Mr. Johnson,
My name is Teri Curington and I am finishing my graduate work this semester at The University of Texas at Tyler’s College of Nursing. I have worked in the field of ER medicine and neurological intensive care, working with patients who have suffered traumatic brain injuries, among other severe neurological injuries.
The purpose of this email is to request your permission to use some of the information and clip-art photo’s displayed at the website: http://www.waiting.com in a presentation I am going to be conducting in April. This presentation is a course requirement and will not be used for any other purpose.
The ‘Waiting’ website is one of the best I have seen which explains in detain and in plain English, brain injuries. In fact, I have recommened this site to several families whose loved ones have suffered severe head trauma (…and could use a good lawyer)!
Very Respectfully,
TCurington RN, BSN, NC USN
We granted this request and asked that she write us back with a copy of her presentation, which we will post when we receive it.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Seoul hospital refuses to end coma patient’s life
Date: 12/17/2008 12:55 AM
SEOUL, South Korea (AP) — A South Korean hospital said Wednesday it will appeal a court order to let a comatose patient die by removing her from a respirator, saying the case could prompt a trend in devaluing human life.
The order issued by the Seoul Western District Court last month was for Severance Hospital in Seoul to end the life of a 76-year-old patient, citing the people’s right to die with dignity.
The decision — the first court ruling of its kind in South Korea — was issued after the patient’s children filed a lawsuit following the hospital’s refusal to end the women’s life.
Severance Hospital announced Wednesday that it cannot accept the court’s ruling because it could lead to a social trend to take human life too lightly.
“We should make decisions carefully on matters of human life,” hospital spokesman Lee Sung-man said.
Lee said the hospital plans to appeal the ruling directly to the Supreme Court and skip an appellate court because the issue needs to be settled as soon as possible.
The hospital will first need the patient’s family — the plaintiffs in the case — to agree to the streamlined process, and if they refuse the hospital will appeal the case to an ordinary appellate court.
The patient’s children have said their mother had always opposed keeping people alive on machines when there is no chance of revival.
The patient, only identified by her family name Kim, has been in a vegetative coma since suffering brain damage in February. The Seoul district court said in a ruling that doctors at major Seoul hospitals agreed that she has no chance of revival and could live as long as three or four months.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
SEOUL, South Korea (AP) — A South Korean hospital said Wednesday it will appeal a court order to let a comatose patient die by removing her from a respirator, saying the case could prompt a trend in devaluing human life.
The order issued by the Seoul Western District Court last month was for Severance Hospital in Seoul to end the life of a 76-year-old patient, citing the people’s right to die with dignity.
The decision — the first court ruling of its kind in South Korea — was issued after the patient’s children filed a lawsuit following the hospital’s refusal to end the women’s life.
Severance Hospital announced Wednesday that it cannot accept the court’s ruling because it could lead to a social trend to take human life too lightly.
“We should make decisions carefully on matters of human life,” hospital spokesman Lee Sung-man said.
Lee said the hospital plans to appeal the ruling directly to the Supreme Court and skip an appellate court because the issue needs to be settled as soon as possible.
The hospital will first need the patient’s family — the plaintiffs in the case — to agree to the streamlined process, and if they refuse the hospital will appeal the case to an ordinary appellate court.
The patient’s children have said their mother had always opposed keeping people alive on machines when there is no chance of revival.
The patient, only identified by her family name Kim, has been in a vegetative coma since suffering brain damage in February. The Seoul district court said in a ruling that doctors at major Seoul hospitals agreed that she has no chance of revival and could live as long as three or four months.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
CA surgeon to stand trial in organ donation case
Date: 11/2/2008 5:28 PM
By GREG RISLING
Associated Press Writer
LOS ANGELES (AP) — Ruben Navarro loved horror movies. He watched the “Nightmare on Elm Street” and “Friday the 13th” series with his mother, Rosa, and liked to visit Knott’s Berry Farm when it was transformed every October to “Knott’s Scary Farm.”
Since his death 2½ years ago, Rosa Navarro says she has been living a real-life nightmare without her only child. Ruben Navarro, who had multiple medical problems, died in a San Luis Obispo hospital following a heart attack, and then was taken off a ventilator and prepared for organ donation.
The circumstances surrounding that death will be center stage as opening statements are scheduled to begin Monday in the trial of Dr. Hootan Roozrokh, a San Francisco transplant surgeon who is accused of hastening Navarro’s death so his organs could be harvested.
“He was my world,” Rosa Navarro told The Associated Press on Thursday. “It’s been very, very hard for me. He didn’t die with respect and integrity.”
Roozrokh, 34, faces one count of felony dependent adult abuse. Two other felony counts were dismissed by San Luis Obispo County Superior Court Judge Martin J. Tangeman in March.
If convicted, he could face four years in prison.
Defense lawyer M. Gerald Schwartzbach has said Roozrokh did nothing wrong, saying he did not endanger Navarro’s health or life. Schwartzbach did not respond to an e-mail message for further comment.
The case against Roozrokh is believed to be the first such criminal action brought against a transplant doctor in the U.S.
Navarro, 25, died in February 2006 at Sierra Vista Regional Medical Center in San Luis Obispo. He had a debilitating neurological disease and was in a coma after suffering the heart attack.
His kidneys and liver were never harvested because he didn’t die within a time frame when those organs would have been considered viable.
The hospital has said it had Rosa Navarro’s permission to remove her son from life support, but she disputes that.
Statements to police by nurses present in the operating room indicated Roozrokh improperly ordered excessive doses of morphine and a sedative for Navarro. State law says transplant surgeons must wait until a potential donor is dead before participating in procedures.
But Tangeman said in his ruling dismissing the other two charges that there was no evidence Roozrokh administered or ordered a combination of morphine and the sedative. The judge also noted that doctors and nurses present when Navarro died gave conflicting accounts of what happened.
Roozrokh, a surgeon at Kaiser Permanente’s now-closed kidney transplant program, was working at the time on behalf of a group that procures and distributes organs.
The case is being watched closely by physicians and others in the medical field, said Arthur Caplan, a professor of medical ethics at the University of Pennsylvania who worries that a conviction could hurt prospects for expanding organ donation.
“It’s a trust issue,” Caplan said. “It’s such a moral taboo to give the appearance of hastening a death through organ donation. Were he to be found guilty, it would be a thunderclap heard through the organ procurement field.”
Navarro, who weighed about 80 pounds, was born with a neurological disorder known as adrenoleukodystrophy and also had cerebral palsy. He lived in a home for mentally and physically challenged adults in the year before his death.
The hospital and its parent company settled a lawsuit last year filed by Rosa Navarro for $250,000. Under terms of the settlement, the hospital acknowledged no wrongdoing.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
By GREG RISLING
Associated Press Writer
LOS ANGELES (AP) — Ruben Navarro loved horror movies. He watched the “Nightmare on Elm Street” and “Friday the 13th” series with his mother, Rosa, and liked to visit Knott’s Berry Farm when it was transformed every October to “Knott’s Scary Farm.”
Since his death 2½ years ago, Rosa Navarro says she has been living a real-life nightmare without her only child. Ruben Navarro, who had multiple medical problems, died in a San Luis Obispo hospital following a heart attack, and then was taken off a ventilator and prepared for organ donation.
The circumstances surrounding that death will be center stage as opening statements are scheduled to begin Monday in the trial of Dr. Hootan Roozrokh, a San Francisco transplant surgeon who is accused of hastening Navarro’s death so his organs could be harvested.
“He was my world,” Rosa Navarro told The Associated Press on Thursday. “It’s been very, very hard for me. He didn’t die with respect and integrity.”
Roozrokh, 34, faces one count of felony dependent adult abuse. Two other felony counts were dismissed by San Luis Obispo County Superior Court Judge Martin J. Tangeman in March.
If convicted, he could face four years in prison.
Defense lawyer M. Gerald Schwartzbach has said Roozrokh did nothing wrong, saying he did not endanger Navarro’s health or life. Schwartzbach did not respond to an e-mail message for further comment.
The case against Roozrokh is believed to be the first such criminal action brought against a transplant doctor in the U.S.
Navarro, 25, died in February 2006 at Sierra Vista Regional Medical Center in San Luis Obispo. He had a debilitating neurological disease and was in a coma after suffering the heart attack.
His kidneys and liver were never harvested because he didn’t die within a time frame when those organs would have been considered viable.
The hospital has said it had Rosa Navarro’s permission to remove her son from life support, but she disputes that.
Statements to police by nurses present in the operating room indicated Roozrokh improperly ordered excessive doses of morphine and a sedative for Navarro. State law says transplant surgeons must wait until a potential donor is dead before participating in procedures.
But Tangeman said in his ruling dismissing the other two charges that there was no evidence Roozrokh administered or ordered a combination of morphine and the sedative. The judge also noted that doctors and nurses present when Navarro died gave conflicting accounts of what happened.
Roozrokh, a surgeon at Kaiser Permanente’s now-closed kidney transplant program, was working at the time on behalf of a group that procures and distributes organs.
The case is being watched closely by physicians and others in the medical field, said Arthur Caplan, a professor of medical ethics at the University of Pennsylvania who worries that a conviction could hurt prospects for expanding organ donation.
“It’s a trust issue,” Caplan said. “It’s such a moral taboo to give the appearance of hastening a death through organ donation. Were he to be found guilty, it would be a thunderclap heard through the organ procurement field.”
Navarro, who weighed about 80 pounds, was born with a neurological disorder known as adrenoleukodystrophy and also had cerebral palsy. He lived in a home for mentally and physically challenged adults in the year before his death.
The hospital and its parent company settled a lawsuit last year filed by Rosa Navarro for $250,000. Under terms of the settlement, the hospital acknowledged no wrongdoing.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Girl with brain injury won’t testify in abuse case
Date: 9/30/2008 6:31 PM
By DENISE LAVOIE
Associated Press Writer
BOSTON (AP) _ A girl who survived an infamous Massachusetts end-of-life case will not be called to testify against the man accused of beating her into a coma and injuring her brain, according to a notice filed Tuesday.
Prosecutors said they decided against calling Haleigh Poutre, 14, as a witness after meeting with her several times, speaking to her doctors, and reviewing her medical and psychological records.
The extent of Haleigh’s recovery is unknown and state officials will not discuss her condition, citing privacy laws.
The notice was filed one day before a scheduled hearing in Hampden Superior Court to determine if Haleigh was mentally competent to be a witness.
“The Commonwealth has concluded that it would not be in the best interests of the child to testify in a public forum and has decided to forego the information she would have supplied rather than further traumatize the child,” Assistant District Attorney Laurel Brandt said in the court filing.
Authorities say Haleigh was severely beaten in 2005 by Jason Strickland and his wife Holli, who was Haleigh’s sister. The Stricklands adopted Haleigh when she was 7. Her birth mother is suing the state, saying she felt pressured by DSS to have the girl adopted.
The state took custody after Haleigh was hospitalized with a damaged brain stem that doctors said left her comatose. She became the center of a heartrending legal case when the Department of Social Services sought to remove her feeding tube, saying she had no hope of recovery.
That decision, and the subsequent criticism that the state moved too quickly after Haleigh improved enough to survive without a ventilator, prompted an exhaustive examination of how the state handles right-to-die questions for children in its care.
The case was key to sparking a massive overhaul of the state’s child welfare system, including the creation of a new Office of the Child Advocate.
If she had been found competent to testify, Haleigh would likely have had to face Strickland in court.
The Department of Children and Families and a court-appointed guardian for Haleigh both argued in court filings that she should not have to go through that anguish.
Strickland is scheduled to go to trial on assault charges Oct. 29. He has pleaded not guilty.
Holli Strickland died in an apparent murder-suicide with her grandmother two weeks after pleading innocent to assault charges in September 2005.
Strickland’s lawyer, Alan Black, did not immediately return messages left at his office.
Hampden District Attorney William Bennett did not immediately return a call seeking comment.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
By DENISE LAVOIE
Associated Press Writer
BOSTON (AP) _ A girl who survived an infamous Massachusetts end-of-life case will not be called to testify against the man accused of beating her into a coma and injuring her brain, according to a notice filed Tuesday.
Prosecutors said they decided against calling Haleigh Poutre, 14, as a witness after meeting with her several times, speaking to her doctors, and reviewing her medical and psychological records.
The extent of Haleigh’s recovery is unknown and state officials will not discuss her condition, citing privacy laws.
The notice was filed one day before a scheduled hearing in Hampden Superior Court to determine if Haleigh was mentally competent to be a witness.
“The Commonwealth has concluded that it would not be in the best interests of the child to testify in a public forum and has decided to forego the information she would have supplied rather than further traumatize the child,” Assistant District Attorney Laurel Brandt said in the court filing.
Authorities say Haleigh was severely beaten in 2005 by Jason Strickland and his wife Holli, who was Haleigh’s sister. The Stricklands adopted Haleigh when she was 7. Her birth mother is suing the state, saying she felt pressured by DSS to have the girl adopted.
The state took custody after Haleigh was hospitalized with a damaged brain stem that doctors said left her comatose. She became the center of a heartrending legal case when the Department of Social Services sought to remove her feeding tube, saying she had no hope of recovery.
That decision, and the subsequent criticism that the state moved too quickly after Haleigh improved enough to survive without a ventilator, prompted an exhaustive examination of how the state handles right-to-die questions for children in its care.
The case was key to sparking a massive overhaul of the state’s child welfare system, including the creation of a new Office of the Child Advocate.
If she had been found competent to testify, Haleigh would likely have had to face Strickland in court.
The Department of Children and Families and a court-appointed guardian for Haleigh both argued in court filings that she should not have to go through that anguish.
Strickland is scheduled to go to trial on assault charges Oct. 29. He has pleaded not guilty.
Holli Strickland died in an apparent murder-suicide with her grandmother two weeks after pleading innocent to assault charges in September 2005.
Strickland’s lawyer, Alan Black, did not immediately return messages left at his office.
Hampden District Attorney William Bennett did not immediately return a call seeking comment.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
The hardest part of waiting for someone to emerge from a coma
From someone who felt the need to connect with our http://waiting.com community:
waiting.com began as the merging of two ideas more than 11 years ago. First, provide as much information as possible to those who were actually waiting in a trauma center waiting room. Two, create a virtual connection to those who had gone thru it before, to those who were going thru it now. When it went online in 1997, it was the first time something like it had ever been done online, not just in brain injury, but in any field. To this day, it is the idea for which I am most proud.
Thank you Y Uribe for your contribution. We will soon add it permanently to the Bridge from Despair.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
“The hardest part of waiting is the feeling of being alone. No matter how many people surround me, I feel alone. I push people away, don’t feel like talking to anyone, yet I am forced to talk. I feel rudest to those closest to me. Its hard how suddenly your the center of attention and it feels inadequate. I’ve learned that people don’t know what to say to you so they offer their help. They want to do something for you, and you should let them. It is hard as all hell in the beginning, but as you go on, you learn that it will be less of a stress to you. Let your friends in. Support is what you need. Take it when you can get it. Call people, talk to people.”
waiting.com began as the merging of two ideas more than 11 years ago. First, provide as much information as possible to those who were actually waiting in a trauma center waiting room. Two, create a virtual connection to those who had gone thru it before, to those who were going thru it now. When it went online in 1997, it was the first time something like it had ever been done online, not just in brain injury, but in any field. To this day, it is the idea for which I am most proud.
Thank you Y Uribe for your contribution. We will soon add it permanently to the Bridge from Despair.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Brain Injury is not New to Iraq
Today’s blog, is a video blog, a bit of a rant about someone who should know better, who made this statement:
“Correct if I am wrong, but I think Traumatic Brain Injury is a new injury unique to the war in Iraq. Suffered by people who have concussive injuries from being near the explosions, not from being hit directly, but from reverberations of the explosion. And um doctors are still trying to figure out how to deal with it. I think there are a lot of questions about medical compensation for it. “
The question came from Terry Gross on an NPR Podcast, Fresh Air. See http://www.npr.org/templates/story/story.php?storyId=90696597
The link to my Youtube video in response to that statement is here. http://youtube.com/watch?v=9huVQtkN2ZY
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
“Correct if I am wrong, but I think Traumatic Brain Injury is a new injury unique to the war in Iraq. Suffered by people who have concussive injuries from being near the explosions, not from being hit directly, but from reverberations of the explosion. And um doctors are still trying to figure out how to deal with it. I think there are a lot of questions about medical compensation for it. “
The question came from Terry Gross on an NPR Podcast, Fresh Air. See http://www.npr.org/templates/story/story.php?storyId=90696597
The link to my Youtube video in response to that statement is here. http://youtube.com/watch?v=9huVQtkN2ZY
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Vietnam Remains Our Biggest Military Health Issue
As we shift our focus of this blog 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 of blogs began with my reaction to this news:
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 55 to 70 years old. That is 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 Vets reaches back to Vietnam, Korea and even World War II survivors?
The issue of the brain injury disability and mental health of older Vets has countless sub-issues, but the most important for this blog is that brain injury and brain damage were not even considered in what we today call mild to moderate brain injury during 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 vets with mild brain injuries in the Vietnam era than in the current generation of soldier and vets, but 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 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.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
“The Associated Press announced that active duty military suicides hit its highest level on record in 2007, 119 soldiers dead. See the AP story at: http://hosted.ap.org/dynamic/stories/M/MILITARY_SUICIDES?SITE=CADIU&SECTION;=HOME&TEMPLATE;=DEFAULT “
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 55 to 70 years old. That is 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 Vets reaches back to Vietnam, Korea and even World War II survivors?
The issue of the brain injury disability and mental health of older Vets has countless sub-issues, but the most important for this blog is that brain injury and brain damage were not even considered in what we today call mild to moderate brain injury during 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 vets with mild brain injuries in the Vietnam era than in the current generation of soldier and vets, but 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 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.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Hysteria or Conversion Diagnosis Focuses on Perceived Character Flaws, not Relevant Injury Factors
In understanding the stain that the “hysteria” diagnosis has left on our medical science, it is important to distinguish “hysteria” from PTSD. The modern term for hysteria (if there should even be a modern term for it) is “Conversion Disorder”. See DSM-IV 300.11. PTSD is an entirely different matter as it relates to the development of specific emotional problems, as a result of emotional trauma. In Conversion Disorder, the emotional issues of the patient (not traumatically induced symptoms) are converted into physical problems. In Myers’ case studies, he attributed the neurological symptoms of his soldiers to this type of “hysterical” conversion of emotional problems.
The DSM-IV criteria for Conversion Disorder, stresses the likelihood that the patient have a prior history of psychosis.
While such criteria were not formally laid out in his time, Myers seemed to sense the need to show that his soldiers were psychologically weak. With respect to Soldier #1, he said:
The significance of the reference to the lumbar pains, seems to be the implication that the emotional stress of coming combat had brought them on.
With respect to Soldier #2:
While he has no comment on the prior history of Soldier #3, he stresses the nervousness of the soldier in his narrative.
While Myers wasn’t working with a formal diagnostic criteria for a “hysterical” diagnosis, the modern definition of Conversion Disorder does at a minimum require ruling out all medical explanations for the neurological symptoms.
The Character Assassination: Soldier #1 back pains prior to deployment; Soldier #2, heavy drinker with domestic problems. While there might be emotional explanations for increasing back pain under extreme stress, that isn’t the type of deep psychosis which would explain an extremely rare diagnosis of “hysteria.” As for his attacks on Soldier #2’s character, one must ask: How many soldiers are heavy drinkers? (Even our current Republican Nominee, John McCain has admitted to hell-raising during his 20’s.) What soldier doesn’t have some worry about his marriage, his family while deployed in a combat zone?
Sleep. Myers discusses sleep with each of his soldiers. But diagnosing hysteria versus organic injury to the brain and neurological system because of pre-morbid problems with sleep, makes as much sense as stating that these soldiers were carrying a gun at the time they were shelled. The soldier who sleeps well, like a soldier who doesn’t carry a gun, is not a oldier to fare well in combat. Combat requires hypervigilance. The soldier who sleeps soundly, especially in World War I, is the soldier who is in peril. One of the most cogent theories of PTSD is that it is a result not of the specific instances of emotional shock, but as a result of the constant need to be hyper-aware. It is the never sleeping well, the need to being always ready to reach for the gun, to leap for cover, that may be the hardest thing for the combat veteran to wind down from, post combat. It may be the inability to shut off the mechanism to never truly sleep, to dream, that causes the surrealistic elements of post combat stress.
Next: We will discuss the elements of PTSD, its roots in combat, and its questionable applicability to more routine civilian stressors. But before this commentary leaves Myers behind, I do want to stress one important point:
Myers was not wrong to factor in the terror at the time of the injury and the precedent emotional vulnerability of the patient. His mistake was to miss the clear organic evidence of brain trauma, brain damage. It may be the terror or the emotional makeup of these specific soldiers, made them more likely to be disabled by the blast injury that might not have disabled a stronger individual. But the diagnosis must begin with a full differential consideration of brain or neurological damage. Once brain damage has been identified, it is fully appropriate to incorporate the synergistic interplay of the vulnerability of each individual, the additive factors of the combat stress such individual was under, and the emotional impact of such injury, on that particular brain.
Myers may not have had all the tools of modern medicine available to him, but he did have the most important: history and examination. He took the history, seemingly quite accurately. He did the examination better than most modern doctor s (especially with respect to the Olfactory Nerve). Where he failed, and perhaps because of British unwillingness to believe the brain could be so easily damaged, was in not believing the realness of his own findings. His soldiers couldn’t smell. They couldn’t remember. They had neurological explanations for the vast majority of their symptoms. Combat emotional stress could certainly explain the rest. Brain injury, by any other name, will still disable.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
The DSM-IV criteria for Conversion Disorder, stresses the likelihood that the patient have a prior history of psychosis.
“A history of other unexplained somatic (especially conversion) or dissociative symptoms signifies a greater likelihood that an apparent conversion symptom is not due to a general medical condition, especially if criteria for Somatization Disorder have been met in the past.”
While such criteria were not formally laid out in his time, Myers seemed to sense the need to show that his soldiers were psychologically weak. With respect to Soldier #1, he said:
“Prior history. –He had been for two months in the Aisne district on the lines of communication, sleeping badly all that time owing to lumbar pains (and toothache during the first three weeks.) He had failed to pass a medical examination some time previously because of renal trouble (abnormal amount of albumin in water) until after a long period of treatment. He had had lumbar pains a few nights before coming to France.”
The significance of the reference to the lumbar pains, seems to be the implication that the emotional stress of coming combat had brought them on.
With respect to Soldier #2:
“As to his past history, he came out to the war on August 13th, and was in the last two days’ retreat at Mons and after at La Bassee. Has slept very badly since the start, often when billeted taking large doses of whisky to procure sleep. Has led a ‘fast’ life and has had recent domestic worry.”
While he has no comment on the prior history of Soldier #3, he stresses the nervousness of the soldier in his narrative.
“A healthy looking man, well-nourished, but obviously in an extremely nervous condition. He complains that the slightest noise makes him start…. His hands became very tremulous and his forehead sweated profusely. He appeared as if about to faint, and says that he felt cold and dizzy, and experienced “round and round movements of the stomach…. He complains that he gets very excited when anyone addresses him.”The use of these implicit (without direct comment on their relevancy) comments by Myers is strongly reminiscent of the character assassination found in Defense neurological and neuropsychological opinions. No where does Myers say these symptoms are related to these character issues, just the “no comment seems necessary.”
While Myers wasn’t working with a formal diagnostic criteria for a “hysterical” diagnosis, the modern definition of Conversion Disorder does at a minimum require ruling out all medical explanations for the neurological symptoms.
“A diagnosis of Conversion Disorder should be made only after a thorough medical investigation has been performed to rule out an etiological neurological or general medical condition. Because a general medical etiology for many cases of apparent Conversion Disorder can take years to become evident, the diagnosis should be evaluated periodically.” DSM-IV, page 493.Did Myers rule out all medical conditions for the neurological symptoms? Of course not. As discussed in the previous blogs, there are clear neurological, biomechanical and pathological explanations for the amnesia and the anosmia. Much is made by Myers of the partial visual complaints of these three soldiers. Yet other Cranial Nerve damage can account for many of these phenomenon, even without any damage to the eye, or the Optic Nerve. There are references to Soldier #3’s stomach complaints, but anyone acquainted with the vestibular system should recognize these symptoms as being explained by vertigo: “He appeared as if about to faint, and says that he felt cold and dizzy, and experienced “round and round movements of the stomach.” See http://vestibulardisorder.com Further, the reports of sweating and feeling like he is about to faint, is clearly explained by a condition called POTS (postural orthostatic tachycardia syndrome), which would also cause the vertigo. POTS, vertigo, cranial nerve damage – are all clear markers of traumatic brain injury.
The Character Assassination: Soldier #1 back pains prior to deployment; Soldier #2, heavy drinker with domestic problems. While there might be emotional explanations for increasing back pain under extreme stress, that isn’t the type of deep psychosis which would explain an extremely rare diagnosis of “hysteria.” As for his attacks on Soldier #2’s character, one must ask: How many soldiers are heavy drinkers? (Even our current Republican Nominee, John McCain has admitted to hell-raising during his 20’s.) What soldier doesn’t have some worry about his marriage, his family while deployed in a combat zone?
Sleep. Myers discusses sleep with each of his soldiers. But diagnosing hysteria versus organic injury to the brain and neurological system because of pre-morbid problems with sleep, makes as much sense as stating that these soldiers were carrying a gun at the time they were shelled. The soldier who sleeps well, like a soldier who doesn’t carry a gun, is not a oldier to fare well in combat. Combat requires hypervigilance. The soldier who sleeps soundly, especially in World War I, is the soldier who is in peril. One of the most cogent theories of PTSD is that it is a result not of the specific instances of emotional shock, but as a result of the constant need to be hyper-aware. It is the never sleeping well, the need to being always ready to reach for the gun, to leap for cover, that may be the hardest thing for the combat veteran to wind down from, post combat. It may be the inability to shut off the mechanism to never truly sleep, to dream, that causes the surrealistic elements of post combat stress.
Next: We will discuss the elements of PTSD, its roots in combat, and its questionable applicability to more routine civilian stressors. But before this commentary leaves Myers behind, I do want to stress one important point:
Myers was not wrong to factor in the terror at the time of the injury and the precedent emotional vulnerability of the patient. His mistake was to miss the clear organic evidence of brain trauma, brain damage. It may be the terror or the emotional makeup of these specific soldiers, made them more likely to be disabled by the blast injury that might not have disabled a stronger individual. But the diagnosis must begin with a full differential consideration of brain or neurological damage. Once brain damage has been identified, it is fully appropriate to incorporate the synergistic interplay of the vulnerability of each individual, the additive factors of the combat stress such individual was under, and the emotional impact of such injury, on that particular brain.
Myers may not have had all the tools of modern medicine available to him, but he did have the most important: history and examination. He took the history, seemingly quite accurately. He did the examination better than most modern doctor s (especially with respect to the Olfactory Nerve). Where he failed, and perhaps because of British unwillingness to believe the brain could be so easily damaged, was in not believing the realness of his own findings. His soldiers couldn’t smell. They couldn’t remember. They had neurological explanations for the vast majority of their symptoms. Combat emotional stress could certainly explain the rest. Brain injury, by any other name, will still disable.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Lancet Case Study of Three World War I Soldiers with Shell Shock
As introduced in yesterday’s blog, Captain Charles Myers, a British Physician authored a significant case study of three wounded soldiers with shell shock in the Lancet, the publication of the British Medical Society. See C.S. Myers, “A Contribution to the Study of Shell Shock” The Lancet, on February 13, 1915 page 316-320.
Myers begins his discussion of the three cases by calling them “remarkably similar.” All three soldiers were
And quite significantly to Myers, despite the proximity of the blasts, none had any significant disruption in hearing.
Soldier # 1:
Myers detailed the history as follows:
Myers details this soldier’s symptoms as follows:
Conclusions. Myers, after discussing the three histories, ends his paper with this comment:
Thus, at a critical juncture in military medicine, with all the observational facts recorded to shift the focus to brain injury, the theory of hysterical illness raises its specter. That pattern gets repeated and becomes the cornerstone of far too much bad diagnosis – even to this day – at least in forensic neurological practice.
Myers’ choice of the word “hysteria”, is now replaced by the words “conversion disorder”. Myers might have been a pioneer – a leader in the field of military medicine in 1915 – yet his ignorance relative to what we know today about brain anatomy, is significant. The two most predictable markers of brain injury are loss of memory for events around the time of the injury (amnesia) and the loss of smell. He dismissed these findings. Further, he clearly lacked any basic understanding of the biomechanical forces which result in brain injury. While his ignorance is understandable, the ongoing use of these ridiculous psychiatric excuses for clear-cut neurological phenomenon, are not.
In the coming blogs, we will look at the clues to a proper diagnosis in these three cases histories: amnesia, loss of smell and the biomechanical and neuropathological explanations for brain injury.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Myers begins his discussion of the three cases by calling them “remarkably similar.” All three soldiers were
• Injured by a by shells bursting near them;
• Had sleep problems before their injuries,
• Had memory disturbances after their injuries;
• Had vision affected;
• Had disturbances of smell and taste.
And quite significantly to Myers, despite the proximity of the blasts, none had any significant disruption in hearing.
Soldier # 1:
Myers describes the first soldiers case as follows:
Soldier # 2:
“During the (retreat) from this trench at 1:30 p.m., they were “found” by the German artillery. Up to that time he had not been feeling afraid; he had rather ‘been enjoying it’ and was in the best of spirits until the shells burst about him… He was trying to creep under wire entanglements when two or three shells burst near him. As he was struggling to disentangle himself from the wire, three more shells burst behind and one in front of him. After the shells had burst he succeeded in getting back under the wire entanglements. … Immediately after the shell burst in front of him his sight became blurred. It hurt his eyes, and they burned when closed. At the same moment he was seized with the shivering, and the cold sweat broke out especially around the loins “like a punch on the head, without any pain of it’. The shell in front cut his haversack clean away, bruised his side, and apparently it burned his little finger. …
“When he got to treatment… he was crying the whole time and worrying as to whether he was going blind. … At the dressing table station he was crying and shivering; he was taken thence to a hospital by horse ambulance… He thinks he must have slept on the ambulance, as he remembers nothing. (Emphasis in original.)
Three months post injury ‘says he has lost the sense of taste and smell since the shell’s burst around him.’
Woke up last night and found himself crying: ‘not thinking of anything in particular’.
Past history: He had been for two months in the Aisne district on the lines of communication, sleeping badly all the time owing to lumbar pain… He had failed to pass a medical examination some time previously because of renal trouble.
Soldier # 2:
Myers says of the second soldiers combat experience:
“The patient says he was buried for 18 hours owing to a shell bursting and ‘blowing in’ the trench in which he lay.”
This soldier also has lost his sense of smell and much of his sense of taste. While some “memory” of the events around the time of his injury returned, comparison to his later description of events was not consistent with what other soldiers who survived the battle remembered. While Myers seemed troubled by the conflict in these stories, it can clearly be explained by the brain injury symptom of “confabulation”.Soldier # 3:
Myers detailed the history as follows:
The patient says was blown off a heap of bricks, 15 feet high, owing to a shell bursting close to him. Thinks he must have fallen into a pool of water, as he next remembers finding himself, about 3 p.m., the same afternoon in a cellar near a church with his clothes drenched. He does not know how he got there or how he left the cellar, but he remembers being in another hospital before he was admitted here.”
Myers details this soldier’s symptoms as follows:
“A healthy-looking man, well-nourished, but obviously in extreme nervous condition. He complains that the slightest noise makes him start. His legs feel weak and he has pain in the precordial region. His sight has been very much impaired since the shock. …
He has slept very little the last two nights. Hands tremulous. Knee jerks normal, but the first attempts to evoke them provoked a spasm of the calf muscles and a few general convulsive movements as the patient lay in bed. His hands became very tremulous and his forehead sweated profusely. He appeared as if about to faint and says that he felt cold and dizzy, and experienced round and round movements of the stomach. … The slightest touch on the legs provoked well-marked spasm of the quadriceps muscles of the same thigh. Extensor muscles of the toes appeared to be in a state of clonic contraction.
Left nostril fails to detect smell of ether, peppermint, eucalyptus, ammonia, carbolic acid, or iodine tincture, all of which are at once recognized when placed beneath the right nostril. No signs of nasal obstruction. Taste: Only tastes very strong solutions of sugar, salt and acid…”
Conclusions. Myers, after discussing the three histories, ends his paper with this comment:
Comment on these cases seems superfluous. They appear to constitute a definite class among others arising from the effects of shell-shock. The shells in question appear to have burst with considerable noise, scattering much dust, but this was not attended by the production of odor. It is therefore difficult to understand why hearing should be (practically) unaffected and the dissociated “complex” be confined to the senses of sight, smell and taste (and to memory). The relation of these cases to those of “hysteria” appears fairly certain.
Thus, at a critical juncture in military medicine, with all the observational facts recorded to shift the focus to brain injury, the theory of hysterical illness raises its specter. That pattern gets repeated and becomes the cornerstone of far too much bad diagnosis – even to this day – at least in forensic neurological practice.
Myers’ choice of the word “hysteria”, is now replaced by the words “conversion disorder”. Myers might have been a pioneer – a leader in the field of military medicine in 1915 – yet his ignorance relative to what we know today about brain anatomy, is significant. The two most predictable markers of brain injury are loss of memory for events around the time of the injury (amnesia) and the loss of smell. He dismissed these findings. Further, he clearly lacked any basic understanding of the biomechanical forces which result in brain injury. While his ignorance is understandable, the ongoing use of these ridiculous psychiatric excuses for clear-cut neurological phenomenon, are not.
In the coming blogs, we will look at the clues to a proper diagnosis in these three cases histories: amnesia, loss of smell and the biomechanical and neuropathological explanations for brain injury.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
World War I Literature Shows the Reluctance to Identify Brain Injury in Shell Shock Soldiers
I owe my perception of the World War I literature on Shell Shock to a good friend’s academic pursuit of such topic while at Yale. The below quotes are from a paper discussing the dichotic treatment of shell shock as an emotional/organic injury in the novel: Return of the Soldier, by Rebecca West. Quoting from Kara Harton’s paper:
In following up on Kara Harton’s research, I found some of the published works of the British physician, Charles S. Myers. Tragically, Myers had immense difficulty overcoming his skepticism that an actual injury to the brain could have occurred without obvious head trauma, despite his focus on the “shell shock” events at the time of onset of the symptoms. While Myers did an excellent job in documenting diagnostic information from which a brain injury diagnosis could have been made, he sarcastically dismissed these cluster of symptoms as “hysterical” (psychiatric) in nature.
Tomorrow: A closer look at Myers’ 1915 seminal paper on “A Contribution to the Study of Shell Shock” published in the British medical journal, The Lancet, on February 13, 1915.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Shell Shock in Rebecca West’s Return of the Soldier
Set in 1916 at the Baldry family estate outside London, Return of the Soldier is the fictional story of Chris Baldry, a veteran of The Great War, who is discharged from the military due to shell shock-induced amnesia. His only memories are expressed as flashbacks of his pre-war life.
The idea of shell shock is introduced in the novel before the main character actually appears. Kitty and Jenny are at Baldry Court, nostalgically reminiscing about the past, when Margaret arrives with news about Chris. She informs the women that Chris has experienced some sort of misfortune on the battlefield but is somewhat hesitant to reveal the details. When Kitty asks if he is wounded, Margaret responds with, “Yes . . . he’s wounded,” but soon corrects herself by explaining, “I don’t know how to put it, he’s not exactly wounded. A shell burst –.” “Concussion?” Kitty asks. Margaret clarifies that Chris has shell shock and is “not dangerously ill.” After her explanation, the women share an awkward silence; they are obviously uncomfortable, and it is clear that neither of them is certain of the implications of the news.
Just as the characters of Return of the Soldier are not quite sure how to classify this condition, most Europeans, including medical and psychological experts, were unsure of the exact cause and characteristics of shell shock. There was an extensive debate about whether the nature of the condition was physical or mental, and whether it could legitimately be classified as a “wound.” The inability to pinpoint Chris’s injury in the previous passage is an excellent illustration of this uncertainty. It is not a tangible injury, and no one can decide exactly how to refer to it. The women seem uncomfortable using the term “shell shock,” which shows their lack of familiarity and understanding of the condition.
In addition to providing an excellent illustration of the uncertainty with which people approached shell shock, Return of the Soldier also contains numerous examples of the way that this condition disrupted society during and after the War. After Chris’s return, Kitty wants their lives to return to normalcy because as members of the upper echelon of society, they both have important responsibilities and obligations to fulfill.* * *
Jay Winter, a notable World War One historian, calls shell shock “a code to describe the shock of the war to the ruling elite, whose sons and apprentices, being groomed for war, were slaughtered in France and Flanders.” (Winter 10) In this war, unlike other wars, the higher a man’s socioeconomic status, the greater his chances of becoming a casualty. This fact was very real to the social elites, and the phenomenon of shell shock provided “a symbol . . . of the effect of the war on both their own social formation and British society as a whole, which many of them took to be interchangeable.” (10) Officers were expected to be shielded from the danger of emotional breakdown by their superior competence and judgment, their position of responsibility, and the need to set an example for their inferiors. The awareness that officers were more likely to become casualties (both due to shell shock and more conventional injuries) was an uncomfortable reality for society.
© Kara S. Harton, 2007 For the full paper, click here.
In following up on Kara Harton’s research, I found some of the published works of the British physician, Charles S. Myers. Tragically, Myers had immense difficulty overcoming his skepticism that an actual injury to the brain could have occurred without obvious head trauma, despite his focus on the “shell shock” events at the time of onset of the symptoms. While Myers did an excellent job in documenting diagnostic information from which a brain injury diagnosis could have been made, he sarcastically dismissed these cluster of symptoms as “hysterical” (psychiatric) in nature.
Tomorrow: A closer look at Myers’ 1915 seminal paper on “A Contribution to the Study of Shell Shock” published in the British medical journal, The Lancet, on February 13, 1915.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney