On Screening for Traumatic Brain Injury in U.S. Soldiers

The Institute of Medicine has released several fascinating reports in the last week.  The first addressed work hours for medical residents and trainees, a subject I have addressed in the past.  The second, released today, addresses traumatic brain injury among U.S. soldiers.  The report is the latest in a series addressing the "Gulf War and Health," which included a report on Gulf War Syndrome, which I mentioned here.

In a curious parallel to some of the themes of visibility and pathology I mentioned in connection with contested illnesses, the N.Y. Times article covering the latest report (entitled "Long-Term Consequences of Traumatic Brain Injury") notes that

For years, veterans’ advocates and researchers have called for more careful investigation of head injuries — not just severe wounds but also “closed head” injuries, which do not produce visible damage and do not show up on CT scans.

Indeed, one of the most serious problems with so-called mild traumatic brain injury ("mTBI") is that the neuropathological sequelae may be protracted, that is, they may take awhile to show up.  (Full disclosure: I have a forthcoming article on concussions in professional American football, so this is an area of interest for me).  Thus a person may suffer some kind of mTBI and by all accounts appear just fine for days on end, with no visible damage.  Again, the importance of the visible in biomedical culture can, IMO, not be overestimated.

In any case, the full report is available for purchase here through IOM, and the executive summary may be downloaded for free. 

Comments

[BrokenBrilliant]

Also, you can read a pre-publication copy of the report in its entirety online at http://www.nap.edu/catalog.php?record_id=12436

It's a little difficult to make out, given the resolution, but it still makes excellent reading, on many levels.

This is great news that official recognition is being given to this need -- for our soldiers, as well as for those of us who have sustained mTBI's over the years, but haven't had our health concerns taken seriously by doctors (including neurologists) who believe that our conditions will just resolve themselves with time. I, myself, have sustained multiple tbi's over the course of the last 30 years, but because I'm a "high functioning" individual, I have had a very difficult time getting my hidden difficulties taken seriously by the medical establishment. My difficulties are actually twice-hidden -- from others, as well as obscured from my view, because the very faculties I need to detect problems are the ones that have been injured. Sadly, it's not till things start to really fall apart, that people start to take notice, and in my case, I had to nearly lose everything before someone would take notice. (And I had to produce graphs of verifiable data, on top of it! long story...)

I am fortunate to have a 20-year track record of "success" (that is, 2 decades of learning how to "spin" my difficulties to look like normal behavior), so I can sometimes fall back on my laurels, when it comes to finding employment and interacting with the world around me. But unfortunately, I am apparently a rare case, and there are so many others out there who have not had the benefit of my type of experience.

Make no mistake -- tbi, even "mild" tbi -- can be a tremendous problem. All the moreso because it can be hidden from those who suffer from it, as well as the rest of the world.

It's my sincerest hope that this report and all the press that it's getting will add credence to the necessity of helping those of us who don't always have the ability to ask for help -- or can even tell that we need it.

[Daniel Goldberg]

BrokenBrilliant,

Thanks for your perspective and for sharing a bit of your own story.

[Robert Gustav]

Being an editor for online medical sites, the lack of seriousness taken to treat these tbi brain injuries is unsettling. I hope this report recieves the media attention that is needed to correct the problem and that the medical field will stop overlooking and start to do the appropriate test to take care of the soldiers and people who need the serious attention