Trump is misinformed about traumatic brain injuries

In the 1992 movie “Scent of a Woman,” Lieutenant Colonel Frank Slade, played by Al Pacino, gives an Academy Award-winning impassioned speech that references his military service and the wounds of war:

“I have seen boys like these, younger than these, their arms torn out, their legs ripped off. But there isn’t nothin’ like the sight of an amputated spirit; there is no prosthetic for that,” he tells the disciplinary board of an elite New England prep school.

For many service members and veterans, the source of their “amputated spirit” is most often an invisible injury, such as a traumatic brain injury (TBI). 

TBIs are generally considered the signature wound of war. Moreover, in the recent conflicts in Iraq and Afghanistan, improvised explosive devices (IEDs) were often the weapon of choice for the insurgent army, thus causing an increase in the number of TBIs diagnosed from previous wars.

Although moderate and severe traumatic head injuries can be readily identified and treated, mild TBIs and related blast injuries are often initially viewed as inconsequential and therefore overlooked in terms of treatment. 

Although a veteran with a mild TBI may not present with obvious symptoms, a missed diagnosis can lead to severe problems. Even mild TBI is associated with psychological distress, suicidal ideation, suicide attempts, completed suicide, substance abuse, and depression. 

At a time when the rate of suicide among veterans and service members remains alarmingly high despite years of reform, suicide prevention efforts often overlook the role of TBI. As the VA, veterans, and stakeholders continue to prioritize suicide prevention efforts, a more direct emphasis on the diagnosis and treatment of TBI is required.

Unfortunately, a series of recent remarks by President Trump revealed that the current administration fell into the category of those who continue to overlook the importance of treating TBI.

Although President Donald Trump saying something controversial is hardly breaking news, he did draw the ire of several veterans groups when he stated last week, in response to reports that 34 service members suffered a traumatic brain injury (TBI) that: “I heard they had headaches and a couple of other things, but I can report that it’s not very serious.” 

Indeed in response, the VFW demanded that the president apologize:

“TBI is a serious injury and one that cannot be taken lightly. TBI is known to cause depression, memory loss, severe headaches, dizziness, and fatigue — all injuries that come with both short- and long-term effects. The VFW expects an apology from the president to our service men and women for his misguided remarks.”

More importantly, however, Trump’s follow up remark, “I don’t consider them severe injuries relative to other injuries that I’ve seen,” is of more significant cause for concern. 

First, these remarks further an unhelpful narrative, that injuries must be visible to be taken seriously. According to The Bush Institute: “Our research indicates that invisible wounds of war pose a significant barrier to continued education, employment, and quality of life.” 

Similarly, according to Dr. Chrisanne Gordon, founder, and Chairman of the Resurrecting Lives Foundation, an organization that offers advocacy and awareness for service members and veterans with TBI: 

“Victims of [TBI] often blame themselves for their changed behavior, not realizing that blows or force to the head have caused lasting harm. Step one is helping them understand they have injuries, not character flaws . . . They’re out of they’re brains; they’re not out of their minds.”

Second, minimizing the impact of TBI may discourage those service members and veterans afflicted with one from seeking necessary medical care. According to RAND, several studies have shown an association between greater availability of mental healthcare and reduced rates in suicide. In other words, the sooner the care is rendered, the fewer the consequences of substance abuse, unemployment, homelessness and suicide.

Finally, regardless of severity, any TBI must be taken seriously, mainly because some symptoms may not be immediately apparent and will increase in severity over a period of time. If left untreated, these symptoms can rapidly progress to more serious complications.

Statements dismissing such injuries as mere headaches, as not serious, or as less severe than other damages that can be “seen” sends the wrong message to service members and veterans and potentially complicates their overall quality of life.

Lt. Col. Frank Slade may be a fictional cinematic character. Still, life often imitates art, and his blindness in the film serves as a metaphor, applicable here, that the right course of action or area of focus cannot always be “seen.” 

Yes, it is true that the worst wounds of war — those that stem from an amputated spirit — are invisible, but we must not spread misinformation that such injuries are any less serious simply because they cannot be seen. 

Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her on Twitter: @RileyTopping.