How TBI and PTSD Are Treated Now in Comparison to the Past

Since the WW I, WW II, and Vietnam, there has been more programmatic effort to treat and evaluate soldiers with TBI and PTSD. But are these issues any better resolved than they were 30, 50, 100 years ago?

See more videos with Dr. Jordan Grafman.

There's a lot more attention now to traumatic brain injury than there was at the time of Vietnam. And that's been--on the one hand--extremely beneficial to the evaluation and care of veterans who have had some exposure to a blast for example, where there was no obvious direct brain injury, yet they are complaining for changes and symptoms after their exposure. So the fact that there's more attention means that this can be detected potentially better. That is good. Whether in fact all these interventions--and there are many of them--and they're coming at these vets from all different angles. Whether one or more of them are going to make it more beneficial for vets is unclear at the moment. So--for example--when we look at incidence of post-traumatic stress disorder after Vietnam it was fairly high at the time; that did get a lot of publicity, particularly in the '70s. And it was thought at the time that the higher incidence of PTSD was due to the bad reception people got when they came back from fighting in Vietnam. There were protests, and people felt the local communities didn't receive them very well. And that certainly wasn't the case in the more modern conflicts that have taken place in Iraq and Afghanistan. And yet, we still see the same rates of PTSD. So, it's pretty clear that it's the combat exposure itself that's leading to this. And if you go back into history, you look at World War I and World War II, you can read about shell shock, you can read about distinguishing a shell shock that might have been due to a brain injury--a mild brain injury-- from the experience of being in combat, seeing loss of life in front of you, or maiming of friends and innocents is traumatic and very difficult to deal with. It's not the movies. It's extraordinarily painful, and so some people have decent coping mechanisms, they don't lose the memories but they know how to cope with it better, and other people are not prepared to cope with it very well. And often those are the people that fall into the category of having post-traumatic stress disorder. Fortunately, we have some treatments for it that are fairly effective in many of the people that report PTSD now. So there's a lot more attention to it than there was at the time of Vietnam, and there are strategies that at least indicates a PTSD to improve outcomes and treat people who have that. In the case of traumatic brain injury with some of the symptoms we've been talking about whether it be memory deficits or executive function problems, knowing, impairments in planning, impairments in decision-making, these kinds of issues, or even impairments in social cognition. Well there are some treatments out there in rehabilitation medicine to try to improve memory, to manage aggressive behavior. And those are being applied--however--it is not clear how effective those are at this point in veterans who've had traumatic brain injury. So, we'll have to learn from the studies that are being done now. What is true is that despite the fact that theres a lot of attention being paid, and a lot more programatic effort to treat and evaluate these soliders, it's not clear that some of the issues are any better resolved now than they were at the time of Vietnam.
Posted on BrainLine February 12, 2013.

Produced by Victoria Tilney McDonough, Justin Rhodes, and Erica Queen, BrainLine.