Volunteers of America CEO Speaks to the Personal Side of Moral Injury

Volunteers of America CEO Mike King provides a history of the term "moral injury" and speaks about his personal experience with caregiver moral injury when his mother suffered from Alzheimers and his father's experiences in WWII.


Mike King:

Well, this is great. I don't get to go to rotary meetings as much anymore, because I'm always on a plane. This is just great, because I was a part of the Dallas Downtown Rotary for years, and years, and years. I love the four-way test. I think that is one of the most brilliant pieces of work that's ever been done about evaluation, because it is so simple and yet so truthful and so true. I've become, especially in the last several years, a huge fan of all of you, of this part of the world. Really started with some real intimate involvement with rescue efforts and housing efforts around Katrina, as we were evacuating literally folks who were from group homes, and disabled areas of New Orleans, and bringing them into East Texas into a little church camp in Palestine.

Literally, there was a bus that was ... Two buses filled with about 115 different severely mentally and physically handicapped folk, as well as our staff, your staff, a lovely staff, as well as what you were doing right here led by Jane Shake back in the day. Because if you don't know, Jane is the queen of social media. I think she ought to be doing a class. Yeah, I think she ought to be doing a class in this. You guys were just central to that during Katrina. I mean, you really were central to all of that. I became very appreciative of it. We were central to a different piece of it in Texas, and so then sort of repeatedly through these challenges, through these weather-related challenges that you talked about even last week, the thought of one. This time last year, absolutely a devastating one.

I've become convinced from watching you and from learning from you that these events truly do not only make us stronger, but I think they make us more loving. I think they make us more compassionate. I mean, I've never seen the kind of compassion that I have seen around these kinds of circumstances, really led by you. Really led by the people of Louisiana, because you catch it every year, every single year. I have to tell you, you're very fortunate, you're very fortunate to have the team that you have in place right now that the Volunteers of America have built, led by Janet and the team largely sitting at these two tables right here. A big round of applause for these two groups. I was tickled to hear the news about what happened with the food from last week. I was convinced it was going to go to one of his neighbors.

I thought, "Boy, are they having a dinner tonight." I mean, holy cow. Here we go. I thought, "Holy smokes. What is that going to be?" I have to give you one more commercial for the local affiliate and that is this afternoon they're going to do a wonderful thing, an absolutely wonderful thing, and we spent most of the morning promoting it, actually. At 4:00 do a rededication in the name of Veda Jackson O'Quinn and Bill and Gil are right there. Thank you so much for being passionate advocates that you've been for mental health. That is a cause that is close to our heart. They are having a rededication at 4:00. Spent this morning, probably before most of you were up, at a morning show. Janet and I were barely up, but we were conscious. We were actually conscious and we were dressed in front of cameras.

Which many times at that hour, I'm not, but I was this morning. Thanks to this circumstance. Then we went from there to the advocate where they were talking about the good work, the good work that this team does. I am thankful for that work, because that's what makes communities a loving community. We like to say that at Volunteers of America we're in the love business. It's just love looks like affordable housing. It looks like a shelter. It looks like a hot meal. It looks like an understanding of what mental illness really is. It looks like services to returning veterans. It looks like those kinds of services with group homes for those who are disabled and are now adults, okay, and we still have responsibility for their care. That's what love looks like inside our organization.

While we are faith-based and we love the fact that we're faith-based, it's a part of our inspiration, it's not a part of the execution, per se. It's not a requirement. We're going to act that out. We're going to act that out and you're going to see that a lot as we project it out. That's kind of what brings us to this whole topic today around moral injury. I want to give you a little bit of background about sort of where that comes from, because it's not an everyday term. How many folks have ever heard of the term, moral injury, before you saw it in the little announcement stuff? Anybody ever heard of it? A few. Yeah, it's not a common term, but I would get to know it. I would get to know it, because it's going to become a major area of study and research and then impact on how well we do our jobs in taking care of those who are most vulnerable.

It's most dramatically seen in serving those who have been veterans and who are returning from a veteran experience, and from a military experience, and frankly, a wartime experience. What we've seen with it, is it has capacity to serve virtually anyone that is hurting. Anyone that is hurting deep. I'll try to go into some of the background of that. It really does start as far back as when were first formed, and that was literally in 1896 when we were founded in the United States. In 1896, most of the folks that we were serving in the same kind of services we have today, in addiction treatment, homelessness, housing, shelter, those kinds of things, those folks were veterans of the Civil War. Think about that.

1896, you're just 31 years. Hence, the end of the Civil War and the dysfunctional behaviors that they were seeing both from substance abuse, alcohol abuse, behavioral issues, behavioral health issues, were coming from the fact that in 1896 they didn't know what PTSD was, okay. They didn't have a clue what PTSD was. Now, some facts about the Civil War, which we don't get a lot today, is it was the most bloodiest, deadly war in our history that we have ever fought before or since. Do you believe that? The highest percentage of the population, as far as percentage of the population that actually served in that war was the highest of any war we've ever fought, even higher than World War II. Highest percentage of casualties of the whole population of the country. Highest from that war of any war we've ever fought. The highest number of injuries. Highest percentage of the population injured in that war than any other war we've ever fought.

Those are just statistical references that tell us nothing ever came close to that as far as how many people it touched in this country. In addition to that, when you think about the intimacy of it, the fact that it was purely ... It wasn't one country attacking another country separated by oceans. It was literally separated by sometimes an arbitrary boundary, an arbitrary boundary, or a river, or a hill. Totally arbitrary, that determined where you had to go, and what you had to do, and what you had to execute. Totally arbitrary. Those who would not want to do that had to risk their lives to not do that. In that sense, you literally had folks who were fighting against their own relatives, their own friends, much less anyone who might've moved in the last five years before that. Clearly, the most intimate war we've ever fought.

Yet, as that war ends and people come out of it from all sides, there are no services, there are no services to help with the trauma that all of those folks have been through on all sides. No services there. No services for reentry. You can imagine then, with that kind of suppression where you had to suppress the things that you sense and feel coming out of that. If you don't deal with that, as we all know, it comes out eventually, doesn't it? If you don't deal with feelings, if you don't deal with trauma, and deal with those impressions, and those experiences, and whatever feelings you have around it, it's going to come out. It's going to leak out, and it's going to affect your behavior, and what you do, and how well you cope with life going forward. Didn't have it. Didn't have it.

Our founder was the first woman in America who literally started working with prisoners in the federal prison system and helping them get ready to come out of that and reenter civilian life. The whole halfway house system of prisoner reentry was created by our founder Maud Booth and today the highest award given in the American Correctional Association is the Maud Booth Award, for folks who have done the most in the past year to further reentry services. Well, I can tell you that most of the folks coming out of incarceration are also going to be suffering from some form, some level of moral injury for the very same reason of that. It's challenging. Let's roll the tape forward, okay. As the Civil War into World War II, into the World War II area. How many folks here, how many folks here have relatives, parents, grandparents who you know served, or yourselves if we have anyone here from that age range, who served in World War II? Raise your hand.

Okay, so a lot of us have talked with ... One of the things that I noticed from that, my father served in World War II, served in the 10th Mountain Division, which fought in the mountains of Italy. Today, that same division is deployed to the mountains of Iraq and Afghanistan. Different set of circumstances. Back in those days they trained in Colorado. Today they train in upstate New York. Very, very challenging terrain. I can tell you that I never heard him talk about it. Never heard my father talk about it, talk about the war, talk about serving in the war, talk about any of those experiences. I presume that's not unusual. I presume most of you probably had to ask questions to get your relative, either parent or grandparent, to talk about it. Why? Because we didn't do that sort of thing, did we? I mean, we just didn't do that sort of thing. We didn't talk about those sorts of things.

Once again, again at a very traumatic experience, no opportunity to debrief, no opportunity to sort of deal with the things that may be giving you nightmares. Truly giving you nightmares. Truly preventing you from being able to sleep. Truly preventing you from being able to almost live a normal life. Again, when you don't deal with it, you don't have any form of dealing with it in an acceptable way, then you either deal with it in unacceptable ways, okay, or it becomes very self-destructive, right? Really, really self-destructive. Literally, that generation, that generation was the last generation to go to war without the knowledge that their country or their force had nuclear superiority. You see, that was the last generation that went into that circumstance where if you talk to the women, the men won't talk to you much, but the women will.

You talk to the moms and the wives, they'll tell you that they didn't know if this democracy and democratic experiment was going to continue. Didn't really know. It was not self-determined that they would win there and it was, of course, a race to see who was going to be the first to create nuclear superiority for them. An incredible generation, an incredible generation. Roll that tape forward, so we've got years, and years, and years of this, okay, with no really fundamental treatment that's designed to deal with that other side of it, okay. We dealt with the physical side. We haven't really dealt with the emotional, much less the spiritual, okay. Whether you're faith-based or not, there's still some sense of that with everyone. Now, rotate forward after the Vietnam War, a VA psychiatrist named Dr. Jonathan Shay wrote a book called Achilles in Vietnam.

Now, only a profound academic would make this comparison, okay. It was kind of amazing, but it was also kind of brilliant. Published in 1994, examining the psychological devastation comparing the soldiers of Homer's Iliad with Vietnam vets suffering from PTSD in a historical context through the history of war. It was brilliant in that he was the first person to coin the term, moral injury. That there was something deeper, there was something deeper than the trauma, even the physical trauma and impact that has on the brain. Clinically, there was something deeper than that. This definition emerged from that. Moral injury is the damage done to one's conscious or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress their own moral and ethical values or codes of conduct.

Fundamental things that you grew up thinking you would never even imagine either witnessing, or doing, or participating in, or being not able to prevent from happening. We've all heard those stories of things that people have had ... That have been confronted with having to do. I read a story last night about a young soldier and it was a suicide victim. That's sort of what happens if you don't deal with this ultimately as a culture, as a society, is that's why we have the dramatic increase of literally 20 veterans a day committing suicide because it's not being dealt with. A young veteran telling the story before he had committed suicide, that he was haunted by having to literally drive his truck over three children who were blockading a barricade in Iraq. They had no choice, where they had given orders saying that everything that they could do.

It was a life or death situation for hundreds of people. No choice what he had to do and it haunted him until his death. It actually caused his death without being able to deal with that. That's just one story, but those stories are in the hundreds of thousands of things that people were confronted with and sometimes had to do. Then you take that and connect it to even more than just wartime, more than just veterans. Point it back to, what about a person that is violated, physically violated, and somehow they feel like they could've prevented that? They feel a sense of guilt. How many times have you heard that when you hear victims talk? They talk about it a lot, that they feel like they should've done something to prevent it and then they are not able to deal with that. That's moral injury is what that is.

When you think about ... I was here last right after the shootings in Baton Rouge and I came because I am from Dallas and I was there during the Kennedy assassination. My parents were waiting for Kennedy at the luncheon that day, so I remember that like it was yesterday. I remember like it was yesterday. Hearing your city talked about on national news in ways that you would never want it to be talked about. When I went through the experience of the police shootings in Dallas last summer and then just following that we had the circumstances here in Baton Rouge. I wanted to come and visit with our staff here in Baton Rouge to say, "I know what you're feeling right now and we're going to get passed it. We're not going to ignore it. We're not going to act like it's not there. We're going to get passed it."

That young man who committed the act of violence in Dallas was a returning vet who'd been suffering from moral injury, but never got it dealt with, never got it dealt with. It is as plain as day that it was trauma and circumstances there. I don't know if we could've ever prevented it, but I know for a fact that that's what planted the seed for all of that. That is the clinical context. If you want to place it in a spiritual context, in a spiritual context, I would say it's no longer believing that you are worthy of God's love. That's when the suicides occur, other dysfunctional behavior that you know will lead, will lead to your demise, occurs. That's where that comes from.

Now, since Johnathon Shay wrote this book, since then the most recent expert in this has been Dr. Rita Nakashima Brock who wrote a book called Soul Repair and then started an entity called the Soul Repair Center at Brite Divinity School at TCU in Fort Worth. Been a best-seller on Amazon. You can still buy it on Amazon. It's a marvelous book mainly of stories, of listening to stories, and then looking at what we can do about that. Really from that, we got introduced to this about three years ago. In seeing that, and hearing that, and learning more about that, I realized that all the audiences that we work with, whether it's folks coming out of addiction treatment, folks coming out of incarceration, folks who have been intense caregivers. Let's take this one a little further out. It's really not moral injury, but it would be termed moral stress, okay, which is like a degree of that but not to the full degree, okay.

Take a caregiver who's been the caregiver of say, a partner with Alzheimer's and you're going to lose the battle and the war. You lose several battles and ultimately you lose the war. I can tell you from a personal experience, after you've gone through that, years later you don't ever wake up in the morning thinking, "Boy, didn't I do a great job?" Do you? You wake up thinking, "Why? Why didn't I do this? Why didn't I do that? Why didn't I do much more than that?" There is literally a guilt there that you never did enough and it would be termed moral stress. Every long-term caregiver, as they get worn out, they go through the depression, they're going to face a piece of moral injury. I got to tell you one last example of this. Just last week, last week with the incredible flooding in Houston, we have a staff person on the national staff, lives in Alexandria, whose parents live in Houston. He was raised in Houston. Named David Burch.

When I called back to the office on the way here yesterday and asked how everybody was doing. They said, "Well, David called us and said his parents got to higher ground and are safe, but they're miserable because most of their best friends were flooded out and they feel immense guilt." David said, "I now get it, that thing that Mike's been talking about for the last three years. My parents have moral injury. They have a degree of moral injury about that, because they take it so spiritually and so deep in that sense." It's an amazing topic. Literally, three years ago we decided, if we can do better at this, if we can create therapeutic programming and counseling, and find better methods of treating with this, we're going to prevent suicides. At the same time, we're going to prevent some dysfunctional behavior at the lighter levels, okay, at the moral stress level.

If that's what we must study and learn about to be more effective in our work, to be better at the love business than we are today, to have even improvements on that, then we have to go on that journey. It's an interesting journey, because I can't tell you where it's going to lead. I don't know where it's going to lead. I just know we have to take the journey, and educate ourselves, and test it, and research it. We started that. We started having two to three national convenings where we bring together academic experts, clinicians, folks from the veterans space, but folks from these other spaces too that I've been sharing with you, where it can relate. We did these in the sort of east-coast, west-coast centers of commerce, along with Chicago and we learned a great deal. Out of the one that was in New York, there was literally a group called Veterans on Wall Street. I love that. Don't you love that?

That there's an organized group of Veterans from Wall Street that attended the convening, heard the discussion, and opportunities. Also, at that same group, was a group of first responders that had been 9/11 responders. They have a national organization of first responders who were coming to that to talk about their moral injury because of what they witnessed that they couldn't prevent. Imagine what they witnessed when they went into the World Trade Center. I mean, think about that. I mean, I feel like my job is the softest job in the world. If the scariest thing that I have to do is to stand up in front of you, I got an easy job. I mean, think about what these folks have had to do, blows me away. Well, absolutely they have a right to research this and to learn about this and find a way to good positive mental health before their life is over. That's what this was about from that.

Those Veterans from Wall Street took this ideal. One of them had a friend with the Bristol-Myers Squibb Foundation. They had an interest in veteran's work and as of about three months ago, they funded the first research project to research new methods, new methods of counseling, and test it, research it, find out what works the best with just under a million dollar grant to Volunteers of America to do this starting this past June. We have started the first research project on this case that's ever been done. There's not a path already laid out, but there's learning out there and the learning is going to come from the experiences and the shared experiences that we can facilitate with you folks. From that, we then went to the funding sources that we had internally and said, "Let's create some grant funds that we can distribute to have regional trainings and regional convenings." Again, collaborative.

This is not a Volunteers of America thing, it's an everybody thing, okay. It's a faith-based thing. It's a civilian thing. It's a veteran's thing. It's an everybody thing to talk about this and bring in acclamations, and clinicians, and theologians, you name it from all walks of life to dig into this and listen to the folks who have been dealing with it, so we can learn from them. I'm here to share with you that the very first regional grant for our regional training is going to be awarded to Baton Rouge and your affiliates right here. That absolutely is a testament to the words I said to you earlier about how impressed, how impressed our whole organization is, our whole staff, everyone that's connected to this with all of you, all of you. You guys have the deepest capacity for loving each other and putting that love into action where we serve each other, and anyone I've ever been around.

You not only have good food, you got great people, okay. You got ... I love your food. I'll have to go on a diet before I come down here so my pants will still fit on the plane ride home. Holy mackerel, the food is unbelievable, just unbelievable, but your people have such a great capacity that who better, who better to have the first regional training event of this type, and to have time to plan it, and pull people together, than all of you right here? I hope I get to come. I hope y'all send me an invite. It's absolutely fantastic work. This is where we need to go. I have to tell you, I probably have a private motivation for this.

A couple years ago our national conference was held in Chicago and there was a really wonderful man there from the city who was supporting the services to veterans, who at the end of that, a young African-American man who was just an amazing guy. He told me he was from the 10th Mountain Division, and that he had served in Afghanistan and Iraq, and gave me a bunch of history. Then I shared about my dad, he was based in Colorado, and he gave me so much background. I hadn't thought about it in years and I realized that ... I really hadn't thought about this before, but I realized then when I met him and he helped me realize that had this been available when pop came back from the war, he had had an amazing experience at World War II. He did serve in Italy. He was in the mountains of Italy and it was ski troopers. He had won the Silver Star for exposing himself to the enemy fire to protect his men and take on a sniper.

Then not in this episode, but in a subsequent episode, was shot through the abdomen, and so came home ... Again, came home a war hero and never talked about it. My mom had two scrapbooks on him, okay, all during that time. I have his uniform in my closet. Never talked about it. Was very successful. Was the first organized labor representative to be Labor Commissioner of Texas under John Connolly after the assassination of JFK. He was still wounded, in fact, at the swearing in ceremony. We grew up a little bit lonely, because that's what you are if you're a liberal democrat in Texas in the '60s. You feel pretty lonely, but that was our life and I loved it. He was always the secular teacher of the biggest class at the church. Yet, at the same time, on the other side he lived too hard, lived too fast, worked too hard, and drank too much.

I'm convinced all of that was driven, all of that was driven by what he had experienced and seen, but could never talk about it. Wasn't okay to talk about it. Maybe, maybe if we had had this back then, maybe he lives long enough to see me graduate, and live long enough to meet his grandkids, and maybe some of that stuff happens. That's what I hope happens from this. I hope more folks get to live long enough to see their kids graduate and to meet their grandkids, and to become productive citizens, and you're going to help make that happen. Thank you very much, appreciate it.