Undiagnosed and Treated TBI and PTSD Plague Vietnam Vets
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As we shift our focus of this page to the emotional side of the synergistic neuropsychiatric disability that faces combat vets, I want to put the context of current soldier suicides and PTSD into perspective. This series began with my reaction to this news:
“The Associated Press announced that active duty military suicides hit its highest level on record in 2007, 119 soldiers dead. “
My first reaction to that number when I read it was that there was something wrong with the record books, because I had remembered reading a number of references over the years about suicide in Vietnam veterans with numbers as high as 250,000 people. Well, the reason 119 is a “record” is the Pentagon didn’t start recording soldier suicides until around 1980 and that number is for active duty soldiers and doesn’t include vets.
Still, the overwhelming question that seems to being missed in the political debate and news coverage of 2008 is what about the Vietnam vets? As tragic as the Iraq and Afghanistan Wars have been, their footprint of death, disability and psychosis has yet to reach 10% of the magnitude of that of Vietnam. While Vietnam is now more than 30 years in our rear view mirrors, the primary group of soldiers it affected are from 60 to 75 years old. That leaves a serious public and military health issue for at least another generation.
$500 million dollars for TBI research for blast injuries in the so-called War on Terror is great – but what about Vietnam? The discovery of brain injury and brain damage in Iraq by the politicos and news media is truly wonderful. But Iraq is not the first war with blast injuries, not the first war where our soldiers suffered brain injury, not the first war where the soldier who returned home is a brittle, vulnerable shadow of the vibrant young man who left.
John McCain makes great political hay out of his Vietnam heroism as a prisoner of war. But how can McCain make those claims without looking back and recognizing that the United States mental health obligations to its Veterans reaches back to Vietnam, Korea and even World War II survivors?
The issue of the Vietnam brain injury disability and mental health of older Vets has countless sub-issues, but the most important here is that in Vietnam brain injury was not even considered.What we today call mild brain injury today, didn’t exist in the triage of Vietnam. Prior to 1990, there was little belief in the medical community that a brain injury that involved less than a five minute loss of consciousness was significant. Now we recognize, and have highly sophisticated neuroimaging and neuropsychological methodologies to confirm, that brain damage can occur without a loss of consciousness.
We often hear that our modern medical interventions result in more people surviving brain injury, because soldiers who would have died in Iraq or Afghanistan are now saved because of the rapid evac and treatment. That is true, but what is implicitly missing in such a statement is the clear fact that almost no one with a mild to moderate brain injury would die from it, regardless of whether they got prompt treatment. The realities of combat in Vietnam, and all wars that preceded it, is that a soldier on the front lines who gets knocked out, dazed or confused – is not likely to die from such injuries, unless he is killed by his inability to respond to the immediacy of the combat demands at the time.
Thus, there are probably far more mild Vietnam brain injuries, than in the current generation of soldier and vets. But because no one knew to concern themselves, there are no medical records to document that they suffered such injuries. A soldier with a short-term confusion in that combat was likely expected to shrug it off and go back to fighting. Making matters worse, the complete catastrophe that is the Vietnam military health records makes it almost a certainty that documentation of Vietnam brain injury is just not there. Further, the brain damage suffered in Vietnam is considerably broader than just brain injury because of the prevalence of Cerebral Malaria, which may have caused brain damage to hundreds of thousands of U.S. soldiers in Vietnam. See http://www.va.gov/OCA/testimony/hvac/16JY98NV.asp
Without the documentation of brain damage, what came out of Vietnam were hundreds of thousands of soldiers with clear cut neuropsychiatric symptoms in search of a diagnosis. The result: PTSD. PTSD is a Vietnam era syndrome of severe emotional problems, that are tied to some type of extreme emotional stressor, such as combat. But as with most “syndromes” the purity of its diagnostic criteria is lacking. The resulting over inclusive use of it in differential diagnosis of any emotional or neuropsychiatric symptom is staggering. At its threshold criteria, it requires life-threatening terror.
See http://en.wikipedia.org/wiki/PTSD which states the threshold requirement that “the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.” The second (A2) requires that “the person’s response involved intense fear, helplessness, or horror.”
This sounds like combat, it does not sound like a rear end automobile collision. While some automobile or other accidents involve prolonged moments of terror, most do not. They are over within a few moments of beginning. I have experienced both kinds but my memory of the truly terrorizing accidents (and yes, I did have that realization that my life was about to end both times) ended abruptly at the moment of collision. Relatively few people who suffer concussions have clear enough memory of the event to be exposed to a pure PTSD terror. What most relate is a moment of surprise that an accident is about to happen and then a gap in memory.
In contrast – combat, rape, fires – involve prolonged exposure to truly terrorizing events. This is the type stressor that can actually make a hard wire change to the way the brain processes information. This is the type of stressor that can create haunting memories. This is the type of stressor that can create nightmares. Yet PTSD should never become a catchall for all emotional reactions to life changing events. The category for stressor has as its blue print combat. When there is no elongated exposure to terror, the focus should be on normal human emotional responses, not a psychiatric catchall.