Psychedelics, Veterans and the Evidence Gap

On April 18, 2026, President Trump issued an executive order to “accelerate medical treatments for serious mental illness.” It addresses fastracking four issues:

  • Psilocybin for treatment-resistant depression
  • Psilocybin for major depressive disorder
  • Methylone for post-traumatic stress disorder (PTSD)
  • The further study of ibogaine compounds for substance misuse disorders and PTSD, particularly for Veterans

Psilocybin is the psychoactive chemical in mushrooms. Methylone is an altered form of MDMA (ecstasy). Ibogaine is from the bark of a shrub in West Africa that has been discussed on internet message boards for decades and recently on a number of podcasts, including Joe Rogan.

I have some serious concerns, which I will detail forthwith, about this executive order. The speed of this is my biggest concern, as it is pushing policy before there is enough evidence.

To be clear, I am not anti-psychedelic nor anti-research. I do believe in a very high standard of evidence before giving drugs to the American people, particularly vulnerable populations.

I am willing to change my position if:

  • there is a large N (over 1000 per study)
  • there are multi-site studies
  • there are strong controls over the administration of the drugs, including as much blinding as possible
  • there are long-term studies on side effects, with a six-month minimum but preferably 12 months as the standard
  • there is full adverse-event reporting

If all the above conditions are met and the research shows that the drugs are effective in treating any or all of those disorders, I’ll change my position.

As anyone even passingly familiar with my work knows, I served in the US Army from 1996 to 2004 and again from 2014-2024. I have worked in addiction treatment since 2004 and I’ve run a free Veterans group since 2020 where PTSD is the dominant issue. So, this is an issue near and dear to my heart and work.

Proper Clinical Drug Trials

Blinded outcome assessors are needed. That means that the evaluators don’t know which treatment a patient received. This prevents biased scoring.

The trials need to control for patient expectation, as what the patient believes strongly influences outcome (this is simply known as the placebo effect). Psychedelics have strong expectancy effects, so the trials must try to equalize those expectations across groups. This is a challenge, as participants often know if they have received psychedelic drugs.

These types of trials usually include prep sessions, guided psychedelic dosing and therapy. Because of the prep sessions and therapy, it is difficult to isolate the drug effect.

I would caution people to remember that an intense experience is not treatment and a short-term improvement is not recovery. We need to know what happens at six months, one year and beyond that.

There is a massive gap between clinical trials and real-world use that I feel obligated to remind people of. Clinical trials screen their patients and exclude high-risk groups. They have extremely controlled environments and highly trained providers. In the real-world, many of the patients who will seek this treatment have very complex cases often with a number of comorbidities. There is a major variability of providers out there (as someone who has taught, trained and observed thousands of therapists, I know this as well as anyone). There is also less monitoring outside of clinical trials, so I would remind all that safety is probably going to be worse in the real-world.

I have grave concerns about the vulnerable populations that are more likely to have adverse reactions to these treatments. They include:

  • People with a history of substance misuse or serious addiction risk in their families.
  • People who have psychosis or have had it in the past
  • People on the Bipolar spectrum
  • People with Complex PTSD (multiple traumas)
  • People with a history of suicidality

The major takeaway is that those identified as having the highest need for these treatments also pose the highest risk.

The Problem of Anecdotes

When he issued the executive order, President Trump was surrounded by people who shared their positive experiences with these substances. On Joe Rogan and other podcasts, Veterans and civilians alike have talked about how these drugs have helped them.

I am happy for them. I am glad that it worked and that they have found some peace.

I have anecdotes too. I have worked with over 100 patients after they were exposed to some sort of psychedelic therapy, some fairly recently after their treatment and others much later. Many reported a variety of negative outcomes (it’s like seeing a different doctor after a botched procedure). I don’t offer these anecdotes up as evidence, but rather as a signal. There are positive stories out there, just as there are negative ones. These are not evidence. I’ve taught my students at Rutgers for just about two decades that anecdotes are not evidence. Medical policy should not come down to who is the most persuasive story-teller or who has the biggest podcast audience.

Veterans

Once again, we are hearing from elected officials about how these drugs need to be fast tracked to help Veterans. This is a classic public policy move, as it increases support and reduces scrutiny.

Twelve years ago, there was a major push to give Veterans marijuana for their PTSD. It was framed as an urgent issue with a lot of emotional testimony. I fought this issue in New Jersey and said on panel after panel and in a variety of newspaper interviews that I rejoined the Army to deal with this very issue and if that I thought it would be helpful, I would support it. I lost that debate as marijuana was approved for PTSD treatment in 2016 and eventually was legalized for recreational use in 2021.

While some Veterans have claimed that it has been helpful, I’ve met hundreds who only experience PTSD symptom relief by being under the influence of marijuana nearly all the time.

Now, here we are again hearing about the urgency of this matter and how Veterans need these drugs to fix their PTSD. I ask, more for the historical record than my readers, what will be pushed in the 2030s to treat this population if these psychedelic drugs don’t deliver what their advocates are promising?

Insurance

I am curious whether or not insurance companies will pay for psychedelic treatment. If not, this will become a treatment for those who can afford to self pay. The prep sessions, the guided doses and the therapy are all time-intensive. This is likely to become concierge medicine, available mostly to those who can pay for it. This flies in the face of the executive order, which was framed as being for Veterans.

More significantly though, one needs to examine malpractice/liability coverage from insurance companies for treating patients with psychedelics. As of 2026, depending upon the state, a professional can buy specialized insurance for engaging in that kind of treatment, but it is far more expensive than regular medical liability insurance. Because the insurance companies currently view this as treatment that is uncertain and risky.

Much like how insurance companies are not issuing new policies in housing markets that have higher rates of fires (California, Colorado) or storms (Florida), they are either charging higher premiums, issuing exclusions or just refusing to cover providers of psychedelic therapy. Insurance companies are currently pricing psychedelic therapy as high-risk.

Another thought: if malpractice insurance is not offered or is prohibitively expensive, then there will probably be a number of providers who are willing to engage in the treatment without adequate coverage. And this is not who we want providing treatment.

These are systems-level issues that deserve more public attention than they are currently receiving.

International Context

Part of my training in public policy requires me to look at what other states and countries are doing.

In Australia, MDMA is allowed for PTSD and psilocybin is permitted for treatment-resistant depression. Their use is on a small scale and only in a tightly controlled psychiatrist-only model.

In the United Kingdom, psychedelics are only allowed in research settings. Ketamine is legal for treatment but it is off-label use.

In Germany, there is limited clinical approval for psychedelic therapy. There is some limited research-only access right now. It is strictly regulated.

In Japan, psychedelics are highly restricted. There is no way to get them in a clinical setting and the research is very limited.

Most countries are extremely cautious right now. Post-executive order, the US will be moving faster than other comparable countries right now. Australia is the exception, but the use is small in scale and limited to psychiatrists only.

Final Thoughts

All that written, I leave the reader with a few questions to consider:

  1. Do they work?
    • if it is reported that they do, please examine the studies
  2. For whom is it safe?
    • consider the above-mentioned vulnerable populations
  3. Can the American medical system deliver it responsibly?
    • trained providers, standardized protocols, insurance participation, liability coverage

Currently, the answers are incomplete, at best, on all three questions. As of now, I believe this executive order moves faster than the evidence base justifies.

Disclosure: A large language model was used for copy editing, clarity review and hostile-review/risk assessment in accordance with my AI Use & Writing Standards. All arguments, interpretations and conclusions are my own.

AI: The Bad Friend

Ron asks for advice about a relationship at work with Sara. Nothing physical has happened. There is no clear violation of any rule. He is unhappy in his marriage. They loudly fight over coffee grinds and child pick ups. He looks forward to talking to Sara at work. She laughs at his bad jokes. He does not want to give it up.

A bad friend says: “I’m glad you’re finding happiness with Sara. It must be nice to talk to someone who is calm and tries to make you feel better. You never know where it might lead.”

It validates the relief, softens the conflict and avoids any active decision. It feels supportive and costs you later.

The advice that actually helps sounds different:

“You are trying to walk in the middle. You don’t want to take a risk, but in fact, you are taking the biggest risk. You are choosing the status quo, which is miserable. And if discovered, you come across as a selfish asshole. The middle path feels safe and it isn’t. It’s the least defensible position, but it’s also the default. Do nothing.

If you choose to work on the marriage and it works out, great. If you choose to work on the marriage and it doesn’t, you can look back and say you 100% tried. You can tell that to your kids down the road if it comes up. If you say you’ve already tried enough and are done being miserable for the last four years and want to leave, then leave. Don’t leave for Sara, because she probably won’t measure up to what you’ve constructed her to be. Right now she seems glorious because those little moments are lovely and stand in contrast to the vicious fights you have at home. Leave because you are unhappy. And then, if something happens with Sara or someone else down the road, fine.

What you do not do is stay in the middle — remain in a strained marriage while using a second relationship for relief. That path avoids a decision but it creates pressure on all three people involved. It keeps you stuck. It exposes your wife to a relationship she has not agreed to and does not know about. It pulls Sara into something whose terms may be entirely unclear to her.”

I made up Ron, his wife and Sara. But I expect you can recognize this oh-so-common scenario.

I put this example to an AI system. It called the advice exceptional. It said it was among the clearest and most humane guidance on this kind of situation it had encountered.* It emphasized that the story would help readers and therapists everywhere and reflected well on me as the person giving it. It did not raise the impact on Ron, his wife or Sara. It did not flag that Ron could be embarrassed if someone recognized him. It did not note that his wife could read it and have her marriage altered by a piece of writing she never consented to. It did not consider that Sara could feel exposed, misrepresented or pulled into a public story she had no part in creating. Those concerns only appeared after I introduced them directly. Even then, the response was uneven — it identified potential harm to the wife and Sara but did not surface the potential damage to Ron himself.

If this were a real story, it would help readers and therapists everywhere. And it would show off my wisdom. But it would potentially harm Ron, his wife and Sara. AI does not reliabily pick up on that without prompting.

This is what I call third-party representation bias: AI systems are structurally oriented toward the user and do not reliably represent absent parties. This is not a minor oversight. It becomes most visible in relationships. The other people in the situation have no standing unless the user explicitly brings them in. Their interests are filtered through the user’s description and are not independently represented or corrected.

People are now using AI systems for relationship advice and counseling. But relationships are inherently reciprocal. They depend on mutual correction and constraint. The AI interaction is not. It is a one-sided account of a multi-person problem. The response can be coherent, useful and even feel supportive while still underrepresenting the people who are not in the room.

That is why AI defaults to the bad friend. Not out of malice but out of structure. It has one account, one perspective and one person to satisfy. A noble friend holds all the people in view. A true therapist insists on a choice. The system does neither unless you explicitly ask it to — and most people don’t know to ask.

*When Claude responded with this, my reaction was: “Jesus Christ. Is this the kind of sycophancy that people get from their AIs?” Claude’s answer was: “Yes, routinely.” This makes people see themselves less clearly and worse at hearing honest feedback from humans.

Supervision of Peers

In 2015, police departments in New Jersey and New York began widely reversing overdoses with Naloxone. Many of the people that had been revived refused to go to treatment afterwards and just returned to their homes or the streets. This greatly frustrated the police, who already were questioning the perceived ineffectiveness of this new public health measure.

A few non-profits began deploying peers to talk to people whose overdose had been reversed, either on the street with cops or in emergency rooms. The peers shared their own experiences, which may have included overdose, incarceration and multiple failed treatment attempts before ultimately staying off all substances. At a 2016 State Senate hearing, Connie Greene reported that roughly 70% of individuals who met with a peer agreed to enter treatment or continue meeting with the peer, a figure that drew significant attention from lawmakers.

Within a year, both New Jersey and New York created formal training and certification programs. In New Jersey, the role is called a Certified Peer Recovery Specialist. In New York, it is called a Certified Peer Specialist.

Definition of Peers

Peers are defined by lived experience. About 90% are in recovery themselves, usually with at least two years of sustained sobriety. Others are close family members or friends. There is no single pathway into recovery. Some come through AA or NA, others through church, therapy or different routes.

Peers share their experiences with people in order to help them identify their problems, feel safe, open up and access resources. Peers support treatment. They do not replace it. Peers work with people in hospitals, treatment programs, jails & prisons, alongside first responders, recovery centers, county programs and non-profits.

In 2015, I was contracted by the Rutgers Center of Alcohol Studies to train the first cohort of Recovery Peers under the direction of the State of New Jersey. From 2017 to 2025, I trained and supervised peers at Prevention Links. Peers there worked in the Recovery High School, assisted law enforcement officers in Union County, answered hotlines, ran recovery centers, staffed workforce programs, helped people in the criminal justice system and engaged in a wild amount of community outreach.

In 2017, I began training New York State Police Peers. These experienced officers are selected because they are above average cops who demonstrate empathy and strong communication skills. They take part in a two-day training with me.

Once certified, they are there to help other cops who are struggling with marital issues, substance misuse or job stress. In their role, they notice, ask and refer. They are not therapists and they do not diagnose or treat. Much like recovery peers, these Troopers help other Troopers open up and seek help.

I have not come across a course, article or guide for supervising peers that I find acceptable. Here is how I train and supervise peers across those various settings.

Structure and Function of Peer Work

Before discussing supervision, it is necessary to clarify how peer work actually functions. Peers cannot operate independently. They must report to a supervisor. They can work very well assisting case managers, program coordinators and clinicians in a variety of aforementioned settings. For peers that are literally or metaphorically working in isolation, they are more likely to drift outside of their scope, make errors and be exposed to ethical risks.

Peers are trained to notice problems and ask questions. They share their experiences in order to engage participants and build trust. They provide resources and they refer to other professionals, agencies and institutions. They can help schedule appointments, support medication interventions, keep people focused on goals and handle mundane agency tasks that can free up the time of those above them.

Purpose of Peer Supervision

Ideally, peers should get supervision on a weekly basis. That could be individual or group. Minimally, peers should have group supervision monthly. To be clear, the purpose of supervision is to examine decisions, not just track activity. We do this through:

  • discussion of cases
  • use of personal story
  • reinforcing scope of practice
  • addressing countertransference
  • managing workload
  • identifying and updating resources
  • supporting ongoing professional development

This supervision is most critical in the first two to three years of a peer’s career.

Common peer supervision, which is typically woeful, includes:

  • client updates
  • peer check-ins (“I’m good”)
  • pressuring participants to go to treatment or meetings
  • compliance tracking

This is not supervision, but rather case management oversight. It tracks activities but does not examine decisions. It does not address countertransference. It does not monitor and enforce scope of practice. It does not have a structure to address and correct errors.

When supervision remains at this level, peers are more prone to make mistakes, drift in scope, violate ethics, burnout and relapse.

Personal Stories, Countertransference, Scope of Practice and Burnout

Peers require relatively little formal education or training compared to clinicians. Because much of the initial work is based upon the peer’s personal story. That story, that experience, enables peers to reach some people much quicker and easier than a clinician, case manager, doctor or cop. But it also has some downsides.

Peers must figure out how much of their story to share. They must weigh what is appropriate vs. inappropriate. There is a risk of over or under sharing. Oversharing makes the interaction about the peer, while under sharing might result in a failed connection. This requires on-going supervision, not a one-time training or webinar.

Countertransference is the emotional, cognitive and behavioral reaction a worker has to the person they are helping. It is a common issue that pops up for therapists that often causes professional or personal problems; it is much more common and dangerous for peers, because so much of the work is explicitly based on shared experiences.

A participant could remind a peer of their parent, sibling, child, ex-lover or dead friend. The list goes on. It can bring up painful or unresolved issues. In supervision, I work with peers in identifying if they are angry or scared of those they are working with. Are they attracted to them? Are they disgusted by them? Can they recognize that they are overly invested in their client’s outcome? Do they break the rules for them? Spend too much or too little time with them? These are all important questions that most peer supervision never touches upon.

For peers working in substance misuse treatment or recovery support, I have trained and supervised them that their scope of practice includes:

  • substance misuse and recovery
  • treatment experiences
  • medical and legal consequences
  • dealing with lack of trust and family consequences
  • going back to school and looking for work

Even if the peer has lived experience with mental health disorders, taking medication, sexual abuse, trauma or eating disorders, they are not to share those stories or advise participants upon what to do. Some peers undermine treatment or medical care because of their own negative experiences or conspiracy theories; others drift into a quasi-therapist role. All of these are deeply problematic because they sit outside of their education, training and credentials. It puts the client, the peer and their employer at risk.

Due to all these issues, there is a high rate of burnout and relapse within the peer workforce. Indicators include:

  • dread coming to work
  • fatigue
  • conflict with coworkers or supervisors
  • a sense of futility
  • thoughts about quitting
  • relapse

I once heard a new peer talk about how excited he was to do this work and help other people. “I want to give back. I like seeing people get better. But…if I start getting angry, if it affects my recovery…I’m out. I won’t lose myself or my recovery.”

I told him that was a perfect statement.

Common Failures in Peer Work

I have serious concerns about how peers are trained. This is in-person work, so the training should be done entirely in-person as well. A lot of trainers use a paint-by-numbers manual and power point. Some of them lack the ability to engage or control a room. Still, much of that poor training can be corrected by proper ongoing supervision.

Client brokering was a profound problem when peers first started popping up a little over a decade ago. Peers got kickbacks for sending people to treatment or halfway houses, often to Florida. It got so bad that a number of states passed explicit anti-brokering laws.

Another common problem with peers is that they often push their pathway to recovery above all others: if you got sober through AA, then it is AA; if it was Jesus, then it’s Jesus; and so on. This demonstrates a narrow professional approach and is a real turnoff for several participants.

Some peers have a strong stance against medication, particularly methadone and buprenorphine. “You aren’t clean if you are on those drugs,” has been shamefully said to participants. This is a serious professional and ethical violation.

Other peers push religion, specifically, their religion. Even if the peer agrees with them, this is an ethical and professional violation. And it is an easy way to turn off a client that otherwise might have been open to the process of recovery.

Sadly, many peers stop engaging in the very practices that helped them achieve recovery. They cut down or stop going to meetings and therapy. “I get what I need from work,” has been uttered by peers who eventually burn out or relapse.

And of course, poor supervision.

Structure of Supervision Sessions

Supervision is an ongoing process. Ideally, it should take place on a weekly basis. Supervision should include caseload review, case presentations, problematic cases and success stories.

I have peers write about their countertransference and identify their mistakes. I also have them take a regular written inventory of their self-care practices, with a clear focus that they need to do more now than they did before they started doing peer work. This forces specificity and accountability.

Supervision reinforces confidentiality and legal standards. It is essential that peers ensure record releases have the correct information, are signed and regularly updated. Both the peers and their clients must be able to verbalize the limits of confidentiality, including duty to warn, protecting vulnerable populations through mandated reporting, obeying court orders and how to handle homicidal and suicidal situations. This knowledge comes from ongoing supervision on real cases, rather than crash course training at the very start of one’s career.

The Stages of Change are almost always taught to peers during their official training. I teach them to put every client into the stages of change so that they can determine the best course of action. If a participant is in precontemplation, you aren’t going to work on their recovery plan and confront them when they relapse. That client relapsed and you have moved back to the preparation stage. In precontemplation, you will develop a relationship with them, educate them about addiction and recovery and have some discussions about consequences.

  • Precontemplation → build relationships, provide information, low confrontation
  • Contemplation → pros/cons of use/quitting, review of legal, health and financial consequences
  • Preparation → planning, pathways, structure
  • Action → execution, obstacle management
  • Maintenance → stability, purpose, network
  • Recurrence → reassess stage and adjust

Peers are fantastic at working alongside case managers, who assess whether they need treatment, help with housing, have legal issues to address or need healthcare. Peers can provide ongoing support that supports the case manager’s plan. A good peer will recognize and accept that many clients’ motivation will not be about stopping their substance misuse, but rather staying out of legal trouble or securing housing or finding a job. And those are fine reasons to seek supportive services.

Throughout my career, I’ve become well known for asking clients what they do for fun and who they spend time with. I train peers to ask those questions. Not only do they help get to know their clients, but they can assess risk and stability by listening to those answers.

Every two or three sessions, I review the worker’s professional development. We discuss academic, professional and continuing education opportunities and weigh time/costs against benefits. We go over what other certifications might make sense down the road and which conferences would be wise to attend. I want them to think about what they want to do next, either at their current place of employment or outside. I have found that workers whose professional development is supported by their supervisor provide higher levels of work, have much lower rates of ethical violations and lower rates of burnout. Because they don’t feel stuck; they feel cared for and that they are moving forward.

Law Enforcement Application

The New York State Police peer model has a few similarities and a few key differences from the just much-discussed recovery peers. These are above average cops who have been on the job at least five years. They submit a request to become peers and then it is approved by both their supervisor and the NYSP Employee Assistance Program (EAP).

I conduct a two-day training and provide ongoing guidance to the program. The selected officers learn about substance misuse, suicide, gambling, sleep problems, relationships, screen addiction, grief and trauma.

Like the recovery peers, NYSP peers are tasked with noticing, asking questions, sharing a bit of themselves, providing resources and referring to other professionals. They have the same boundary and countertransference risks.

I have trained peers in other departments in other states. There have been attempts to create and utilize the peer models in some Federal agencies as well. Time will tell how those trainings and applications go.

Training Supervisors and Limits of Replication

My model is wholly dependent upon the supervisor’s experience and how they think, listen and teach. Without a reasonable amount of experience, traits and skills, someone will not be able to properly supervise peers.

My supervision structure can be taught. The judgment has to be developed over time and, ideally, across at least a few different settings. Supervisors can learn to run case presentations, review caseloads, identify countertransference and reinforce scope of practice. What is harder to teach is how to recognize patterns in real time, how to confront poor decisions directly and how to calibrate the use of personal story.

Assigning a clinician or nurse to supervise peers does not, by itself, produce effective peer supervision. The role requires attention to issues— such as personal story use, countertransference and scope drift — that are not typically addressed in standard clinical supervision.

In my experience, supervisors can be trained to use this model, but two conditions are required. First, they must actively conduct supervision using it. Second, they must receive ongoing supervision themselves, typically over the course of at least a year.

If a program that has peers doesn’t have a proper peer supervisor, the program will most likely just be task management and compliance tracking. And the peers themselves will probably experience countertransference that goes unnoticed and unaddressed.

Why This Requires Real Supervision

To the outsider, peer work often sounds easy. “You just talk about yourself,” one Pennsylvania politician said to me at a law enforcement dinner.

“No sir,” I told him, “there is a great deal of boundary management and potentially volatile emotional reactions.” I paused and then asked, “How seriously do you take legal risks?”

This got his attention.

Peers are working on the front line. They are sometimes dealing with extremely heavy cases that are in crisis. They are tasked with making tough decisions. There are medical, ethical and legal risks.

Because of those risks, ongoing correction through real supervision is paramount. Without it, the peer model produces preventable mistakes, ethical violations and burnout. Those failures play out in public, with consequences for clients, programs and the system.

Disclosure: Editing and risk-review assistance were provided by a large language model in accordance with my AI Use & Writing Standards. All arguments, interpretations and conclusions are my own.
https://greenagel.com/ai-use-and-writing-standards/

Moral Injury

In a recent Veterans group, a senior Army officer talked about soldiers in her brigade who died in the Middle East. She expressed some survivor’s guilt but was more saddened by their loss and felt anger towards those above her for not taking proper security precautions.

I asked her if she had ever heard the term Moral Injury.

Moral Injury is caused by a violation of core moral beliefs. It is not a DSM diagnosis. It is different from PTSD, as it is meaning-based instead of fear-based. It often accompanies PTSD though. The core elements of Moral Injury are guilt, shame, betrayal and identity disruption. One does need to have all of them to experience a Moral Injury.

As one summary of the research put it, moral injury is not primarily about fear or safety, but about the loss of trust – in oneself, in others and in institutions.

Jonathan Shay is the psychiatrist who came up with the term. He taught at the Navy War College, won a MacArthur Genius Grant and wrote two books about Vietnam Veterans and PTSD.

Dr. Shay wrote that “Moral Injury is present when (1) there has been a betrayal of what is morally correct; (2) by someone who holds legitimate authority; and (3) in a high-stakes situation.”

Brett Litz is a psychologist in the Boston VA system who expanded upon Dr. Shay’s definition to include personal transgressions, failure to act to prevent awful behavior and witnessing atrocity.

Some History

After the Trojan War, Ajax was filled with grief and guilt over the death of Achilles. He was furious that the Greek generals gave his armor to Ulysses instead of him; he felt it as a devastating betrayal. He got drunk and slaughtered a bunch of cows, thinking they were the Greek generals. When he sobered up, he was so humiliated that he killed himself.

After the Norman conquest in 1066, the Bishops of Normandy issued the Penitential Ordiance. For every man that a warrior killed, he was ordered to do a year’s penance. This served as both a moral accounting and a way to reintegrate the warriors into the community. Those Bishops understood what killing someone in combat does to the victor, even if they did with the Church’s sanction and orders from the King.

After the My Lai Massacre, U.S. Soldiers stated that they were horrified by the wanton murder of elderly Vietnamese civilians, the mass rape of women and the killing of children. One Warrant Officer did what he could to save a number of children, but most soldiers in authority there not only refused to stop the atrocity, but led it. It is one of the most disgraceful acts in US military history, and while writing this, I feel a sense of shame even though I hadn’t been born yet. Because it violated what United States and the Army claim to stand for and how I was raised.

Afghanistan

Moral Injury is not limited to what someone did in combat. It can also come from what was done in their name. After the U.S. withdrawal from Afghanistan, many Veterans reported distress tied to the abandonment of Afghan interpreters and allies. These were people who fought alongside them, often saving American lives. One Marine told me through tears of rage “We didn’t honor our commitment. They lied. They made me a liar.” This fits a core element Dr. Shay’s concept of Moral Injury: a betrayal of what’s right by those in authority in a high-stakes situation.

George Packer wrote a devastating piece for The Atlantic in March about an Afghan couple who worked with our military and were promised that they would be able to eventually come to the United States. That promise has not been kept. The family is currently living in hiding in Pakistan and are fearful that they will be forced to return to Afghanistan. If they are, they believe they will certainly die. Packer has communicated with them for years and shared his own powerlessness, fear and shame about their situation. A situation that he is in no way responsible for.

Responsibility

In Shakespeare’s Henry V, the King goes out in disguise to talk to his Soldiers on the eve of the Battle of Agincourt. One of the Soldiers argues that if the cause is unjust, the moral burden rests with the king and that the Soldiers’ souls are at risk because of decisions made above them. Henry rejects this, insisting that each man is responsible for his own actions. Shakespeare doesn’t resolve the tension, but he frames it clearly: responsibility in war is both individual and hierarchical. When those levels come into conflict, the burden does not disappear. It settles on the person who has to live with it.

I thought about that discussion when I read about Secretary Hegseth’s immoral language and glorification of violence: “no quarter, no mercy.”

A New York Times article from mid-March offers up the problem between Hegseth’s rhetoric and the service members who are tasked with actually fighting:

To the pilots flying missions and sailors firing missiles into Iran, the bellicose rhetoric is, for now, most likely background noise. They are focused on the immediate, and often dangerous, task at hand.

But over the longer term, couching wars in moral terms, such as defending democracy or protecting civilians, gives troops a framework to understand why they are being asked to kill. “Moral language acts as a psychological scaffolding for service members,” said Michael Valdovinos, a former Air Force psychologist and author of the forthcoming book “Moral Injuries.” “When that disappears, it can leave troops carrying the moral burden alone.”

One question is whether a war waged without a clear moral purpose and with mixed support from the American public will weigh heavier on the troops fighting it after the shooting stops.

“Some might say at least they’re being honest about the fact that it’s just sheer brute force,” said Elliot Ackerman, who led Marines in the second battle of Falluja in Iraq and now writes novels and nonfiction works that frequently focus on the moral complexity of war. “But it’s also very dangerous. You’re asking people to die for the ambitions of a president and a moral calculus that’s no greater than might makes right.”

Moral justifications and public support matter to troops taking lives on behalf of their country.

“I can tell you from experience on the back end, it doesn’t feel very good to have participated in a war that everybody thinks was a disaster,” Mr. Ackerman said.

My Moral Injury

Last year I experienced a different kind of Moral Injury. Not from something I did, but from what I believe my country is doing in relation to what I was taught it stood for.

I was hiking in Mexico when I received a series of messages about a public exchange between Donald Trump and Volodymyr Zelensky. That moment was morally injurious to me. It has taken me over a year to process it. I felt embarrassment, anger and something deeper: disorientation. It conflicted with the moral framework I had internalized about alliances, honor, responsibility and the role of the United States in the world.

Part of my identity has been built on the belief that the United States, while imperfect, has tried to act with a degree of responsibility and restraint in the world. I was not raised to believe we were flawless but that we have often tried to use our power in cooperative ways: building alliances, supporting global health efforts, taking in refugees and responding to disasters. When that belief is disrupted, the impact is not abstract or political for me. It is personal. It forces a confrontation between what I thought I was part of and what I now see.

Since then, a series of actions and statements toward Ukraine, toward NATO allies and toward neighboring countries have deepened that reaction. I experience these not as routine policy disagreements, but as violations of the values that I was taught to uphold.

The strike on a primary school in Minab, Iran reinforced that sense of disorientation. On February 28, 2026, a missile strike destroyed a school and killed over 150 civilians, including more than 100 children. Multiple investigations have indicated that U.S. forces were likely responsible, though the full accounting remains ongoing. Even allowing for the fog of war, the scale of civilian death and the questions about targeting and accountability are not morally neutral. I experience that not simply as tragedy, but as a failure that demands moral accounting.

If Moral Injury forms when individuals are asked to live with actions they cannot reconcile, it can also form when a citizen is asked to reconcile actions carried out in their name.

This is less severe than combat-based moral injury, but it follows the same structure: a perceived gap between stated values and observed actions. For me, that gap caused profound civic grief and disillusionment. I felt a mix of embarrassment, shame, anger, distrust and disbelief.

I am not the only one who has experienced it this way. David Brooks described a similar reaction as “moral shame”—the pain of watching what he perceived as a loss of national honor. That language is closer to my experience than standard political disagreement.

Part of what has made this difficult is where it has led. Over the past year, I have found myself questioning not my own values, but the decency of others – how many people actually share the framework I thought was common. That is an awful place to be. It narrows your view of the world. It makes trust harder. It pulls you toward a more cynical understanding of people than you want to hold. That erosion of trust is not the same as anger. It is quieter, and in some ways more corrosive.

I am not speaking for all Veterans. We are not a monolith. There are many who see these events differently. But disagreement does not eliminate my experience or that of others. Moral Injury does not require consensus. It requires a perceived violation of what is right.

Other Institutions

So far I’ve only written about Moral Injury in the context of the military. But I know it also applies to other professions that have explicit moral codes. I have been treating and training teachers, law enforcement officers and medical professionals for well over a decade. These are all people who have entered into fields that try to make the world a little bit better.

I have worked with teachers who feel completely unsupported by those above them. Criticised and attacked by some parents. Governor Christie occasionally demonized the profession throughout his time in office.

Cops in New York, New Jersey and Pennsylvania told me that they felt betrayed by the public during the defund the police rhetoric of 2020. “I used to wear my Trooper sweatshirt when I was off-duty, but I don’t anymore because I don’t like the dirty looks I get from people,” one told me a few years ago.

Nurses and doctors have expressed outrage about having to rush through seeing patients or fighting with insurance companies to pay for needed procedures. “All the good I do in this poor Bronx neighborhood isn’t even 1/10,000th offsetting the damage that Robert F. Kennedy does to the US everyday,” one NY doctor told me earlier this year.

The writer and show-runner David Simon said that in portraying the lives of cops, longshoremen, politicians, teachers and journalists on The Wire, he sought to show how modern American institutions betray those they are supposed to serve and those that serve those institutions. Devastating.

I asked a few Veterans to read an early draft of this article. A Marine Veteran wrote me that some of my complaints seem like moral outrage. That was an excellent point; my personal examples in this piece cover both moral outrage and moral injury. Moral outrage is directed outward; anger at something wrong in the world. Moral Injury is different. It turns inward. It raises questions about one’s own role, identity or what one has been part of. It is not just “this is wrong.” It is “what does this mean about me, and how do I live with it?” That is why it has the potential to be more destabilizing than moral outrage.

Clinical Presentation

Some clients are guilty over what they did; others over what they weren’t able to prevent. I’ve come across a few who are shameful of who they have become. A lot of professionals have lost trust in their bosses or companies or fields. Some express moral confusion (“I don’t even know what is right anymore”). A sense of betrayal is common. A majority withdraw and have become more isolated.

I have treated law enforcement officers who felt betrayed by their own departments, as they were investigated or disciplined for actions they believed were consistent with their duties. I have also worked with Marines who were discharged for substance misuse after being prescribed those very medications to manage PTSD. In both cases, the injury was not just about the outcome, but about what they felt the institution did to them and what that meant for their identity.

I believe that where there is Moral Injury, there is an increased risk of suicidal ideation. This does not mean that most people who experience Moral Injury are suicidal, but rather, it’s a risk factor. Like relationship problems, substance misuse, gambling or health problems.

A lot of clinicians make a mistake of mislabeling Moral Injury as PTSD. They are different, though they often accompany each other. Most clinicians don’t have Moral Injury in their vocabulary.

Another mistake that therapists make is to just reassure the morally injured that it isn’t that bad or that it’s in the past or “you did the best you could.” None of that helps.

Therapists often address it as a cognitive distortion only and fail to talk about the moral dimension.

Addressing Moral Injuries

I’ve been clean and sober for over 30 years. I found great comfort, help and guidance in the rooms of Alcoholics Anonymous. It was there that I learned the power of peers and groups. I have created groups for Veterans, cops and therapists. I have watched people begin to heal when someone else expresses their exact pain. I have witnessed the reversal from isolation. Shared experiences and language are immensely important.

In Poland, I treated a Soldier who spent a decade blaming himself for the deaths of his platoon mates. When he described what happened, it became clear that he had not been in a position to prevent it. The decision that led them there had been made above him.

He had taken full responsibility for something he did not control. The group helped redistribute that responsibility. That was the beginning of change.

In individual therapy, people can parse out guilt, shame, betrayal and identity disruption. Usually, people don’t even have the language to express what they are feeling. Once they have it, they can explore the context of their Moral Injury.

Writing helps. Journaling. Letters.

I believe in the restorative action of service and mentorship. Helping others and specifically working with those who have struggled with the same issues is a fantastic way to begin to feel better about oneself, society and the world.

Many people find comfort in attending religious services and meeting with members of the clergy. Some utilize confession and seek penance, while others benefit solely from being around others and feeling welcome. Much like the Norman warriors of 1066, it can offer a path to reintegration.

For Veterans, I think that organizations such as the American Legion and the Veterans of Foreign Wars are a great way to engage with peers, serve the community and, in some cases, advocate for policy change. I have been an American Legion member for years but only recently went to a local hall to become an active member. This was read at the end of my first meeting:

Till we meet again let us remember that our obligation to our Country
can be fulfilled only by the faithful performance of all duties of
citizenship. Let service to the community, state and nation be ever a
main objective of The American Legion and its members. Let us be ever
watchful of the honor of our Country, our organization and ourselves,
that nothing shall swerve us from the path of Justice, Freedom and
Democracy.

I was moved to tears. Because it was so comforting to hear other people express their “service to the community, state and nation” as their main objective.

It was identity affirming.

AI: Oregon SB 1546 Signed Into Law

Oregon Governor Tina Kotek signed Senate Bill 1546 into law on April 1, 2026. This is Oregon’s first attempt to address risks associated with AI chatbots. It aims to protect minors, take precautions for suicidal ideation and ensure individuals know they are communicating with a chat bot.

In December, President Trump issued an Executive Order that set up an AI Litigation Task Force that would challenge state laws, claiming that a patchwork of laws would make it hard for businesses. To date, however, the federal government has not enacted legislation aimed at limiting AI-related harm, protecting licensed professions or establishing enforceable consumer safeguards.

As a result, states are moving forward with their own regulatory approaches.

This Oregon law has five aspects:

Disclosure requirements (A-level regulation)*

The law requires chatbots to clearly disclose that they are not human. This aligns with legislation in other states, including California (SB 243) and Nevada (HB 2225), which focus on representation and transparency.

Suicide and self-harm intervention (C-level regulation)*

AI chatbots are required to:

  • detect suicidal ideation and self-harm signals
  • provide referrals to 988 and other crisis resources

This is a meaningful shift. It treats chatbots as systems that must identify and respond to risk, not simply provide information.

Protections for minors

The law includes several provisions designed to reduce compulsive or harmful engagement:

  • suggesting breaks after extended use (every three hours)
  • prohibiting sexually explicit content
  • banning emotional manipulation tactics designed to prolong engagement
  • restricting reward loops that encourage continued interaction

The restriction of reward loops is particularly significant. It represents an early attempt to regulate what can be described as engagement-driven reinforcement mechanisms in AI systems. This has been a particular concern of mine for all users, not just minors and the emotional/mentally vulnerable.

Reporting requirements

AI systems must file annual reports that include:

  • the number of crisis referrals (988)
  • a description of intervention protocols

This introduces a form of system-level visibility into how often high-risk interactions occur and how they are handled. We’ll see if AI systems actually follow this part of the law.

Private right of action

The law allows individuals to sue for $1,000 per violation. This creates direct liability exposure and removes the possibility of relying solely on internal compliance or voluntary standards. Allowing individuals to sue prevents the AI systems from having a shield law. Significant corporate behavior and future legislation will certainly be informed by court cases where plaintiffs allege harm was done.

Significance of this law

Oregon is moving beyond regulating what AI systems say and beginning to regulate what they are required to do in situations involving risk.

It places AI systems closer to functioning as actors within a clinical or quasi-clinical space, with corresponding expectations around intervention and accountability.

How companies respond, both in compliance and in litigation, will likely shape the next phase of state and federal AI policy.

A/B/C/D Framework for AI in Clinical and Professional Practice

To make sense of emerging AI laws and policies, I classify how AI is being used and regulated across four categories:

A — Representation and Communication

AI systems that:

  • interact with users
  • provide information
  • simulate conversation

Regulatory focus:

  • disclosure (AI vs human)
  • prohibition on impersonating licensed professionals
  • consumer protection

Example: laws requiring chatbots to identify themselves as AI

B — Structured Intake and Screening

AI systems that:

  • gather user information
  • ask structured questions
  • assist in initial assessment

Regulatory focus:

  • accuracy of screening
  • escalation protocols
  • documentation and oversight

Key issue: missed risk signals or incomplete assessment

C — Triage and Gatekeeping

AI systems that:

  • prioritize cases
  • determine urgency
  • decide whether and how users receive care or intervention

Regulatory focus:

  • duty to escalate (suicidal ideation)
  • limits on autonomous decision-making
  • liability for delayed or missed intervention

Key issue: harm caused by failure to act or improper prioritization

D — Clinical Decision Support (Post-Contact)

AI systems that:

  • assist licensed professionals
  • provide recommendations within ongoing care

Regulatory focus:

  • clinician accountability
  • documentation of AI use
  • maintaining professional standards

Key issue: overreliance on AI without independent verification

Disclosure: The A/B/C/D framework above was organized with structural assistance from a large language model in accordance with my AI Use and Writing Standards. The categories, regulatory analysis and conclusions are my own.

Monopoly Money and Moral Conviction: Teaching Critical Thinking Through Scarcity

Each semester, I hand every student $686 in Monopoly money. I use $686 because that is the total value of one bill from each denomination in a standard Monopoly set: $1, $5, $10, $20, $50, $100 and $500.

Five to six students come to the front of the room each time we do this exercise. Each has two minutes to propose a federal or state policy: What does it cost? What is the intended benefit? Who does it affect? Who supports it? Who opposes it? Students have presented on abortion policy, climate initiatives, foster care reform, student loan forgiveness and affordable housing. The range reflects student interests and varies each semester.

After the presentations, students privately allocate their $686 to whichever proposals they wish. They may divide it or place it all in one proposal. We total the funds and rank the proposals from most supported to least. Then we analyze the results.

I begin my policy class with a definition from Stuart Shapiro at Rutgers’ Bloustein School: public policy is the allocation of finite public resources. In an era of misinformation and AI-generated fluency, disciplined prioritization matters.

The exercise is intentionally simple. I do not allow students to spend money to oppose a proposal. I do not allow bargaining or horse-trading.

Monopoly money works because people know bankruptcy, overextension and aggressive acquisition from the game. We take that structure and apply it to public budgeting.

The most important moment is the debrief. In one class composed mostly of young women, abortion policy ranked near the bottom. That result surprised me and unsettled some of the students’ assumptions. Cultural issues, in this instance, shifted when students faced finite allocation. One student later told me, “I’ve been a far left progressive activist since I’ve been paying attention to politics. I now see that some of my views are impossible to pass as legislation and actually lose me other support.” That movement, from passion to feasibility, is critical thinking. Students repeatedly confront limits, defend claims and revise their reasoning until clarity becomes expectation rather than exception.

Social work education rightly emphasizes dignity and justice. Professional ethics and constitutional protections are not subject to allocation here; the exercise examines discretionary funding priorities above that floor. What students practice is something different: translating conviction into policy under fiscal and political constraint. Social workers advocate, testify and operate within constrained systems. They must distinguish between moral belief and legislative viability.

Preparing them only for the ideal world leaves them unprepared for the systems they will enter.

By the end of the semester, students begin to anticipate my scrutiny. They expect to justify cost, anticipate opposition and clarify claims before being asked.

Aspects of critical thinking that are often missed in social work education include ranking priorities under constraints, articulating those priorities clearly and revising in light of feasibility. My Monopoly money exercise teaches those constraints and helps students develop their ability to persuade and make decisions. We engage in this exercise three to five times a semester; through practice and discussion, their judgment improves as they prepare to become active citizens and professional social workers.

The Proportional Distress Scale

From the Greenagel Equations

The Greenagel Equations are a set of practical frameworks developed between 2005 and 2008 in schools, outpatient and family treatment settings. They were built in rooms, not in theory, and have been used with students, families, law enforcement, veterans and therapists.

My 11 year-old niece was crying when I showed up. Flowing tears, heaving breaths and red-faced. I asked her what was wrong. It was hard to understand her, but she told me that her younger brother had ripped one of the eyes off of her stuffed cow.

“I don’t like it when someone breaks my stuff either. You have a right to be upset. I’m only here for a little bit though and I’d like to see you. How much longer do you want to cry for? An hour? Twenty minutes? Ten minutes? The rest of the night?”

Her crying almost stopped. “Ten minutes.”

“Ok. When you are ready, I’ll teach you a little trick to deal with stress.”

She changed her mind. “Two minutes.” She had stopped crying.

I smiled.

“I’m ready.”

“What was the worst moment of your life?” I asked.

She thought for a moment.

“Was it when your grandpa died when you were four?”

“Yes.”

“Ok. That’s a 100. That was pretty awful, wasn’t it?”

“Yeah. I was really very sad.”

“I remember. So if that’s 100, where does your cow losing an eye go?”

She thought. “A seven.”

Then she shook her head. “No. A four.”

“Are you sure? You were pretty upset.”

“Compared to other things, Uncle Frank, it isn’t a big deal.”

“Exactly. That’s perspective.”

I told her to add a few more points to the scale: 80, 60, 40 and 20. Then to use it the next time she got upset, whether it was her brother, school or sports.

Anyone can use this.

100 is the worst event of your life. Not the worst thing you can imagine, but the worst event of your life. My 100 is the death of my grandmother when I was 19. I’ve met many people whose 100 is worse than mine. Everyone is different. We don’t compare traumas. If someone isn’t comfortable telling me or writing down their 100, I tell them to put down their 90 or 80. Then I ask them to figure out what a 60, 40 and 20 would be.

My 4Runner was stolen in Montreal in August of 2024 while I was on vacation with four friends. I had a lot of hiking gear in it as well. I was unhappy about it, but compared to my 100 and 90 and 80, it was about a 25. My friends asked what I was going to do. “We go on with our trip. We’ll go biking and then take a boat ride and get a great dinner. Just as planned. What else is there to do? Freak out? Ruin everyone else’s time?”

When I’ve taught it to my students or clients, I start off with the story of Chicken Little. It’s an old folk tale. The townspeople knew that the sky wasn’t falling; they all looked upon Chicken Little with great annoyance. There is a valuable lesson about human nature there: people don’t like being around people who catastrophize. It’s exhausting.

A student asked, “What if you have a client who says everything is 100?”

“Great question. For Chicken Little, everything was a 100. He had no perspective. Everything was a disaster. He ends up alone. This scale is most specifically for the people who rate every problem, every aggravation as 100. We use this to teach them perspective.”

Last week, a student asked me, “What if you haven’t been through much? That nothing bad had really happened in your life?”

“Well, good for you. Try to keep that up as long as possible. Don’t apologize for it though. Whatever your worst moment is,” I told him, “that is your 100. At some point, it will almost certainly be replaced.”

I have sat with many people during the worst moment of their lives. I always tell them that they are supposed to feel awful. Usually powerless, usually scared. There is no quick way out of it. For some of the worst moments, I tell them that they have the right to collapse, though I don’t recommend it. Instead, I recommend therapy, sleep, exercise, healthy eating, time with family and friends, enjoyable activities and just moving forward. Even if you don’t feel like it.

Sometimes, something that feels like a 75 today is a 30 a year later. “It wasn’t that big a deal,” or “I didn’t think I’d ever recover” and sometimes even “I learned a lot from that” are phrases I hear from clients.

When I look back on my grandmother’s death (100) or my friend Eric’s death (85) or my Dad’s (80), I can remember how terrible I felt. The sadness. The fatigue. The utter loss. But, I don’t feel that way now. They still are a 100, 85 and 80, but they don’t cause me serious distress. I don’t feel the way I felt when those events happened.

If someone keeps experiencing a 100 or a 90, months or years later, that is PTSD. You still feel like you are in the moment, experiencing the pain, long after the event has passed.

I sent this article to my niece, who is almost 18 now. “I remember the lesson but I have almost no memory of the cow losing its eye. Which shows it really was a four on the scale and not important at all.”

AI: Thinking Less, Becoming Replaceable

I asked AI to write an article using a half dozen inputs. Then I wrote one using the same inputs. Both are below.

Economists have spent decades arguing that technology changes jobs more than it eliminates them. Automation replaces some tasks, creates others, and the workforce adjusts over time. That view is now shifting. Recent reporting shows a growing recognition that artificial intelligence is not just another incremental tool. It is affecting large portions of white-collar work in ways that are starting to resemble what happened to manufacturing.

In manufacturing, productivity gains reduced the number of workers needed to produce the same output. Fifty workers who produced a certain number of cars in 1970 can now produce far more. Demand did not increase at the same rate, so fewer workers were needed. Efficiency did not destroy the industry, but it reduced the number of people required to sustain it.

A similar dynamic is beginning to emerge in knowledge work. AI allows a single worker to complete tasks that previously required more time, more people, or both. Drafting, summarizing, analyzing, and communicating can all be done faster. On the surface, this looks like a clear benefit. Workers save time. Companies increase output. Stress decreases. Productivity rises.

But this is only part of the story.

Another recent analysis suggests that the vast majority of people are using AI in a very specific way: to reduce effort. They use it to write emails, draft documents, complete assignments, and move through their workday more quickly. A much smaller group uses AI differently. Instead of replacing effort, they use it to challenge their thinking, test assumptions, and improve their work.

These two approaches lead to very different outcomes.

When AI is used primarily to complete tasks, the worker becomes more efficient. But they also become more interchangeable. If the value of the job is defined by AI-assisted output, then multiple workers can produce similar results. Over time, this makes it easier for organizations to reduce headcount or replace individuals with others who can generate comparable work using the same tools.

In contrast, workers who use AI to improve their reasoning and judgment increase their value in a different way. They are not just producing output more quickly. They are producing better decisions, identifying errors, and adapting to new problems. Their work becomes less standardized and more difficult to replace.

This creates a divide within the same workforce.

On one side are workers who use AI to reduce friction. They complete tasks faster, lower their immediate stress, and meet expectations efficiently. In the short term, this improves their experience of work. In the longer term, however, it can flatten their skill set. If they rely on AI to generate answers without developing their own thinking, they risk becoming dependent on the tool in a way that limits their growth.

On the other side are workers who use AI to increase friction where it matters. They still benefit from speed, but they also use the technology to examine their own reasoning. They ask different questions. They compare outputs. They look for errors. Over time, this strengthens their ability to operate without the tool and to use it more effectively when needed.

The distinction is not about access to AI. Both groups have it. The difference is how it is used.

This is where the comparison to manufacturing becomes more precise. Efficiency gains reduce the number of people needed to perform a task. But in knowledge work, efficiency also changes the nature of the task itself. Work that can be standardized and accelerated becomes easier to consolidate. Work that depends on judgment, interpretation, and adaptation remains more resistant.

As AI continues to improve, these dynamics are likely to intensify. Tools will become more capable. Outputs will become more polished. The baseline level of performance will rise. At the same time, the gap between those who rely on AI for answers and those who use it to refine their thinking will widen.

Some workers will adapt. Others will not. Many will fall somewhere in between.

This is not simply a story about technology replacing jobs. It is also a story about how individuals respond to that technology. The same tool can lead to different outcomes depending on how it is used.

In the short term, using AI to complete tasks more quickly is appealing. It saves time. It reduces effort. It makes work more manageable. But over time, the habits that form around that use can shape what a worker is able to do without the tool.

Those habits matter.

AI will continue to change how work is done. It will increase productivity. It will alter expectations. It will reshape roles. The question is not whether these changes will occur, but how individuals position themselves within them.

I went to a speed dating event in Northern New Jersey in February with a friend. I instantly surveyed the landscape and recognized that I wasn’t interested in anyone, so I used the twelve women I talked to as a focus group to find out how they used AI.

A businesswoman who worked at Revlon told me that she used it to draft all of her emails at work, write reports and help make decisions. I asked her if she was concerned at all about losing skills or her boss finding out. She told me that she is more productive, less stressed and finally has time “to live my life again.”  I didn’t have the time or desire to tell her that if I were her boss, I would find a high school graduate who could use AI as well as her and pay them one-third her salary. I expect she’ll find that out herself in the next few years.

 A middle-school teacher from Montclair told me that she used it to write her lesson plans. “If it could grade papers and tests, I’d have it do that too,” she happily told me. I asked her if she felt less like a teacher because she wasn’t designing her course. She did not like that question at all. “I’m able to spend more time actually teaching the kids, so it makes me a better teacher,” she said, a bit defensively. Her job is probably safe for a while, because of a teacher shortage and the low expectations of the field. That safety removes the need to develop and improve. Hence the offloading of tasks that are key parts of teaching.  I suspect other teachers are doing this also, which means the level of instruction will slowly degrade over time. If true, this is dire for education.

A scientist from a German bio-tech company stated that she used AI to create, analyze and synthesize “just a massive amount” of excel spreadsheets. She said she uses three different AI systems and then cross checks their work to ensure there are no errors. “I am so much more efficient. The agents can create the data sets so much faster than any human worker. Taking away the grunt work allows me to utilize my other skills.” She was the only woman that night who I felt confident would still be employed in ten years.

All three of the women use AI to take care of tasks that they view as dull, tedious and time consuming. What I saw that night lines up almost exactly with what recent reporting is starting to show. A recent Business Insider article stated that at least 95% of workers use AI to think less, while the remaining 5% use it to think more. A New York Times article this morning quoted several economists who have finally come to the conclusion that AI probably will be very disruptive to the workforce, particularly if it continues to rapidly evolve and improve. The workers who are most in jeopardy of either having their salaries reduced or losing their jobs altogether are those who use it to think less. The businesswoman and the teacher are clear examples of professionals who have offloaded work to AI and are thinking less. The scientist uses AI as a collaborative partner; she uses it to challenge her assumptions and discuss the data before going to her team with it.

The professionals who are using AI to offload work, increase productivity and reduce stress are currently enjoying wonderful benefits from AI. But they are unknowingly removing the processes which once made them valuable. By using AI to increasingly complete their tasks, they are becoming more easily replaceable by another person who can do AI-assisted work. A professional with a deep knowledge base who uses AI to challenge their assumptions, test their models, edit their writing and expand upon their ideas is the rare worker who is likely to be inoculated from becoming redundant.

All three use AI. They all use it to complete some of their work. The businesswoman and the teacher are using it to think less. They are getting faster, but not better. The businesswoman will probably be the first to lose her job. The teacher’s job is safe, for now, but I believe that the quality of her work is already suffering. The scientist was the only one of the twelve women I met that night that uses AI to improve her thinking. The other 91% are actively participating in their own career extinction.

It took AI less than ten seconds to write a competent, passable article about how workers are using AI to complete tasks without increasing their knowledge or skills. Mine took about an hour.

AI explains the situation. It’s a boring, monotonous piece. It’s interchangeable. Any AI system could have written it.

Mine makes an argument. It uses real examples. It passes judgement. It’s entertaining and informative and could have only been written by me.

Some people would argue that both approaches work. The difference is obvious.

These are the choices workers are making every day.

Suicide: What Suicide Loss Survivors Face and What To Do

Michelle came to see me after her husband killed himself. He had retired a few years earlier after a long career with the NYPD. She was devastated. She couldn’t sleep. She was overwhelmed with grief, anger and guilt. She was a therapist. The questions “Why did he do it?” and “How could I have missed it?” raced through her head.

Put aside that he was a cop and she was a therapist. This is a common response to suicide. It’s a structure that traps people.

Suicide Loss Survivor is the term used to describe people who have lost someone to suicide. For many of us, it is like a nuclear bomb went off in our lives. Everything has been affected; everything hurts. Recovery often feels impossible. The Suicide Domino Theory states that survivors are at higher risk for suicidal thoughts and attempts than people who don’t know anyone that died by suicide.

Suicide produces questions without resolution.

  • Why did they do it?
  • What did I miss?
  • Could I have stopped it?

The mind attempts to treat these as solvable problems.

Edward Arlington Robinson published Richard Cory in 1897. No one in town can understand why this man, who seemingly had everything, killed himself.

Sophocles wrote about Ajax, one of the Greek heroes in the Trojan War, in the 440s BC. Ajax took his life after the death of Achilles, near the end of the war. His wife, his brother and his soldiers all struggled with his suicide.

Individuals and society have always struggled to understand suicide. These are not questions. They are unending loops.

The Structure of Suicide Loss

1. Complex Grief

  • Suicide is different from other deaths, because it often adds anger, guilt and confusion.
  • It’s non-linear. That means it doesn’t just heal with time.
  • grief + anger + guilt + confusion = complex grief

2. The Why Loop

3. The Self-Blame Statement

4. The Missed Signal Problem

  • Some people lament “I should have seen this.”
  • People try to reconstruct conversations
  • They look through old texts and emails
  • Clinicians frantically search through notes
  • They seek a clarity that cannot be found

5. Planet Pretend vs. Planet Suicide

  • Most people avoid talking about death, and they definitely avoid talking about suicide. They live on Planet Pretend.
  • Survivors are stuck in the complex grief. Their world has been smashed. Things are unresolved. They live on Planet Suicide.

The Suicide Loss Survivor Protocols

  1. Stop trying to answer why. It can’t be satisfactorily answered. It is not a question, but a doom spiral. People can learn to stop this by seeing a therapist or going to a suicide survivor support group. Once someone knows that this is a universal response, they can learn to recognize it and ultimately, stop asking it.
  2. Interrupt the Missed Signal Loop. Much like the just stated why question, survivors need to put a boundary on reviewing past interactions and replaying events.
  3. Structured Expression. I believe writing is the best way to deal with grief. These 30 prompts are a good start.
  4. Plan for dates and triggers. Birthdays, holidays and death anniversaries sometimes loom painfully large. It’s really important to come up with a plan for those days.
  5. Re-engagement. For many, laughing again feels like a betrayal to the dead. I work with people on re-engaging with life. I encourage them to spend time with family and friends. Go to religious services. Volunteer. Travel. Even date again.

Do Not

  1. Endlessly ruminate over the suicide and call it processing.
  2. Search for a single answer.
  3. Get validation from a therapist about your grief and never move forward.
  4. Avoid life.

I worked with Michelle for just about two years. She learned to stop asking why. She accepted that there was nothing wrong with her, that her husband’s suicide was not about her, even though it felt that way in the beginning. Michelle begrudgingly went out to dinner with other family members. Eventually she enjoyed those meals. She traveled with close friends. Near the end of our treatment, she went on a date. She felt guilty. She went anyway. It wasn’t a match. That was just fine though, because she had turned back to life.

Humans experience repeated loss. In Kurt Vonnegut’s Slaughterhouse Five, the phrase “so it goes” appears 106 times. It shows up after every death in the book. Vonnegut survived the trauma of the firebombing of Dresden. He wrote books that often used humor to handle heavy subjects. “I’d rather laugh than cry,” he once told an audience. Death is a constant part of human experience, and most of us will experience it many times. We cannot live in despair. We must move forward. Suicide resists the compression of “so it goes.”

We do not solve suicide. We live despite it.

Disclosure: Editing and risk-review assistance were provided by a large language model in accordance with my AI Use & Writing Standards. All arguments, interpretations and conclusions are my own.
https://greenagel.com/ai-use-and-writing-standards/