting evaluated for obstructive sleep apnea because that most certainly will prevent quality sleep. And the brain is going to have difficulty recuperating from the stress of the moral injury of abandonment if it cannot rest and rebalance. Circadian rhythms are involved in everything, not just sleep. So it's important. They've done a lot of research that has found that after a trauma, the sooner people can get back to their normal routines or some semblance of normality, the less likely they are to develop post traumatic stress. Now that doesn't mean ignore it and just get on with life. That's not what I'm saying. What I'm saying is try to maintain some sort of routine. So getting up about the same time every day, eating about the same times every day, doing stuff during the day, even if you're not going back to work, even if what you're doing during the day has changed, trying to maintain some sort of predictability in your rhythms can be very helpful. Nutrition, what you eat is broken down by your body to make the neurotransmitters, to make the hormones to help repair the tissues. So if you eat crappy, then your body's not going to have the building blocks to repair you. It's not going to have the building blocks to make the neurotransmitters that could possibly help you feel better and help improve your cognition. Now, nutrition itself is not going to make the moral injury of abandonment go away. That is something that you're going to have to process. But processing that takes a crap ton of energy and it is an exhausting endeavor. So it is so important to fuel your body so it can help support you through that process. Use caffeine and alcohol in moderation. When we don't get adequate sleep, a lot of times we rely too much on caffeine. That can end up disrupting the quality of our sleep later that night. So caffeine and it also keeps that threat response system, your HPA axis, extra activated, so you're putting extra strain on your body if you're pushing through with caffeine. Now, I'm not saying completely stop using it if you've been using it, because some people are like, oh no. What I'm saying is moderation. Caffeine stays in your system for up to 8 to 12 hours after you drink it. So what you're drinking at noon may still be impacting your ability to get quality sleep, you know, at 8, 10, maybe even 12 at night, depending on how well your liver works. Use alcohol in moderation. Some people are social drinkers and you know, that is a personal choice. It is important to make sure to use it in moderation though, so it doesn't become a habit that you're using to escape from negative feelings affectively, cognitively, so your moods and your thoughts. Practice mindfulness. Be aware of how you're feeling and what you're thinking in the moment. And that's not just how you're feeling emotionally, but also how you're feeling physically. Be mindful if you know you're not on an A day. Okay, be mindful of that. So what do you need to change? Be mindful of your thoughts, not that they're right or wrong. Just accept non judgmentally what you're thinking and what you're feeling. Until you are mindful, until you notice what's going on, you can't address it. You know, it's kind of like a supervisor walking around on the floor. When that supervisor walks around and observes what's going on, they are able to identify if there are breakdowns or issues that are causing loss of efficiency in the factory. Mindfulness of yourself means basically doing the same thing. Scanning, making sure that you are addressing anything that needs to be taken care of and recognizing that, you know, some days some systems are just going to go offline and you're going to have to figure out how to adapt. Emotional awareness and processing is kind of part of mindfulness, but it's the next step. So once you're mindful, once you're aware of how you're feeling and what you're thinking, then processing those feelings so you can work through them. Guilt, grief, anger, depression, anxiety, any of those dysphoric feelings that you're. You're experiencing, it's going to be important to understand what is causing them, what is maintaining them, and how are you going to deal with them. Pastors, support groups, and therapists can be very helpful at helping people process and work through those emotional issues. Distress tolerance skills can be helpful in the interim. And I use the mnemonic tags. T stands for thoughts. You want to stop thoughts that are intrusive and running and oppressive. So practice and learn how to stop your thoughts and ideally replace them with something more empowering. And there's a lot to that. You know, this sounds really simple, but there's a lot to that. A stands for activities. Identify activities that you can do that can help you get a break from your racing thoughts and your distress. It may be watching a comedian for a little while. It may be doing something that at least occupies your mind if it doesn't make you happy. So activities. G stands for guided imagery. Sometimes mentally teleporting yourself to a safe place or to a mental vacation can help your brain get a break. It can help it cool off a little bit. So, so you aren't focused on all those thoughts. You're focused on going to this place that promotes feelings of safety and relaxation. And when you're doing that, your brain can't go those other directions. You're using all of your brain power, so to speak, on this one activity. And S stands for sensations. And that can be smells, can be sights, it can be sounds. But sensations are wonderful triggers of prior memories. So if you can trigger prior positive memories or trigger thoughts of hope for the future, those can be things that can help you tolerate distress. Now, distress tolerance, these are just tools to help you get a break when you are in your emotional mind, when you are revved up, when you are angry, anxious, you know, feeling threatened in some way. A lot of times you're in an adrenaline haze and it's hard to think clearly about what's going on. You just want to fight or flee. So distress tolerance skills can help you take those emotions and say, okay, I recognize I'm feeling this way, but I am going to set it aside for a second until I can get into my wise mind and then I will process it. Distress tolerance activities can also Be helpful to help you get through the day. If you are at work and all of a sudden you start having a grief burst and a moment where you start feeling completely overwhelmed by the thoughts of what happened, distress tolerance skills can help you down regulate that and sort of pack it up so you can deal with it at a later time where it may be more appropriate. So distress tolerance skills have a place. It's not a replacement for processing and dealing with stuff. It is a stopgap, if you will, to, to allow you to get to a safe place where you can be in your wise mind and use all of your abilities, not just your emotions, but also your thoughts and your cognitive abilities, to process what's going on. FCP and purposeful Action is another technique. And FCP stands for facts, Control and Probability. So you want to look at the situation, whatever it was that you are experiencing. Moral injury of abandonment about what are the facts for and against your beliefs about that situation? What's right, what's wrong, your beliefs about yourself, what are your facts? What are the facts for and against that? C stands for control. All right, now that you know the facts, what aspects of that situation were within your control or are within your control? And that's the one that can be really hard when we're talking about moral injury. A lot of times we have very little control. But recognizing what you did and did not have control over can be liberating sometimes. And P stands for probability. If you look at the facts and you did whatever you could that was within your control, what is the probability that things would have gone differently? You know, could you have actually changed the situation? What's the probability of that? Purposeful action means examining the situation now that you're looking at it through a more logical, broader lens, looking at all the facts and what you had control over and what you continue to have control over. Purposeful action says, okay, now that you know the situation, what can you do with your energy in the present to help you move towards a rich and meaningful life, to help you move towards being the person you want to be. Does that mean getting involved in some sort of grassroots organization? Does that mean continuing to do what you've been doing? You know, purposeful action means choosing to effectively use your energy instead of using it to beat yourself up or feel guilty or just stew in your anger at someone or something else that doesn't do any good. It's like sitting in the mud and pushing the, pushing the gas pedal. You just dig deeper into the mud and, and get dirt all over the place that's not an effective use of your gas. So purposeful action says, all right, how can I best use my energy now to become the person I want to be? Hardiness is another tool. And hardiness has three Cs, commitment, control, and challenge. And there was research done on this mainly back in the late 70s, early 80s. Yeah, I know that was a long time ago. But people who had a more hearty approach to life tended to recover more quickly from things like open heart surgery. But also they tend to have a better outlook and prognosis for mental health issues. Now, what do the three Cs stand for? Commitment, control, and challenge. The theory behind hardiness is to recognize that all of our proverbial eggs are in one basket. The first C, commitment, encourages people to look at their life and identify all of the things in their life that are important in their family, their health, their dogs, their experiences, whatever it is that's important to them in life. The second C, control. Control comes up a lot, but again, in this theory, it's examining what aspects of each situation you have control over. So if you had open heart surgery, you know, recognizing all of the things that are important to you, all of your reasons to do what you need to do to get better control. What aspects of this situation can I control so I can get better? And then the final C is challenge. Instead of seeing it as an obstacle or a barrier or something awful, seeing what. What you have to do in order to move forward as a challenge, yes, it's hard, but it's a challenge. And it's just a different perspective. In terms of the moral injury of abandonment, yes, you may have abandoned something that was important to you. That's why you're feeling this moral injury. You may have done something that went against what you thought were your core beliefs. Okay. You know, that's what happens with moral injury, unfortunately. But the first C says, okay, there's that aspect. What other things? You know, if you were leaving a domestically violent situation, maybe you had to abandon your dog that you've had for 12 years, and you were focusing your energy on keeping yourself and your children safe. Okay, so you were committed to a lot of things, and you had to make some unpleasant choices looking at what aspects you had control over. You know, if you would have been able to take the dog, you would have. If you would have had someone, you could set someone somewhere you could take them to, you would have, but you didn't. And then the sea of challenge is figuring out how you are going to process and Reconcile what you have done in order to continue to be the person you know yourself to be and have a rich and meaningful life. Finally, be compassionate with yourself. I've said this before today and I'm going to say it again. Not every day is an a day. Some days you are going to get up and you are just doing good to put one foot in front of the other and that's okay. Recovering from moral injury takes time and there's often a grieving process and that can take time as well. Environmentally and relationally, you're going to work. You're going to have to work on redefining your self concept. One strategy that can be helpful is to recognize the difference between who you are and your behaviors. You can be a very good person and do things that aren't necessarily, weren't necessarily the best choices, but maybe it was the best choice in that situation. You know, it's not something that you would do if you had other options, but you made the best Choice out of 2 bad options. Remove or minimize triggering stimuli. That can mean turning off the television. The news especially likes to bombard us, assault us, if you will, regularly with just repeated minutia about bad things. I went online yesterday and I looked for stories about ways to improve your mental health and help you feel better and cope with all of the stuff that's going on. I found zero that had been published in the last six months. I found a few that were on one channel that had been posted, you know, prior to that, in the prior six months. But in the past six months there was like nothing on coping with what's going on. It was just distressful triggers. I'll leave it at that. Add empowering stimuli. Pictures of things that make you happy, pictures of things that remind you of who you are and who you want to be. Connect with positive social support. If the social support you are connected with tends to mull over and nurture and stew in anger and resentment and just not do anything, they just sit there and stew in it. That's generally not helpful. It doesn't mean that people don't have the right to be angry. Everybody has the right to their feelings. But our feelings are designed to tell us to check out the situation and do something. So when we feel angry, you know, you can connect with other people who are similarly angry about the situation and figure out what is something positive we can do in order to try to address it or prevent it from happening again. So that is going back to that purposeful action. Using your energy instead of using it to press on that gas pedal and get deeper in the mud, using your energy to affect positive change so people aren't abandoned in the future. So this doesn't happen in the future. Moral injury is defined as the profound psychological distress that results from the actions or lack of actions by a person or people who lead them. Abandonment means leaving, relinquishing, or even choosing one thing over another. People sometimes have to make the devastating choice to abandon one thing for the good of another. Other times, like in terminal illness, people may not have a choice. People may also suffer moral injury by proxy when the leaders of a culture with whom they identify engage in morally reprehensible acts because that person is essentially representing you to the world. Moral injury has multiple impacts on people's physical health, their affective, their emotional health, their cognitive health, the way they think about and perceive things, their environment and their relationships. It's important that we recognize that the far reaching impact that moral injury of abandonment can have on individuals and the fact that it's not something that you just have for a minute and it goes away, it alters, it actually alters their perception, the way they think about themselves and others. You can find out more about moral injury@docsnipes.com YouTube this show was produced by Executive Producer Mr. Charles Snipes Presenter, Dr. Donnelly Snipes, both of whom can be contacted at 1633 West Main Street, Suite 9O2, Lebanon, Tennessee 37087.