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Healing From Soul Injury Presented by Deborah Grassman at National Symposium

The CSU Shiley Haynes Institute for Palliative Care is delighted to announce that Deborah Grassman, NP, will be speaking at the 2022 National Symposium for Academic Palliative Care Education and Research, April 21─22, in San Diego. She is a mental health nurse practitioner, CEO and founder of Opus Peace, and a former director of Hospice for the U.S. Department of Veterans Affairs. During her 30-year career with that agency, she cared for more than 10,000 veterans nearing and/or at the end of life and introduced the palliative care and hospice field to the special needs and experiences of “wounded warriors” at the end of life.

At the Symposium, Grassman will share her explorations of “Soul Injury,” which especially besets our healthcare system and caregivers. The COVID pandemic and the attendant upheavals of the past two years have left many with the need for help with mental, emotional, and even existential challenges.

Grassman will address this parallel pandemic of Soul Injury and, with her experience and Opus Peace Tools, help attendees begin a process that “restores the soul.” She developed a Soul Injury Assessment for anyone to gauge the effects of cumulative traumas large and small. If you register for the National Symposium, please take a moment to complete the assessment before you come.

In a recent interview, Grassman reflected on the lessons of COVID and her message to healthcare professionals and faculty: You already have what you need to be whole. Take the lessons and turn them positive and discover how to recover. What follows are paraphrased excerpts from the conversation. She’ll explore these themes and insights in depth at the Symposium.

What has the impact of COVID been on Palliative Care?

“I can relate to the symposium theme of Disparities, Distress, and the Future of Palliative Care, especially distress,” she reflected. “Palliative care is a stressful job and it’s hard to know at what point stress morphs into distress.” COVID has moved many caregivers into serious distress.

Even though healthcare providers are lauded now as “heroes,” Grassman cautions about the subtle negative effects of such a label: (1) If, say, a nurse finds she can’t stay in the field, then what does that make her feel like? like she’s abandoning her colleagues and calling. (2) For the nurse who stays, the label can manipulate him into not feeling free to acknowledge the losses, the distress, the burden.

Healthcare workers are leaving their jobs and the field in droves. This will leave the ones who stay more vulnerable to more burnout as there are fewer staff and less resources.

Where does “Soul Injury” come in?

“Soul Injury occurs when we become disconnected from our own sense of self,” Grassman explained. “When we move from stress into distress, when hardship becomes burden. When we cross that line, we live in the energy of fear instead of the energy in the grace of our being. That is Soul Injury. Disconnection creates a loss.”

What causes Soul Injury?

“It took me more than a decade of research to tease it out,” she said. There are three causes (1) unmourned loss and hurt, (2) unforgiven guilt and shame, and (3) fear of helplessness and loss of control.

There are insidious Soul Injuries that are common and aren’t by themselves traumatic, but they add up. This is any experience that separates us from our true selves. So, for example, if someone was bullied as a kid, he may begin to question his own self-worth, and that belief can perpetuate that sense of pervasive loss, which erodes one’s inner sense of self. While these are clearly not the same as traumatic losses, acute trauma can almost be “easier” to help someone with, as it is usually more obvious. You can usually find the big traumas; it’s the little ones that gnaw away at you that are harder to uncover.

Once a Soul Injury is uncovered, what can be done?

After understanding the causes, the next steps are to Learn how to mourn, learn how to forgive, and learn to feel our helplessness. The broad impacts of the COVID-related lockdowns brought out conversations around non-death losses such as loss of routine, loss of casual interactions, and loss of social structure. Learning to feel helplessness entails feeling it in your body. Owning helplessness is part of the process of healing. Grassman will lead a workshop at the Symposium that will outline these approaches in more detail.

How does Soul Injury work differ from more typical work in PTSD?

The message is simple. The essential core of Soul Injury work is about grieving and forgiving; these facets are just not taught in medical or PTSD curriculum. So, the first step really is to raise awareness of the existence of potential Soul Injury, and then to learn how to grieve these losses and forgive. Again, while hospice professionals have understood these issues to be an important part of working with the dying, embracing the work of Soul Injury allows them to reach into other communities to offer tools and support. “Just using the term ‘Soul Injury’ can be therapeutic,” Grassman noted, “One reaction from those who learn about it is, ‘Yes exactly!’ I have also had someone explain it to me this way: ‘PTSD is something I have. Soul Injury is something that happened to me.’ This open doors and provokes an important conversation.”

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