Even though I live near Washington, DC, I'm not a politics maven. I remember when Sen. Max Cleland lost his seat in 2002, but I hadn't heard anything about him since, so I figured he had happily retired from the often-dirty fray. I could not have been more wrong.
I saw him again last month when he spoke to the researchers, biotech workers, and advocates at the "Next Frontier of the Brain" forum in Boston. Instead of relaxing after his decades of public service, Cleland had spiraled down into the abyss of PTSD—more than 40 years after he was grievously wounded in Vietnam.
"People who overcome, especially, physical injuries…usually do it by means of having some kind of purpose in their life. I had a strong meaning and purpose; it was called politics, government service."
"But then I lost [the election]. I lost my sense of meaning and purpose and destiny, vision. And at that point, then the reality of the wounding came into play. Then I realized, only recently, I was dealing with something that was much bigger than I was. And that was the basic, fundamental aspect of your brain.
"I went down into a massive, deep, dark depression sparked by massive anxiety and what we now know flooding of adrenaline and cortisol into the system—and all of that stuff came flooding back from forty-some-odd years ago, just like I was on the battlefield again, dying, overwhelmed, overcome." At one point, he said, he was so disabled, emotionally and cognitively, that he lost the ability to read.
Cleland went back to Walter Reed hospital, where he had first recovered from the loss of parts of three limbs in 1968. This time, the doctors helped him start to heal his inner wounds. "Thank God, patient help, trauma counseling at Walter Reed…anti-depressant for a while, I began to recover. And I'm beginning to restore my sense of self and all these other things, and then, you know, magically the emotions come back, and the cerebral capability comes back, and then you begin to start thinking again about meaning and purpose."
Cleland also tells his story in the documentary film Halfway Home, which follows several veterans through their first years home from war. The film had its Boston premiere as part of the forum; its director, Paul Freedman, and narrator, Martin Sheen, joined Cleland to talk about the film after the showing.
In the film, Cleland describes one of his low moments at Walter Reed, sitting and sobbing uncontrollably and then hearing, through the wall, his own voice, cheerful. It was from a video he had recorded long ago to inspire newly wounded patients to not give up.
"I had no idea for years, for decades, that I might have some kind of something called post-traumatic stress disorder," he said at the forum. "For those who have been wounded, whether they have been physically wounded or not, when they have been traumatized, that old horse, that thousand-pound steed in your mind, has been spooked. It has been spooked. And if it has been spooked numerous times, it ain't ever forgetting."
"And so anything that comes along and spooks that horse—we call it triggers, nowadays—then you're off and running. You're liable to be thrown off the horse and dragged along the ground."
Now Cleland is secretary of the American Battle Monuments Commission and, as always, a strong advocate for veterans. And he wrote a book about his journey, Heart of a Patriot: How I Found the Courage to Survive Vietnam, Walter Reed and Karl Rove. He ended his remarks with a plea to the audience: "Those of us that have made that journey and hundreds of thousands, really, millions of young Americans who have put their lives on the line for the rest of us, need you. We need you."
His remarks start just after the first minute of the video; researchers on pain, PTSD, and concussion follow (here you can find a description of those presentations). Video and mp3 audio also available on The Science Network site.
The forum was held in Boston May 23–25 by the One Mind for Research campaign, whose goal is "to significantly reduce the U.S. burden of disability due to brain disorders." The campaigners released a blueprint of research goals at the event: "A Ten-Year Plan for Neuroscience: From Molecules to Brain Health" (PDF). Videos of all the sessions and interviews are collected on the Science Network site.
Just before I left to travel to the conference, I read in my local paper of a hit-and-run driver who had killed a pedestrian in the dark of night. The top of the story described the accident and suggested alcohol was involved. In the middle of the story, I read that the driver, who was found disoriented in a nearby field, was a friend of the person he had allegedly hit; they were both headed home in the same neighborhood. At the end of the story, I learned that the driver was recently returned from a war zone. Now when I hear these stories, I wonder: Was he showing symptoms of PTSD? Was he getting the re-entry care he needed? Are there others like him we must help?
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Traumatic brain injury (TBI), the signature injury of the current U.S. wars, calls for the nation's best "emergency medicine," Kevin Kit Parker told a group of top scientists, medicine makers, and policy makers, this spring at the One Mind for Research conference in Boston.
"Certainly TBI, as it affects the force, is a national security issue, and it's certainly an emergency issue." Like the race to the moon and the Manhattan project, he said, TBI is an emergency science project with national security at stake and a need to move rapidly.
"You've got young NCOs [non-commissioned officers], young soldiers out there that have been blown up a dozen times, a dozen times they've suffered a traumatic brain injury, since 9/11. We have this growing cadre of our professional warriors that are out there, that are walking around, and the concern is, what does the future hold for them?"
The timelines of TBI damage range from nanoseconds to years. "The data now is pretty clear that TBI can potentiate a variety of neurodegenerative diseases, including Parkinson's and Alzheimer's disease," Parker said. "So the outlook for these young soldiers is kind of bleak right now."
Parker, a professor at Harvard, has also served multiple tours in Afghanistan in the Army Reserve, tending the wounded immediately after impact and observing their recovery on base and back in the United States. The experiences led him to expand his research focus from the physics of the heart to the brain. "When people started trying to kill me with IED's I thought I'd better get a piece of this," he said.
His background also led to an unusual approach to the problem, or at least unusual for neuroscientists. "I'm an infantry officer in the reserve, and I'm not a physician, I'm a physicist, so I look at things in terms of scaling laws." Interested in how mechanical energy (such as from blasts) affects neurons, he and the people in his lab decided to try to build physical models of blast injury from molecule to cell and from cell to tissue.
"We use tissue engineering as a tool, including blasting neurons," he said. "What we found right away is that we can mimic some of the things that the neuropathologists are reporting that they're seeing in patients."
"Now that we've got all these models, we're working on developing a systematic understanding of the mechanical forces required to injure these neurons, these vascular tissues, and understand the chemical cascades that are turned on by these mechanical forces." If they understand these chemical cascades, they could start to identify which molecules along the cascade are the most vulnerable—and which might be easily reached by drugs and other therapies.
Part of emergency medicine is exploring many avenues simultaneously, Parker said. His theory is it's diffused axonal injury that leads to damage from TBI, but researchers need to work on multiple hypotheses, to "flank the problem" with the outside-the-box ideas until someone finds some badly needed solutions.
One giant challenge: "We need to build a brain," he said. "Everyone would benefit from having a brain in their [laboratory] dish to work on:" a 1 mm3 piece of brain that mimics the neural microenvironment, scalable so what people discover in the lab can be tested in drug-maker's wide-assay studies. He's working on it.
In addition, "we need to push the science as far forward [on the battlefield] as we possibly can," he said. "It might be a diffusion tensor imager that we put downrange, it might be a biomarkers lab that we put downrange … so we can understand, as these soldiers come off the battlefield, what's happening to them, rather than waiting 6 months, 12 months before they present at a VA emergency room."
"The whole idea is that when these guys [medics] run up there to pull these broken kids out of this MRAP [armored vehicle], that there's a whole team behind them supporting them," he said. "If I run up there and this kid's got a leg dangling off, I know how to apply a tourniquet to him. If I run up there and he's got his bell rung, I got no way of treating this guy right now. And right now he's at the genesis of these neurodegenerative diseases that might not appear for 20-30 years down the road."
His remarks start just after minute 1 of the video. The slides he uses are especially useful in understanding the science.
The forum was held in Boston May 23–25 by the One Mind for Research campaign, whose goal is "to significantly reduce the U.S. burden of disability due to brain disorders." The campaigners released a blueprint of research goals at the event: "A Ten-Year Plan for Neuroscience: From Molecules to Brain Health" (PDF). Videos of all the sessions are collected on the Science Network site.
The Science Network also did a wide-ranging interview with Parker, on work in the lab, his experience in Afghanistan, how he got started in science, and his passionate advocacy for his compatriots in the field. (22 min). It's also well worth a listen.