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Making the Invisible Visible

June 24, 2016 by Colonel Miguel Howe, USA, Ret.
Working together we can make sure invisible wounds do not limit the quality of life for those who bear the costs of war. We especially don't want to limit their ability to lead our families, businesses and communities

For our nation’s warriors and their caregivers, traumatic brain injury, post-traumatic stress and other invisible wounds of war are the result of a complex intersection of physical, mental, emotional, spiritual, and social injuries.

Groundbreaking research released last week in the scientific journal, The Lancet Neurology, underscores this intersection. A blast brain injury may be the cause of post-traumatic stress in some warriors.

This finding is important for at least two reasons. It may explain the overlapping symptoms of memory loss, cognitive problems, inability to sleep, irritability, and profound depression in both post-traumatic stress and traumatic brain injury. It also underscores the intersection of neurology and psychology as a way to effectively treat invisible wounds.  

Dr. Daniel Perl, a neuropathologist at the Uniformed Services University of Health Sciences, and his colleagues focused their ground-breaking research on the brains of Soldiers injured by blasts. They compared them to those injured by blunt force trauma and ones damaged by substance abuse. They also compared them to a control group.

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The researchers discovered the scarring and patterns for blast injuries are distinctive from that of a blunt force trauma, such as a concussion. Blast injuries occurred in the parts of the brain that correspond with centers for sleep, cognition, and other classic trouble spots.

If subsequent research bears out these findings, then a physical, or a neurological, factor will have been established that results in a psychological condition, such as post-traumatic stress.  

If subsequent research bears out these findings, then a physical, or a neurological, factor will have been established that results in a psychological condition, such as post-traumatic stress.

This important research will invariably lead to intense discussion among researchers and practitioners. As that discussion takes place, it should not distract from one key factor.  Neurologists and psychiatrists/psychologists are all essential to treating the invisible wounds of war. 

Too many barriers already exist for our warriors and their caregivers who are seeking and hoping to access and receive high quality care. We don't need another barrier by caring for our warriors through separate siloes, where one expertise may not deal with the other.

Fortunately, the Defense Department's National Intrepid Center of Excellence,  New York University's Langone Military Family Clinic,  and Home Base are widely considered national leaders in providing care for the most complex cases of the invisible wounds of war.

Those flagship programs not only focus on intensive therapies from neurology and psychology. They also provide an array of innovative, non-traditional care, social work, family services, and peer-to-peer networking.

They have had significant success in reduced rates of symptoms and increased quality of life. One key to their success is neurologists, psychologists, social workers, and others work together with warriors.

The result is effective rehabilitation, recovery, resilience, and reintegration. The teams have placed care of the warrior at the center of their work. And they focus together on all elements of patient-centered care and best outcomes.

These examples are ones we all should follow in caring for our warriors. Working together we can make sure invisible wounds do not limit the quality of life for those who bear the costs of war. We especially don't want to limit their ability to lead our families, businesses and communities.


Author

Colonel Miguel Howe, USA, Ret.
Colonel Miguel Howe, USA, Ret.

Colonel Miguel Howe, USA, Ret. is the inaugural April and Jay Graham Fellow of the Military Service Initiative at the George W. Bush Institute. As an endowed Fellow, Colonel Howe represents the Bush Institute's work to improve the transition of post-9/11 veterans to civilian life, and to foster veteran leadership to enhance our businesses, communities and nation. In this role, he advocates for post 9-11 veterans and builds awareness for the issues that affect their transitions, with a focus on employment, education, and health and wellbeing.

Colonel Howe retired from the United States Army where he served for over 24 years in a myriad of command and staff assignments to include in Iraq and Afghanistan. He deployed in support of Operation Enduring Freedom as the commander of the Afghan National Army Special Operations Advisory Group, Camp Morehead Afghanistan. He also deployed in support of Operation Iraqi Freedom as the Chief of Staff for the NATO Training Mission in Al Rustamiyah, Iraq. A Special Forces Officer, he has commanded special operations forces on numerous deployments throughout Latin America with the 7th Special Forces Group (Airborne). Colonel Howe served as the Special Assistant to the CEO of the Millennium Challenge Corporation (MCC) and commanded the U.S. Army Southern California Recruiting Battalion. He began his Army career in the 25th Infantry Division as a Rifle Platoon Leader.

Colonel Howe was selected in 2006 by President George W. Bush to serve as a White House Fellow. He is a graduate of the United States Military Academy and earned a Master of Arts in National Security Studies from Georgetown University. He is married with two children.

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