Today's Stories

June 17, 2008

Conn Hallinan
The Brain Trauma Vets

Wajahat Ali
Chomsky Speaks: On Iran and Iraq

Marjorie Cohn
Reviving Habeas Corpus

Uri Avnery
Two Professors: Mearsheimer and Walt in Israel

David Macaray
Adversarial Relationship

Rannie Amiri
Forgotten Lives in a Forgotten War

Website of the Day
Pentagon Money

June 16, 2008

Uri Avnery
An Apology

Corey D. B. Walker
The Racial Politics of Symbols

Howard Lisnoff
Files Upon Files

Dennis Loo
2008 Elections: Of Whales and Worms

Paul Craig Roberts
Obama and the Fall Into Tyranny

June 13 / 15, 2008

Douglas Valentine
McCain: War Hero or Go-To Collaborator?

Alexander Cockburn
Change, What Change?

Jeffrey St. Clair
The Politics of Timber Theft

Peter Linebaugh
On Wat Tyler Day

Ishmael Reed
The Colossus: Sonny Rollins, Take One

Joe Bageant
Old Dogs and Hard Time

Harry Browne
Ireland Shows the Way!

Andy Worthington
The Supreme Court's Gitmo Decision: What Does It Mean?

Jeff Sharlet
The F-Word

Binoy Kampmark
They Gassed Us: Agent Orange in OZ

Alan Farago
His Little Piece of the Pie

Brian Cloughley
America the Detested: the Pakistan Airstrikes

Manuel Garcia, Jr.
How to Stretch Gasoline

Reza Fiyouzat
Oil and Racism

Patrick Bond /
Richard Kamidza
How Europe Underdevelops Africa

David Yearsley
Music in the Rubble

Niranjan Ramakrishnan
Thank You, Dennis Kucinich!

Ronnie Cummins
Don't Panic; Go Organic

Dan Bacher
Bush Tries to Raid Salmon Disaster Funds

Michael Dickinson
Jesus in Megiddo Prison

Seth Sandronsky
My Father's World

Poets' Basement
Tu Fu / Rexroth

Website of the Weekend
Torture and the American Psyche

June 12, 2008

Judith Levine
As Cranes Fall and People Die

Patrick Cockburn
Amid Iraqi Fury, U.S. Offers Concessions on Military Bases

Saul Landau
The Iraq War Becomes Suicidal

Christopher Brauchli
Bush Bling-Bling: Government by Crony

Norman Solomon
Deadly Diplomacy

Helen Redmond
Why Can't We All Get KennedyCare?

Laura Carlsen
No Rest for the Working Poor

Jeremy R. Hammond
Threats Against Iran Escalate

Anne Landman
Pinkwashing: Can Shopping Cure Breast Cancer?

Website of the Day
Fire in Watts

June 11, 2008

Paul Craig Roberts
Why Oil Prices Are So High

Ralph Nader
Wall Street Gamblers

Joshua Frank
Why I Can't Support Barack Obama

Clifton Ross
Conversation in Miami: the Neoliberal Left and Socialism

Muhammad Idrees Ahmad
Whatever Happened to "Democracy Now?"

Stephen Lendman
Exposing Pentagon and CIA Corruption

Diane Farsetta
Talking Back to Bill O'Reilly

Ron Jacobs
The Sixties Painted Black

Deborah Rich
Hay Belly Nation: the FDA and the O-Word

Hop Wechsler
A Friend of Women? My Bill Clinton ... and Ours

Website of the Day
A New Path to the Waterfall

June 10, 2008

Alan Farago
John McCain and the Company He Keeps

James G. Abourezk
Deadly Fallout From Obama's Groveling Before Israel Lobby

Saree Makdisi
Banned in the U.S.A. (Almost)

Malini Johar Schueller
A Picture From Beirut

John Ross
Killing Foods, Killing People

Wajahat Ali
Rumi and Sufism

Peter Morici
Bernanke Aggravates Recession Risks

Jordan Flaherty
Inside Angola Prison, Louisiana's Last Slave Plantation

Gary Macfarlane
Collaboration on the Clearwater: Is It Legitimate?

Joanne Mariner
The Gitmo Trials: an Inglorious Start

Website of the Day
The End of the Clinton Machine?

June 9, 2008

Uri Avnery
No, I Can't: Obama, Israel and AIPAC

Nikolas Kozloff
McCain & the Republican Insitute: Promoting Iraqi Occupation for "a Million Years"

Allan Nairn
Drawing Your Last Breath Hungry

Dennis Loo
Threats on Iran and the "Batterer's Defense"

Harry Browne
Irish Euro Vote Comes Down to the Wire

C. Hand
U. S. Bid to Hike Iran's Gas Prices Seems Doomed

Peter Morici
An Unsustainable Trade Deficit

Kenneth Couesbouc
A Ripe Time for Inflation

Martha Rosenberg
The Inconvenient Senator Grassley

James L. Secor
Chinese Superstition or Unconscious Oracle?

Website of the Day
Pay Bo Diddley!

June 7 / 8, 2008

Alexander Cockburn
Obama Goes Over the Top

Ishmael Reed
How Miles Davis Changed My Life

Jeffrey St. Clair
What a Miner's Life is Worth

Nikolas Kozloff
Meet the King the Beers: John McCain and Latin America

Dave Lindorff
The High Cost of a Single War-Like Remark: Oil Prices, Israel, Iran and the U.S.

Robert Fantina
When Truth is the Casualty

Conn Hallinan
Iran and Rumors of War

Neve Gordon
The Occupation and the Politics of Death

Tom Barry
The Deterrence Strategy of Homeland Security

Patrick Irelan
Raiding the Packing House

Tim Wise
Your Whiteness is Showing

David Ker Thomson
The Hard Question

Joshua Frank
"Socialist" Wins Republican Nomination in Montana

David Yearsley
Disaster Music

James T. Phillips
1968: Year of the Rat

Joe Allen
The Real Bobby Kennedy

P. Sainath
Making Life Brighter in Kondapur

David Macaray
Should Unions be More Democratic?

B.R. Gowani
Experience and the Two-for-One

Fred Gardner
What Happened (at the DA's Office)

Peter Harley
Technology to the Rescue? Kurzweil and the Human Machines

Michael Dickinson
Surrender the Bones of Geronimo!

Jen Roesch
Where are the Real Women in Sex and the City?

Poets' Basement
Gibbons, Landau, and Buknatski

Website of the Day
Partying with the Waltons

June 6, 2008

Frank Barat
An Interview with Ilan Pappé and Noam Chomsky on the Future of Israel / Palestine

Patrick Cockburn
U.S. Extorts Iraq to Approve Military Deal

Gary Leupp
Cheney Enrages Iraqis Over Security Deal

James Abourezk
Name That Terrorist

Peter Morici
Recession Grips the Jobs Market

Faheem Hussain
What is NATO Doing in Afghanistan?

Andy Worthington
Guantánamo's Britons Go on Hunger Strike

Ayesha Ijaz Khan
How Will Musharraf Go? Impeachment or Safe Exit?

Dave Lindorff
Congress Needs to Defend Itself

Website of the Day
Backstage with Bo Diddley

June 5, 2008

Patrick Cockburn
Bush's Secret Deal Would Ensure Permanent U.S. Occupation of Iraq

Sharon Smith
Hillary's Wreckage

Nikolas Kozloff
Obama's Electoral Dilemma: Latinos or Reagan Democrats?

Linn Washington, Jr.
Police Brutality and Cover-Up in Philly

Omar Barghouti
60 Years of Nakba, 41 Years of Occupation ...

Scott Pellegrino
Jim Crow Radio: Bob Grant's Lifetime Achievement Award

John Walsh
Obama Woos AIPAC

Dan Bacher
The Parching of California

DC Larson
Nazi Rockers ... F-Off

Robert Jensen
Masculine, Feminine or Human?

Website of the Day
Ohio Cops Attack Long Walkers

June 4, 2008

Eric Walberg
Princess Patricia and the Taliban

Gary Leupp
Iran and EFPs: Chronology of a Lie

Ralph Nader
Disenfranchised Youth

Dave Lindorff
Of Whiners and Poor Losers

George Wuerthner
Farm Economics

Victor M. Rodriguez
The Puzzle of Race and Politics

Remi Kanazi
Why a Cultural Boycott of Israel is Needed

Stephane Luçon
Renault's Romanian Fairyland Suspended

Farzana Versey
The Tablighi Jamaat Movement

Laray Polk
The Militarization of Space

Website of the Day
Red State Rebels

June 3, 2008

Paul Craig Roberts /
Lawrence M. Stratton
Legislating Tyranny

Mike Whitney
The Withering Economy

Steve Early
San Juan Showdown

Manuel Otero
Why Hillary Won Puerto Rico: the View from the Colony

George Bisharat
The Hope of a Victimized People

Nikolas Kozloff
Obama's VP Quandry

Dan Bacher
Death on the Salmon Highway

Website of the Day
Censoring Bill Knott?

June 2, 2008

Uri Avnery
The Olmert Scandal

Nikolas Kozloff
Obama's Latino Problem Getting Worse

Allan J. Lichtman
Revisionist History: Bush, Borah and Hitler

Malini Johar Schueller
The Color of Randomness: Returning to the US From Beirut Via Syria

Robert Weissman
What's Driving Skyrocketing Oil Prices?

Peter Morici
Bailing Out Wall Street

Manuel Garcia, Jr.
Don't Get Burned: How to Protect Yourself From Raytheon's Pain Gun

John Ross
Celebrating Catholic Fanaticism in Mexico

Ahmad Al-Akhras
Encounters with the Watch List

Website of the Day
Man on Earth

May 31 / June 1, 2008

Alexander Cockburn
The Worst is Yet to Come

Jeffrey St. Clair
Arkansas Bloodsuckers

Gary Leupp
How McClellan Prettifies Bush

Stan Cox
Broken Agriculture

Rannie Amiri
Lebanon: the Domino That Wouldn't Fall

P. Sainath
A Guaranteed Day's Work--in the Fields, at 110 Degrees, for $2 a Day

Binoy Kampmark
Going Bankrupt in Vallejo

Robert Fantina
Bush, Rice and McClellan

Seth Sandronsky
Will There be Water Riots, as Sacramento Goes Dry?

Corporate Crime Reporter
Death Penalty for Bush?

Anthony DiMaggio
Gaming the Ghetto: Grand Theft Auto IV, Racist Media and the Concrete Jungle

Karl Grossman
A Half-Trillion for Nukes

Matt Reichel
From Vegas to the Heartland and Back Again

Paul Myron Hillier
Of Gas and God

Andy Worthington
Suicide at Guantánamo

David Yearsley
And the Winner is ... Wayne Shorter

Daniel Cassidy
Free Lunch

Charles Thomson
If Hitler Had Been a Hippy ...

Gary Corseri
A Dream Deferred: Activism and the Arts

Wajahat Ali
Sex and the City Through a Man's Eyes

Ron Jacobs
Robins Weep

Poets' Basement
McNeill and Davies

Website of the Day
Last Charge of the Light Horse

May 30, 2008

Bassam Aramin
Here's the Truth You've Been Running From

Andrew Cockburn
Petraeus' Iran Obsession

Saul Landau
How We Got Into This Mess

Nikolas Kozloff
Meet South America's New Secessionists

Robert Sandels
Turning Back the Clock on Cuba

Dave Lindorff
Talk is Cheap

Martha Rosenberg
Raiding Big Meat; Arresting the Wrong People

Harvey Wasserman
Lieberman & McCain: Linking Internet Censorship and Atomic Reactor Terror

Doug Giebel
A Plague on Both Your Houses (of Congress)

Shaun Harkin
The Trial of the Raytheon 9

Website of the Day
The Once and Future Environmental Movement

May 29, 2008

Jeffrey St. Clair
Bill Clinton and the Rich Women

Nikolas Kozloff
Puerto Rico, Obama and the Politics of Race

Col. Dan Smith
Deceiving the Dead

Karl Grossman
The Most Lucrative Incentive for Nuclear Power in the History of the United States

William S. Lind
Inside the Washington Game

Robert Weissman
What to do About the Price of Oil

Dave Lindorff
Why Puerto Rico Won't Matter

David Macaray
A Union Fable

Chris Genovali
Fear and Loathing in the Northern Rockies

Laura Carlsen
Mexico's Battle Over Oil

Website of the Day
Support Antiwar.com

May 28, 2008

Wajahat Ali
The Libertarian Dark Horse: An Exclusive Interview with Ron Paul

Ralph Nader
What's Really Driving the High Price of Oil?

Brian McKenna
Why I Want to Teach Anthropology at the Army War College

Corporate Crime Reporter
Why Vincent Bugliosi Wants to Prosecute George W. Bush for Murder

Brian Cloughley
The Attack on Damadola

Eric Walberg
Opium for the Masses from Afghanistan

Michael Dickinson
Raytheon's Pain Ray: Coming to a Protest Near You

Ijaz Khan
Opening Windows in Pakistan

Website of the Day
Older Than America

May 27, 2008

Alexander Cockburn
In Her Mind She's Killed Before: the Plot to Assassinate Ralph Nader

Greg Kafoury
Is Obama Turning (Further) Right?

Jean Bricmont
Western Delusions

Tim Wise
Farrakhan is not the Problem

Ricardo Alarcón
Puerto Rico's Turn

Stephen Soldz
APA Supports Psychologist Engagement in Bush Regime Interrogations

Andy Worthington
The Guantánamo 16

Alan Singer
Vapid, Stupid and Insulting: Chuck Schumer Speaks to the Graduates

Richard Neville
Storm in an A-Cup

Susie Day
Gone with the W

May 26, 2008

Uri Avnery
The Syrian Option

Bill Quigley
War Immemorial Day

Col. Dan Smith
Retreating from Hell: a Different Memorial Day

Cindy Sheehan
Why Memorial Day is a Double-Whammy for Me

Marjorie Cohn
Hillary's Assassination Politics: Her Last Shot?

Fred Gardner
Does the VA Care?

Raymond J. Lawrence
Pain Pays: Getting Rich at NY Presbyterian Hospital

Harvey Wasserman
Mugging the Election System

Moncia Benderman
Truth Matters

David Rovics
In Praise of Utah Phillips

Website of the Day
Fox News Jokes About "Knocking Off" Osama and Obama

May 24 / 25, 2008

Alexander Cockburn
Death-Wish Hillary Primes Manchurian Candidate

Jeffrey St. Clair
Yellowstone: How Sununu Shrank the Ecosystem

Barbara Rose Johnston
Dam Legacies, Damned Futures

Nikolas Kozloff
U.S. Fourth Fleet in Venezuelan Waters

Adriana Kojeve
The Environment and the 2008 Elections

Robert Fantina
Justice Department's Revelations on Torture

Dave Lindorff
Bush's War on Children in Iraq

David Yearsley
The War on Kitsch

Nelson P. Valdés
The Buying of "Democracy" Agents in Cuba

Kathleen M. Barry
Celebrating Ethnic Cleansing

John Ross
Mexico's Narco Opera Reaches for High Point

Allison Kilkenny
Apathy Doesn't Live in Bronx

Fred Gardner
Orangeburg, 1968

Elizabeth Schulte
Can the Whole World be Fed?

Daniel Gross
Remembering the Wendy's Massacre: the Dangerous Side of Retail Work

Christopher Brauchli
The Search for a Token Right-winger

Richard Rhames
A Nation of Sheep

Daniel Cassidy
My Mother

Poets' Basement
Davies, Klipschutz and Willson

Website of the Weekend
Happy Birthday, Bob

May 23, 2008

Paul Craig Roberts
War Abroad, Poverty at Home

Alan Farago
The Radical Extremists of the Building Industry

Conn Hallinan
Ballots and Bullets: From Beirut to Bolivia

Mark Engler
The World After Bush

George Wuerthner
Cars and Cows: Living Large in America

Kamran Matin
The Kurds and American Neo-Imperialism

Sandy Boyer /
Shaun Harkin
The Long Incarceration of Pol Brennan

Robert Weitzel
A "Holey" Instrument of Peace in Iraq

Cindy Sheehan
An Uphill Battle

Liaquat Ali Khan
Pakistan's Futile Constitutional Amendment

Website of the Day
A Message from the Moral Compass of the McCain Campaign

May 22, 2008

Vijay Prashad
Racist Grammar

Joanne Mariner
A Military Commissions Cheat Sheet

Sharon Smith
60 Years of Apartheid

Jeff Birkenstein
Disaster Redux: Some Early Thoughts on the Earthquake in China

Brendan McQuade
From Obama to the PRTs in Iraq

Peter Morici
The Sorry State of the Banking Industry

Niranjan Ramakrishnan
Restoration Boulevard

Dave Zirin
What I Want to Ask Mary Tillman

Ron Jacobs
CPR for the Antiwar Movement

Stephen Lendman
Immoral Hazard

Website of the Day
Hagee: God Sent Hitler to Drive the Jews to Israel

May 21, 2008

Jeffrey St. Clair
The Gothic Politics of Hillary Clinton

Nikolas Kozloff
U.S. Military Bases in South America

Alan Farago
Miami, Cuba and the Presidential Campaign

Dave Lindorff
Big John and the Scary, Scary Iran Threat

David Model
Genocide in Iraq?

Eric Walberg
Afghanistan: Who is the Enemy?

Franklin Lamb
Lebanon Gets a President

Kenneth Couesbouc
Tax Against Tyranny

Website of the Day
Child Labor and War-Affected Children: a Photo Essay

May 20, 2008

Ralph Nader
A Trip Inside Google

Uri Avnery
With Friends Like These

Patrick Irelan
The Empire and the Fleet

Ray McGovern
Come Out, Admiral Fallon, Wherever You Are

David Macaray
The UAW Strike Against American Axle

Chris Genovali
Big Oil on the Water: Skating Around the Tanker Issue

Ibrahim Fawal
Birmingham, Israel and the Nakba

Christopher Ketcham
Let Us Now Praise Famous Suicides

Andy Worthington
Guantánamo Trial Delayed

Martha Rosenberg
Merck is a Repeat Offender

Website of the Day
Defend the Students Who Pied Tom Friedman

May 19, 2008

Saul Landau
Cuba Will Live

Paul Craig Roberts
The Metamorphosis of the Conservative Movement

Brian McKenna
Brotherly Love in Philly's Badlands

Patrick Cockburn
City of the Dead: Mosul on Lockdown

B. R. Gowani
The Central Problem Pakistan Needs to Tackle

Dr. Trudy Bond
Psychologists and Torture: If Not Now, When?

Cindy Sheehan
Whose War is It?

John Mohawk
The Warriors Who Turned to Peace

Remi Kanazi
When Free Speech Doesn't Come for Free

Robert Day
I Get a Horse

Website of the Day
Evolve or Die

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An Epidemic of Psychological Wounds

The Brain Trauma Vets

By CONN HALLINAN

“We are facing a massive mental health problem as a result of our wars in Iraq and Afghanistan. As a country, we have not responded adequately to this problem. Unless we act urgently and wisely, we’ll be dealing with an epidemic of service-related psychological wounds for years to come.”

--Bobby Muller, President, Veterans For America

David Hovda, director of the Brain Injury Research Center at the University of California at Los Angeles (UCLA), calls traumatic brain injury (TBI) the “silent epidemic.” It is the most common cause of death for U.S. adults under the age of 45, deadlier than AIDS, Multiple Sclerosis, spinal cord injury and breast cancer combined. It strikes down 1.6 million Americans a year. And while TBI may be a quiet wound, its consequences for victims, family, friends and co-workers can be catastrophic.

Adding to that 1.6 million figure are two wars whose signature injury are blast-induced head wounds. A recent study by the General Accounting Office found that, “Traumatic brain injury has emerged as the leading injury among U.S. forces serving in Afghanistan and Iraq.”

According to a Walter Reed Hospital study, “closed brain” injuries—injuries with no visible marks—outnumber “penetrating brain injuries” seven to one. Other researchers put the ratio much higher.

 “We are looking at a very frightening situation,” says Dr. Judith Landau, psychiatrist and president of Linking Human Systems in Boulder, Colorado, who works with vets and their families.

And yet, according to Dr. Michael Weiner, professor of medicine, radiology, psychiatry and neurology at the University of California at San Francisco (UCSF), and director of the Center for Imaging of Neurodegenerative Disease at the Veteran’s Administration Medical Center,

 “There is a lot more that we don’t know about it [TBI], than we do.”

For starters it’s hard to spot. “Our scans show nothing,” says Weiner.

TBI is a slippery beast, or “murky” as Weiner puts it. It can cause symptoms ranging from depression and uncontrollable rages, to irritable bowels and emotional disengagement. It can suddenly appear long after the incident that caused it, and it is difficult and complex to treat.

While medicine is beginning to understand more about the kind of TBI generated by car accidents, falls, or sports injuries, no one is quite sure exactly what causes the TBI generated by roadside bombs in Iraq and Afghanistan.“It is a complicated injury to the most complicated part of the body, says Dr. Alisa Gean, chief of Neuroradiology at San Francisco General Hospital, who has worked with wounded soldiers at the U.S. Army’s Regional Medical Center at Landstuhl, Germany.

Whatever the causes, the constellation of symptoms that TBI induce include short term memory loss, stomach, chest, back and head pain, dizziness, racing pulse, constipation, diarrhea, sexual dysfunction, insomnia, inability to concentrate, damage to hearing and vision, personality changes, and Post Traumatic Stress Disorder (PTSD).

Indeed, part of the problem in identifying TBI is that its symptoms are so similar to PTSD.

A recent study of veterans returning from Iraq and Afghanistan found that the severity of those symptoms was greatly affected by how serious the incident that caused the TBI was: whether the victim was knocked unconsciousness, or was simply dazed and confused, in what is called an “altered state.” A U.S. military study notes, “Injuries associated with the loss of consciousness carried a much greater risk of health problems than did injuries associated with altered mental states.”

The Pentagon says about 20,000 GIs have returned with TBI, but most experts say the figure is much higher. U.S. Rep. Bill Pascrell (D-NJ), founder of the Congressional Brain Injury Task Force, says the figure could be as high as 150,000.

TBI is hardy new. Some 5.3 million people in the country are currently hospitalized or in residential facilities because of it. And its consequences surround us.

For instance, researchers have found a relationship between TBI, and problems like addiction and homelessness. “Unidentified traumatic brain injury is an unrecognized major source of social and vocational failure,” says Wayne A. Gordon, director of the Brain Injury Research Center at Mt. Sinai School of Medicine.

One Mt. Sinai study of 100 homeless men in New York found that 80 of them had suffered brain trauma, much of it from child abuse. A similar study of 5,000 homeless people in New Haven, Conn., discovered that those who had suffered a blow that knocked them unconscious or into an altered state were twice as likely to have alcohol and drug problems and to be depressed. It also found higher rates of suicide attempts, panic attacks, and obsessive-compulsive disorder.

A Canadian study indicates that a blow powerful enough to cause unconsciousness causes a loss of brain tissue. “There is more damage and it is more widespread that we had expected,” Brian Levine of the University of Toronto’s Rotman Research Institute told the Toronto Star.

Levine says the cell loss appears to be in the brain’s white matter that is essential to communication. Even a small loss in this region of the brain, “Will have a quite large effect on behavior,” he says. 

If its effects are dramatic, its profile has been modest until recently. Gean says she has been “carrying a torch” on civilian TBI for over 20 years—she is the author of what is considered the standard textbook on imaging TBI—but the subject has “escaped the radar of funding.” People worry about whether they are going to get breast cancer or AIDS, but “people don’t think they are going to get TBI,” she says.

Afghanistan and Iraq have changed all that. “The wars have caused people to come around to acknowledge the psychological aspects of TBI,” says Gean, and she credits ABC’s Bob Woodruff for helping to bring the subject before the public.

Woodruff was seriously wounded in the head by a roadside bomb in Iraq and his struggle to return to work was covered extensively by the news organization. Woodruff has since done a number of reports on soldiers suffering from TBI   

Gean says there are many similarities between civilian TBIs and those inflicted in combat; “Penetrating injuries are penetrating injuries. They are seen everyday in gang warfare,” she says, although in Iran and Afghanistan the projectiles may be “nuts, bolts and pieces of car fenders” rather than bullets.

But there are also major differences. “Combat trauma is trauma on steroids,” she says, “It is truly polytraumatic.” When she talks about seeing soldiers with burns, open wounds, multiple amputations and TBI at Landstuhl. At one point she stops, remembering looking at one mutilated 20-year old. “I will never forget those injuries,” she says quietly.

While there is general agreement in the field about what causes TBI in impact injuries like an auto accident or a sports concussion, there is no such agreement when it comes to how massive explosions affect the brain.

Most researchers assume the damage comes from a violent shaking of the head. “These brains are rattled like a yolk in an egg,” says Jessica Martinez, an occupational therapist at Scripps Memorial Hospital in Encinitas, Ca.

However, P. Stephen Macedo, a doctor formerly with the VA, told the Toronto Star, that when the force of an explosion “moves through the brain, it seems to cause little gas bubbles to form. When they pop, it leaves a cavity. So you are littering people’s brains with these little holes.”

U.S. physician Susan Okie thinks that the combination of a blast wave followed by a sudden drop in pressure is the culprit.

Psychiatrist Evan Kanter of the University of Washington argues that explosions disconnect the amygdala, or emotional part of the brain, from the frontal lobes, which control planning and decision-making.

And Dr. Ibolja Cernak of Johns Hopkins postulates that blast waves generate powerful vibrations of major blood vessels in the chest and abdomen, which transfer that energy to areas deep in the brain, such as the hippocampus. Cernak says the damage eventually leads to premature aging of the brain.

A recent Army study downplayed the seriousness of mild TBI (MTBI), suggesting that the health problems associated with MTBI were largely a result of PTSD and depression.

But a careful reading of the study reveals that researchers failed to directly link PTSD to MTBI and that “These data should not be construed as suggesting that mild traumatic brain injury is not a serious medical concern.” Solders who suffer MTBI, especially those knocked unconscious or who experience it multiple times, “were at a very high risk for physical and mental health problems.”

UCLA’s Hovda even questions the term “mild.” He says, “I don’t know what makes it ‘ mild,’ because it can evolve into anxiety disorders, personality changes, and depression.”

Besides the acute symptoms of TBI, there is a tapestry of psychological syndromes that victims can suffer. “Even mild brain trauma shakes up the entire body,” says Dr. Landau. “Many doctors and therapists just don’t see this.”

One problem, says Landau, is that MTBI can produce such a wide variety of systems, from disrupting the female hormone system to irritable bowels.

One of the major effects of TBI is what Landau calls the development of “identity ambiguity: people who were decisive become indecisive. People who were charming become withdrawn. They may have trouble reading. They may fly into rages.”

Landau says this can be devastating for those around TBI sufferers. “The family is excited that this young person is coming home [from the war] with no major injuries. They left as a good son, a good father, and a good husband. Suddenly they start hitting their children, can’t have sex, start drinking too much, talking too loud.”

Mary Watson, RN, DSM, a psychiatric nurse at a Cleveland, VA hospital, says TBI sufferers can “seem to be perfectly normal and then spontaneously become confused and irritated, suddenly set off by something in their surroundings and start yelling and cussing.”

Pennsylvania Psychologist Barry Jacobs, author of “Emotional Guide for Caregivers,” says TBI victims may lose their ability to empathize with others. “It is like a stranger has suddenly shown up.”

Jacobs says he is particularly concerned about MTBI. “Mild injuries are most at risk,” he says, because the symptoms are subtle and may not be recognized as neurological. But while the symptoms may be subtle, the consequences for family, friends and coworkers “may be severe,” he says. 

According to Landau, “There is a 70 percent chance that relationships will break down after TBI.”

Treating TBI is tricky, not just because it can be both subtle and stubborn, but because military culture resists admitting to problems. A Pentagon study found that 60 percent of the soldiers who suffered from the symptoms of TBI refused to seek help because they felt their unit leaders would treat them differently. Some 55 percent refused help because they thought they would be seen as weak, or would lose the trust of their fellow soldiers. A number feared that reporting the symptoms of TBI could prevent them from getting jobs as police and firemen once they left the military.

“Vets don’t tell the truth,” says Hovda. “They say, ‘I’m fine, I can go back into battle.” The result, however, is that TBI victims may be exposed to further damage before they can heal. “MTBI is a biochemical event,” says Hovda, that creates a crisis for the brain. During this crisis, “the brain is vulnerable to another incident. A second incident during this phase is likely to have more severe repercussions.”

The Center for the Study of Retired Athletes found that three or more concussions meant that athletes were three times as likely to have “significant memory problems,” and five times as likely to suffer from depression or develop an Alzheimer’s-like syndrome called Chronic Traumatic Encephalopathy.

Whether it is sports or war, the more one is exposed to trauma, the worse the damage.

Multiple tours and longer deployments mean soldiers are exposed to more explosions. “The multiple nature of it is unprecedented. People just get blasted, and blasted, and blasted,” says Maj. Connie Johnmeyer of the 332ed Medical Group, a unit that deals with psychological problems.

But with a major shortage of troops, the pressure is to get lightly wounded soldiers back into battle. Out of the 1.6 million who served in both wars, some 525,000 troops have had more than two combat tours, 70,000 have served three, and 20,000 have done five or more.

When soldiers are first wounded, says Gean, “The acute care [at Landstuhl and Walter Reed] is truly world class,” far better than most people could get in the U.S., bar a few trauma centers. But she thinks that the TBI problem “is larger than we think,” and she worries about “what happens after” they leave.

The worry is well placed. Soldiers return to find that there are few psychological resources for them, and virtually no individual therapy. “There are two things going on regarding vets,” says Col. (ret) Will Wilson, chair of the American Psychological Association’s Division 19 (Military Psychology). “One, there are not enough care providers available, and two, there are not enough people focusing on the problem outside of the military.”

The Department of Defense’s (DOD) Task Force on Mental Health concluded that “The psychological health needs of service members, their families, and their survivors are daunting and growing.” And yet the military has lost 22 percent of its psychologists in the past several years, most from burn out.

At Walter Reed, soldiers with PTSD outnumber amputees 43 to 1, but the hospital has no PTSD center. “TBI can be missed,” says Watson. “People demonstrating psychological problems can be sent to the general psych unit where they are locked up.”

Soldiers are also routinely treated with medications rather than therapy. A study by Veterans for America found that some soldiers were taking 20 different medications at once, some of which canceled others out.

Soldiers also have difficulty finding therapists because the VA pays below market rates, and even cut those reimbursements 6.4 percent in 2007. The result is that some 30 percent of psychologists are unwilling to take on military patients. For regular soldiers, one 45-minute session once a month is not uncommon, and they may be treated by a different health professional each time.

This situation may be worse for the National Guard and the Reserves, who make up almost 50 percent of the troops deployed in both wars and who, according to the Veterans for America study, “are experiencing rates of mental health problems 44 percent higher than their active duty counterparts.” Health care for such troops may be inferior to that offered to full-time regulars.

The problem is broader than psychological services. A Harvard study found that 1.8 million vets under 65 have no health care or access to the VA. “Most uninsured veterans are low-to-middle income workers who may be too poor to afford private coverage but are not poor enough to qualify for Medicaid or free VA care,” the study found. 

“The insurance situation is horrible,” says Landau.

Therapists like Landau and Jacobs point out that while TBI may affect an individual, its consequences ripple out to a much wider audience.

“You have to mobilize their [TBI sufferers] support system,” says Landau. Educating a TBI sufferer’s family is essential, and “very possible to do.” But many in the military are not trained in skills like family therapy.

Watson agrees about the importance of working with families, but points out “that in many cases there is no core family” and TBI sufferers are on their own.

As grim as the current situation looks, most health professionals say there is hope for many TBI sufferers.

Gean says that when she was in school, conventional wisdom was that damaged brains couldn’t heal. “But we now know that the brain can heal. It has an intrinsic plasticity that allows it to recover, and this is particularly true for the young brain.”

On the psychological side, while recovering from TBI may take a long time—Landau says sometimes from five to 10 years—if the proper care is given, recovery is possible.  Jacobs agrees the recovery period may be extensive, but, “things do get better over time.”

Rehabilitation, however, is expensive, and it is by no means clear how many victims there are. Between TBI and the kind of damage that substance abuse inflicts, Landau guesses that “40 percent of the returning vets will have physical and psychological difficulties.”

No one has put a final figure on what that will cost, but $14 billion over the next 20 years is not out of the question. 

Right now the resources don’t meet the demand. “Currently the VA system cannot manage patients with TBI,” says Dr. Heekin Chee of Boston’s Spaulding Rehabilitation Hospital. Jacobs agrees: “The infrastructure that exists is not going to be able to cope.”

UCSF researcher Weiner ticks off what he sees as at least some of the solutions: “First, everyone of these people has to have access to quality clinical care, and physicians need to get educated about this syndrome. Second, we have to create a national database on this so we can figure out what is going on, and what we can learn from clinical treatment. Third, there needs to be a lot more organized research on these people.”

Weiner says the federal government has made $300 million available for research, “Which sounds like a lot of money, but really isn’t.”

Following the revelations of inadequate medical care at Walter Reed, Congress has gotten more involved in the issue.

Last July Congress passed the Wounded Warrior Bill (S 1606) to improve care for troops and veterans, and the House Energy and Commerce Committee just passed a reauthorization of Traumatic Brain Injury Act (HR 1418) to support research and rehabilitation for TBI sufferers.

Rep. Pascrell led the push for the bill. “This is not just for the military,” says Pascrell’s Communication’s Director, Caley Gray, but for TBI sufferers nationwide.

It has taken a war to put the issue of TBI on the nation’s health agenda, but the cost of that awareness in blood, flesh, and decimated relationships is high. Even if the war ends soon, there will be hundreds of thousands of soldiers and veterans who will bear the burden of TBI. Sorting out how to deal with it may well test the nation’s mettle far more than the conflicts that produced the damage.

For Gean, who has seen some of that wreckage first hand, the solution is clear: “We have to do something for these soldiers.”

Conn Hallinan is an analyst for Foreign Policy in Focus.

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