Why aren’t brain injuries taken seriously?

“The 360” shows you diverse perspectives on the day’s top stories and debates.

What’s happening

More than 100 members of the U.S. military suffered traumatic brain injuries as a result of an Iranian missile attack on a base in Iraq that housed American troops, according to the U.S. Department of Defense.

Iran bombarded the base in early January in retaliation for an American airstrike that killed Qassem Soleimani, one of the country’s top generals. Though there were no U.S. fatalities, the number of military members who have been treated for brain injuries has gradually increased in the weeks since the attack. Last month, President Trump downplayed the injuries, saying the soldiers were experiencing “headaches,” which he didn’t consider “very serious injuries relative to other injuries.”

To the general public, traumatic brain injury (TBI) is most commonly understood to be caused by a direct blow to the head like the ones football players endure. The impact from an explosion — even if it doesn’t cause bodily injury — could cause TBI. Brain injuries have been called the “signature wound” of the wars in Afghanistan and Iraq, where improvised explosive devices have been a persistent threat. More than 413,000 American soldiers have suffered TBI since 2000, according to the Department of Defense. 

Most of those cases involved mild TBI, which can lead to headaches, cognitive impairment, mood changes and fatigue in the short term. Research has shown that even mild brain injuries can be linked to a increased long-term risk of depression, post-traumatic stress disorder and suicide.

Why there’s debate

The president’s comments echo a view, prevalent in the military and in sports, that brain injuries aren’t considered as serious as physical injuries. Part of the disconnect may stem from the nature of the injuries. A bullet wound, for example, is immediately noticeable and easily understood as life-threatening. The symptoms of head injuries, however, can take days to show up and are often difficult to define. Severe outcomes, like depression, may not manifest for months or even years and can be difficult to attribute directly to head trauma.

Some military veterans say the culture of the armed forces puts pressure on soldiers to return to action unless physically unable, which can lead to TBI symptoms going unreported. Others argue that military leadership has been too slow to respond to the issue and that the government doesn’t do enough to provide mental health services to veterans after their service is complete. 

What’s next

The modern understanding of the impact of traumatic brain injuries is still relatively new. Scientists and doctors are working to develop better methods to diagnose, monitor and treat TBI. The military has instituted new procedures for managing brain injuries within its ranks in recent years. President Trump, however, appears committed to his view that TBI isn’t as serious as other injuries. “I viewed it a little bit differently than most, and I won't be changing my mind on that," he said Monday.

Perspectives

Symptoms can take time to surface

“The long-lasting effects of TBI can be delayed, and its victims can appear unchanged to the eye. Because of this, it is easy to dismiss mild TBI or concussion as a bump to the head, and the victims of TBI are often returned back to the field, the court, work or the battlefield all too soon without the necessary neuropsychological testing and subsequent treatment.”
— Neurologist Starane Shepherd, Newsweek

Veterans often see their symptoms as personality problems 

“Victims of traumatic brain injury often blame themselves for their changed behavior, not realizing that blows or force to the head have caused lasting harm. … Step one is helping them understand they have injuries, not character flaws.” — Dr. Chrisanne Gordon, Columbus Dispatch

Fear of judgment prevents soldiers from seeking treatment

“A major hurdle has been to destigmatize brain injury and make people realize that injuries to the brain that can’t be seen are just as serious — and sometimes more difficult to treat — than bloody wounds to other parts of the body.” — Editorial, Washington Post

Mental health is consistently treated as less seriously than physical health

“Historically, mental health services get shortchanged in funding and support across the country, but the failure to care for the war fighters has been notably shameful. Looking back 18 years, we find that the medical campaign to treat psychological problems and brain injury has largely failed.” — Stephen N. Xenakis, USA Today

Medical science is only starting to understand brain injuries

“It's the brain — and medicine is only on the forefront of understanding what, exactly, goes on in there.” — Leah Asmelash, CNN

Many doctors still rely on ineffective treatments

"A lot of physicians will say, 'Well, you shouldn't do anything. Go into a dark room, don't strain the brain and wait until you recover.’ … And we have a national epidemic of people that are sitting in a room waiting for their headache to go away.” — Dr. Jamshid Ghajar to Military.com

TBI symptoms are often discounted

“What I know is that if you show most people an invisible wound, you’ll get invisible compassion. Wear earplugs all the time, and even your close friends will just blow it off. … Empathy requires stimulus, and in the average person’s perspective, anybody can just ‘fake’ post-traumatic stress or a TBI.” — Military veteran Bryan Box, New Republic 

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Photo illustration: Yahoo News; photos: universityofcalifornia.edu, Getty Images