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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.

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.

His was the first autopsy to clearly show CTE.  Since then other autopsies are beginning to confirm the pattern.

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.

Originally posted to teacherken on Thu Apr 26, 2012 at 03:12 AM PDT.

Also republished by DKos Military Veterans and Military Community Members of Daily Kos.

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Comment Preferences

  •  Tip Jar (25+ / 0-)

    "what the best and wisest parent wants for his child is what we should want for all the children of the community" - John Dewey

    by teacherken on Thu Apr 26, 2012 at 03:12:22 AM PDT

  •  interfering with radio signals does not stop IEDs. (1+ / 0-)
    Recommended by:
    BlackSheep1

    Without getting into a digression here, I'll just say that, having studied the subject extensively, there is no truly effective way to stop or detect or counteract IEDs.  And now that IEDs have been unleashed upon the world as an effective weapon of insurgencies, they will continue to be used in future conflicts.

    The bottom line is, "boots on the ground" = people exposed to the risk of these things, some of whom will come back home with permanent damage as a result.  This is unavoidable in ground warfare from here forward.  

    "Minus two votes for the Democrat" equals "plus one vote for the Republican." Arithmetic doesn't care about your feelings.

    by G2geek on Thu Apr 26, 2012 at 03:23:49 AM PDT

    •  G2geek: It goes back further than the post- (1+ / 0-)
      Recommended by:
      G2geek

      11SEP01 wars too.

      A friend of mine from high school served in Desert Shield/Storm & came home with a TBI.

      He'd been home about 16 months when he committed suicide.

      LBJ & Lady Bird, Sully Sullenberger, Molly Ivins, Barbara Jordan, Ann Richards, Drew Brees: Texas is No Bush League! -7.50,-5.59

      by BlackSheep1 on Thu Apr 26, 2012 at 10:47:00 AM PDT

      [ Parent ]

      •  ohboy, sorry to hear that. (1+ / 0-)
        Recommended by:
        BlackSheep1

        Clearly there have been TBIs happening on the battlefield since forever-ago, the nature of warfare involving explosions at close range.  IEDs just introduced a new and unexpectedly effective method for putting explosions close to targets.  

        "Minus two votes for the Democrat" equals "plus one vote for the Republican." Arithmetic doesn't care about your feelings.

        by G2geek on Thu Apr 26, 2012 at 02:38:25 PM PDT

        [ Parent ]

  •  I Will Just Say This ............ (5+ / 0-)

    My father is maybe, as a high-level DoD guy more of a pacificist then I am. Ask him he will tell you we are good at blowing shit up. That is what our military does. I am the first person in four generation that has not served. The use of military force is the LAST thing you do. The last. IMHO those that say we should just fight harder, including Obama, are pussies. They've never fought. Bring our kids home now. Yesterday.

    If you are asked to do terrible shit, when you come home why is it even remotely strange that things are fucked up.

    When opportunity calls pick up the phone and give it directions to your house.

    by webranding on Thu Apr 26, 2012 at 03:25:55 AM PDT

  •  as for sports... (3+ / 0-)
    Recommended by:
    teacherken, mookins, greengemini

    ... moves that are known to cause brain damage should be prohibited under the rules of each sport, with ferociously harsh penalties including full-season suspension of players on the first offense and permanent ban from the sport on the second offense.  

    Think about this for a moment:  Imagine that the testicles were the target, instead of the head, and permanent sterility was the result.  Yah, you betcha anyone who kicked another player in the ballz would be outta' there pronto.  

    We can see about letting people hit each other in the head once we have a pill that will re-grow brain cells at least as fast as modern medicine can heal sprains and torn muscles and broken bones.  

    "Minus two votes for the Democrat" equals "plus one vote for the Republican." Arithmetic doesn't care about your feelings.

    by G2geek on Thu Apr 26, 2012 at 03:29:18 AM PDT

    •  My Parents Never "Let" Me Play (0+ / 0-)

      football. I went to college on a D1 golf scholarship. At many times I went and saw fucked up shit. You and I played I'd would be looking to drill your ass into the grouping. Just football. Just how it works. Do the same to me.

      When opportunity calls pick up the phone and give it directions to your house.

      by webranding on Thu Apr 26, 2012 at 03:38:49 AM PDT

      [ Parent ]

  •  In fact the brain is so delicate (4+ / 0-)

    that based on the pattern of damage (the resulting whiplash) and knowledge a physics, they can figure out whether the head was steady and the object was moving, or if the object was steady and the head was moving.

    Also, "encephalopathy" just means brain injury. The more specific condition is dementia (or loss of orientation to place and time) and is a huge burden to families and society.

    •  head trauma caused my father's passing (3+ / 0-)
      Recommended by:
      QDMacaw, greengemini, BlackSheep1

      He was taken to the hospital after falling and hitting his head on the street curb. He had just turned 90, but was checked out and released. I hold a sour spot inside that the hospital and doctors that treated him did not warn us of the possible repercussions (ironic word choice?) of his accident, especially regarding swelling of the brain, in my father's instance.
      A month later, my father suddenly lapsed into a coma and never recovered from the swelling that had gone undiagnosed.

      I do share your concern for our soldiers and our gladiators, teach. And, I do know why we keep butting our heads against walls; supposedly, it feels better when we stop. Let's hope we find out someday.

  •  Just a slight lesion on the prefrontal lobes (5+ / 0-)

    the result, perhaps, of a forceps delivery, can result in having no sense of time, no sense of sequence, no sense of order, no sense of the negative as the opposite of the positive.
    To "knock someone senseless" is not a short-term event.  The problem with the brain is that it does not know, cannot monitor itself. Ignorance of the self may not be self-deception; it may be the consequence of a disconnect that occurred even before we were born.  After all, it's not necessary to think to survive.

    People to Wall Street: "LET OUR MONEY GO"

    by hannah on Thu Apr 26, 2012 at 04:13:55 AM PDT

  •  Blowing brains apart one nueron at a time? (3+ / 0-)

    Damage may be hidden for years.  Our vets deserve the best life long medical care that we can provide for them. I wish it were true.  The true cost and long term consequences of our actions as a country or as individuals is rarely accounted for.  

    I also wonder about the potential brain damage caused by police using LRAD cannons on protesters, and a disturbing story about the record breaking die off of dolphins off the coast of Peru this year.

    causes could be acoustic impact from testing for oil
    TK, another great thought provoking diary.  Thanks.

    I play for keeps. Kindness, Equality, Enlightenment, Peace, and Sustainability.

    by QDMacaw on Thu Apr 26, 2012 at 09:36:12 AM PDT

  •  This may be (1+ / 0-)
    Recommended by:
    JML9999

    how my spouse died, although most of the head traumas happened post-service

    slutty voter for a "dangerous president"; Präsidentenelf-maßschach; Warning-Some Snark Above"Nous sommes un groupuscule" (-9.50; -7.03) "Sciant terra viam monstrare." 政治委员, 政委!

    by annieli on Thu Apr 26, 2012 at 12:05:09 PM PDT

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