We train soldiers for war. Let's train them to come home, too | Hector Garcia

87,336 views ・ 2016-12-06

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Carlos,
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the Vietnam vet Marine
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who volunteered for three tours and got shot up in every one.
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In 1971, he was medically retired
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because he had so much shrapnel in his body
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that he was setting off metal detectors.
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For the next 42 years, he suffered from nightmares,
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extreme anxiety in public,
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isolation, depression.
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He self-medicated with alcohol.
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He was married and divorced three times.
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Carlos had post-traumatic stress disorder.
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Now, I became a psychologist to help mitigate human suffering,
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and for the past 10 years, my target has been the suffering caused by PTSD,
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as experienced by veterans like Carlos.
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Until recently, the science of PTSD just wasn't there.
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And so, we didn't know what to do.
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We put some veterans on heavy drugs.
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Others we hospitalized and gave generic group therapy,
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and others still we simply said to them,
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"Just go home and try to forget about your experiences."
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More recently, we've tried therapy dogs, wilderness retreats --
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many things which may temporarily relieve stress,
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but which don't actually eliminate PTSD symptoms over the long term.
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But things have changed.
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And I am here to tell you that we can now eliminate PTSD,
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not just manage the symptoms,
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and in huge numbers of veterans.
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Because new scientific research has been able to show,
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objectively, repeatedly,
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which treatments actually get rid of symptoms and which do not.
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Now as it turns out,
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the best treatments for PTSD use many of the very same training principles
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that the military uses in preparing its trainees for war.
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Now, making war --
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this is something that we are good at.
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We humans have been making war since before we were even fully human.
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And since then, we have gone from using stone and sinew
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to developing the most sophisticated and devastating weapon systems imaginable.
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And to enable our warriors to use these weapons,
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we employ the most cutting-edge training methods.
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We are good at making war.
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And we are good at training our warriors to fight.
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Yet, when we consider the experience of the modern-day combat veteran,
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we begin to see that we have not been as good
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at preparing them to come home.
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Why is that?
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Well, our ancestors lived immersed in conflict,
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and they fought right where they lived.
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So until only very recently in our evolutionary history,
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there was hardly a need to learn how to come home from war,
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because we never really did.
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But thankfully, today,
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most of humanity lives in far more peaceful societies,
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and when there is conflict, we, especially in the United States,
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now have the technology to put our warriors through advanced training,
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drop them in to fight anywhere on the globe
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and when they're done,
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jet them back to peacetime suburbia.
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But just imagine for a moment what this must feel like.
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I've spoken with veterans who've told me
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that one day they're in a brutal firefight in Afghanistan
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where they saw carnage and death,
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and just three days later, they found themselves
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toting an ice chest to their kid's soccer game.
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"Mindfuck" is the most common term.
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(Laughter)
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It's the most common term I've heard to describe that experience.
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And that's exactly what that is.
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Because while our warriors spend countless hours training for war,
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we've only recently come to understand
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that many require training on how to return to civilian life.
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Now, like any training, the best PTSD treatments require repetition.
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In the military,
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we don't simply hand trainees Mark-19 automatic grenade launchers
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and say, "Here's the trigger, here's some ammo and good luck."
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No. We train them, on the range and in specific contexts,
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over and over and over
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until lifting their weapon and engaging their target
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is so engrained into muscle memory
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that it can be performed without even thinking,
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even under the most stressful conditions you can imagine.
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Now, the same holds for training-based treatments.
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The first of these treatments is cognitive therapy,
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and this is a kind of mental recalibration.
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When veterans come home from war,
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their way of mentally framing the world is calibrated
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to an immensely more dangerous environment.
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So when you try to overlay that mind frame onto a peacetime environment,
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you get problems.
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You begin drowning in worries about dangers that aren't present.
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You begin not trusting family or friends.
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Which is not to say there are no dangers in civilian life; there are.
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It's just that the probability of encountering them
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compared to combat
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is astronomically lower.
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So we never advise veterans to turn off caution completely.
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We do train them, however, to adjust caution
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according to where they are.
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If you find yourself in a bad neighborhood,
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you turn it up.
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Out to dinner with family?
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You turn it way down.
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We train veterans to be fiercely rational,
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to systematically gauge the actual statistical probability
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of encountering, say, an IED here in peacetime America.
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With enough practice, those recalibrations stick.
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The next of these treatments is exposure therapy,
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and this is a kind of field training,
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and the fastest of the proven effective treatments out there.
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You remember Carlos?
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This was the treatment that he chose.
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And so we started off by giving him exercises,
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for him, challenging ones:
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going to a grocery store,
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going to a shopping mall, going to a restaurant,
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sitting with his back to the door.
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And, critically --
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staying in these environments.
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Now, at first he was very anxious.
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He wanted to sit where he could scan the room,
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where he could plan escape routes,
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where he could get his hands on a makeshift weapon.
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And he wanted to leave, but he didn't.
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He remembered his training in the Marine Corps,
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and he pushed through his discomfort.
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And every time he did this, his anxiety ratcheted down a little bit,
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and then a little bit more and then a little bit more,
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until in the end,
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he had effectively relearned how to sit in a public space
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and just enjoy himself.
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He also listened to recordings of his combat experiences,
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over and over and over.
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He listened until those memories no longer generated any anxiety.
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He processed his memories so much
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that his brain no longer needed to return to those experiences
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in his sleep.
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And when I spoke with him a year after treatment had finished,
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he told me,
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"Doc, this is the first time in 43 years
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that I haven't had nightmares."
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Now, this is different than erasing a memory.
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Veterans will always remember their traumatic experiences,
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but with enough practice,
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those memories are no longer as raw or as painful as they once were.
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They don't feel emotionally like they just happened yesterday,
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and that is an immensely better place to be.
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But it's often difficult.
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And, like any training, it may not work for everybody.
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And there are trust issues.
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Sometimes I'm asked,
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"If you haven't been there, Doc, how can you help me?"
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Which is understandable.
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But at the point of returning to civilian life,
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you do not require somebody who's been there.
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You don't require training for operations on the battlefield;
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you require training on how to come home.
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For the past 10 years of my work,
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I have been exposed to detailed accounts
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of the worst experiences that you can imagine,
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daily.
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And it hasn't always been easy.
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There have been times where I have just felt my heart break
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or that I've absorbed too much.
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But these training-based treatments work so well,
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that whatever this work takes out of me, it puts back even more,
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because I see people get better.
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I see people's lives transform.
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Carlos can now enjoy outings with his grandchildren,
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which is something he couldn't even do with his own children.
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And what's amazing to me is that after 43 years of suffering,
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it only took him 10 weeks of intense training to get his life back.
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And when I spoke with him, he told me,
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"I know that I can't get those years back.
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But at least now, whatever days that I have left on this Earth,
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I can live them in peace."
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He also said, "I hope that these younger veterans don't wait
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to get the help they need."
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And that's my hope, too.
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Because ...
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this life is short,
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and if you are fortunate enough to have survived war
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or any kind of traumatic experience,
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you owe it to yourself to live your life well.
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And you shouldn't wait to get the training you need
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to make that happen.
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Now, the best way of ending human suffering caused by war
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is to never go to war.
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But we are just not there yet as a species.
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Until we are,
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the mental suffering that we create in our sons and in our daughters
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when we send them off to fight
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can be alleviated.
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But we must ensure that the science, the energy level, the value
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that we place on sending them off to war
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is at the very least mirrored
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in how well we prepare them to come back home to us.
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This much, we owe them.
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Thank you.
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(Applause)
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