The impact of war can be felt long after it ends. Of the 1.64 million servicemen and women deployed in Iraq and Afghanistan in October 2007, approximately 320,000 sustained TBIs.
Due to better equipment and access to emergency care in the field, more individuals have survived, and some are living with the effects of TBI (Okie 2005).
Between 18% and 25% of the returning veterans from modern wars have suffered a TBI/concussion, (Carson 2007, Terrio 2009) with most of them being due to the effects of a blast (Ling 2009).
The New England Journal of Medicine reported a survey of 2525 returning soldiers after a year-long deployment in Iraq. According to the study, 124 (4.9%) reported injuries with LOC, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting LOC, 43.9% met the criteria for post-traumatic stress disorder (PTSD) as compared to the 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who experienced LOC, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and post-concussive symptoms than those with other injuries (Hoge 2008).
PTSD is a condition in which a person who either experienced trauma or witnessed one develops symptoms that are physically and psychologically tied to the experience. These individuals have anniversary-type symptoms that cause them to re-live the trauma in some way, at times not realizing that this is in fact the case. This can manifest through a racing heartbeat, bad dreams, anxiety, fear, and other negative experiences that may transpire when they are reminded of the incident or are triggered by a particular experience and their internal sense, circumstance, or environment.
So, are you beginning to pay attention now?
Do you know people who have trouble staying on task and completing projects, constantly experience mood swings, have trouble with sleep, make inappropriate comments at inappropriate times, lose their temper for little to no reason, are highly narcissistic, and see themselves as the center of the universe or need attention constantly? Well, they may have suffered a concussion or a TBI sometime in their past.
Irrespective of your stand on aberrant social behavior, including criminal, antisocial, and other negative behavior in society, not recognizing the fact that TBI and concussion play important roles in the evolution of these disorders is a travesty. So, let’s think logically for a moment. If most of the prison population comprises of African American and Hispanic males, and between 25% and 87% of those incarcerated suffered a Concussion or TBI, then what other conclusions we can draw about the minority populations in prison? A significant portion of that population must have experienced TBI. We need to study this issue in a serious way. In my opinion, the legal system, our schools, religious organizations, and other institutions fail society when they do not ask questions about the role of TBI and concussion in antisocial behavioral conditions that lead to incarceration. Our society is often insensitive to the plight of others until they themselves or a person close to them is affected by such conditions that manifest abhorrent behavior. While most individuals with TBI and concussion do not engage in antisocial behavior, a significant number of individuals are negatively impacted. TBI and concussion at any age can cause dysfunction of the hierarchical brain organization that ultimately disrupts the social order. This problem is more pervasive than we once thought and affects our world in more ways than we are prepared to address as a society. Well, this is the story of the lion’s share of individuals with TBI and concussion with manifested physical, cognitive, and behavioral impairment. So, let’s give this disorder the attention it deserves!
Wake up America and Wake up World!
I HAVE HEARD and read with interest the Story of Benet Omalu; the Nigerian born neuropathologist who has popularized the term chronic traumatic encephalopathy (CTE). As a victim of the traditional approach to medical care, medical systems, and medical research, his story has become a catalyst for all to wake up and take note. This wake-up call is for the medical community, sports organizations such as the NFL, and the field of brain injury. In his book Truth has no sides, he tells the story of how a not-so-well-known neuropathologist lost his job and was asked to recant a landmark paper on the subject of CTE that he published in the Journal of Neurosurgery. The story describes the finding of CTE in a famous NFL player, Mike Webster who was featured in the movie, “Concussion.” Dr. Omalu fell prey to criticism by the institution of one of America’s favorite pastimes, American football. He took a position that made the parents of our kids stand up and take notice, exposing the short-and long-term impacts of injuries suffered in contact sports. His point about not allowing children to play contact sports such as football before the age of 18 resonates with me. In my role as a physician who often takes care of children, I am constantly asked this question: Would you allow your kid to play American football or, for that matter, contact sports? The real issue here is science! Irrespective of what side you are on, and yes, there are sides, this concern must be addressed in our society.
At a recent survey of neurologists, performed at the Texas Neurological Society’s 20th Annual Winter Conference in 2017, the question “would you allow your son or grandson to play American football?” was asked. Well, guess what the answer of most neurologists was. A resounding NO! (Evans 2018).
If you are driving a car in America and not wearing a seat belt, the police can stop you and give you a ticket. You are actually more likely to suffer a concussion in a game of American football than you are driving a car, if you measure game on game vs getting in your vehicle each day. An entire sector of the automotive industry has been built around this issue of safety. Despite the risk associated with driving, people still drive because it is a necessity. So, let us ask ourselves a question: Are contact sports necessary in our society?
Like Dr. Omalu, I came to America from a small island nation called Grenada in the Caribbean, otherwise known of the island of spice. I did not grow up playing football, and the sport was completely new to me when I arrived in America in 1975. I too had concerns about the hits I witnessed during games. My introduction to concussion occurred when I was attending medical school in Kansas City, Missouri, at the University of Medicine and Bioscience. I had volunteered as a second-year medical student to examine youth involved in an organization called “Golden Gloves.” This was a boxing movement that helped disadvantaged kids and even those not so disadvantaged. It was the kind of program that kept youths off the streets, while actually helping them to build character and a future. Despite wearing head and face gear, we saw knockouts, concussions, and on one occasion a more severe injury that resulted in a youth being hospitalized. Even for teenagers, the hits were palpable. You could literally feel a vibration in the air when some of the punches landed. Just following the career of Muhammad Ali and his subsequent development of what is believed to be pugilistic dementia and then Parkinson’s helped shape my opinions. As a neuroscientist, I was forced to hook my wagon to the issue of brain injury, its consequences, and the subsequent treatment and recovery. From the time I started in the field, it took approximately two and a half decades from my first interaction with this issue to this point where the industry now recognizes the connection between concussion and sports. Yet, compared to strokes, multiple sclerosis, and cancer, from a human manpower and resource standpoint, the allocation of financial capital and devotion to this cause remains in its infancy. The question here is “why.” More importantly, the second question is “what can be done about it.”
Let’s first deal with the question of why.
20:20 hindsight. We can all learn from the experiences of the past, and there is plenty of blame to go around. Now, many of you reading this book may have “an ax to grind” for whatever reason. I truly like
