The war changed me: brain injury after combat

The Washington Post has an amazing series of video reports on US soldiers who have returned from Iraq and Afghanistan with brain injury – often leading to a marked change in personality.

The reports cover veterans who have suffered numerous types of brain injury, from shrapnel-driven penetrating brain injuries to concussion-related mild-traumatic brain injury, and how they have adapted after returning home.

The treatments range from brain surgery to psychological rehabilitation and the interviews cover the difficulties from all angles – including the patients’, families’ and medical professionals’ perspectives.

It’s probably worth noting that this combat brain injury is not an area without controversy and the Washington Post piece follows the US military orthodoxy on mild traumatic brain injury – that all problems after blast concussion are due to brain damage.

Owing to the widespread use of improvised explosive devices many soldiers get caught up in a blast without suffering any visible physical injury, although they may suffer concussion due to the shock waves.

The US military is focused on the idea that subsequent problems – such as headaches, mood problems, trouble concentrating, irritability, impulsiveness or personality change – are due to the physical effects of the blast. This cluster of symptoms is often diagnosed as post-concussion syndrome or PCS.

Studies have found that, on average, soldiers who have experienced a blast are more likely to show changes in the micro-structure of the brain. However, not every soldier who shows the PCS symptom cluster has detectable brain changes or shows a clear link between the symptoms and the blast.

This latter point is important because the same symptoms can arise from combat stress – being caused by the emotional impact of war rather than a direct result of a shock to the brain.

It becomes clear why this distinction is crucial when you read the US military’s guidance on screening for mild traumatic brain injury which doesn’t have a specific way of distinguishing the effects of emotional stress from the effects of brain disturbance.

Owing to the fact that blasts are such common experiences for soldiers, this could lead to false positives where veterans are thought to have brain damage when they would be better off being treated for combat stress.

In fact, this exact same scenario was played out in World War I where ‘shell shock’ was originally considered to be caused by blast waves affecting the brain (hence the name) only for it to be later discovered that not everyone who had the symptoms had even been near a shell explosion.

Regardless of this medical debate, The Washington Post special report is a fantastic combination of real life experiences and the neuroscience of combat-related brain injuries. Highly recommended.
 

Link to WashPost ‘Coming home a different person’ with intro clip.
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