Veterans of the Global War on Terror who sustain traumatic brain injuries are twice as likely to end their own lives, according to a study released by the VA-funded Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC).
Dr. Robert Shura and his team based their conclusions on interviews with almost 1,000 Iraq and Afghanistan veterans. In addition to a higher suicide rate, the multiple TBI group also struggled with severe depression and extreme trouble sleeping. These symptoms dramatically affect a person’s quality of life at home, work, and school. Curiously, the increased suicide risk was not associated with Post Traumatic Stress Disorder. This fact suggests that combat-related brain injuries may be even more complex than researchers currently believe.
When asked about a cause, Dr. Shura referred to a previous study which concluded that “Slowed processing speed and/or memory difficulties may make it challenging to access and use past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and suicidal ideation in Veterans with three or more mTBIs.”
Traditional Views on Combat-Related Brain Injuries
Some say the first reports of combat-related brain injuries were in the ancient Assyrian army around 1300 B.C. In the First World War, a startling number of soldiers developed “shell shock.” Their neurological disorders largely dissipated after extended and extensive physical therapy. One would think that insurance companies would understand the value of such therapy. But as outlined below, that is usually not the case.
The PTSD diagnosis first surfaced in 1952 as gross stress reaction. This condition involved “a normal personality [affected by] established patterns of reaction to deal with overwhelming fear” as a reaction to “conditions of great stress.” In the late 1970s, as Vietnam veterans began showing signs of brain injuries, the Post Traumatic Stress DIsorder diagnosis gained wider acceptance.
These diagnoses treat brain injuries as processing disorders instead of physical brain injuries. That is quite understandable, given the diagnostic equipment available at the time. Even in the 1970s, and especially in the 1950s, internal injuries were difficult to diagnose. Brain injuries were even harder to spot. When the brain bleeds and swells, the skull contains the swelling and the blood. There are few or no outward physical symptoms.
So, attitudes about PTSD became entrenched. Even today, many practitioners insist that victims of combat-related brain injuries just need a little time to sort things out, and then they will be fine.
This flawed conclusion flies in the face of the most recent research on combat-related brain injuries. There have been many recent discoveries, and two of them are especially significant.
Scientists now know a lot more about what causes brain injuries. After a sudden loud noise, like an explosive blast, there is a secondary shock wave that is basically like a biological Electromagnetic Pulse. This shockwave disrupts brain functions. So, a victim might be close to an explosion, like a roadside bomb blast, and have no external trauma injuries. But the brain has felt the effects.
This diagnosis explains the spike in shell shock incidents in World War I. Shortly before that conflict erupted in 1914, the world’s armies stopped using ordnance with picric acid. This substance is basically the same chemical used in fireworks. Its explosive effects were therefore limited to a small blast radius.
In World War I, the world’s armies used TNT, which is many times more powerful than picric acid. Furthermore, as the war progressed, Allied engineers dug tunnels under German trenches, packed the tunnels with explosives, and set them off. The effect was much more powerful than even the largest cannon shells.
Doctors have also discovered additional details about the effects of combat stress on the brain. First, a little background. Combat-related brain injuries affect the balance between the amygdala, which controls emotional reactions, and the cerebral cortex, which controls logical thought.
Researchers are not exactly sure why, but combat stress erodes the cerebral cortex. That is not true of other types of stress, such as worries about money or relationships. If the cerebral cortex becomes weak, it is unable to control the amygdala’s emotional reactions. As a result, brain injury victims often experience symptoms like:
- Heightened awareness,
- Flashbacks, and
Some people describe the relationship between the cerebral cortex and amygdala as like a rider and a wild stallion. If the rider is not diligent, the wild stallion runs out of control.
So, overseas contractors can suffer brain injuries after a one-time traumatic event or as the result of repeated exposure to combat stress.
How the Defense Base Act Helps You Deal with Combat-Related TBIs
Brain injuries are permanent. Once brain cells die, they never regenerate. However, it is possible to successfully manage these injuries. After sufficient treatment and therapy, victims usually still have some lingering effects. But these residual symptoms may not significantly affect health or quality of life.
Surgery can relieve the pressure on the brain due to the aforementioned bleeding and swelling. Brain surgery sounds delicate and is delicate. So, it is very important that your doctor is highly experienced in these matters.
Fortunately, the Defense Base Act usually allows victims to select their own doctors and change physicians at any time during the course of treatment. There is no reason to wait for a referral. Victims just look for the best doctor available and make appointments.
Physical therapy after an external trauma injury, like a broken bone, is nothing like physical therapy after a brain injury. In the first circumstance, victims just need to train existing muscles to work again. But brain injury physical therapy must train other, non-injured areas of the brain to assume lost functions. This process is painstaking to say the least. Furthermore, progress is often uneven; sudden breakthroughs can punctuate extended periods of futility.
Because of the nature of brain injury physical therapy, many insurance companies insist that victims have achieved MMI (maximum medical improvement) when that is not the case. After victims reach MMI, they are no longer entitled to physical therapy. So, an attorney must continue fighting even after the victim reaches the home stretch of recovery.
Contact Barnett, Lerner, Karsen, Frankel & Castro, P.A. to learn more about Defense Base Act procedures.