Combat-related Traumatic Brain Injuries & Cognitive Disorders-Responding to Our Veterans Needs: Response by Jeremy Bourrét
Some have argued that it is very important for many reasons that our country, including new and future counselors, learn the most important and germane lessons from Vietnam (The Conversation.com, 2012). For counselors, it is important to know that PTSD was diagnosed too late for Vietnam Veterans so many who could have received the necessary care and treatment that they deserved. Also, Traumatic Brain Injuries occurred in Vietnam; but, how many Vietnam War Veterans were never diagnosed, misdiagnosed, or diagnosed and treated too late? So, the question is: have we learned anything about mental health and disorders that can also now affect our Iraq and Afghanistan Veterans?
If traumatic brain injuries can be related to dementia (Butcher, Mineka, & Hooley, 2012; Comber, 2010), which the American Psychiatric Association (2000) has acknowledged, some important questions should be asked. For instance, in both the civilian and in the Veteran populations, how are traumatic brain injuries assessed; what criteria are used? First a myth or misunderstanding needs to be addressed:
“Many patients and clinicians assume that the terms mild, moderate and severe TBI refer to the severity of symptoms associated with the injury. In fact these terms refer to the nature of the injury itself… Moderate traumatic brain injuries entail loss of consciousness > 30 minutes, post-traumatic amnesia > 24 hours, and an initial GCS 9-12. Severe brain injuries entail all of the moderate criteria listed above, but with a GCS < 9. [Regarding civilians who not Veterans] …about 80% of all TBI’s in the civilian population are mild traumatic brain injuries (mTBI)… However, some 10-15% of patients may go on to develop chronic post-concussive symptoms. These symptoms can be grouped into three categories: somatic (headache, tinnitus, insomnia, etc.), cognitive (memory, attention and concentration difficulties…” (n.p.).
This can, then, sometimes lead to a person eventually developing any
of some of the various types of Cognitive Disorders (American Psychiatric Association, 2000, Comber, 2010). Also, Summerall (2011), one of the Veterans Administration/Department of Defense’s sources, who has written about TBI’s, has noted about the nature of more intense traumas and injuries which civilians are less likely to experience than combat-Veterans; also, the diagnostic and treatment needs of those with serious TBI’s, like combat-Veterans, are complex:
“Moderate and Severe TBI Patients with moderate and severe brain injuries often have focal deficits and occasionally profound brain damage. … The diagnosis of TBI, associated post-concussive symptoms and other comorbidities such as PTSD, presents unique challenges for diagnosticians” (Summerall, 2011, n.p.).
It has been recommended by the Veterans Administration’s guidelines (Summerall, 2011) that additional factors should be taken into consideration by diagnosticians of various professions, including psychologists, counselors, neurologists, and psychiatrists:
“…Another factor is that these injuries can occur in chaotic circumstances, such as combat, and may be ignored in the heat of events. Clinicians may be presented with vague concerns and little relevant detail about the original injury; whenever possible, clinicians and patients should attempt to obtain supporting documentation. At minimum clinicians should elicit as detailed an injury history as possible. Once the injury history has been established, the patient’s course of recovery and remaining post-concussive symptoms should be documented. [And, given the complexity of diagnosing a poly-trauma client accurately] because of the considerable symptom overlap between post-concussive symptoms and symptoms of many psychiatric and neurologic disorders, this process can be challenging” (Summerall, 2011, n.p.).
It is true that family involvement (e.g., social supportiveness) is extremely necessary to help the poly-trauma patient to begin the process of recovery or the person to begin dealing with the traumas or for a partial recovery that may sometimes be possible with effort and encouragement as well as medical treatment, a team approach:
“Education for the patient and family early in the course of recovery can improve outcomes in patients with TBI and help to prevent the development of other psychological problems. Unfortunately… many patients and their families do not receive education early in the course of illness and may require intervention after symptoms have become well established. Currently, the VA encourages a recovery message when prognosis is discussed, and inclusion of the family in treatment planning” (Summerall, 2011, n.p.).
It is wise advice for treatment providers of returning Veterans and for the civilian population, as well, for providers to be careful in noting and documenting recent or past head traumas (Summerall, 2011). According to Summerall (2011) is an unfortunate fact that for injured Veterans including those who have recently returned from serving their country in combat in Iraq or Afghanistan or will be returning soon and need to seek out treatment by counselors and other professionals:
“…TBI of any severity can disrupt families, in no small part because of family members’ changing roles in response to the patient’s difficulties, even if these problems ultimately improve. Immediate family involvement and education about the course of illness is crucial, and ongoing attention should be paid to family needs as time passes. Supporting families can improve outcomes by ensuring that the patient’s recovery is not hampered by a deteriorating family situation. Many providers will not have the time or expertise to include families in all phases of treatment; again, clinicians should not hesitate to seek out available expertise and support groups early in the course of illness” (n.p.).
Last, for our country’s Veterans who had served their country but ultimately were injured by PTSD, TBI’s, and other polytrauma syndromes (and, in some cases, from Agent Orange or Gulf War Syndrome) who served in Iraq, Afghanistan and the baby-boomers who served in Vietnam, we should answer this question: What can we do for all Veterans as future counselors? That is the question as counselors, I believe, we need to raise.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (IV-TR). Washington, DC: Author.
Butcher, J., Mineka, S., & Hooley, J. (2012). Abnormal psychology (14th ed.). Boston, MA: Pearson.
Comber, R. (2010). Abnormal psychology. New York, NY: Worth.
Summerall, E. (2011). Traumatic Brain Injury and PTSD. [Veterans Administration/Department of Defense Website] Retrieved from: www.ptsd.va.gov/professional/pages/traumatic-brain-injury-ptsd.asp
The Conversation.com (2012). Vietnam and Iraq lessons to be learned about mental health and war. Retrieved from: http://theconversation.com/vietnam-and-iraq-lessons-to-be-learned-about-mental-health-and-war-6661
Mike, now go to this great article: