Traumatic brain injury may be the most elusive of all war injuries. It presents itself through a number of symptoms -- mood changes, insomnia, headaches, memory loss, irritability -- and in varying degrees. The conversation surrounding such injuries recently became louder after Staff Sergeant Robert Bales was formally accused with killing 17 Afghan civilians while on his fourth tour of duty, after suffering injuries from roadside bombings.
Dr. Richard Robinson, the Polytrauma Network Site Medical Director at the Dallas VA Medical Center, talked to Unfair Park about the cases he sees in his office every day. "Traumatic brain injury is, by definition, a disruption of brain function as a result of an external blow to the head," he explains. "It [a mild case] affects one's ability to do a lot of their personal affairs independently, for example managing their bills, planning their days," he says.
As to whether he believes it could have been a factor in Bales' alleged massacre, Robinson said the cause was more likely something else. "My thoughts are that it's less likely that this particular soldier was impaired from a traumatic brain injury standpoint and more likely disabled from PTSD," he says. "Brain injury generally doesn't cause someone to be aggressive in that sort of way. PTSD will often be associated with very aggressive behaviors; it can be."
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Since 2004, 1.5 million veterans of recent wars have been screened for brain injuries, he says. Of them, half have have reported troubles with memory or sleeping, indicating the need for a more thorough evaluation. A high percentage of those who've had multiple or severe concussions suffer from traumatic brain injury, he says. But the syndrome is difficult to diagnose because service members often return with a "complex combination of disorders" that affect memory and other mental functions.
Multiple tours of duty with multiple concussions from roadside bombs, as Bales experienced, make it more likely that a soldier will suffer from traumatic brain injury, but military culture discourages soldiers from seeking help. "Many of the soldiers when they experience a mild head injury or mild combat stress will not share that with the medical personnel because they're committed to their mission; they're committed to their unit, and they want to stay a part of the military," he says.
And those who come to the VA suspecting they may have traumatic brain injury are often experiencing the normal, though challenging, period of post-deployment readjustment. "There's a heightened sense that they're different, and they are different. They'll come in and say that 'My wife tells me that I don't remember stuff anymore.'" To some degree, that's normal, Robinson says. When someone is forced to prioritize what to remember during a stressful wartime environment, responsibilities like picking up milk can feel insignificant and go by the wayside.
While the entire country has become more aware of traumatic brain injury, Robinson says, awareness is heightened in Texas, which is home to larger proportion of combat veterans because of the state's military bases. As he has since 2004 when his department was created, Robinson continues to see a steady stream of war veterans coming through his office expressing symptoms of traumatic brain injury. It hasn't slowed yet.