As if PTSD, CTE, and Moral Injury Weren't Enough
by Russ Wellen
Turns out soldiers are subject to yet another, separate form of brain trauma from blast effects.
Throughout history, it's been obvious that soldiers returning home from war are changed men. From being silent to just "different," soldiers have been suffering what's been variously called, in the last 200 years, "soldier's heart," "shell shock," "war neuroses," and, more recently, post-traumatic stress syndrome. Sometimes, PTSD is a result of chronic traumatic encephalopathy, a form of dementia caused by degenerative brain tissue and characterized by deep depression, failing memory, and rage.
In April, at CNN, veteran Shane Garcie talks about the concussions he experienced.
“… there’s so many. There’s so many,” says Garcie. “There are so many reasons for the jarrings, for the beatings. Not just IEDs, not just car bombs, not just in a firefight or grenades going off.”
“Think about it, you know. Iraq doesn’t have the best roads,” Garcie continues. “And you hit that bump and your head — it smacks the turret. Rollovers are severe because of the canals.”
Turns out that, as if PTSD and CTE weren't enough, yet another syndrome causes the same symptoms. In the New York Times, Robert Worth reports that "soldiers exposed to blasts often had memory and focus problems that did not go away and that seemed distinct from battlefield trauma."
If the blasts were repeated, the lapses sometimes devolved into career-ending mental and behavioral struggles. [A research team] shared a gut-level belief that a blast wave's effects on the body were far more extreme, and more complex, than the concussion model could account for. [Emphasis added.]
Working for the Pentagon, neurophathologist Daniel Perl and his colleagues "recognized that the injury that they were looking at was nothing like concussion."
The hallmark of C.T.E. is an abnormal protein called tau, which builds up, usually over years, throughout the cerebral cortex but especially in the temporal lobes, visible across the stained tissue like brown mold. What they found in these traumatic-brain-injury cases was totally different: a dustlike scarring, often at the border between gray matter (where synapses reside) and the white matter that interconnects it.
How exactly does a blast leave such a distinctive impression on the brain? Worth explains (or attempts to; I don't quite get what he's saying):
[Bosnian researcher Ibolja] Cernak became convinced that blast ripples through the body like rings on a pond's surface. Its speed changes when it encounters materials of different density, like air pockets or the border between the brain's gray and white matter, and can inflict greater damage in those places.
Worth writes: "Nearly 350,000 service members have been given a diagnosis of traumatic brain injury over the past 15 years, many of them from blast exposure. The real number is likely to be much higher, because so many who have enlisted are too proud to report a wound that remains invisible."
Putting aside the human costs just for a moment, when considering military intervention, policymakers need to factor in the costs of the lifelong care of those whose brains are injured by warfare. After a while, military intervention will seem like a less and less viable option. (More likely, it would spur the military to turn to robots to wage war.)
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"As if PTSD, CTE, and Moral Injury Weren't Enough "