Friday, April 30, 2010

Rand gets it wromg

This post was written by a Marine Vietnam Vet friend:

In 2008, the RAND Institute put out a report "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery." In this report was an estimate that about 320,000 service members might have experienced a traumatic brain injury (TBI) during deployments up to that time.

Most people are now aware that an extreme TBI effectively scrambles the brain circuits badly, leaving the victim in awful condition, unable to care for themselves at all, often with very limited ability to communicate, and dramatically reduced cognitive ability. While some progress can be made to restoring functions, the lives of such men are pretty much permanently impaired to a terrifying degree.

Thus it seems the cost of war in Iraq/Afghanistan has brought about an unheard of level of suffering and loss to many thousands of our soldiers, and their families.

One would expect that an institute as prestigious as RAND would really have gotten this right. One would be wrong.

What they did was a phone survey of a sample of those who have served in those countries, and asked them if they had ever been near an explosion. Naturally, since even those who lived most of their tours behind the wire have heard explosions, many of respondents answered yes. They then applied that percentage to the total of those who had served by that time, and came up with the number of about 320K likely victims of TBI.

Which would actually have meant that for every single contact of any sort with opposing forces up until 2008 there would have had to be multiple TBI events, which is patently ridiculous.

I recently spoke with a veteran of Iraq, a psychologist intimately familiar with the facts, and in 2007 there were 23,000 reported head traumas, of which 85% were simple concussions from which people recovered completely in periods of a couple of days to a couple of weeks. These are pretty much the same kind of thing that happens daily on football fields in the US.

There are indeed major victims of TBI, something under 1000 right now. Still a number that is hard to dismiss, they are all terrible tragedies. But the RAND report was very inaccurate and misleading, and I see that same number cropping up in various articles and blogs today. Like so many bad reports, it rapidly became "what everybody knows".

And then there are the reports of very high levels of PTSD among returning troops. Repeated deployments in dangerous areas do bring this on, as it did in Viet Nam, and in fact among those Marines in WW2 who were involved in several different island campaigns. The cumulative effect of repeated periods of extreme high stress can affect even balanced personalities over time.

However, what is often referred to as PTSD is actually operational stress, which is comes from combinations of things like being away from home, rough living conditions (heat, dust, poor sleep), worries about home (girl friends or wives breaking away, family finances deteriorating), dislike of men or the officers of the unit, and of course, the really high frustration at times with the pages of Rules of Engagement everyone is supposed to know by heart even when bullets are flying past your head and explosions are rattling your brain. (Maybe add to that the worry as to whether the people in charge back in those panelled DC offices have any real idea of what they're doing.)

Operational stress does not condition someone for the rest of their life, any more than that really lousy first job you had does. You can move on from it. However, that stress on top of combat horrors can help cause PTSD. The real question is whether people are experiencing PTSD at rates well beyond our past wars, and so far the actual figures (as known by my contact) don't support that. Media coverage make it sound worse, and does contribute to people thinking they must have PTSD; after all, if you hear about it again and again and again, and you were in Iraq and now you have some problems in your civilian life, it becomes natural to think it must be PTSD.

It reminds me of a technician that worked with me in the early 1970s, who had a problem with alcoholism that he blamed on his 8 hours on Omaha Beach. He was in the 3rd wave, got on shore, laid flat on the sand under fire, had a German bullet crease one of his butt cheeks. He laid there until it was all over, the wound wasn't dangerous but they put him right back on a ship to England, he recovered completely, became a clerk, never saw combat again. But when he came home and got out, he started drinking.

He started complaining to the VA about this in the 1960s, finally got a minor disability, went back repeatedly over the years and kept getting it increased. He finally got it to 100%, quit working, and went home.

What was somewhat important to know was that "Stash" was from a very hard drinking Polish family, both parents were alcoholics, most of his uncles too, and more than half his siblings as well. None of them were ever on Omaha Beach. But he really sincerely believed his drinking problem came from that time lying on the sand.

It seems some things don't change, but they may get different names.

Anyhow, the point of all this is that when even RAND gets stuff seriously wrong, all of us have to be very cautious in accepting what we read and hear. --Del

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