Imagine that you're hung over and haven't slept in two nights. You can't think clearly, can't focus or concentrate. You forget things -- even important things -- and spend your energy just trying to stay awake and drag yourself through the day. When you finally get to sleep, you drift off hoping tomorrow will be better. But it won't. That's what life with traumatic brain injury (TBI) is like, relentlessly.
It's one reason suicide rates among the military are at an all-time high. Additionally, the brain changes identified among athletes who committed suicide are being inflicted upon military personnel with the same deadly result -- one person on active duty now kills himself every day; one veteran dies by his own hand every 80 minutes. Suicide is now the most common form of death in the Army, claiming more lives than combat or motor vehicle accidents. Gen. Lloyd J. Austin III, Army Vice Chief of Staff, said: "Suicide is the toughest enemy I have faced in my 37 years in the Army." This enemy will not be defeated until we recognize the link between TBI and suicide, and are able to quickly and effectively diagnose and treat TBI.
Pretend that you've trained to become an incredibly competent and focused team member who responds rapidly and decisively, under fire. But lately you're unable to drive or even walk confidently, because your brain is not reacting properly to sensory cues. It is excessively sensitive to some things, and misses others entirely. You become easily confused and hypersensitive to noise and bright light. You keep trying to push through, but you can't. Ordinary tasks of daily life defeat you. It becomes hard to follow or participate in conversation. Reading, writing, and simple arithmetic can feel like too much to handle. Even the supermarket is overwhelming
You used to respond to complicated emotional situations with your spouse or child with insight and compassion. Now they leave you frustrated, angry and almost out of control. You no longer recognize yourself or know who you are and neither do your loved ones. Frustration and aggravation can rise to rage and explosive acts of temper. Your family and work life will likely unravel, and there doesn't seem to be anything you can do about it, no matter how hard you try.
People, even those closest to you, are unsympathetic because they don't understand what is wrong with you; you should be better by now, you aren't trying hard enough, you just don't care. Without any visible injury, it's easy for people to conclude that you must be faking or exaggerating.
Eventually you are just lost, unable to hold a job, keep a spouse, or raise a child. The only comfort is being alone in the dark and quiet. It seems there are no other possibilities left. All you want is a way -- any way -- out.
This is TBI from the inside -- what those who have it are no longer able to explain. It is not depression. It is not PTSD. It is that cells, neurons, the pathways in your brain, have been damaged and don't work. They will never work the same way again.
We know that TBI increases rates of suicide and that it is the "signature injury" of the current wars. Yet it frequently goes undetected, or is misdiagnosed as PTSD or depression. Patients who are misdiagnosed, and therefore mistreated, are unlikely to recover. Instead, they are likely to despair.
People who have TBI may also suffer PTSD and depression. Once one's personal and professional life start spinning out of control, one can easily become depressed. But the treatments for either of these will not address the damage of TBI and may aggravate its symptoms, thereby increasing the patient's hopelessness and despair.
Even though there is no cure for TBI, patients can improve their functioning with long-term, individualized cognitive therapy that teaches strategies tailored to each patient's life. A strong therapy program would also educate patients' loved ones, giving them information, methods and strategies to assist these wounded warriors.
This therapy -- along with the relief that comes from finally having a correct diagnosis -- can give TBI patients the hope and tools necessary to rebuild functional, rewarding lives; a way out besides suicide. But right now our wounded soldiers and veterans don't receive that help.
While it may seem that providing long-term individualized therapy will be too expensive, we are already paying a great deal more -- in dollars as well as ruined lives -- for the consequences of leaving TBI undiagnosed and untreated: domestic violence, incarceration, alcohol and drug abuse, homelessness, and suicide. Unless action is taken, we can expect the military suicide rate to continue rising, killing 25 soldiers off the battlefield for every one killed on it.
The 250,000 TBIs sustained by military personnel since 2000 is staggering, but they pale in comparison with the two million civilians who are diagnosed with TBI every year. Consequently, military and civilian suicide rates are rising precipitously.
Public service announcements describing the signs and symptoms of TBI in clear, simple language, disseminated widely enough that everyone in the country knows them, would increase the likelihood of accurate diagnosis and effective treatment. Right now, the long-term therapy necessary to regain functioning after a TBI is not covered for anyone -- active military personnel, veterans or civilians. Until that changes, the nightmarish rising tide of suicide will not subside.
Dr. Ruth Bettelheim is a writer, lecturer, and executive/life coach specializing in the development of human potential. She is based in New York and Los Angeles and can be found at RuthBettelheim.com.
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