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War-related moral injury: what is it? What helps? 


I’m reading David Wood’s What Have We Done: The Moral Injury of Our Longest Wars (2016, Little, Brown and Company). David is a journalist and has experiences embedded in military operations in Iraq and Afghanistan. PTSD is well-known and discussed, especially in the context of war. If you have listened to the news, you know that many veterans struggle with it and struggle with return to civilian life. Suicide rates of current and former military members should grab your attention and tell you that we have a serious problem on our hands. If you have read further, you probably have heard about treatments such as Prolonged Exposure and Cognitive Processing Therapy being used by VA mental health practitioners. 

This book, however, introduces readers to the concept of moral injury, a cousin to PTSD. While the features may look similar to PTSD, moral injury may better account for some of the experiences, especially where terror (the emotion, not behaviors) may not have been the main experience. 

The book opens with a story of a Nik, a Marine whose position came under fire from a small boy with an assault rifle. 

“According to the military’s exacting legal principles and rules, it was a justifiable kill, even laudable, an action taken against an enemy combatant in defense of Nik himself and his fellow marines. But now Nik is back home in civilian life, where killing a child violates the bedrock moral ideals we all hold. His action that day, righteous in combat, nonetheless is a bruise on his soul, a painful violation of the simple understanding of right and wrong that he and all of us carry subconsciously through life. 

… At home strangers thank him for his service, and politicians celebrate him and other combat veterans as heroes. And Nik carries on his conscience a child’s death.” (8)

The author goes on to argue with illustration after illustration that to go to war is to suffer moral injury, to suffer the disconnect between deeply held values and the experiences during war. While it is easy to see moral injury in the forced choice to kill a child vs. save one’s own life, moral injury can also result from being sent on a fool’s errand–political reasons sent to war vs. need to protect or defend freedoms. 

PTSD v. Moral Injury? 

Post-traumatic stress disorder is biology. It is the body’s involuntary physical reaction as we relive the intense fear of a life-threatening event and the scalding emotional responses that follow: terror and a debilitating sense of helplessness. (15)

He goes on for paragraphs to depict the experience of PTSD and its cascade of symptoms–“fear-circuitry dysregulation.” But then listen to how he talks about Nik

…Nik doesn’t have PTSD. What Nik struggles with is not the involuntary recurrence of fear. He’s okay with the crowds at Walmart. He doesn’t startle at loud noises. In contrast with veterans who’ve experienced PTSD, Nik didn’t feel the pain of his moral injury at the moment of the incident…. [But] he is bothered by the memory of that Afghan boy and with questions about what he did that day. Like all of us, Nik had always thought of himself as a good person. But does a good person kill a child? …No, a good person doesn’t kill a child, therefore I must be a bad person. …The symptoms can be similar to those of PTSD: anxiety, depression, sleeplessness, anger. But sorrow, remorse, grief, shame, bitterness, and moral confusion–what is right?–signal moral injury while flashbacks, loss of memory, fear, and startle complex seem to characterize PTSD. (17)

PTSD has little to do with sin. It is a psychological wound caused by something done to you. Someone with PTSD is a victim. A moral injury is a self-accusation, prompted by something you did, something you failed to do, as well as something done to you. (18)

Guilt and shame are key characteristics. Not being able to save a buddy, making a quick decision that also included losses of civilian life, betrayal by leaders but being forced to carry out orders, or not being protected by buddies–all can create a moral injury. Add a mega dose of grief/loss from death and loss of companionship after the unit breaks up and you have a serious problem. (Don’t forget once home and safe, the loss of adrenaline, the loss of status, the replacement of dullness and the rebuilding of old relationships without your friends and without purpose will enhance all painful feelings including nagging guilt and shame.)

Definition offered

The lasting psychological, biological, spiritual, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. (250)

Spiritual community interventions? 

Despite their attractiveness, short-term interventions like CISD aren’t effective (chapter 6 details this). In addition, straight up attempts to challenge distorted thoughts are likely to fail. So, what might work? The book details some listening and validating activities by chaplains, including the burning of cards listing their “sins” as they leave the battlefront symbolizing their remorse and reception of God’s forgiveness. Talking about guilt, confessing failures and shame seem central. Note that confessing and validating do not necessarily mean that others agree that sins have been committed or that perceptions of self are accurate. They merely acknowledge the burden the veteran carries. Even the secular therapy models validate feelings of guilt while finding acceptance and forgiveness. Saying, “don’t blame yourself, you couldn’t help it” to Nik aren’t helpful. Finding a path that doesn’t blame or excuse (237) allows for a different path between all or nothing shame responses. 

It seems that what spiritual mentors and Christian practitioners have to offer in light of these themes are central to recovery from moral injury. 

The reality, says the author, our current therapies are only marginally helpful and sometimes harmful. Near the end of the book he concludes with this conviction,

True healing of veterans with war-related moral injuries will only come from community, however we and they define community–peers, neighborhoods, faith congregations, service organizations, individuals. That means it is up to us. (260)

And thus, YOU have a job to do

Listen. I highly recommend you read his last chapter (“Listen” begins on page 261). He will tell you how to engage a conversation in order to learn. No matter your personal beliefs about war, this is something you can do. Don’t look for the government to do the job, be the one to listen and learn yourself. Be the one to bear witness, as silently as you can. Your presence (more than your words) will convey compassion, understanding, and God’s presence.

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Does trusting God remove anxiety?


Over the years of doing therapy with Christians I have noticed how many feel guilty for their anxieties. “If only I could trust God more…I say I believe he is good but clearly I don’t trust him because I can’t stop being anxious.” Still others express distress that their faith in God does not change their feelings of hurt over past relational wounds and fears it will never get better.

It seems we believe this maxim: If I really trust in God, I will be at peace. I will not struggle with the brokenness around me or with the unknown future.

Is this true? Is it possible to trust God fully and experience chronic negative emotion?

Let me suggest a better maxim and then illustrate it with a couple of Psalms.

Because I trust God completely, I bring him my angst again and again.

At the recent #CCEF16 conference on emotions, David Powlison referred to Psalm 62:8a, Trust in him at all times, O people; He noted that this assertion is strong. But what does it look like in action? David pointed us to the next line (8b) Pour out your hearts to him, for God is our refuge. Trusting God looks a lot like venting, crying out in our confusion, sharing our fears and despairs.

Take a closer look at this Psalm. The writer is under assault by others. He likens himself to being a tottering fence, something easily knocked over. He is asking his enemies, “how long are you going to harm me?” He knows their intent. But their evil is the worst sort, one that pretends to be good but is really evil. They take delight in lies. With their mouths they bless, but in their hearts they curse. It is likely the psalmist could say, “with friends like this, who needs enemies?”

So, how does he talk to himself? Look at the cyclical pattern: reminder-pain-reminder-warning-reminder

  1. He starts with some truth. My only rest (or silence/peace) is in you God. You alone are my fortress. I will never [ultimately] be shaken.
  2. He laments. But you enemies are trying your best to destroy me, a weak, tottering fence.
  3. He reminds himself. Remember, look for rest and peace in God alone, it is only there you can find it, even when the ground is shaking
  4. He warns self and others. Don’t trust in your position, don’t trust in ill-gotten gain. And if God blesses you, don’t trust in the blessing
  5. He cycles back to truth. Remember this one thing: God you are strong AND loving. You will remain righteous in your dealings with us.

While the Psalm ends, I suspect the writer could easily have kept the pattern going, as in starting again with the first verse or adding more to the pattern.

This pattern of truth, honest admission of pain, reminder of truth is a far better picture of the reality of life hidden in Christ than the false stoic (or Zen) image of being unperturbed by the chaos in and around us. God does not remove us from the storm. Instead, we express our trust (as much to remind ourselves as in bold assertion), we lament, we groan, we pour out our troubles and we circle back to the one truth we can hang our hope on.

You can see this pattern also in Psalm 42 and 43 with slight variations: Remember when I used to be out in front leading the worship but now my tears are my only food. Why am I like this? I hope in God. But I am downcast. Day and night God is loving…but it seems you have forgotten me in my oppression? Vindicate me. You are my stronghold so why is this not getting better? Free me so I can worship you…yet I am still in despair even as I hope in you.

If you feel guilty much of the time when thinking about your level of trusting God, consider this alternative narrative: it is the greatest act of trust to keep bringing God your troubles, even when things or your response to them do not get easier.

So, does trust in God remove our anxieties? Not as much as we might think. But, if you could no longer feel guilty about your angst, might you in fact feel more peace as you trust God through the storm?

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Filed under Anxiety, Biblical Reflection, CCEF, christian counseling, counseling, Uncategorized

Reading the Bible as a Refugee


Because we are enculturated people, we always read Scripture from a particular vantage point. Sometimes it can be helpful to consider the lens we use and to try reading the Bible from the vantage point of others. I’d like to suggest that you take a tour of the Bible through the eyes of a refugee–a displaced person. Some 60 million people in the world today live displaced from their homes due to human and natural caused disasters. They have lost most if not all of their comforts (language, home, family, land, food, community, protection, job, etc).

Does the bible have anything to say about their experiences?

Right off, we see Adam and Eve, forcibly displaced from their lovely home, barred by an angel with a flaming sword, never to return. We often think about their culpability. It was their own sin that caused this trouble. Set aside that fact. Imagine what it was like for them to be removed from the best place ever to live for over 900 years in exile where nothing could compare to what was lost.

At the other end of the Bible we have John writing Revelation from…wait for it…exile on Patmos. In between these bookends, we have Abraham as sojourner. Israel moves to Egypt to escape a famine only to be enslaved for 400 years. Generations later David in on the run from Saul. Still later, both the Northern and Southern Kingdoms are sent off to exile with only a small remnant able to return after 70 years. Displacement doesn’t stop at the end of the Old Testament. Jesus’ first life experience is on the run from King Herod. Later, after Pentecost, Christians flee Jerusalem to avoid Jewish and Roman persecution.

But there is much more to see in the Bible than examples of displacement. Consider these biblical themes that relate to refugee experiences:Refugees from Syria

  1. God pursues displaced peoples. God chases down Adam and Eve after their sin. During the time of the Judges, God becomes impatient with Israel’s misery (10:16)
  2. God protects even within trouble. When Cain is exiled for murdering Abel, God marks Cain in order to protect him. Israel grows while enslaved. Exiles in Babylon rise to leadership.
  3. God sees our troubles and his moved by it. Notice God’s special kindness to Hagar.
  4. God wants to hear our complaints. With 1/3 of the Psalms in the form of laments, it is clear God desires our complaints and groaning.
  5. God invites us to share in his life by willingly displacing himself to share in ours. The incarnation reveals a God who willingly leaves perfection in relationship and community and lowers himself into a world of war and brokenness. His work enables us to enter in with those who have been displaced, “for such a time as this.”
  6. God prepares a place where we will one day be at home again. One day, we will all be at home in our true country with bodies that work as they were originally designed.

These truths do not remove the pain of displacement now. God’s protection in this world is not one that keeps us from all harm. In fact, our relationship with him promises that sharing in his death and resurrection we will face sorrow upon sorrow. However, knowing that God pursues us, sits with us, listening to our complaints, and provides blessings in the midst of hardship gives us hope for the day with all will be made right.

So, the next time you hear about the political and social challenges due to illegal immigration in the United States or the crisis in the Middle East and Europe, let that be a reminder to go to your Bible and read as if you are yourself displaced. Surely, we all need to work together to find solutions to these problems we face today. I suspect, however, we will be more prepared when we have the mind of Christ regarding displaced peoples. See how that perspective shapes how you live your life today and how you decide to respond to those in greater need than yourself.

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Confusing Culture and Christ?


The Christmas season is a good time for Christians to examine who they really serve. Sometimes, in the chaos we call “life” we can lose sight of who we worship. Last September Diane Langberg gave a twenty minute challenge to her audience about the dangers of confusing culture and Christendom with Christ. In her talk she explores the deception we mistake Christendom for the church. When we do, we fall prey to blind guides and to the temptation to protect institutions over being the hands and feet of Christ to the vulnerable. We fall prey to seeking power (or maintaining it) over speaking and being truth.

And for those who are not tempted to mistake Christendom for Christ, another danger exists. It is easy to become jaded with the church and want to abandon her as unhealthy. We can trust in our shrewd critique of the wrong things within the church. Yet, she calls us not to be toxic or arrogant. That will not serve the church well.

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Lessons learned in the Middle East


I traveled to Jordan in early November to do trauma recovery training/equipping work for Jordan Bible Society as a volunteer representative of the Trauma Healing Institute. Today, I posted a blog on the BTS faculty blog page on some of the lessons I learned there. I encourage you to check out those insights. The title of the post says, “5 Lessons Learned…” but in fact there are 6. Consider it your Christmas bonus (wink).

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Spiritual Trauma and Abuse: Assessments and Interventions


Today I will be presenting a break out at the AACC World Conference on spiritual abuse. If you are interested in seeing slides of my talk, click: Spiritual Abuse.

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Evaluating Character of a Leader? See How they Treat “The Other”


How a person treats “the little people” or “outsiders” tells you a lot about a person’s character. I once remember interviewing someone with great credential for an upper level job. On paper and in the interview, this person seemed like a perfect fit. But afterwards, I learned that this potential hire had clearly mistreated (with arrogance) a lower level administrative assistant in the organization. That changed everything I thought about the quality of the character of the person.

Most leaders are gifted. They have vision and drive and a capacity to instill both in their followers. Usually, this means the person has an excellent command of language so as to move others to feel as she or he does. But such strengths can be easily cloaked in deceptive languages and what could have been good is used for a bad purpose, most often that of personal gain.

How much more dangerous if the leader combines these gifts with spiritual/religious language. Notice how the cloak of good things could easily cover up evil outcomes:

GOOD WORD  ==> CLOAKED INTENT

  • unity                      your opinion doesn’t matter
  • trust                      don’t question my actions and decisions
  • truth                      believe as I do or you are out

An Evaluation Tool Better than Words?

Check how they treat vulnerable people, people who do not tend to listen well, people who need lots of attention due to their weaknesses. See how they talk about those who work for them and who get little public glory. Do they blame underlings for their mistakes. Do they receive criticism well? Do they talk in “we” language (vs. “I”) and back that talk up with giving glory to others where it is due? And finally, how do they describe their enemies or those who are not part of the cheerleader squad?

For all of us who have any leadership, let us remember God’s strong warning to shepherds in Ezekiel 34. False shepherds are those who

  • Use the sheep for personal gain (milk, wool, meat)
  • Starve the sheep
  • Not cared for weak, sick or injured
  • Not sought after the lost ones
  • Ruled with harshness
  • Abandoned the flock altogether

These are God’s enemies, destined for destruction. But we are not left in the dark about what a good leader looks like. Ezekiel 34:11f provides the test of a true shepherd, God himself. He finds, rescues, brings back, feeds, provided pleasant places and peace. He will bandage and heal and bring justice.

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Are all sins equal? The dangers of leveling all sins


There but for the grace of God go I.

Humility requires that we do not think too highly of ourselves; that we do not think ourselves better than anyone else. We all struggle with the same weakness–the desire to love self more than neighbor and to be our own god. We are all easily deceived, born into sin.

And yet, the evidence of humility is not equalizing all sins. Sadly, treating all as human has led some Christians to believe that it is wrong to point out the sins of others, to seek justice after wrongdoing. The error in thinking goes something like this:

  1. We have all sinned and come short of the glory of God. We all deserve judgment. No one can earn God’s love.
  2. God’s love is a free gift for all, not based on merit.
  3. Therefore, we must treat all sinners the same; that grace means the same treatment for all.

But ask victims who have heard this stated something like this and they hear, “since we’re all sinners then the way you were sinned against is no different than the way you sinned against God.” So, if there are no differences, then what happened to you (victimization) is no different than what happens to anyone.

Get over it. That is the message we send to victims when we level all sins.

So, consider this question: Does Jesus differentiate between sins? Do some sins result in more judgment and consequence? What about how he speaks of those who hinder the little children from coming to him? How does he speak to those who understand the depth of their sin vs. those who deflect or deny their sin?

Some years ago I was speaking to a large gathering of church leaders about the care for victims and sex offenders. I suggested that sex offenders did not have an automatic right to attend worship but that we could find meaningful ways to bring worship to sex offenders. One leader stood up and accused me of making multiple classes of sinners and ignoring the sin of victims (in his mind they would forever control the lives of the offenders thereby becoming abusive to the offenders). He claimed that I did not believe that God can restore and redeem the worst of sinners. This leader believed that all sin is forgiven (as do I) and thus all consequences should also be erased.

Leveling sins actually harms both victims and offenders. If consequences are erased, then offenders risk remaining unaware of unique temptations, unaware of how they may follow Zaccheus and pay back above and beyond what the Law requires. Victims continue to have little to no voice because what happened (and continues to happen) to them is just commonplace.

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Filed under Christianity: Leaders and Leadership, counseling

On having substantive conversations about race relations


Maybe it has always been this way, but it seems harder these days to have substantive conversations about race relations. I think the same struggle exists when you try to talk about sexual identity, gay marriage and anything else that is a hot button issue today. Does it seem that way to you?

In the realm of race relations, we have dueling images (Baltimore burning v. images of a black man being beaten by police), dueling sound bytes (Baltimore mayor portrayed as giving permission to rioters “space to destroy” property v. Franklin Graham’s “Blacks, Whites, Latinos, and everybody else, Listen up” comment) and dueling diagnoses (racist cops v. thug culture). These seem to generate much emotion and quick reaction but little in the way of deep conversation and understanding.

Who should we blame?

It is easy to lay blame at the feet of ideologically-focused cable “news” programs. Their incessant demand for sound bytes and finding “breaking” news requires that they pump up anything that might be controversial to keep the viewer on the channel. But the only reason these stations need to do this is because of the proliferation of choices from where we get our news. If the show doesn’t deliver, we’ll find our news elsewhere on the television or, more likely, online.

We could also blame twitter and other micro-blogs that allow us to make a point in less than 140 characters. These formats provide “data” but without context enable us to believe we have facts when we only have a single data point.

But in truth, we need to lay most of the blame at our American culture’s feet. We want sound bytes. Like fast food, we want ready-to-consume information pre-packaged and simple. And we are an increasingly angry culture, angry and feeling lost in a sea of divergent opinions. Maybe this is because the comfort we once had living in a homogenous society where everyone appeared to think and believe like us is no longer present.

What can we do?

First, let’s be honest, in some settings and with some people, we may not be able to have substantive conversations about race. The environment may not be right, the other person(s) may not be interested or able due to their pain. In these cases, let us follow the advice of Solomon and remember there is a time to keep silent (Eccl 3:7a). Of course, if  you do remain silent, remember not to gossip about it later.

When we do decide to try dialogue, let us endeavor with God’s help to do the following:

  1. Be quick (first) to listen. Our temptation is often the opposite. We have much to say and we want a hearing. Follow the admonition of James to be quick to listen, slow to speak and slow to become angry (Jas 1:19-20).
  2. Listen to the story behind the opinion. Sometimes we jump to debating facts, especially when those facts are part of the other’s experience. We may be quick to dismiss experience as anecdotal. Yet, the story of pain, confusion, and racializations are worthy of our attention because we are listening to the life and challenge of an image bearer.
  3. Give the best interpretation of what was said. When emotions run high, it is easy to react to things we hear that sound wrong to us. When trust is low, it is likely that we will provide the worst possible interpretation rather than the best. 1 Cor 13:7 reminds us that love “believes all things.” So, give the best possible interpretation of what was heard. If you aren’t sure what the person meant, ask, but do so without thinking you already know the answer. Assume your partner has truth to tell you.
  4. Avoid equalizing pain. Sometimes we fear giving credence to another’s opinions for fear of negating our own opinions. It is quite fine to acknowledge systemic abuse against one people group in one sentence without needing to equalize pain by pointing out an opposing fact (even if it is true). When we try to equalize, our dialogue partner will likely believe we have just negated their point.
  5. Avoid using some impersonal extreme case you heard to make your point. While extreme personal stories need to be listened to and cared for, we can be tempted to tell of an extreme case or fact to make our point. Remember, there are fringe stories but these fringe stories rarely tell the main problem. However, if you believe the other side is using an extreme case, don’t jump on your dialogue partner but listen for substance that you can agree with.
  6. Be willing to confess corporate sin. Both Nehemiah and Ezra confess sin that is not really their own but owned by all of Israel together. Be willing to own and confess the sins of your “people” even if they are not your own sins.
  7. Underline shared truth and shared goals. While you may disagree on most things, be on the lookout for where you can agree and highlight shared truth or goals.
  8. Finally, determine one way to move the conversation to action. Dialogue and understanding are good. Action is better when we work together. Find one thing you can do with your dialogue partner.

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Turn the other cheek? Does this apply to abuse victims?


The Christian Scriptures teach followers of Jesus to forgive as we are forgiven, to love our enemies, and to turn the other cheek rather than seek revenge when mistreated. Does this mean that victims of domestic violence and abuse need to, sometimes quite literally, take it on the chin without seeking protection or justice?

There are a good many resources out there right now that help teach Christians how we should respond to domestic violence and abuse. If you want some in depth argumentation why victims do NOT need to just take it, you can consider my top 3

  • Leslie Vernick (website and books)
  • No Place for Abuse (Book, and when you follow the link, notice the many suggested books on the same topic; books by Brancroft, Roberts, Crippen, and more!)
  • G.R.A.C.E (website with information about the moral requirement to report child abuse)

Rather than repeat the good advice in these resources–biblical foundations for protecting victims and calling out offenders–I want to point you to an older resource given to me in the past week. Older resource as in from 1840! Henry Burton, in chapter 22 (“The Ethics of the Gospel”) of his Expositor’s Bible: The Gospel of St. Luke discusses the application of Luke 6:27f to those inside the community of Christ as well as to “enemies.”

First he reminds readers to love enemies,

We must bear them neither hatred nor resentment; we must guard our hearts sacredly from all malevolent, vindictive feelings. We must not be our own avenger, taking vengeance upon our adversaries, as we let loose the barking Cerberus to track and run them down. All such feelings are contrary to the Law of Love, and so are contraband, entirely foreign to the heart that calls itself Christian. (p. 344-5)

I suppose his words capture most Christian teaching on what it means to love our enemies and to use the Golden Rule as our measure for how we respond. And yet, listen to his very next sentence:

But with all this we are not to meet all sorts of injuries and wrongs without protest or resistance. (p. 345)

Did you catch his point between the double negatives? We MAY and OUGHT to meet all injuries with resistance and protest. Burton goes on to answer why we should resist wrongs done to ourselves and to those around us,

We cannot condone a wrong without being accomplices in the wrong. (ibid)

There you have it. Complicity with evil, especially evil within the community of Jesus, is tantamount to approval and support of that evil act. Thus, telling a victim of abuse to “turn the other cheek” is essentially the same as abusing the victim yourself.

Burton extends his argument in the following way,

To defend our property and life is just as much our duty as it was the wisdom and the duty of those to whom Jesus spoke to offer an uncomplaining cheek to the Gentile [outsider] smiter. Not to do this is to encourage crime, and to put a premium upon evil. Nor is it inconsistent with a true love to seek to punish, by lawful means, the wrong-doer. Justice here is the highest type of mercy, and pains and penalties have a remedial virtue, taming the passions which had grown too wild, or straightening the conscience that had become warped. (ibid)

He completes his thoughts on this by reminding the reader that none of this justice seeking activity (to the point of excommunication if necessary) negates forgiving when the offender repents. We still love, we still forgive, we still treat others by the Golden Rule. But we do not avoid justice and protection seeking behavior, both for the sake of the one being harmed and for the one doing the harm. Both need rescue. The means of rescue differ for sure and may not be viewed as rescue when it comes in the form of sanctions and restrictions. But to look away from abuse and cover it up with “turn the other cheek” does not do right by the true meaning of love.

 

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