Check out the app: No Warriors Left Behind. Now downloadeble on IPhones and Android.
Helping prevent suicide among veterans. Because ONE suicide among veterans is too many.
The free book is located under PTSD Facts
Check out the app: No Warriors Left Behind. Now downloadeble on IPhones and Android.
Helping prevent suicide among veterans. Because ONE suicide among veterans is too many.
The free book is located under PTSD Facts
Veterans are some of our nation’s most brave and generous souls. From the military to the navy, from the air force to the marines, our veterans literally risked their lives so that their fellow citizens could continue living in a safe and prosperous nation.
Sadly, many veterans return home after serving their country with physical and mental health issues that can lead to other more serious issues such as suicidal thoughts and substance abuse, and possibly even a sense of uncertainty about what to do next. For wounded veterans who must now learn to live with disabilities, it can feel like hope is lost for reclaiming the lives they enjoyed before.
Thanks to government assistance programs and advances in modern technology, many veterans – including those with mental health issues and physical disabilities – are finding new freedom as business owners. In fact, if every disabled veteran in the United States started his or her own business this year, it would bring an additional 3.8 million businesses into the nation’s economy.
It’s a fact that many veterans are not only turning their lives around as entrepreneurs; many are also thriving in happy, fulfilled lifestyles and relationships. If you or a loved one are a wounded veteran considering taking taking the plunge into business ownership, here are a few things to consider:
What type of business do you want to run?
Your very first step on the path to entrepreneurship should be your business idea. What type of business do you want to run? What industry would be a good fit for you? Will you build your own idea from scratch, assist the government with a project, or open a franchise?
Veterans should also take their physical health, mental health, location and interests into consideration when deciding on the right business idea. Here’s a great list of business ideas for veterans, if you need help brainstorming.
Who are your ideal clients?
Will you continue to collaborate with the government as a contractor? This can be an easy transition for many veterans. Many of these government contracts are in high demand and include great pay and benefits.
If government contracting is not for you, you could also consider making money from your passions. Many veterans are choosing to open retail stores or selling crafts online. Wheelchair-bound veterans may be happy to know that online businesses could be a great fit for them. By taking a moment to consider your industry and the types of clients you want to work with, you can help narrow your focus and set your future business up for success!
How will you secure funding?
Financing a new business is a hurdle many business owners need some assistance overcoming – and the same is true for veterans. Luckily, the government and the Veteran’s Health Administration are here to help. The United States government offers a variety of grants for new business owners, and some of these are specifically reserved for veterans interested in opening their own businesses.
If you apply for a grant and are turned down, don’t fret. Angel investors and venture capital are two other ways to raise money to launch a new business idea. Of course, it’s important to realize that not all cities have angel investors or venture capitalists. Depending on where you live, it may be necessary to travel out of state to pitch your idea to investors.
What are you waiting for?
As you can see, there are many options for veterans looking to open their own business. Disabled veterans should not despair; entrepreneurship can be a fulfilling pathway into a free and happy life after serving your country. Although you might have to put a bit more thought into your business strategy as a disabled veteran, the rewards of running your own business are well worth it.
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We met her at an LA Collaborative meeting. That’s the Los Angeles Veterans Collaborative, a group of community stakeholders, agencies and representatives serving veterans and military families in Greater Los Angeles. Like the NVF’s Women Veteran Outreach Coordinator Leaphy Khim, this woman Is a veteran. The two of them sat together in an early morning focus group for women veterans. Melanie Brown raised the issue of the scarcity of services for women who were pre-9/11 vets like her. Many agencies serve post 9/11 veterans only. She was quick to volunteer to put together a list of agencies who work specifically with women veterans. She and Leaphy struck up a conversation that led to more conversations about their experiences as women vets, and the needs of women veterans.
Brown’s experience as a US Army veteran in the years before 9/11 held its own kind of combat. In a war zone, yes, but not what you’re expecting. This wasn’t the desert or the jungle. This was basic training. Brown made a short, animated documentary about her experience. Her “Lion in a Box” is available on Vimeo.
Watching it, I remembered the nurses in Vietnam, what they experienced in the field hospitals and also after hours. How their lives were so different from what they would have been stateside. And I thought of the women vets we see in our outreach. Mary Ann Mayer, our Women Veteran Outreach Director, says this about them. “Here is the incredible strength of women veteran survivors of MST. These women can get knocked down, and still not break. They inspire me every single day.”
It takes a special kind of woman to want to train for combat. Melanie Brown is that woman. It riles her when someone makes the assumption that because she was not in a designated combat zone, she had an easy time of it. Her experience of harassment and unfair treatment is painful to watch, the more so because you know it’s not unusual. At the risk of repeating myself, here’s from my blog of 8/4 this year:
Forty percent of military women have experienced MST (Military Sexual Trauma) while 67% have experienced sexual harassment. And these figures don’t include unreported cases. Multiple studies show that PTSD from Military Sexual Trauma (MST) is twice as severe as combat PTSD.
The level of reported incidents of MST have risen, but the number of cases actually going to court hasn’t kept pace with the increase of reports. What we (still) have here is a situation where there doesn’t seem to be accountability for actions. Attention is drawn to problems and issues, and that’s all well and good. That’s the first step. What we need is substantive change.
There are ranking officers in the military justice system who see the need for change. Likewise in the Senate. Likewise in the ranks of women veterans who are telling their stories now. Let’s hope it’s just a matter of time, but let’s do keep the pressure on.
If you know a veteran who needs help, here’s our Lifeline for Vets number where they can talk vet-to-vet: 888.777.4443.
Source: The KKK Unmasked
Unfortunately, many soldiers experience traumatic brain injury when in combat, but is traumatic brain injury (TBI) linked to later combat posttraumatic stress disorder (PTSD)? Two recent studies examined the link between traumatic brain injury and PTSD in marines and army soldiers.
In a study published last year, Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty Marines1 shows that 19.8% of Marines reported sustaining a deployment-related TBI where most (87.2%) were mild in nature. It was noted that while predeployment PTSD symptoms and severity of combat intensity did predict a higher risk of postdeployment combat PTSD, a better predictor was the experience of a TBI during deployment. Moderate or severe TBIs predicted the presence of PTSD symptoms at three months postdeployment more than mild TBIs did.
What this all means that a TBI during deployment actually predicts the presence of PTSD symptoms better than other known risk factors and that the more severe the TBI, the greater the risk of combat PTSD.
In the latest study, Prospective Longitudinal Evaluation of the Effect of Deployment-Acquired Traumatic Brain Injury on Posttraumatic Stress and Related Disorders: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)2, 4,645 soldiers who were deployed to Afghanistan were studied and results showed that 18% of soldiers experienced mild TBIs while 1.2% of soldiers experienced more-then-mild TBIs during deployment. Even after taking into account other known risk factors for combat PTSD causes such as pre-deployment mental health, prior TBIs and severity of deployment stress, it was found that:
This study shows that there is a risk of, not only PTSD for those who have suffered a TBI, but also other mental health issues as well.
While we don’t currently understand why the link between TBIs and PTSD exists, it’s clear that it does. What this, like other studies, suggests is that PTSD is, indeed, a physical illness and not “all in one’s head” like some would have you believe (You Don’t Have A Mental Illness: It’s All In Your Head!). What this means for soldiers is that greater care should be taken in screening for PTSD after a TBI is sustained and, critically, even mild injuries can increase a soldier’s risk of PTSD.
While this may seem like a bleak finding, really it is not. What this finding does is further our understanding of combat PTSD and it allows us to further target risk groups to better treat those in the military as a whole; because, we know that treatment of combat PTSD is possible and we know that people successfully recover from combat PTSD every day.
Mission: H.E.R.O.E.S. Care provides coordinated support for military members and their families before, during, and after deployment in the communities where they live through specially trained caregivers.
Results: Since 2003, over 150,000 military members and their families have received material, financial and other support through our network of volunteers and specially trained caregivers
Target demographics: Military Families in Genuine Need.
Direct beneficiaries per year: Each year H.E.R.O.E.S. Care provides real and meaningful support for more than 50,000 military families.
Geographic areas served: National
Programs: The H.E.R.O.E.S. Care Hometown Support Program is an affiliation of program partners working together to provide one-on-one dedicated care for military families in the communities where they live. A specially trained, gender matched volunteer is assigned to a primary care receiver or PCR (spouse/significant other/other adult family member) designated by the deploying service member. This Hometown Support Volunteer (HSV) monitors the family situation and coordinates community support. The HSV also has dedicated access to national organizations that can provide for financial needs and job placement services. The HSV is specially trained to detect the need for professional mental health care and can refer the PCR to the affiliated partner organization to intervene.All of this care begins before deployment, continues through deployment, and up to two years post deployment at the discretion of the family. There are no contracts to sign and all services are free of charge.
Mission: Travis Manion Foundation (TMF) empowers veterans and families of fallen heroes to develop character in future generations. In 2007, 1stLt Travis Manion (USMC) was killed in Iraq while saving his wounded teammates. Today, Travis’ legacy lives on in the words he spoke before leaving for his final deployment, “If Not Me, Then Who…” Guided by this mantra, veterans continue their service, develop strong relationships with their communities, and thrive in their post-military lives. As a result, communities prosper and the character of our nation’s heroes live on in the next generation.
Target demographics: Veterans, families of the fallen, and our nation’s youth.
Direct beneficiaries per year: 150,000+ YOUNG ADULTS, 60,000+ VETERANS & SURVIVORS, and 4,000+ VOLUNTEERS
Geographic areas served: We are a national foundation.
Programs: THE TRAVIS MANION FOUNDATION (TMF) EMPOWERS VETERANS AND THE FAMILIES OF FALLEN HEROES TO DEVELOP CHARACTER IN FUTURE GENERATIONS. IN 2007, 1ST LT TRAVIS MANION (USMC) WAS KILLED IN IRAQ WHILE SAVING HIS WOUNDED TEAMMATES. TODAY, TRAVIS’ LEGACY LIVES ON IN THE WORDS HE SPOKE BEFORE LEAVING FOR HIS FINAL DEPLOYMENT, “IF NOT ME, THEN WHO…”
Perl’s findings, published in the scientific journal The Lancet Neurology, may represent the key to a medical mystery first glimpsed a century ago in the trenches of World War I. It was first known as shell shock, then combat fatigue and finally PTSD, and in each case, it was almost universally understood as a psychic rather than a physical affliction. Only in the past decade or so did an elite group of neurologists, physicists and senior officers begin pushing back at a military leadership that had long told recruits with these wounds to “deal with it,” fed them pills and sent them back into battle.
If Perl’s discovery is confirmed by other scientists — and if one of blast’s short-term signatures is indeed a pattern of scarring in the brain — then the implications for the military and for society at large could be vast. Much of what has passed for emotional trauma may be reinterpreted, and many veterans may step forward to demand recognition of an injury that cannot be definitively diagnosed until after death. There will be calls for more research, for drug trials, for better helmets and for expanded veteran care. But these palliatives are unlikely to erase the crude message that lurks, unavoidable, behind Perl’s discovery: Modern warfare destroys your brain.
The physics behind blast forces was almost unknown until the modern era, and it remains so mysterious and terrifying that scientists sometimes invoke the word “magic” when talking about it. A blast begins simply: A detonator turns a lump of solid matter into a deadly fireball. Within that moment, three distinct things happen. The first is the blast wave, a wall of static pressure traveling outward in all directions faster than the speed of sound. Next, a blast wind fills the void and carries with it any objects it encounters. This is the most manifestly destructive part of the blast, capable of hurling cars, people and shrapnel against buildings and roadsides. The remaining effects include fire and toxic gases, which can sear, poison and asphyxiate anyone within range.
The effects of all of this on the human body are myriad and more complicated than the blast itself. People who have been exposed to blasts at close range usually describe it as an overpowering, full-body experience unlike anything they have ever known. Many soldiers do not recall the moment of impact: it gets lost in the flash of light, the deafening sound or unconsciousness. Those who do remember it often speak of a simultaneous punching and squeezing effect, a feeling at once generalized and intensely violent, as if someone had put a board against your body and then struck it with dozens of hammers. From a distance, a blast makes a distinctive thump, the sound of air pressure clapping outward. When I lived in Baghdad, reporting for this newspaper, I would sometimes be awakened by that sound early in the morning. I would sit up in bed, instantly alert, with a surreal and awful realization: Someone who was just as healthy as me 30 seconds ago has been shredded to pieces.
Credit Greg Kahn for The New York Time.
Trinitrotoluene, or TNT, was first used in artillery shells by the German Army in 1902. Soon after the First World War started in 1914, a rain of these devices was falling on the hapless men on each side of the front. It was a level of violence and horror far beyond the cavalry charges of earlier wars. Very quickly, soldiers began emerging with bizarre symptoms; they shuddered and gibbered or became unable to speak at all. Many observers were struck by the apparent capacity of these blasts to kill and maim without leaving any visible trace. The British journalist Ellis Ashmead-Bartlett famously described the sight of seven Turks at Gallipoli in 1915, sitting together with their rifles across their knees: “One man has his arm across the neck of his friend and a smile on his face as if they had been cracking a joke when death overwhelmed them. All now have the appearance of being merely asleep; for of the several I can only see one who shows any outward injury.”
For those who survived a blast and suffered the mysterious symptoms, soldiers quickly coined their own phrase: shell shock. One period lyric went like this:
Perhaps you’re broke and paralyzed
Perhaps your memory goes
But it’s only just called shell shock
For you’ve nothing there that shows.
One British doctor, Frederick Mott, believed the shock was caused by a physical wound and proposed dissecting the brains of men who suffered from it. He even had some prescient hunches about the mechanism of blast’s effects: the compression wave, the concussion and the toxic gases. In a paper published in The Lancet in February 1916, he posited a “physical or chemical change and a break in the links of the chain of neurons which subserve a particular function.” Mott might not have seen anything abnormal in the soldiers’ brains, even if he had examined them under a microscope; neuropathology was still in its infancy. But his prophetic intuitions made him something of a hero to Perl.
Mott’s views were soon eclipsed by those of other doctors who saw shell shock more as a matter of emotional trauma. This was partly a function of the intellectual climate; Freud and other early psychologists had recently begun sketching provocative new ideas about how the mind responds to stress. Soldiers suffering from shell shock were often described as possessing “a neuropathic tendency or inheritance” or even a lack of manly vigor and patriotic spirit. Many shell-shock victims were derided as shirkers; some were even sentenced to death by firing squad after fleeing the field in a state of mental confusion.
This consensus held sway for decades, even as the terminology shifted, settling in 1980 on “post-traumatic stress disorder,” a coinage tailored to the unique social and emotional strain of returning veterans of the war in Vietnam. No one doubted that blasts had powerful and mysterious effects on the body, and starting in 1951, the U.S. government established the Blast Overpressure Program to observe the effects of large explosions, including atomic bombs, on living tissue. One of my uncles recalls standing in the Nevada desert as an Army private in 1955, taking photographs of a nuclear blast amid a weird landscape of test objects: cars, houses and mannequins in Chinese and Soviet military uniforms. At the time, scientists believed blasts would mainly affect air pockets in the body like the lungs, the digestive system and the ears. Few asked what it would mean for the body’s most complex and vulnerable organ.
Only after yet another European war broke out did scientists begin looking again at blast’s effects on the brain. When the Balkans collapsed into fratricidal violence in the early 1990s, Ibolja Cernak, a small, tenacious woman who grew up in the countryside of what is now Serbia, was working as a doctor and researcher at a military hospital in Belgrade. She soon began seeing large numbers of soldiers with blast trauma, usually from mortars and artillery fire, a common feature of that war. As in World War I, the men often suffered from striking mental impairments but few visible wounds. Cernak, whose colleagues call her Ibi, has an appealing blend of briskness and warmth, along with a clinician’s conviction that you must listen to your patients. It is easy to imagine her running around the battlefields of Bosnia and Serbia, collecting blood samples from soldiers. That is what she did for several years, at no small risk to her life, for a study cataloging the neurological effects of blast on 1,300 recruits. “The blast covers the entire body,” she told me. “It has a squeezing effect. Ask soldiers what they felt: The first thing they say is that their ears were popped out, they were gasping for air, like some huge fist is squeezing them. The entire body is involved in that interaction.”
Cernak became convinced that blast ripples through the body like rings on a pond’s surface. Its speed changes when it encounters materials of different density, like air pockets or the border between the brain’s gray and white matter, and can inflict greater damage in those places. As it happens, physicists would later theorize some very similar models for how blast damages the brain. Several possibilities have now been explored, including surges of blood upward from the chest; shearing loads on brain tissue; and the brain bouncing back and forth inside the skull, as happens with concussion. Charles Needham, a renowned authority on blast physics, told me post-mortems on blast injuries have lent some support to all of those theories, and the truth may be that several are at play simultaneously.
A decade after her initial battlefield surveys in the Balkans, Cernak took a position at Johns Hopkins University in Baltimore, where she did animal research that bolstered her conviction about blast’s full-body effects. She found that even if an animal’s head is protected during a blast, the brain can sustain damage, because the blast wave transfers through the body via blood and tissue. Cernak also came to believe that blast injuries to the brain were cumulative and that even small explosions with no discernible effects could, if repeated, produce terrible and irreversible damage. Much of this would later be confirmed by other scientists.
Even Cernak’s limited conclusions about blast injuries were heresy to much of the military-medical establishment at the time. She presented some of her findings at a conference in Vienna in the late 1990s, and before she was even finished, “an older gentleman stood up, a military doctor from the U.S.A.,” she recalled. “He said: ‘Stop with this nonsense. If you give soldiers fluid replacement, they’ll do fine after 24 hours, so it’s not this.’ … I was taken aback. It’s been an uphill battle.”
Credit Australian War Memorial
It was not until 2001, when America embarked on what became an era of constant warfare, that doctors began to move slowly toward Cernak’s way of thinking. A new generation of more powerful roadside bombs — improvised explosive devices, or I.E.D.s, in military parlance — became a signature of the fighting in Iraq and Afghanistan, yielding an epidemic of blast injury. Medics soon noticed an oddity of blast: It reflects off hard surfaces and multiplies, so that people who appear to be protected inside an enclosed space like a Humvee often suffer much worse brain injuries than those outside. Military and civilian researchers began focusing their work on the brain rather than just the body. But it was still very difficult to isolate blast from all the other physical and mental effects of being exposed to an explosion in a combat zone.
A landmark advance came in 2007, when an engineering firm called Applied Research Associates received a call from the SWAT team of the Arapahoe County Sheriff’s Office in Colorado. The officers were worried about possible neurological effects from breaching, the practice of blowing open doors with small explosive charges. Almost every major city in the United States has breacher teams, as do militaries in war zones. The Applied Research team quickly recognized that monitoring breachers would allow them to observe blast in its pure form, because the charges are too small to knock soldiers over or give them concussions; they are subject to the blast wave only. Plus, the researchers could bypass any ethical concerns about running tests on human subjects, because the breachers were doing it anyway.
The Applied Research team quickly designed and led a study on military breachers, rigging its own blast gauges and subjecting the recruits and trainers to neuropsychological tests at the beginning and end of a two-week breaching course. The resulting report, circulated in 2008, found a small but distinct decline in performance among the instructors, who are exposed to far more blasts than students. It was only a pilot study, but one author, Leanne Young, told me it added to “converging evidence that there is a cumulative effect with chronic exposure to blast,” even at relatively low levels.
The military was still reluctant to take blast seriously or even to concede that the symptoms it caused were a matter of physical harm. As late as 2008, researchers at the Walter Reed Army Institute of Research published a paper suggesting that the symptoms of traumatic brain injury could be caused in large part by PTSD and brushing off “theoretical concern” about neurological effects of the blast wave. By that time, American doctors who had gained Cernak’s unusual blend of medical expertise and battle experience were starting to draw their own conclusions.
One of the first to challenge the military from within was a 44-year-old Army lieutenant colonel named Christian Macedonia. In March 2008, Macedonia was in Arlington, Va., listening to a group of scientists and government bureaucrats talk about roadside bombs. The talk was dry and technical, and finally Macedonia, a square-jawed man with an air of urgent candor, could no longer contain himself. He lashed out against the military’s inaction on brain injury, using what he recalls as “some pretty salty language” to make his point. “I see no movement, and I’m kind of sick of it,” he concluded. As the meeting broke up, Macedonia expected other participants to politely avoid him. Instead, a younger aide approached, gave him a business card and urged him to get in touch with Adm. Michael Mullen, then chairman of the Joint Chiefs of Staff. Macedonia contacted Mullen and repeated his pitch. To his surprise, Mullen hired him.
At the time, “you had an entrenched military-medical community that did not want to go down that road,” Macedonia told me. “They didn’t want to give any credence to the idea that these symptoms were anything other than emotional difficulty.” Macedonia, an obstetrician as well as a soldier, knew otherwise. He did a tour in Anbar province in Iraq in 2004 and 2005 with soldiers who were being targeted frequently by mortars and roadside bombs. As an officer and doctor, he felt responsible for younger soldiers and their injuries. “Kids exposed to explosions were asking for help, and I was mouthing the party line: ‘You’ll be O.K.’ I was part of the machine that didn’t help. That’s what haunts me.”
Like Macedonia, some senior officers, including Gen. Peter Chiarelli of the Army and Gen. James Amos of the Marines, were also frustrated. They had seen too many soldiers discharged for disciplinary issues that were related to brain injury. Mullen hired several other experts to join Macedonia, asking them to monitor and improve the treatment of brain injury across the entire military. They called it the “Gray Team” — partly a play on gray matter and partly because the men were mostly in their 40s and going gray. They were an extraordinary group: mostly military officers, all of them had advanced degrees in medicine or science. And almost all of them had seen combat.
One of them was Jim Hancock, an emergency physician and Navy captain whose main qualification, he told me, was that he had suffered a traumatic brain injury himself, in southern Afghanistan. He also suffered concussions twice as a college athlete, so he had a basis for comparison. “The theory at the time was, it was a concussive event,” Hancock told me. “I said, ‘B.S.’ I’ve been concussed. I’ve never had anything like blast.” Like other members of the team, Hancock had noticed that soldiers exposed to blasts often had memory and focus problems that did not go away and that seemed distinct from battlefield trauma. If the blasts were repeated, the lapses sometimes devolved into career-ending mental and behavioral struggles. The Gray Team shared a gut-level belief that a blast wave’s effects on the body were far more extreme, and more complex, than the concussion model could account for. But their main task was to push the military to take brain injury more seriously, whatever its causes.
In early 2009, the Gray Team’s first five members traveled to military bases in Iraq and Afghanistan, meeting with trauma surgeons and other doctors to see how they handled brain injury. They found a wildly inconsistent picture. There were three extraordinary doctors who understood brain trauma and how to handle it. But “our fear was, those three rotate out, and it disappears,” said Dr. Geoffrey Ling, another member of the Gray Team.
Credit Nick Oza for The New York Times
When they got home, the team identified the most valuable practices and, along with Chiarelli and Amos, had them codified. Any soldier who was within 50 meters of a blast or who was in a vehicle behind or ahead of one struck by a bomb would have to be screened for brain injury. Anyone who suffered a concussion would have to be pulled out of combat. The Gray Team used a checklist to help identify concussed soldiers, although they were soon forced to write six different versions of it, because so many Marines memorized the correct answers to avoid being pulled out of combat. They also found a civilian contractor to build blast gauges, like the ones used in the breacher study. Every recruit or officer in a combat zone now wears three of these tiny devices, which weigh 20 grams each. The gauges are designed to turn red if they register a force of more than 12 pounds per square inch, the lower limit indicating a possible concussion or brain injury. The soldiers can no longer brush it off: If your sensor is red, you must be screened for brain injury.
The military has taken the new rules seriously. Less than a year after its first tour, the Gray Team went out to the field again and found that 90 percent of the bases they visited were in compliance. Still, the larger question of blast’s residue inside the skull remained a mystery.
Brandon Matthews is built like a tank, with huge humps of muscle outlining his back and shoulders. Ugly scars run down his biceps and forearms, cutting deep creases into the muscle. Others line his legs and sides, the legacy of an 11-year career as an Army Ranger. Matthews, registered with the military as Brandon Matthew Sipp, was exposed to so many blasts, in Iraq and other places, that he cannot count them all. The worst was a suicide bombing that sent him flying down a corridor and left him in a coma. He was hospitalized for months, and his military career was over. But his struggles with brain injury were only starting.
“I have moments when I forget everything: who I am, where I am, what I’m doing,” he told me. “It happens almost every day,” sometimes while he is driving. Decisions, once easy, have become impossible. He turns the kitchen burner on and then walks out, returning to discover a fire raging.
Matthews has 24 names tattooed down the center of his back. Eighteen are former war buddies who were killed in action. The more painful losses, in a sense, are five others: friends who have killed themselves since returning from the war. One of them, another Special Operations veteran with an undiagnosed traumatic brain injury, threatened his wife and children with a gun six months ago, Matthews told me, then shot himself in the head. Matthews spoke at the funeral. Undiagnosed blast injuries are common among the Special Operations soldiers, he said, because members of this military elite prize their toughness and do not want to risk losing their careers. “Here’s the harsh reality,” another veteran told me. “In the Special Forces especially, if I fail my physical, I’m done. That’s all there is to it. My cool-guy stuff is done.” So they keep their heads down, say nothing and suffer more blasts. Until one day, like Brandon Matthews, they are too damaged to fight.
I met Matthews at a hotel in Scottsdale, Ariz., where he now lives, and within an hour he had consumed several vodka-and-waters. He was warm and talkative, but every now and then he got a lost, plaintive look in his green eyes; I had the impression of a man who is clinging to a precipice. Before I could turn in, he insisted on steering me to a series of nightclubs, where he drank round after round and regaled strangers with his war stories. I asked him about friends, and he told me that almost all of them were dead. He lives on his military pension, and at 33, seems to have given up on holding down a job.
All this is fairly typical of service members and veterans who have suffered serious or repeated blast injuries, I was told by Susan Ullman, who runs an outreach network called Warrior2Warrior. (Ullman’s own husband, a Green Beret who suffered a traumatic brain injury, killed himself in 2013.) When I asked Matthews about other veterans and suicide, he grimaced and unleashed a string of obscenities about the cowardice of taking your own life. It felt cruel, and a little unnecessary, to ask if he had been tempted that way himself. (He has his own name tattooed on his back after those of friends who have killed themselves.)
Even if the underlying wounds of men like Matthews cannot be treated, the symptoms of brain injury, like those of trauma, can often be alleviated. The distinction between organic and emotional injury can be very blurry; trauma changes neuronal patterns, and therapy can alter a brain that has been physically damaged. “Everything we know suggests that people with structural lesion will also respond to pharmacological and psychological treatment,” said David Brody, a neurologist who has worked extensively with the military. Finding the right treatment is the key. Many veterans told me that they had gone to the V.A. and been handed pills indiscriminately. A number of mostly untested treatments have gained traction in the past few years, from hyperbaric chambers to ergonomic mouth guards, and some veterans swear by them.
For all his mental confusion, Matthews told me that he thinks he can now distinguish between the emotional wounds he suffered — the survivor’s guilt, the bad dreams and night terrors — and the more concrete cognitive problems that he traces to his blast exposure. A number of Special Operations soldiers said the same thing. They also said it makes a big difference to be told they have a physical wound rather than a mental one, even if it is incurable. Some brain injuries can now be seen on M.R.I.-type brain scans of living people, though precise diagnoses remain elusive. Matthews told me he would find some solace in simply being able to see what was going on inside his head.
Daniel Perl is continuing to examine the brains of blast-injured soldiers. After five years of working with the military, he feels sure, he told me, that many blast injuries have not been identified. “We could be talking many thousands,” he said. “And what scares me is that what we’re seeing now might just be the first round. If they survive the initial injuries, many of them may develop C.T.E. years or decades later.”
Perl takes some solace from the past. He has read a great deal about the men who suffered from shell shock during World War I and the doctors who struggled to treat them. He mentioned a monument in central England called “Shot at Dawn,” dedicated to British and Commonwealth soldiers who were executed by a firing squad after being convicted of cowardice or desertion. It is a stone figure of a blindfolded man in a military storm coat, his hands bound behind him. At his back is a field of thin stakes, each of them bearing a name, rank, age and date of execution. Some of these men, Perl believes, probably had traumatic brain injuries from blasts and should not have been held responsible for their actions. He has begun looking into the possibility of obtaining brain samples of shellshocked soldiers from that war. He hopes to examine them under the microscope, and perhaps, a century later, grant them and their descendants the diagnoses they deserve.