Don't worry if that term is new to you.
It was to me as well, until I just read Veterans and Brain Disease, today's New York Times column by Nicholas Kristof.
It is hard for anyone who pays attention to avoid knowing the high rate of suicide among veterans of Iraq and Afghanistan. Many of those not killing themselves have remained seriously troubled and disturbed.
Some of this has been attributed to Post Traumatic Stress Disorder.
We know that people subject to the overpressure of the explosions of IEDs have suffered what has been called Traumatic Brain Injury.
Now, thanks to the autopsy after his suicide of the brain of a young Marine who had been diagnosed with PTSD there is the possibility that our understanding will be more complete, that we will realize there is quite possibly a physical cause underlying the troubles of so many of our recent combat veterans.
What that autopsy showed is critical:
His brain had been physically changed by a disease called chronic traumatic encephalopathy, or C.T.E. That’s a degenerative condition best-known for affecting boxers, football players and other athletes who endure repeated blows to the head.His was the first autopsy to clearly show CTE. Since then other autopsies are beginning to confirm the pattern.
In people with C.T.E., an abnormal form of a protein accumulates and eventually destroys cells throughout the brain, including the frontal and temporal lobes. Those are areas that regulate impulse control, judgment, multitasking, memory and emotions.
I am going to urge you to carefully read Kristof's column, which is clearly written, to see the nature of the problem.
Below the fold I want to explore the implications for both our obsession with sports and the our continued involvement in wars of choice in places where one likely response is exposure to things like IEDs.
Let me start with sports.
Football has long been played with helmets. In recent decades hockey, another collision sport, has also required helmets. Amateur boxing requires helmets. In the Olympics, while one can still win by a knockout, victory is usually achieved on points scored by the white surface of the gloves, which do not have to make contact with the head in order to score. Professional boxing is still geared towards blows to the head.
Yet a helmet provides only partial protection. After all, one does have a hard skull. Yet within that protective shell of bone, one's brain is not rigid: it can move.
Imagine that you are punched in the chin sufficiently to cause you to lose consciousness even very briefly. Your head is snapped back, but the brain inside does not move immediately, and thus bounces off the inside of your skull. Should you fall to the canvas, when your head hits the brain keeps moving inside the skull and bounces again off the inside.
Now think about the impact of collision sports like football and soccer as you read the following paragraph from the column:
“Imagine a squishy, gelatinous material, surrounded by fluid, and then surrounded by a hard skull,” explained Robert A. Stern, a C.T.E. expert at Boston University School of Medicine. “The brain is going to move, jiggle around inside the skull. A helmet cannot do anything about that.”a helmet cannot do anything about that especially in a circumstance where the head itself is the primary target, as in boxing.
In hockey the head can be slammed against the plexiglass above the boards surrounding the rink, and if the contact on the ice is severe enough - quite possible with players skating at speeds much greater than any football player can achieve on the gridiron - a head snap and subsequent fall to the ice are quite possible, with impacts similar to those in boxing.
What Price Glory? How much damage are we willing to endure for the fame and wealth and - yes - glory of the various sports we play? How much are we willing to watch it, or should we be, if we consider the price the players may pay for the rest of their lives? Are we fascinating with football's greatest hits, or the smashing of bodies in hockey?
I largely stopped watching professional boxing when I was in my teens. The reason was a fight on March 24, 1962. I saw a man get killed. His name was Benny "Kid" Paret and his opponent was Emile Griffith. There was no love lost between the two. They almost came to blows at the weigh-in. What happened in the fight may have been complicated by Paret's reputation as one who feigned injury.
Perhaps of greater importance is that Paret may have already been injured - he had about a month before fought the heavier middleweight (Paret and Griffith were welterweights) Gene Fullmer, a hard puncher, had said he could not remember ever having hit a boxer so many times in the head and not knocked him out.
In the fight, the referee was the very experienced and respected Ruby Goldstein. As I remember it, apparently Paret got hung up on the ropes, and for a few seconds Griffith, throwing punches in a frenzy, used his head as a speed bag. By the time Goldstein realized what was going on and stepped in, it was already too late.
Paret went into a coma, never regained consciousness, and died ten days later.
There is video of the fight. I will neither imbed nor link to it. It has remained burned into my memory and my consciousness for half a century.
Perhaps that is why reading Kristof's column had such an impact upon me this morning.
The overpressure of an explosion can have a force much greater than the impact of the punch, even of a professional boxer. It can be like the accumulation of punches over a career.
We know the damage of such blows - one need merely look at Mohammed Ali to see what such an accumulation can cause.
We have some choice in sports - we can change the rules to lessen such occurrences, although it is hard to see how professional boxing can be sufficiently changed to properly protect the participants and still generate the huge sums it does for promoters and venues as well as the boxers.
Then there is war. Mankind has tried to impose rules of war. In many ways it is a futile effort, because the way to win a war is to crush and destroy your enemy, to break his will to continue resisting. Often killing is less effective than maiming, because a wounded soldier who is not abandoned by his buddies may effectively remove one or more additional fighters from the conflict as they attempt to care for and protect him. That is one appeal of things like shrapnel and grapeshot - they do as much damage by maiming as they do in killing.
It is not difficult to make explosives. The chemistry is pretty basic.
More powerful explosives? One can as did Timothy McVeigh combine otherwise useful and readily available substances and bring down large buildings.
There is no way to avoid exposure to explosions in a combat situation. They are far to easy to plant and detonate as means of sowing terror outside of the immediate combat situation, as those who have lived in places on ongoing conflict like Northern Ireland and Israel know all too well.
We can to some degree protect our troops by interfering with radio signals intended to detonate remotely-activated bombs. We can better protect bodies by armoring vehicles, or enclosing the personnel in protective armor.
Yet the overpressure of an explosion can all too easily damage the brain inside the skull, with devastating consequences.
It is not just the lives lost. We already know that.
It is not just the visible mangling of bodies, with losses of appendages while the combat veteran still survives, thanks to the miracles of modern medicine and care.
Certainly we know there are psychological impacts. PTSD does exist, and should not be ignored.
But what do we do when the brain has been permanently altered? What do we do about C.T.E.?
Perhaps it is a first step to recognize that it exists. To know there is a physical cause for the severe changes to a loved one is actually, according to the mother of one veteran with whom Kristof talked, somewhat comforting.
Still, for me at least, even had I not become a Quaker, realizing the permanent damage we do to those who survive our current combat would give me pause. Are the circumstances into which we thrust them really necessary? Are we really willing to demand the price they and those they love and those that love them have to pay as a result?
That does not mean we will never expose our military to such risks.
I do think it should give us some pause.
And I do not think it should have taken us this long to begin to understand what has been happening to our military and our veterans.