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Friday, October 17, 2014

Writing About Combat Veterans - Part 2: Traumatic Brain Injury

 Most people are familiar with PTSD (Post Traumatic Stress Disorder) being one of the psychological injuries that may be suffered by combat veterans. However, along with PTSD, another combat-related trauma that is considered one of the "signature" injuries of the Iraq and Afghanistan wars is TBI (traumatic brain injury).

Just what is TBI and how can you as an author portray in your work a character acquiring and suffering from such a condition?

To do so, it is important to know what TBIs are, how warriors receive this type of injury, and what symptoms are manifested. Here are a few quick details about TBIs:

1.  Wars in Iraq and Afghanistan led to increased awareness of TBI among the troops.

2.  Modern protective gear has protected soldiers and advances in battlefield medicine have increased survival rates for many injuries caused by IEDs (improvised explosive devices), RPGs (rocket propelled grenades) and other weaponry. In spite of that, some of these warriors have experienced serious brain injuries which have resulted in long-term impairment of how they function physically, cognitively and behaviorally. 

3.  This type of injury has often been referred to as “having your bell rung” or “seeing stars.”

4.  A TBI is caused by the high pressure blast waves from explosions. They rattle the brain inside the skull. Helmets cannot protect from this kind of injury.

5.  There is a distinction between a mTBI (mild traumatic brain injury) also known as a concussion, which cannot be diagnosed by medical tests, and those TBIs that are moderate to severe, which can show up on brains scans. About 20 percent of soldiers from these wars have experienced at least one TBI, but 99 percent are concussions that are considered mild. 

6.  Diagnosis is based on the severity at the time of the injury, not according to the nature or duration of the symptoms afterwards.

7.  Mild TBIs do not require evacuation from the combat area.

8.  Symptoms of TBIs can be confused with those of PTSD. They are both considered “silent” wounds. They are not readily apparent by looking at the injured person.

9.  When a soldier experiences a moderate to severe TBI, s/he is almost always evacuated by air transport away from the battlefield and sent to Germany or the USA for evaluation and treatment.

10.  Some cases of TBI are severely debilitating and require long-term treatment.

11.  A concussion (mild TBI) is defined as a blow or jolt to the head. It briefly causes a person to lose consciousness, even if only for seconds. It causes a temporary gap in memory and leaves the person confused and disoriented. It can cause headaches, irritability, anger, dizziness, balance problems, fatigue, sleep disturbance, ringing in the ears, blurred vision, apathy, cognitive problems which include difficulty concentrating, problems making decisions or difficulty remembering things. Concussion sufferers often experience a low tolerance for lights and noise.

12.  These problems usually clear up shortly after the injury. In some cases, they may last for a longer period of time. In a few cases, symptoms such as headache, insomnia, memory problems, attention, and cognitive issues become chronic.

13.  The treatment for concussion is rest and avoidance of alcohol and drugs until the symptoms go away, which can take anywhere from a few hours to a few days.

14.  When symptoms continue for some time after a battle-related concussion, it is difficult to separate the cause of the symptoms from other types of injuries or physiological effects of working in a combat situation.
15.  Concussion is not the same as PTSD even though many of the symptoms are the same. Concussion is a physical injury to the brain. PTSD is a set of reactions or symptoms after trauma that may or may not have a physical origin.

16.  A warrior who has suffered a concussion may be at greater risk for PTSD.

17.  As with most injuries of this nature, many active-duty soldiers and combat veterans who suffer from the effects of a TBI do not like to talk about what they are experiencing.

18.  Symptoms of moderate or severe TBI include persistent headache, repeated nausea and vomiting, convulsions or seizures, inability to awaken from sleep, stupor, coma, vegetative state (similar to coma, but the person continues to have a sleep-wake cycle and periods of alertness) and persistent vegetative state (lasts more than a month). Recovery is possible in many cases, but generally is a long and slow process.

In my novel, Family Secrets, Jennie's estranged husband, Gerald begins to act in ways that are not like him. She tries to puzzle out how much of his strange behavior is due to their crumbling relationship and how much may be do to what he is experiencing in Afghanistan. She has no idea what he might be suffering from until later in the book she is asked,

   "Mrs. Howell, do you know if your husband has ever had his bell rung?"
   "Excuse me?" Jennie asked, bewildered.
    "Has he ever suffered a concussion from being too close to an IED explosion?"
   "No," Jennie shook her head. "I mean, I don't know. He's never said anything."

Even though Jennie is married to a soldier deployed to Afghanistan, and the novel includes scenes from the year Jennie's Grandpa Mike fought in the Vietnam War, Family Secrets is not a war story.

Family Secrets is not a traditional Thanksgiving Day story, although Thanksgiving plays a big role in this novel. Not only do we learn of Mike's Thanksgiving experience in Vietnam, but he shares the reason it is important to him to celebrate this particular holiday each year surrounded by his family.

Family Secrets is about three generations of a family, their secrets, how they resolve their individual challenges and draw closer together.

Family Secrets by Zina Abbott is scheduled to be published by Fire Star Press in the last week of October. Plan to get your copy and gain another perspective on why Thanksgiving Day can be a special day for more reasons than remembering the Pilgrims.

Robyn Echols writing as Zina Abbott.

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