that neither she nor her prior treating physicians had any idea as to what the cause of her symptoms was. She was given various diagnoses, including bipolar disorder, major depression, fibromyalgia, Meniere’s disease, and multiple sclerosis. Jill was unable to work and had become antisocial. Her parents and siblings attributed it to being lazy, as those close to her questioned the legitimacy of her disease. In fact, she was thrown out of her parents’ house and forced to live with an abusive boyfriend.
Jill would have crippling panic attacks, sometimes up to 5 or 6 times a day. Moreover, despite been treated by many health care professionals and with medications, she could not shake off those attacks. She had also developed a fear of leaving the house and could not enter an elevator or places with closed doors. She had a negative outlook and a firm belief that she could not succeed at most things. This got her to a place where she had just stopped trying. I became impatient during my examination, as she would not allow me to interrupt her while she was telling her story. If interrupted, she would start telling her story all over again. She was obsessed with telling her story. Like many persons with TBI/concussion, she experienced dizziness, vertigo, and severe headaches, had trouble reading while driving, and could not tolerate being on a boat or riding a bus. Jill could not multitask, had trouble handling multiple conversations, and was easily distracted. Her family and friends started asking what was wrong with her over the years. She graduated from high school at the bottom of her class with significant struggles, as she could not retain information. Jill could never hold a constant job by which she could support herself. Unfortunately, she developed an emotional and economic dependence on her boyfriend to the extent that she was afraid to leave him, despite repeated physical and emotional abuse. By now, after reading all these signs and symptoms, you must have gotten the story.
Until Jill heard my lecture and visited me as her doctor, she did not realize the impact being hit at 9 years old by a rock on the forehead had on her life and future. The details of the incident became clearer when she recalled she was in a childhood fight with her neighbor’s son. He had thrown a rock that impacted her on the left forehead just above her eyebrow. She recalled very little as to what transpired afterward, but her mother related how she could not attend school for over 3 weeks and thereafter developed severe headaches. No connection had previously been made between her significant decline in academic performance and reduced motivation for life and being hit by the rock. Until I showed her the head scar in the left frontal supraorbital region, she did not realize the seriousness of the incident. Her mother confirmed that the scar on the forehead was that from the rock incident. The neuropsychological testing performed at our center demonstrated findings consistent with frontal lobe dysfunction, findings commonly seen in TBI/concussion. An MRI was performed with two sequences: one called diffusion tensor imaging (DTI) showed damage to the white matter tracks in the brain, and the other known as susceptibility weighted images (SWI) showed the evidence of a past injury due to the presence of blood breakdown products in the brain. These blood breakdown products confirmed a prior bleed or hemorrhage in the brain at some point in the past. After spending 2 months in the US with medication management and therapy, Jill went back to her country and was able to complete 2 years of college. She now works for a small company as a receptionist.
I saw her about 5 years after my initial treatment. Despite her progress, she could not come to terms with the fact that until the age of 25, she was not able to understand why her life was out of control. Her story is one that I hear on a regular basis, and she is only one of the few success stories of patients whom medical science was able to discover and help. In the context of what we now know about TBI/concussion, you can imagine the number of injured individuals who have not been able to receive medical attention and, thus, have suffered the consequences of such condition.
If you are reading this book and you are wondering if you fit this picture, then it is important that you seek help from competent professionals because you can in fact change your life, depending upon your situation.
It’s About Time we pay attention!
UNTIL RECENTLY, TBI/CONCUSSION received relatively little attention in the field of neuroscience. Nevertheless, due to increased consumerism, this subject has now become one of the most popular matters of concern in our society.
I recently learned that the American Academy of Neurology receives more inquiries about concussion and TBI than other neurological disorders. For those of us who attend meetings in the field, we can see it has become a very popular subject of discussion. It is clearly a sign that greater action on these issues is necessary. What the public fails to understand about TBI/concussion is that it is a significant cause of disruption in our social order and is responsible for disruption in families, causing divorces, child and spouse abuse, loss of wages and jobs, criminal and antisocial behavior, and substance abuse. In fact, whenever I evaluate a patient with history of anger management, violence, panic attacks, motion sickness, headaches, panic disorder, autism, severe anxiety, phobias, OCD, attention deficit, bipolar disorders, and even schizophrenia; I ask them or their family members if they recall even the most insignificant incident of trauma to the head. An individual may have hit their head as a child, infant, or adult on the cupboard, on the side of the pool, during a sporting event, while navigating the monkey bar, or even in a car or bicycle accident. These individuals may not have thought much of the fact that they were dizzy, experienced vertigo, faced trouble concentrating, or had a headache and that these symptoms lasted for days or weeks. I can recall that, in the not too distant past, physicians such as emergency room doctors, neurologists, neurosurgeons, physical medicine and rehabilitation specialists, pediatricians, primary care physicians, and psychiatrists would say to patients that they have not suffered a TBI or concussion, as they did not experience loss of consciousness, despite hitting their head and having symptoms. In my practice, I see patients having suffered major disruption in their lives, who despite being evaluated and treated by competent health care providers, failed to receive appropriate treatments due to this issue of determining whether they have had a concussion. This often arises from the fact that they themselves or their healthcare providers entirely missed that they had a TBI or concussion sometime in the past, since many of these injuries occurred during childhood. When clinicians do not explore the issue of concussion and TBI, they can miss important facts in the diagnosis and treatment of patients. Many of these patients may report dizziness and vertigo while on elevators, driving, or on a boat and plane, but they were not able to see the link to a past traumatic event. From my work in the field and from reviewing medical literature and media stories, I have seen that the issue of TBI/concussion, its impact, and its effects are very complex and at times not well understood. Raising these issues has been long overdue.
The Penal System and TBI/concussion
Considering the tremendous impact that concussion and TBI have on our society, let us look at the penal system.
| Image # 3 – Penal System |
“Within five years following injury, nearly one-third of individuals with TBI report some involvement with the criminal justice system,” said Farrer et al. (Farrer 2011). An article published in the American Psychological Association Newsletter stated, “Since 1980, the number of prisoners has more than tripled to 743 per 100,000 people, an increase brought on in part by mandatory minimum sentences and the war on drugs” (Brian 2014).
This explosion in the number of individuals behind bars is due to the significant legislation passed by Congress and pressure from society to lock up persons with antisocial, substance-abusing, and criminal behavior. For decades now, the issue of African American males in America being imprisoned at a much higher rate than Whites has been talked about. We know that substance abuse has been at the center of the discussion. Substance abusers with low income,
