Traumatic Brain Injuries – Part 5 of 5
Chronic Traumatic Encephalopathy (C.T.E.)
Thomas Insel, Director of the National Institute of Mental Health (NIMH) wrote in his director’s report on May 28, 2012, that “NIMH was established nearly 65 years ago to help the nation address the mental health issues of veterans after World War II.”
I’ve been affiliated with NIMH for many years and hadn’t realized the original mission of the organization involved helping combat veterans of WWII reintegrate into society. My immediate thought, is that if the ‘greatest generation’ needed assistance with mental health issues, why do we still have the stigma we have today when a brain goes bad?
A brain can go bad for many reasons. It can be physically injured as is the case with a Traumatic Brain Injury (TBI). The brain can additionally be injured because the individual witnessed or experienced a traumatic event too encompassing to process. Finally, there are chemical and physiological reasons as to why a brain goes bad: bipolar disorder, personality disorders, schizophrenia, etc. For the purposes of this discussion I’ve elected to focus on traumatic brain injury and discoveries resulting in lingering healthcare questions for veterans in the decades to come.
In the report by Director Thomas Insel of NIMH, he brings to attention the following relevant facts: 2.7 million men and women have served in Iraq and Afghanistan over the past decade; most were under age 25, many had never traveled before, and all are volunteers. Additionally, for many the wars have translated into so-called invisible wounds (TBI and PTSD). While improvements in body armor have protected limbs and lives, the brains and minds of our returning soldiers have not escaped the modern battlefield unscathed.
Statistics are unavailable for the exact number of TBIs and PTSD cases as a result of the dual wars. It wasn’t until National Public Radio (NPR) and ProPublica began intense reporting that a number of issues were brought to light. These included: no guidelines for testing or treating soldiers and no reporting mechanism. Furthermore, while the Defense Department spent close to $3 billion between 2003 and 2012 to treat and study traumatic brain injuries and post traumatic stress disorder (the leading injuries suffered by US military in Iraq and Afghanistan), a federal investigation found that the department’s programs were so disorganized it couldn’t figure out how the money had been spent.
Fortunately, as a result of the development of the Defense and Veterans Brain Injury Center (DVBIC) referenced in Part 2 of this discussion, all divisions of the military now have a central location for the collection of data, accountability of expenditures, and policies for guidelines and treatment modalities.
On May 16, 2012, the New York Times reported that scientists had discovered an organic structural problem in the brain associated with blast exposure.
The paper provides the strongest evidence that perhaps many combat veterans with invisible brain injuries caused by explosions are at risk of developing long-term neurological disease—a finding that, if confirmed, will have profound implications for military policy, veterans programs, and future research.
Fox News reported on the comparisons of professional football players and combat soldiers with traumatic brain injuries. Their report of May 17, 2012, suggests that brain injuries suffered by thousands of soldiers may be at risk of developing the same degenerative brain disease as some retired football players.
Autopsies of four young veterans found the earliest signs of chronic traumatic encephalopathy, or C.T.E., in their brain tissue.
C.T.E. is a progressive disease linked to multiple concussions. Unfortunately only an autopsy can confirm a diagnosis.
The four young veterans, ages 22 – 45, lived for a year or longer after their military TBIs, but complained of problems with memory, irritability, sleep and other issues before dying of suicide or other causes. Drs. Goldstein and McKee found the veterans’ brains contained broken axons, the nerve fibers that act as the brain’s telephone system.
C.T.E. is a close relative of Alzheimer’s disease. Despite the fact that C.T.E. can only be diagnosed posthumously, it does show itself in symptoms like memory loss, impulsiveness, mood swings, and addictions.
Additionally, it’s as though the individual’s personality leaves them and they are always flat or one-dimensional. Unlike TBI wherein there are problems with sleep, the individual with C.T.E. often falls asleep in the middle of an activity.
In the case of professional hockey player, Derek Boogaard, diagnosed with C.T.E., he died of a drug and alcohol overdose at 28. It was reported that he lived in a fog of post-concussion syndrome and that he slid into a hazy shade of loneliness. He grew desperate for company and his memory lapses grew more severe.
Additional signs of Boogaard’s brain gone bad was that he would go days without showering and would make grandiose and scattered plans.
Derek Boogaard’s symptoms are similar to many of our returning combat soldiers.
In closing, as I stated in my first blog of this series, I take the position, ‘don’t send a soldier back into combat after receiving a traumatic brain injury.’
My reasoning might best be summed up by referring to the suicide numbers being higher than our actual combat casualties. Never in the history of our nation have we asked so much from so few.
An article in USA Today on May 14, 2012, caught my eye and I instantly thought it could possibly be the best outcome for any service member separating from the military and facing an immediate need for medical care. We know the wait time for processing into the VA is lengthy and the USA Today article titled ‘Studies up as War Winding Down’ from page 2A speaks of medical studies being conducted as a result of combat. My suggestion to combat veterans: run, don’t walk to the head of any line where volunteers are being accepted and sign-up. Most studies will last for decades and you’ll be in the system for medical care for the duration.
For anyone with a traumatic brain injury or any other brain injury—I wish you the best. It’s not easy living day-to-day with a brain injury. I discover new concessions I must make on a regular basis. Click to view April and Tom Marcum’s experiences.
Thank you for reading with me. I welcome your comments about brain injuries: experiences you might have had (good or bad), treatment that has worked or not, what you might have done differently, or anything else you might like to add.