The Warrior's Brain

By Bast, Andrew | Newsweek, November 22, 2010 | Go to article overview

The Warrior's Brain

Bast, Andrew, Newsweek

Byline: Andrew Bast

What happens when PTSD and battlefield concussions collide?

The worst was the day Brooke Brown came home to find her husband with a shotgun in his mouth. But there had been many bad days since Lance Cpl. David Brown had returned from Iraq. Days when he would shake uncontrollably in crowded places, when a family visit to a restaurant would send him on a frantic search for the nearest exit. He couldn't concentrate; he couldn't do his job. After a second deployment, the Marine Corps placed him on leave, then discharged him. Brooke quit her job to care for him and their three children. The bills piled up.

It sounds like another troubling case of posttraumatic stress disorder, or PTSD, the up-to-the-moment diagnosis for the anxiety and depression that has afflicted returning veterans at least since the Napoleonic wars. (In the times of French conquest, it was called nostalgia.) But Brown's case is more complicated. He also suffered a succession of mild seizures that culminated in a devastating grand mal episode that sent him to the hospital covered in his own blood, vomit, and excrement. He had vision problems and excruciating headaches, dating back almost two years to his first deployment, when a mortar attack on his post in Fallujah knocked him to the ground.

Brown, now 23, didn't sustain visible injuries in the attack, but clearly the man who returned from war was not the same as the proud, can-do soldier whom Brooke had kissed and sent off to battle. "Our middle son clings to David; he knows something is wrong," says Brooke, 22. "Our 4-year-old doesn't know what caused it, but he knows Daddy's sick and he needs help."

But what kind of help does Brown need? His case perplexed civilian doctors--one of whom suggested the painkiller tramadol for his headaches, which instantly made the seizures worse--as well as the Department of Veterans Affairs. The headaches and seizures suggest the aftereffects of an undiagnosed concussion--or, in the current jargon, mild traumatic brain injury (TBI). But his other symptoms point to PTSD. Or perhaps it's both--and if so, are they reinforcing one another in a vicious cycle? Several federally funded research projects now aim to answer the question of exactly how PTSD might aggravate the long-term effects of brain injuries. Dr. Murray Stein, a psychiatry professor at the University of California, San Diego, who's leading a consortium of scientists at 10 clinical trial sites around the country, says that while his team is "agnostic" about what they'll find, "you have to figure they are linked in most people." Brooke is unqualified: she believes the emotional weight of David's best friend's deployment last year with the Second Battalion, Eighth Marines, as part of President Obama's surge in Afghanistan caused one of his worst seizures.

If that's the case, Brown may be in the vanguard of a wave of badly wounded warriors for which the military and veterans' medical systems are woefully unprepared. A common estimate inside the military is that 20 percent of veterans in combat theaters return with some degree of PTSD, although--largely because of the stigma within the military ranks--less than half of those actually seek treatment. Some 2.1 million service members have been deployed to Iraq and Afghanistan, implying more than 400,000 potential cases. While the Pentagon claims to count battlefield concussions with precision, the official figure of 144,453 since 2000 might understate the real number by as much as 40 percent, according to a study done at the Army's Fort Carson in Colorado. Nobody can accurately estimate how many veterans might be walking around with both.

The interrelationship between PTSD and TBI is still mostly unexplored. The same event may give rise to both, and the symptoms overlap and shade into one another. "You may have been injured, may have lost a buddy during an attack," says Col. John Bradley, head of psychiatry at Walter Reed Army Medical Center. …

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