The challenges with the military in Iraq and Afghanistan
have been multifaceted.
And when I was growing up, we had the Vietnam war.
And war and conflict have changed so much over the years
that now it doesn't look at all
in Afghanistan and Iraq, or you know, hopefully not, but maybe Libya.
It won't look the same as it did when we had these nice clean lines
and we would advance in armies, and they would advance in armies.
Now it's an intermingled mass of insurgencies.
So, the reason I bring that up is that the injuries are different.
And so in World War I, we used to have what was called shell shock syndrome.
And people knew what that was.
In World War II, there was a certain number of days
an individual would stay in active duty in World War II
and I think it was about 160 days
and at the end of 160 days, they had to be taken off the line.
And they found that either they were...after that, either they were
wounded, dead, or crazy.
So that's where they came up with 160 days.
And the military has these...is very analytical.
It, you know, so you'll hear statements about
Well, you don't have a concussion because you were not within 50 meters of the blast.
And they don't care about how big the blast was, or where it came from
or...but they're very analytical about those types of things.
And the challenges were, first, to try to get past
the differentiation between the Department of Defense
and the VA and the different branches of the service.
Ah, because they're not very good at talking with each other to begin with.
And second of all, the disabilities that are paid out
for individuals that are in the VA are much different
than what I had envisioned for people with head injuries and with concussions.
And people with post-traumatic stress were thought to be just weak
and not have the...and were trying to play the system
and game the system and be malingerers to get this through.
And if you were a Marine or a soldier, and you were in Afghanistan
you wanted to perform at the highest level.
This is now an all-volunteer army or all-volunteer service.
Whereas before, in Vietnam, we had draft people.
People didn't want to be there. These kids want to be there.
So, the first big challenge was to, when I was asked to give a briefing at the Pentagon
was to try to tell it...try to advise the Vice Chief of the Army, Pete Chiarelli
and the then Vice Commandant of the Marine Corp, Jim Amos
what concussion was and how can you diagnose this.
And I remember at dinner at General Chiarelli's house
where we were discussing this, and I said
Well here, this is how you can image it.
And this is what happens to the brain
and this is why it is vulnerable to second insults.
And this is why you want to take individuals away from a football field
from a boxing match or from a battlefield.
And they looked at me, and they said, we've never heard this before.
And I said...I can remember telling them
I said my father served in the Navy. He was a doctor.
You've got great physicians here, this is not a problem.
There's got to be some doctors that will help you with this here in the military.
And they asked me to give a briefing the very next day
in the Pentagon, and this was in 2009.
And I gave that briefing, and the room was...
had General Chiarelli and General Amos
and then it had their medical expertise staff
of about 20 neurologists, psychiatrists around the room.
And so I gave the same briefing about concussions
and then individuals would get up in the room, and they would say
You know, Dr Hovda, we respect your authority and your expertise
but you don't understand, this is not a problem in the military.
We don't have concussions in the military.
And if you take individuals out and away from the battlefield
or inside, what they call inside the wire, after a brain injury
or a concussion, this is bad medicine.
You're gonna make things worse because you're gonna label them
as a brain-injured person, and they're going to perseverate
and they're going to become a brain-injured person.
And I said, you know, I respectfully disagree
and that ended up being a very loud debate which lasted for a long time.
And so then Pete...General Chiarelli and General Amos
asked if I would put together a blue ribbon symposium of civilian expertise.
And they did not want anybody in the military to be a part of this.
And so we brought in what I felt were the best people
that were here with the National Neurotrauma Society that knew
concussions and traumatic brain injury
and also the best experts I knew of that did post-traumatic stress.
Because there's a lot of co-morbidity between these 2 events.
And we held 2 sessions, and we put out a series of suggestions to them
and then they, through Admiral Mullen, they sent out the orders
and they implemented the program.
Much quicker than...That's one of the beautiful things about the military.
When somebody up high says we're gonna do something
it actually happens, as opposed to the National Football League
where you have to have committees and figure out what you're gonna do.
David A. Hovda, PhD is the director of the UCLA Brain Injury Research Center. He is past president of the National Neurotrauma Society and past president of the International Neurotrauma Society. He has served as chair of study sections for the National Institute for Neurological Disease and Stroke (NINDS).
BrainLine.org
