WEBVTT

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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
because he had so much shrapnel

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in his body 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

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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,
the best treatments for PTSD

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use many of the very same
training principles

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that the military uses

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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 to developing

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the most sophisticated and devastating
weapons 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, most of humanity
lives in far more peaceable societies,

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and when there is conflict,

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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 into 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 have told me
that one day they're in

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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
that many require training

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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, we don't simply hand
trainees MK-19 automatic grenade launchers

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and say, here's a 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
base 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,
their way of mentally framing the world

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is calibrated to an immensely
more dangerous environment.

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So when you try to overlay
that mind frame

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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 that there are
no dangers in civilian life.

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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,

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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, he had effectively
relearned how to sit

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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

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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, those memories
are no longer as raw

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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, "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, you do not require

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somebody who has 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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Now, for the past 10 years of my work,

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I have been exposed to detailed accounts
of the worst experiences

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that you can imagine, 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 I have 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 that he couldn't
even do with his own children,

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and what's amazing to me

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is that after 43 years of suffering,
it only took him 10 weeks

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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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And 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, 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 that 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, the mental suffering
that we create

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in our sons and in our daughters
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,
that the energy level, that the value

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that we place on sending them
off to war is at very least mirrored

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in how well we prepare them

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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)