Sunday, October 01, 2017 - by Support TRR
A blog about our article was forwarded to us from a colleague in the equine industry. There does not seem to be a way to leave a comment on the blog author’s website so we are posting this as our response in a way that can encourage dialogue. The links to the blog we are responding to, as well as our original article, are below.
In our published article, “Why We Don’t Ride: Equine Assisted Psychotherapy, Military Veterans and Moral Injury,” we very carefully do not say that horse riding is "contraindicated for the psychological treatment of veterans with moral injury." This is because it blurs the very lines we meticulously kept clear: we address, not treat, moral injury, not as a psychological problem or disorder, but as an existential phenomenon of the human post war experience. This is not, strictly speaking, "psychological treatment." We are not trying to soothe the limbic nervous system, or align the brain systems--we have other tools for that; we assume that moral injury becomes more pronounced AS the limbic system comes into alignment through EMDR and Yoga, which is why the arena is our most powerful transformative space, and which is why we emphasis the power of the ground work; that's where moral injury healing takes place. Even while your blog recognizes our distinctions between moral injury and ptsd, it is our observation that you, unwittingly, fell right back into the trap of amalgamating them. We are not denying the nice things you documented about riding horses in general, but are alerting to the danger of putting a morally injured veteran on a horse to attain a therapeutic goal related to the healing of moral injury. So, much of your blog is rather superfluous as a response to what we were actually talking about. We never say horses can't be ridden well and with benefit to horse and rider alike, but we do stand by our experience - that a horse's back is not the place for moral injury repair.
It is very important to clarify that we never (ever) said that horses are "victimized by mounted work." We do say "for a war veteran we have invoked the experience of being a perpetrator in control of a victim." But that is about the veteran's experience, not the horse's. Your suggestion that power and domination can invade the relationship between horse and human on the ground just as in riding seems a bit of a stretch. It is not as inherent on the ground as it could be in the saddle with bit and bridle. Moreover, we TOTALLY disagree that "the most intimate we will ever be with a horse is on its back." That can be challenged powerfully--as if horses were creatures who were created to be ridden. They will allow us that, but that is not their purpose or their nature, any more than pulling a carriage is. They will cooperate with us and carry us, but that is not the most intimate we will ever be with a horse. We think intimacy is best experienced when the horse is free to address us or not; when the horse(s) incorporate us into their herd, rather than the reverse, true connection is made.
Over all, we think the blog article treats our perspective pretty fairly, but that the authors misunderstand some of our points. It is also the case that while they credited and cited our article, there was no link to it so that attentive readers could review what we actually said, rather than an interpretation of it. That would allow them to see the biases in both and reconcile it all in their own thought processes.
To that end, here are the links to the blog commentary, and our original article.
Thursday, August 03, 2017 - by Support TRR
In America, those of us who understand Moral Injury as an existential and spiritual concern find ourselves in conflict with a popular misconception that makes of Moral Injury a cognitive problem. The kinds of struggles that Warriors experience in the aftermath of war often seem like plagues of "bad information" about self, war, and the world, and if, as the story goes, bad information can be displaced with "good" information, then the symptoms that the Warrior experiences will subside. Moral Injury can be seen, from this perspective, as a malfunction of cognition. Fix the thinking, remove the problem.
What constitutes "good" information? Often, the moral crises experienced by war fighters receive a flood of patriotic rhetoric designed to wash away--forcefully--the moral ambivalence that many war veterans experience. "Thank you for your service, you did the right thing, you are a hero, that is your job, you signed up for this, you are a defender of freedom, this is a just war, you supported a good cause," etc. ad infinitum--these sorts of statements, and many others like them, all assume that a Warrior's struggle comes from a lack of good information. "You gotta get your head right!!!" This all to common tag phrase, and the information barrage that Warriors receive as they wrestle with moral ambiguity, represent the "moral-quandary-as-dysfunctional-thinking" perspective.
PTSD and Moral Injury represent starkly different experiences, but this they share in common: neither one constitutes a "thinking problem." Granted, many Warriors absolutely have "thinking problems." No question. Yet, many of those patterns of dysfunctional thinking (cognitive distortions) do not emerge within the context of combat, but rather come with the Warrior into the theater of war. These problematic thinking patterns can be instigated and exacerbated in combat, and once these ways of thought become activated, they can and do cause cognitive dissonance and emotional distress. That experience, in and of itself--not at all uncommon in civilians who never even join the military, let alone deploy into combat--does not fulfill the broader and deeper criteria for Moral Injury.
The symptoms of PTSD point to a specific kind of sympathetic nervous system disregulation -- it is a "brain/mind" upset. We know where it happens in the brain, and we have specific trauma treatments that address the limbic brain in order to re-regulate that system. Eye Movement Desensitization and Reprocessing (EMDR) Therapy has proven to address this with powerful effectiveness as has been shown qualitatively in the lives of many war trauma survivors who have experienced this therapy and quantitatively in several validated outcome studies. No educated person questions the effectiveness of EMDR Therapy as a PTSD treatment. PTSD is a limbic nervous system disruption that can be treated, not with "good information," but with the application of a treatment that reaches into and helps re-regulate the limbic brain.
Moral Injury constitutes neither a "thinking problem" nor a "brain/mind upset," but rather an existential crisis based in both articulated and tacit morality--a deeply owned sense of what is right and wrong. Moral Injury does not emerge from "bad" or "ineffective" morals. The point is not to cognitively adjust the moral viewpoint and thus resolve the symptoms of the moral crisis. That would be the adjustment of a thinking problem. Instead, Moral Injury must be addressed as a deeply valid moral response to immoral experiences. Moral Injury does not come from moral misperceptions, but from valid moral observations about what is right and wrong in a combat situation. Notice the following contrast:
"I should have been able to save my Section Sergeant. He always gave us all he had; I should have been there for him" (even though the Section Sergeant was one hundred meters away and the Warrior speaking could have done nothing to change the event or its outcome). This is a cognitive distortion based in an under-processed traumatic situation. With further processing of the experience, the cognitive distortion will likely dissipate naturally.
"I followed the Rules of Engagement and the Laws of War, but I am plagued, haunted by the killing I did in combat; some part of me just knows it was a bad thing to do." This observation is based in moral conviction. This is about morality, not cognition or faulty belief systems.
When we address a Warrior's moral self-evaluation with an information campaign designed to adjust the Warrior's thinking about him-/herself, or the actions of his/her fellow service members, we simply miss the point. We apply an ineffective method to the situation at hand.
In both PTSD and Moral Injury, one will find cognitive distortions. However, to work with cognitive distortions without addressing the root cause of the larger experience distress (be it brain/mind dysregulation or moral crisis) will be largely futile in terms of long-term healing and wellness. Cognitive distortions have a tendency to dissipate naturally as the root issues of PTSD and Moral Injury receive appropriate attention. In neither case can one hope to clear up problematic thinking patterns without going deep into the causes of the post-combat distress of which these cognitive distortions are only one small part. To apply "thinking/cognitive" measures to situations that stem from neurobiological and moral concerns is the same as trying to cure a tree that is sick at the roots by dealing with individual leaves on the branches.
Moral Injury is not primarily a cognitive problem (even though it may have a cognitive component). Moral Injury is a moral crisis that must be honored before it can be addressed, and we fail to honor the profundity of this struggle when we throw cognitive and/or behavioral treatments at it.