Our military veterans often return from multiple tours of duty with injuries that offer no apparent physical wounds. Among the most substantial injuries are those to the brain. Improvised explosive devices striking patrol vehicles can cause traumatic brain injuries (TBIs) with slowly developing disabilities. Superimposed on the TBIs are psychological effects of battle stress and living close to unremitting danger. These effects overlay one another and may affect a veteran years after the causative events, resulting in psychosocial crises and loss.
Current solutions are ineffective and incomplete. Prevention is limited to better equipment and to preemptive battle tactics that remove threats. Cures seem based primarily on the latest knowledge of brain function and on pathology from concussion and impact. Psychosocial issues such as shame, insufficient support, and suffering alone are too often self-medicated with illicit drugs, medications, and alcohol.
What is missing is an immersion into the world of combat veterans in order to deeply understand their needs and concerns and to determine possible solutions. Imposing brain science and the best of known psychological care is a generic solution applied to a large problem that may or may not exist as a general diagnosis. After building trust, we would interview veterans and learn from their experiences at the local molar level, rather than assume some grand scheme meant to apply to most cases.
This is an area of great concern during times of conflicts in the world, and it is a problem that may have applications for others operating within extraordinary settings and circumstances.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.