While I have been away from writing this blog, there has been more concussion news than I can remember. And as always, the real story usually gets lost in the headlines.
Tiger Woods is a perfect example. From all bystander and news accounts, he was undoubtedly knocked out when his SUV hit a tree. Much speculation swirled before the infidelity took over the story, but no one said it quite this clearly:
Tiger Woods must have had a brain injury and his reluctance to speak in public may have been for medical reasons in addition to his reluctance to discuss his marriage. He might have cancelled his next golf tournament because of injuries he suffered. I am not naive to the more likely motivations for his disappearance from the public stage, but concussion is an issue that should not be forgotten.
The good news on the concussion front is that awareness seems to be growing daily. The NFL has gotten headlines for its new concussion policies, which don’t read any different to me than what should have always been its policy, but something clearly has changed. Players who would have been medically cleared to play, have been told they couldn’t. That includes starting quarterbacks on what were playoff caliber teams at the time, the Phoenix Cardinals and the Pittsburg Steelers. Yet the same week, I saw Jermichael Finley take a horrendous hit to his jaw from another players helmet, yet not even be taken out for one play. They stopped the play for the penalty and by the time they had marked off the yardage, he was lined up again.
How could anyone have known what lingering effects he had of a ding everyone clearly saw, if he didn’t even come to the sidelines?
One of the continuing problems with sideline concussion evaluations is the presumption that anyone noticed the initial concussion. That is an organic problem that can’t really be avoided, but if a player isn’t pulled out of a game to talk to the trainer, there is no chance to avoid the catastrophic second impact syndrome that turns a concussion into a severe and even life threatening injury.
The story of concussion in sport and its relevancy to the non-fan in us, will be a focus of the blogs to come.
Department of Defense Treated Brain Injured Vets Like Defense Lawyers Do
I have always called it the Defense of Misdirection. This year, is an election year, and I have an easier term for people to understand: SPIN. Spin is what defense attorney’s do. They spin everything, ignoring the obvious and coming up with some type of misdirection to disregard the diagnosis of treating doctors. The goal is to shift blame from everyone but the defendant who actually caused the injury by his/her/its wrongful conduct.
The favorite spin of defense attorneys is to blame it on pre-injury (pre-morbid is the medical term, meaning previously to the injury “mordibity”) psychological problems. The Army now is using similar tactics. With insurance companies the motive is to build up the skepticism of the jury, to reduce the amount its insured is required to pay. With the Military, the motive is to find as many warm bodies as possible to send back into a combat zone, to keep the numbers up for the surge in Iraq. There might also be the motive to save billions in VA benefits, too.
An April 23, 2007 story in the Army Times details the way in which the Army is using so-called “personality disorders” and tactics typical of Defense lawyers to force soldiers to go back into combat, or deny them proper veterans medical and disability benefits. For the full story, click here: http://www.armytimes.com/news/2007/04/military_braininjury_thurman_070420w/
The insurance industry propaganda machine is always trying to stir up sentiment about frivolous lawsuits. What actually happens in the Courtroom is dramatically different.
Defense attorneys learn how to spin any disability into something where they can raise jurors skepticism. Defense attorneys hire doctors who know what is expected of them. Ridiculous, psychosomatic diagnosis not found in the real medical world since Freud, are reinvented.
(The actual condition of Conversion disorder is so rare, that only left-over Freudian influence in the psychiatric profession, keeps it in the DSM-IV.) Pre-morbid personality disorders are found even though the person was considered well adjusted and productive before they got hurt. Any emotional counseling around life’s normal challenges such as divorce or marital difficulties is turned into evidence of deep seeded psychosis.
Jurors often see the Defense doctors as equally credible to the plaintiffs treating doctors, for reasons that are hard to fathom. As the plaintiff has the “burden of proof”, any doubts are resolved in favor of the Spin Doctors. Often the most credible evidence is that of friends and co-workers, who tell of how normal and productive the plaintiff was before. Defense lawyers try to spin this, and apparently, so does the military. The Army Times story linked above, tells of a soldier who was claimed to have a personality disorder, even though it didn’t show itself until he returned from Iraq.
Edward Kaspar said he served as Town’s lieutenant and was a witness to the incident in which a rocket exploded above Town’s head in Iraq, causing his brain injury.
“I was pretty shocked to hear about his problems now,” Kaspar said by e-mail. “This personality disorder thing just doesn’t make sense. I’m not a trained medical professional, but I can say that in the years he served as one of my soldiers, he definitely had it together. _ I relied on him to get the job done and he never failed me, both in peacetime and in war.”
Senators and Congressmen are calling for our wounded soldiers to get better treatment than this. While Bush and McCain are still fighting giving maximum benefits to Iraq Veterans, the political tide looks like by early next year, the laws will be improve. But changing the written rules won’t be enough. The culture of denial must be changed. Doctors, both civilian and military must start to believe that good, hard working people, are not malingers, just waiting for a chance for a free ride. People don’t choose the life of the disabled. They are disabled because their minds have been fundamentally changed by either trauma or extraordinary stress in a way, that has left them only a shadow of who they were. This is not a life of luxury, but a tragedy that deserves all of the assistance either our court system in the case of civilian injuries, or the VA system, in case of military injuries, can provide.
There can be no disagreement on this: forcing a soldier with a brain injury or PTSD to return to combat is unconscionable, not just because it is exposes that soldier to death and more disability, but because it exposes other soldiers to the same, because they will not be able to rely on that soldier.
The favorite spin of defense attorneys is to blame it on pre-injury (pre-morbid is the medical term, meaning previously to the injury “mordibity”) psychological problems. The Army now is using similar tactics. With insurance companies the motive is to build up the skepticism of the jury, to reduce the amount its insured is required to pay. With the Military, the motive is to find as many warm bodies as possible to send back into a combat zone, to keep the numbers up for the surge in Iraq. There might also be the motive to save billions in VA benefits, too.
An April 23, 2007 story in the Army Times details the way in which the Army is using so-called “personality disorders” and tactics typical of Defense lawyers to force soldiers to go back into combat, or deny them proper veterans medical and disability benefits. For the full story, click here: http://www.armytimes.com/news/2007/04/military_braininjury_thurman_070420w/
The insurance industry propaganda machine is always trying to stir up sentiment about frivolous lawsuits. What actually happens in the Courtroom is dramatically different.
Defense attorneys learn how to spin any disability into something where they can raise jurors skepticism. Defense attorneys hire doctors who know what is expected of them. Ridiculous, psychosomatic diagnosis not found in the real medical world since Freud, are reinvented.
(The actual condition of Conversion disorder is so rare, that only left-over Freudian influence in the psychiatric profession, keeps it in the DSM-IV.) Pre-morbid personality disorders are found even though the person was considered well adjusted and productive before they got hurt. Any emotional counseling around life’s normal challenges such as divorce or marital difficulties is turned into evidence of deep seeded psychosis.
Jurors often see the Defense doctors as equally credible to the plaintiffs treating doctors, for reasons that are hard to fathom. As the plaintiff has the “burden of proof”, any doubts are resolved in favor of the Spin Doctors. Often the most credible evidence is that of friends and co-workers, who tell of how normal and productive the plaintiff was before. Defense lawyers try to spin this, and apparently, so does the military. The Army Times story linked above, tells of a soldier who was claimed to have a personality disorder, even though it didn’t show itself until he returned from Iraq.
Edward Kaspar said he served as Town’s lieutenant and was a witness to the incident in which a rocket exploded above Town’s head in Iraq, causing his brain injury.
“I was pretty shocked to hear about his problems now,” Kaspar said by e-mail. “This personality disorder thing just doesn’t make sense. I’m not a trained medical professional, but I can say that in the years he served as one of my soldiers, he definitely had it together. _ I relied on him to get the job done and he never failed me, both in peacetime and in war.”
Senators and Congressmen are calling for our wounded soldiers to get better treatment than this. While Bush and McCain are still fighting giving maximum benefits to Iraq Veterans, the political tide looks like by early next year, the laws will be improve. But changing the written rules won’t be enough. The culture of denial must be changed. Doctors, both civilian and military must start to believe that good, hard working people, are not malingers, just waiting for a chance for a free ride. People don’t choose the life of the disabled. They are disabled because their minds have been fundamentally changed by either trauma or extraordinary stress in a way, that has left them only a shadow of who they were. This is not a life of luxury, but a tragedy that deserves all of the assistance either our court system in the case of civilian injuries, or the VA system, in case of military injuries, can provide.
There can be no disagreement on this: forcing a soldier with a brain injury or PTSD to return to combat is unconscionable, not just because it is exposes that soldier to death and more disability, but because it exposes other soldiers to the same, because they will not be able to rely on that soldier.
NFL, War and Brain Injury, Part II
Yesterday I commented on the intersection of news about Iraq War veterans and the death of an NFL player. Today, we focus more on the synergistic effect of the interplay between brain injury and emotional problems.
It was reported in the April 19, 2008 edition of the Science Daily that one in five Iraq and Afghanistan Veterans suffer from PTSD or major depression. In addition, 19% are reported to be suffering from the effects of brain injury.
Click here for the complete story: http://www.sciencedaily.com/releases/2008/04/080417112102.htm
According to this article:
Combat involves a synergistic (as defined yesterday) exposure to screwing up what makes the brain work. Not only are enemy attacks particularly bad for the organic matter inside the brain, but the constant vigilance and stress that which can occur, can create a more vulnerable brain to an “organic” injury. Prevalent throughout almost all neuropsychological literature is the challenge to distinguish between actual physical injury to brain tissue (organic injury) and the effect of emotional responses on the brain. There is no shortage of areas that the allocated research funds could be directed. Still, we believe that focusing on the synergistic effect and the vulnerabilities to injury of someone exposed to the stress of combat, should be near the forefront of priorities.
It was reported in the April 19, 2008 edition of the Science Daily that one in five Iraq and Afghanistan Veterans suffer from PTSD or major depression. In addition, 19% are reported to be suffering from the effects of brain injury.
Click here for the complete story: http://www.sciencedaily.com/releases/2008/04/080417112102.htm
According to this article:
Researchers surveyed 1,965 service members from 24 communities across the country to assess their exposure to traumatic events and possible brain injury while deployed, evaluate current symptoms of psychological illness, and gauge whether they have received care for combat-related problems.The article said:
“There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan,” said Terri Tanielian, the project’s co-leader and a researcher at RAND, a nonprofit research organization. “Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation. Unfortunately, we found there are many barriers preventing them from getting the high-quality treatment they need.”Odds are that they will get this attention. The recent federal funding has allocated large sums of money for TBI research and treatment from these two wars. Still, these numbers, if they are to be believed (i.e.,19% with TBI) mean that there are considerably more veterans involved the 20,000 or so that have been involved in recent studies. A 19% figure could push the number of vets with post concussional syndrome well into the hundreds of thousands. That would make even a half of billion dollars, seem inadequate.
Combat involves a synergistic (as defined yesterday) exposure to screwing up what makes the brain work. Not only are enemy attacks particularly bad for the organic matter inside the brain, but the constant vigilance and stress that which can occur, can create a more vulnerable brain to an “organic” injury. Prevalent throughout almost all neuropsychological literature is the challenge to distinguish between actual physical injury to brain tissue (organic injury) and the effect of emotional responses on the brain. There is no shortage of areas that the allocated research funds could be directed. Still, we believe that focusing on the synergistic effect and the vulnerabilities to injury of someone exposed to the stress of combat, should be near the forefront of priorities.