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Jack Sisson's TBI Blog
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Tuesday, May 08, 2012
We owe it to our troops to rehabilitate brain injuries
From The Orlando Sentinel:
It is now believed that Sgt. Robert Bales, the U.S. soldier who is accused of killing 16 Afghanistan civilians in cold blood, had a previous history of traumatic brain injury.
This confluence of circumstances — a war-torn soldier likely with post-traumatic stress disorder gone unexpectedly violent — could easily boil down to the neuroanatomy of Bales' brain. Not unlike when theNFL had to ultimately recognize that violent, repeat head trauma to players can irrevocably change a player's mental state, the military may now be forced to recognize that war trauma can cause complex impacts on the brain, which can contribute to making soldiers social risks.
If Bales had suffered a previous brain injury, we know the likely effects include what is known as "disinhibition," due to frontal-lobe injury. Brain injury could have damaged the area of the brain that controls his emotional reactions and speech, making him unable or less able to control his anger and suffer from explosive outbursts.
This condition often makes victims maladapted to the exquisite complexities of social interactions and can often lead them to be socially isolated, suffering depression and anxiety.
To compound this history of a brain injury with the extraordinary level of stress involved in serving in war on numerous deployments makes the emergence of PTSD far more likely. Recent research has shown that exposure to life-threatening situations, such as criminal victimization, natural disasters and war, can change both the wiring and neurochemical make-up of our brains.
The region of the brain that controls "fight or flight" fear is known as the amygdala. When this area becomes over-stimulated by life-threatening circumstances, it triggers past memories and fears, which repeat in a pathological cycle. This condition is not caused by character flaws. It is caused by biological processes in the brain.
The pioneering neuroanatomy work of Dr. Joseph LaDoux has shown us that in dangerous environments, the brain reacts to sudden stimuli, not with our rational frontal-lobe, but with our amygdala. The instantaneous reaction to danger actually bypasses our higher brain and its rational judgments.
Thus, the area of the brain affected by PTSD is the same area of the brain that reacts to danger. Placing a soldier in a hostile environment with a brain injury and PTSD greatly increases the likelihood of a violent reaction to perceived danger.
Soldiers who have suffered a brain injury and are suffering from severe PTSD should not be on the front lines of any war zone. When I lecture around the world on frontal-lobe damage, I explain that such an injury inevitably makes the victim "less human and more animal." His judgments, as well as his emotions, are impaired, and he is certainly ill-equipped to deal with the extraordinary stressors and rapid-fire, life-or-death decisions experienced in a battle zone.
This is not to make excuses for the actions of Bales, but to put his actions in proper context.
Perhaps Bales' case will open up the long-overdue discussion about the complex impacts of brain injury, for our soldiers and others in society who need an honest evaluation of their circumstances. Many of our violent prisoners, and particularly our death-row prisoners, have a history of brain injury. Their relative inability to resist the lures of drugs, alcohol or violence can, in part, be explained by the faulty wiring in their brains.
With an untold number of soldiers returning from the battlefield with brain injury and/or PTSD, the U.S. must embark upon proper rehabilitation and acknowledgment of this problem. We need to allocate the resources to rehabilitate our soldiers as fully as possible, to make them as human as possible upon their return.
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