June 11, 2016

"What if PTSD Is More Physical Than Psychological?"

"A new study supports what a small group of military researchers has suspected for decades: that modern warfare destroys the brain."
For years, many scientists have assumed that explosive blasts affect the brain in much the same way as concussions from football or car accidents. Perl himself was a leading researcher on chronic traumatic encephalopathy, or C.T.E., which has caused dementia in N.F.L. players. Several veterans who died after suffering blast wounds have in fact developed C.T.E. But those veterans had other, nonblast injuries too. No one had done a systematic post-mortem study of blast-injured troops. That was exactly what the Pentagon asked Perl to do in 2010, offering him access to the brains they had gathered for research....

36 comments:

Sydney said...

Shouldn't the headline be "concussions destroy the brain?" To say "modern warfare destroys the brain," implies that just participating in war destroys the brain, rather than a suffering a specific injury.

LuAnn Zieman said...

Isn't there something wrong with the sentence "Several veterans who died after suffering blast wounds have in fact developed C.T.E."? Shouldn't it be "had" rather than "have" if the veterans were dead? It seems as if the brain continued responding after death. Or, am I missing something?

GAHCindy said...

"Several veterans who died after suffering blast wounds have in fact developed C.T.E."

Is this like that plane crash riddle that asks where to bury the survivors?

Sydney said...

I would like to modify my comment to reflect that the article is talking about a specific subset of concussions - those caused by blast injuries, but the point still stands.

The Drill SGT said...

The article also conflates CTE with PTSD without talking much about the actual forms of PTSD that are NOT Blast related.

Fernandinande said...

"a wall of static pressure traveling outward"

Stationary traveling.

The Drill SGT said...
The article also conflates CTE with PTSD without talking much about the actual forms of PTSD that are NOT Blast related.


Yeah, that was pretty poor.

"Why do some people develop posttraumatic stress disorder (PTSD) when others exposed to the same trauma do not? Studies show that genetic factors interact with trauma to determine who will develop PTSD, but the mechanism for this heritability has been unknown."

LarsPorsena said...

I've wondered why PTSD is a modern phenomenon. Did Alexanders armies suffer from it?
The Jews and the Romans fought in blood that was ankle deep in the Temple during the first revolt. Did they suffer PTSD. Did the survivors of Borodino, Leipzig, and Waterloo have it?

There is little or no mention of it before WWI. Why is this?

Quaestor said...

For years, many scientists have assumed that explosive blasts affect the brain in much the same way as concussions from football or car accidents.

"For years" = about 100 years. In 1916 the medical phenomenon known then as shell shock was widely documented as a primarily physical (i.e. neurological) condition.

The French apparently got the worst of it. Historians have speculated on the reasons of which two come to mind: French artillery vs. German artillery, and French policy vs. German field fortifications. Prior to the outbreak war in 1914 French planners had theorized that the advantage in war had passed irrevocably to the offense, that the next war would be won by something the French termed élan. The result of that theorizing was an army constituted and equipped to apply a policy of rapid, unceasing attack.

One weapon in particular was emblematic of élan, the Matériel de 75mm Mle 1897, famous around the world as the "French 75". This was a rapid-fring artillery piece ideal for destroying enemy infantry in the field. It was not only fast to shoot (15 aimed rounds per minute) it was fast to transport and deploy. It was not, however, particular effective against entrenched troops. Since the 75 was by far the most abundant artillery weapon available to the French in the early stages of the Great War the damage their shellfire could inflict on the Germans, concealed in their deep, concrete-reinforced trenches, was quite limited, resulting in comparatively fewer "shell shock" casualties among German troops facing French-held positions.

Another reason the French were shell shocked so badly was policy set at the higher levels of French leadership, from Poincaré and Viviani down to regimental level. The brutal German occupation of our sacred soil is temporary, they said to everyone. Any day now a great attack by the valiant French Army will sweep the despicable Boche from La Belle France. To be consistent with that policy French sappers were ordered not to waste resources on elaborate trench systems. The trenches were temporary fortifications only, they were to be in no way interpretable as demarcations of a new border with the German Empire. Consequently when German artillery rained down on French troops they had comparatively inferior protection and comparatively higher casualties.

Lucien said...

If everyone exposed to traumatic stress got PTSD it wouldn't be a disorder. The idea of a mental disorder is that it is out of the ordinary and abnormal. That is one reason why, even though the symptoms of grief may look a lot like depression, "uncomplicated bereavement" was not classified as a disorder -- at least not through DSM IV.

Sebastian said...

"that modern warfare destroys the brain." As opposed to premodern warfare. Because research.

Still, the military should invest much more in trying to predict physical and psychological resilience of future troops.

buwaya puti said...

The ongoing speculation about PTSD in history is that formerly the high stress was episodic, lasting only a few hours at most, and not usually repeated for days, weeks or months. The pace of warfare was much slower, armies fought or even skirmished relatively seldom.
Modern war kept men under stress for days weeks or months on end. Armies in contact were always expecting attack and usually receiving artillery fire, on the front lines danger was constant. This all was a result of 19th century technology, giving weapons great range and plenty of ammunition.
The only exception in earlier times was during sieges, especially from @1600 onwards, where the well-led besieging force kept to a rapid schedule and maintained a continuous bombardment precisely in order to wear out the defenders. In such a case opposing forces would be in contact for a period of weeks with at least a part of each force under fire at all times. In effect it was very similar to WWI trench warfare, on a small scale. Only a minority of any army would have been in this position however.
In the case of guerrilla wars there is even more speculation.

Mark said...

Veteran care just got even more expensive.

Thanks to George Bush for invading Iraq, an act whose total bill is yet unknown.

Quaestor said...

There is little or no mention of it before WWI. Why is this?

Most of what we know of ancient warfare comes from writers who were not present on the battlefield, what historians call secondary sources. The only primary sources we have of the Punic wars for example, are archeological rather than written — a ram prow from the seabed near the island of Levanzo, cooking equipment from a campsite occupied by Hannibal's Army of Italy. The first evidence of military medicine have come from Roman forts along the Rhine, which have revealed surprisingly advanced surgical implements such as scalpels, bone saws, arterial clamps, and even silver staples used to close wounds in lieu of suturing.

Michael K said...

"I've wondered why PTSD is a modern phenomenon."

This.

"The pace of warfare was much slower, armies fought or even skirmished relatively seldom. "

The front lines were more stable until Vietnam. The exception was the Pacific Theater in WWII. Read Sledge's "With the Old Breed" about Okinawa.

Also air Corps and submarines had higher mortality rates in some theaters, the 8th Air Force had a 30% mortality rate in air crews.

I've not seen a study of PTSD in air crews in WWII.

Another reason, and this is just my personal speculation, a lot of leftist draft dodgers from Vietnam got jobs in the VA after the war and moved the goalposts. Sort of like Major Hassan telling Afghanistan vets they had done something immoral.

buwaya puti said...

We have excellent documentation, by participants, for a great many European and colonial campaigns from the seventeenth century on, including daily reports from staff officers covering nearly everything. Not all campaigns were so completely documented, but a great many are.
And there are a huge number of participants accounts.
Almost the first, and the most detailed and complete of the private-soldier level accounts, is that of Bernal Diaz.

Quaestor said...

LarsPorsena wrote: The Jews and the Romans fought in blood that was ankle deep in the Temple during the first revolt.

Knee-deep, ankle-deep, wading in blood — this kind of language is very typical of ancient reports about warfare, written almost invariably by people who did not witness what they recorded.

The volume of blood in the average adult human is 4.7 liters, say 5000 cc for computational purposes. Assuming that the area of the walled enclosure of Harod's Temple stated in Middot 2.1. is accurate and that a cubit is 53 cm, the the area covered by blood is 67,600 square meters. The blood of two totally exsanguinated men will cover 1 square meter to a depth of 1 centimeter. Assuming that the height of an ankle is 5 centimeters the number of slaughtered adults required to flood the Temple precinct to ankle-depth is 676,000.

The largest force ever assembled in classical antiquity was the invasion army raised by Xerxes I for the Second Greco-Persian War. Scholars estimate its strength to have been 380,000 effectives. Consequently I do not believe the ankle-deep blood thing.

The Drill SGT said...

Quaestor said...

However, if each of those square meters also has a corpse in it along with the blood, then the you only need 67k corpses :)

The Drill SGT said...

Quaestor said...

alternately with fewer corpses and a lot of splashing around you could get calf covering with blood on all participants and a lot fewer corpses...

buwaya puti said...

On ankle-deep-
Low spots, uneven ground, puddles of water with dead bodies in them. It seems to be a tradition toi, that after every great battle there is a great rain.

Robert Cook said...

"Another reason, and this is just my personal speculation, a lot of leftist draft dodgers from Vietnam got jobs in the VA after the war and moved the goalposts."

"Personal speculation" here means "I'm just making up shit."

buwaya puti said...

If you want a very "realistic", personal view of the way Napoleonic wars were conducted, from a participants point of view, you can't do better than the memoirs of Baron Marbot, available free online.

buwaya puti said...

The other, possible, reason for the lack of prominence of PTSD in earlier times was that there were such incredible hardships in military campaigns, exposure, exhaustion, malnutrition and disease (see above, Marbot on the Siege of Genoa, he was a participant), that there was an extremely high rate of wastage for these reasons, relative to combat casualties. I forget where I saw it, may have been one of Duffy's books, that the majority of the men recruited into Fredericks Prussian armies did not survive the Seven Years War, and that one was, by the standards of other times, an orderly, civilized war of the Age of Reason.
Between that and the lifelong physical side effects of extreme hardship PTSD as a psychological condition may not have been noticable.

Quaestor said...

Until the invention of pesticides typhus was always more deadly than weapons in warfare.

cubanbob said...

Mark said...
Veteran care just got even more expensive.

Thanks to George Bush for invading Iraq, an act whose total bill is yet unknown.

6/11/16, 10:00 AM"

That can be paid for with diverting the funds from Lyndon Johnson's forever war on poverty.

cubanbob said...

As long as war exists and explosives are used in war this becomes an unresolvable problem.
While the cause was wrongly attributed in many instances the shell shock effect, that is the blast pressure wave damage became noticeable in WW1 simply because prior to that war troops had never been subjected to such intense and prolonged artillery bombardment. Has there been any studies or evidence of bomb blast effects of this type on civilians resulting from aerial bombardment during WW2 or from those exposed to bomb blast pressure waves in terrorists bombings?

Ann Althouse said...

Thanks for the ankle-deep in blood debunking, Quaester.

buwaya puti said...

Thats not to say that PTSD didnt exist, there are plenty of historical cases of extended stress that isnt limited to military combat. Slaves, prisoners, and the like.
My great uncle was imprisoned and tortured by the Kempeitai 1943-45, and was one of the few to survive and escape their dungeons. I suspect his erratic behavior and consequent problems in later life were the result of that.

mockturtle said...

I'm no neuropsychiatrist but I would guess that many, of not most, psychiatric disorders have a 'physical' base, usually chemical, or electro-chemical. This is why modern psychiatry is drug-based rather than psychoanalysis-based.

traditionalguy said...

Revelations says the battle for Jerusalem fought north of town on the plain of Megiddo will kill enough soldiers to result in the plain being covered up to a horse's bridal in men's blood. Maybe horse blood is included too. And I think that prophesy included some 200,000,000 Chinese soldiers.

Christy said...

I figured that my great granddaddy suffered PTSD. Maybe wishful thinking. At 13 he marched down to Rhea county here in East Tennessee and joined up with the Union Army. In his pension archive records is a statement from a neighboring farmer declaring great-grandpa was a right good worker before the war, but pretty useless after.

Michael K said...

"if each of those square meters also has a corpse in it "

In "The Face of Battle," John Keegan made a real effort to collect contemporaneous accounts of ancient battles. There were descriptions of bodies piled so high that men had to climb over them. The same applied to Waterloo.

Achilles said...

I love watching people discuss PTSD. All the theories and generalizations and pure bald faced ignorance. It makes us all feel so cared about. Because the VA takes such good care of us there is no resentment. None at all.

We don't think this country has gone craven. Or that many people don't deserve the freedom that they take for granted. Nothing of the sort. I am sure this will all end happily.

Quaestor said...

Revelations says the battle for Jerusalem fought north of town on the plain of Megiddo will kill enough soldiers to result in the plain being covered up to a horse's bridal in men's blood.

I will not bother to debunk that one, as I have better things to do.

Quaestor said...

I detect a whiff of insincerity, Achilles.

Achilles said...

Quaestor said...
"I detect a whiff of insincerity, Achilles."

For some PTSD is burning explosions death body parts nightmares.

For others that was the fun part. The hard part is seeing what the people of this country have become in our absence.

Louise Cavanaugh Roslansky said...

The soldiers have an intense experience based on life and death; the civilians of the same age in college think that having to hear disagreement causes a version of PTS. So how can the soldiers' experience be understood or their questions be answered?