Chiarelli: Stress Disorder, Brain Injury Science Lacking

WASHINGTON The ther­a­pies used for the treat­ment of brain injuries lag behind the advanced med­ical sci­ence employed for treat­ing mechan­i­cal injuries, such as miss­ing limbs, Army Vice Chief of Staff Gen. Peter W. Chiarel­li told reporters here today at the Defense Writ­ers Group break­fast.

Chiarel­li said more work must be done to prop­er­ly diag­nose and treat ser­vice mem­bers suf­fer­ing from post-trau­mat­ic stress dis­or­der, trau­mat­ic brain injury and sui­ci­dal thoughts.

“There’s a lot of crit­i­cism with how we han­dle PTSD and TBI and oth­er behav­ioral health issues,” he said. “I think a lot of that is unfair, because if you study this, we don’t know as much about the brain. That is the basis of the prob­lem.”

Mean­while, Chiarel­li said, the stig­ma that some ser­vice mem­bers asso­ciate with active­ly seek­ing treat­ment for men­tal health issues is still active. “Break­ing the stig­ma of men­tal health issues is the hard­est part,” the gen­er­al acknowl­edged.

Chiarel­li said mil­i­tary med­i­cine has been very suc­cess­ful in replac­ing injured ser­vice mem­bers’ lost arms and limbs with high-tech pros­thet­ics in tan­dem with reha­bil­i­ta­tion train­ing.

“None of you has asked what we’re able to do with sol­diers who lose arms and legs,” Chiarel­li told reporters. “I’ve been using my bul­ly pul­pit in the last year or so to say that as an agency we do every­thing we can to under­stand the brain as we do the rest of the body.” Chiarel­li said progress has been made in diag­nos­ing and treat­ing PTSD and TBI, though he acknowl­edged that much work remains.

“We’re begin­ning to get some trac­tion,” Chiarel­li said of new infor­ma­tion pro­vid­ed by recent stud­ies of PTSD and TBI issues. The gen­er­al said he’s “harkened” by the Army and Nation­al Men­tal Health Insti­tute all-sol­dier study of PTSD and TBI, now into its third month.

“We’re start­ing to get back some data,” he said. “I feel good about it.” The study starts with mon­i­tor­ing new trainees — a process that has nev­er been done before, the gen­er­al said. The Army study, he added, will track sol­diers dur­ing their careers to mon­i­tor them for poten­tial risks.

“Our hope is we’ll get algo­rithms,” Chiarel­li said, “and will be able to tell some­one: ‘You’re at a high­er risk of devel­op­ing some kind of behav­ior health issue and this is what you ought to do about it.’ ”

Trau­mat­ic brain injuries that occur in com­bat are dif­fi­cult to iden­ti­fy, the gen­er­al said, because the major­i­ty of cas­es are caused by a blast, where the ser­vice member’s head usu­al­ly doesn’t col­lide with the ground or any hard sur­face to pro­duce a tell-tale wound. There­fore, Chiarel­li said he wants to devel­op the abil­i­ty to col­lect data on com­bat explo­sions inside vehi­cles to have a basis to bet­ter under­stand blast injuries to the brain.

Chiarel­li said stud­ies show that blasts occur­ring inside a mil­i­tary vehi­cle can result in an 11-per­cent chance for occu­pants los­ing a limb; a 65-per­cent chance for occu­pants devel­op­ing PTSD or TBI, and a 16 to 17 per­cent chance of occu­pants suf­fer­ing a brain injury.

The Army hopes to devel­op a track­ing sys­tem for brain injuries, the gen­er­al said, that’s sim­i­lar to meth­ods used to iden­ti­fy and track dis­eases that occur in organs such as the heart.

“That’s what we don’t ful­ly under­stand,” he said. “We don’t know at what lev­el that [injury] occurs and we need to find that out.” Injured ser­vice mem­bers with PTSD or TBI may feel fine ini­tial­ly, but the symp­toms will even­tu­al­ly emerge, the gen­er­al said.

“When a sol­dier comes back from war, he might look exact­ly the same and act the same, but after two weeks or so, the signs start to show up,” Chiarel­li said. “He goes to the doc­tor and says ‘fix it,’ and the doc­tor can’t fix it. It’s got to be the most frus­trat­ing thing in the world. That’s what we’re faced with.”

The Army also is work­ing with the Depart­ment of Vet­er­ans Affairs to aid vet­er­ans expe­ri­enc­ing PTSD, TBI and oth­er issues, he said.

“We are work­ing close­ly with the VA in ways we’ve nev­er worked before,” Chiarel­li said. “We’re work­ing on how to improve the dis­abil­i­ty eval­u­a­tion process, and lessons learned — what’s work­ing and what’s not work­ing.”

Mean­while, he said, mil­i­tary health care providers “need to do a bet­ter job of screen­ing , with [bet­ter] sci­ence that has some kind of cer­tain­ty to make the prop­er diag­no­sis and [pre­scribe the best] treat­ment.”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)

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