Traumatic Brain Injury (TBI) is in the news again. Robert Bales murdered 16 civilians in Afghanistan. He has TBI, drinks too much, and just saw a friend lose a leg. Why does TBI matter? 

Traumatic brain injuries are head injuries that can occur from a direct blow to the head, in an accident, sports, or assault (how most civilians get them), or from the shock waves of an explosion (how many military people get them). People who have strokes or brain aneurisms or too many steroids may have the same symptoms. 

Symptoms can include disorientation, memory loss, difficulty learning things, headaches, and confusion. Some people with TBI get right brain damage that makes them lose control of their emotions. They can have outbursts of rage, uncontrollable weeping, major depression that doesn't quit, and even laugh too long and too loudly. When traumatized or provoked, they don't have the normal "off" switch. If you add alcohol to TBI, you add more disinhibiton. If you add trauma, which amps up emotions, you can have the human equivalent of a bomb.  

I don't know Robert Bales, so I can't say more about what turned a nice guy into a mass murderer. However, I have worked with people with TBI. My clients all had memory loss, headaches, and wild emotions. They all had increased startle response, out-of-control anger, low frustration thresholds, and lives that were falling, or had fallen, apart. All these bright people needed help organizing basic things in their lives: finances, schedules, social lives, medical care. All felt dissociative, but weren't: one person when not filled with affect, but like a whole other person when showing emotion. 

With each one, I used EMDR, lots of support, and lots of cognitive work. We always targeted the accident with EMDR. With one person, who had had a tree-limb put a big dent in her skull, we were able to halve the pain, recover a fair amount of memory (2 years of graduate school), and cut back "out-of-her-mind" affect(emotion) in about 10 sessions. With others, it went more slowly, but was still helpful. The EMDR targets for most included the day of the accident, the losses that accrued from the head injury, the daily frustration, and the targets that would bring up much affect. We would imagine emotion rising and cognitively and physiologically calming it down. I taught basic relaxation, refocusing, grounding techniques, and how to deal with others. We brought in family and friends to teach time outs. Either the TBI survivor or the other person could call a timeout and the other one would have to back off, until the injured brain could cool out. I used the future template of EMDR for survivors to image using these techniques when needed. 

I've had a few clients that I didn't know had TBI, until nothing worked with them. After scratching my head, I would finally ask the question: "Have you ever been hit in the head?" In both cases, TBI answered my question, and I knew what to do. When people exhibit TBI symptoms, I always ask this questions at the intake. When people don't exhibit these questions, I try to remember to ask.

Back to military people. I have been hearing that many active duty military and veterans aren't getting proper care for TBI. Why? Poor screening and institutionally not wanting to pay for the cost of extensive, long-term treatment. In my opinion, it's a crime to ignore this devestating injury in the people that are taking the hits for the rest of us. If our country won't pay for the treatment, we will pay for it in traumatized families, increased suicides of military personnel, and more chaos in theaters of war and at home.

An op-ed in the NYTimes: War is Brain-Damaging

TBI Website: