Why is it important for a patient to have a sense of control?
[Lt. Col. Jeffrey Yarvis] I think personal control is absolutely critical.
As somebody who does psychotherapy, having the sense that one
has mastery again and control is really, really important.
We train and train and train to give soldiers a sense of competence
both on and of the battlefield, and when you have a trauma—
I always say with any kind of trauma, whether it be psychological or physical,
there's a sense of betrayal—betrayal of one's body, betrayal of one's God,
betrayal of a sense of safety—and there's grief associated with that.
If we can restore the sense of control that's very powerful because one of the things,
I think, that amplifies psychological trauma and maybe misinterpreted as TBI
by the patient is the sense of locus of control.
"I can't affect the things going on around me, and I couldn't do anything to change that."
When we say—it's almost like metaphorically like Dorothy in her ruby slippers—
"All you really needed to know how to do is click your heels together three times,
and you can get back to Kansas, and you never lost that ability.
The trip to Kansas might look different than it used to. That's probably the tricky part.
We might have to take the longer route, but we think you can get there."
There may be some tougher discussions.
If there really is a true change in functioning
then we're going to have to have a discussion about that
and talk to the family about that as well,
but for these mild-to-moderate traumatic brain injury cases where they're ambulatory—
the walking wounded with the invisible wounds of war—
they're already functioning a little bit better
than the ones with more severe head injuries.
It's not going to be as obvious.
Usually we can restore a lot of those neurocognitive pathways.
We can show the patient that they do still maintain competency
in probably most areas, and what we'll do is exploit their successes
and try to build up the areas where they have some deficits now.
The brain is remarkably resilient that way.
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Lt. Col. Jeffrey Yarvis, PhD is the first integrated service chief of the Fort Belvoir Community Hospital. He is an assistant professor of Family Medicine and director of Social Work at the Uniformed Services University of the Health Sciences.
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