Wounds we don't see

If there is an upside to modern warfare, it is the advance in battlefield medicine. Soldiers with wounds that were typically fatal during the Vietnam War now survive. An extraordinary 90% of U.S. soldiers who were wounded in Iraq have survived, compared with just 76% of those wounded in Vietnam, and this is a triumph.

But because of the nature of the fighting in Iraq and Afghanistan -- frequent exposure to roadside explosives and other blasts that aren't always fatal to soldiers who wear high-tech body armor and receive high-quality emergency care -- the survivors are far more likely to suffer brain injuries. Some of these are less obvious than shell shock. Cognitive problems can be subtle and long lasting, and symptoms, including forgetfulness, difficulty in concentrating or headaches, can be mistaken for or coexist with post-traumatic stress and depression.

When these veterans come home, many find that high-quality mental health and neurological treatment is scarce. Because cognitive and psychological wounds leave no visible scars, many find that compassion can be even scarcer. Meanwhile, the numbers of those with physical and mental damage continue to rise. Although the death toll in Iraq had been falling since the troop surge last summer, in March the number of those killed in action rose to 36, up from 25 in February. The number of wounded soared from 214 to 323, reflecting a sharp increase in fighting.

A comprehensive new Rand Corp. study highlights the hidden costs of America's involvement in Iraq and Afghanistan and documents the extent of these “invisible wounds of war.” A survey of veterans found 14% suffering from post-traumatic stress disorder and 14% reporting major depression within the last 30 days, and a stunning 19% reporting a likely traumatic brain injury during their deployment. That would suggest that as many as 320,000 of the 1.64 million soldiers deployed may have suffered a traumatic brain injury -- yet 57% of those surveyed had never been evaluated. The costs of treating brain injuries in 2007 ranged from $26,000 for mild cases to $409,000 for severe ones. The survey estimated that costs for treating post-traumatic stress disorder and depression in the first two years after deployment are as high as $6 billion. Pain, heartache and blighted young lives, of course, are incalculable.

Brain injury research is still in its infancy, and more funding for basic neurological research is essential. Scientifically, more is known about how to treat stress and depression, but that knowledge too often isn't translated into high-quality care for our veterans. We can and must learn to do a better job of healing the mind and the brain -- and of helping and honoring those who cannot now be healed.

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