Medical Officers Discuss Efforts to Identify, Treat Brain Injuries, Stress

By Gerry J. Gilmore
American Forces Press Service

March 24, 2009 - Two Air Force medical officers highlighted military efforts to identify and assist servicemembers with traumatic brain injury and post-traumatic stress disorder at a military mental health care seminar here yesterday. Air Force Col. (Dr.) Christopher S. Williams, senior executive director for traumatic brain injury at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, told participants at the Reserve Officers Association-sponsored seminar that he's personally acquainted with TBI after being injured in a parachuting accident at Fort Benning, Ga., in the early 1990s.

"I have about 20 hours [of memory] that I'll never get back," Williams said, "that's probably a result of that bad parachute-landing fall."

TBI had affected him "in some ways that are indescribable," Williams said.

Fast-forwarding to present day, Williams said he'd witnessed servicemembers with TBI injuries last year during five months of service at an Air Force combat hospital in Kirkuk, Iraq.

Head concussions caused by explosions, blasts or blunt-force trauma constitute about 90 percent of TBI incidents that result in a loss of consciousness or an alteration of consciousness, Williams said.

And, post-concussive symptoms "are a hodge-podge of a lot of nonspecific things," Williams explained, including headaches, dizziness, balance problems, nausea and vomiting, fatigue and visual disturbances.

"All of those things own to a number of emotional things," Williams pointed out, such as irritability, anxiety, moodiness and cognitive problems.

Unreported or undiagnosed cognitive problems caused by TBI, he said, may constitute "one of the most significant" and potentially dangerous symptoms exhibited by injured servicemembers in war zones.

"When they have slow processing, decreased attention, poor concentration, they are a danger to their teammates when they are out on patrols and so on," Williams said of servicemembers who've sustained TBI. Many of those injured troops must be forced to seek treatment, he said, because they want to continue to serve with their comrades.

Consequently, Williams said, the military has instituted overseas field-screening processes to identify and treat servicemembers with TBI. And, he said, medical research, often taken from National Football League studies, shows that people who sustain three or more concussions exhibit more pronounced symptoms and lower memory scores.

And, TBI and post-traumatic stress disorder symptoms can appear intermixed, Williams pointed out.

"A lot of these [TBI] symptoms," he said, can be "overlapped with some of the psychological and mental health disorders, such as PTSD."

PTSD has been with the military a long time, said Air Force Lt. Col. (Dr.) Jay M. Stone, a clinical psychologist and Iraq veteran who also works at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

PTSD-related symptoms have been described and addressed by writers "for centuries," Stone said, going back to Homer in ancient Greece. The malady, he added, has been known as shell-shock, war-neurosis, combat exhaustion, battle fatigue, combat stress, and now PTSD.

Yet, PTSD isn't caused only by combat experiences, Stone pointed out, noting that any horrific, life-threatening event can trigger the disorder.

"Most people during their lifetime will be exposed to a traumatic incident," Stone said. However, he said, most don't develop PTSD.

Research demonstrates that the encountering of horrific, severe experiences increases a person's likelihood of developing PTSD, Stone said. The absence of social support after the trauma, he said, also supports the development of PTSD.

People who have had bad childhood experiences, have little education and low social-economic status, as well as those who have been exposed to multiple stressful events are at increased risk for developing PTSD, Stone said. Women are twice as likely to develop PTSD as men, he said.

Many other problems seem to develop alongside PTSD, Stone said, such as drinking and drugging, legal and relationship problems, and divorce. Feelings of hopelessness, shame or despair may beset a person afflicted with the disorder, which may end in homelessness or suicide.

No one knows how many servicemembers have PTSD, Stone said, noting best-guess estimates are based on the reporting of symptoms. However, he said, studies show that people who have experienced combat are five times more likely to report PTSD symptoms than others who didn't.

Meanwhile, Stone said, it's important that all of the military services have programs in place that address PTSD across the spectrum, from pre-deployment to in-country and back to post-deployment screenings, as well as educational briefings.

"That's having programs to prevent PTSD from developing and building resilience among our military members so that they're less likely to have problems," Stone said.