The treatment of veterans for mental health disorders stemming from their time in the Armed Forces is shamefully under-funded, because the vast majority of veterans are men. Many end up among the street homeless, and they are denied treatment (e.g. for PTSD) if they self-medicate with alcohol or other drugs in a bid to cope. A piece in today’s Telegraph:
Experts say explosive blast waves are the roots of many veterans’ mental health traumas and treatment should not be dominated by psychiatry
In 2003 James England was an army officer in the Queen’s Dragoon Guards, deployed to Iraq on the first of three tours in the country.
He was on the initial wave into Basra and, at one point, had his vehicle fired on by other British troops who mistook his Striker guided missile carrier for an Iraqi vehicle. He watched as bullets kicked up the sand around him, fearful that an anti-tank missile would soon follow.
Later that year he suffered severe head injuries following a car crash in Germany.
He subsequently had difficulty sleeping and over time changes in his character became apparent.
Progressive deterioration followed. James, 39, suffered constant head pain, issues with his balance and short-term memory loss. He started drinking to dull the pain. An MRI scan in 2006 showed bleeds on the brain, and evidence of earlier bleeds.
He attempted suicide in 2014, again the following year and, after a flashback event in 2017, was sectioned under the Mental Health Act. He was diagnosed with Complex PTSD.
“It was a nightmare for us as a family,” James’s wife, Kate, told the Telegraph.
“If you’ve lost an arm, it’s very visual,” Kate says. “But with a head injury you’re not always going to see evidence of that event.”
Veterans and medical professionals are questioning whether the accepted understanding of PTSD and related conditions such as Traumatic Brain Injury (TBI) as having psychological roots needs updating in light of emerging practice from the US that suggests they may instead result from physical damage to the brain.
Experts say physical damage to the brain can be indicated by measuring its magnetic field using magnetoencephalography, better known as a MEG scan. They say associated hormonal deficiencies, which can lead to personality changes, can be detected through blood tests and the study of the body’s neuroendocrine system.
Although in common practice in the US with the military and veteran communities, neither are used in the UK to treat military personnel with traumatic brain injuries.
Critically, new thinking suggests physical damage to the brain can occur through exposure to blast waves, without the need for any contact with bullets or shrapnel.
The Telegraph knows of SAS soldiers who are self-funding travel to the US and access to MEG and neuroendocrine treatments.
In a letter shared with the Telegraph, a Consultant in Rehabilitation Medicine said he had “no doubt” James England suffers from a traumatic brain injury, but ‘within the NHS we only have access to standard radiological assessments which cannot sufficiently demonstrate pathology in Mr England’s case’.
The Consultant also said: “I accept that a MEG scan can provide more objective evidence of traumatic brain injury…to help Mr England improve his quality of life”.
Dr Mark Gordon, a specialist in brain trauma practicing in California, says PTSD is treated “too superficially” and given as a label without examination of the physical damage that he says is the root of many issues.
“Stress causes changes in the chemistry of the brain,” he told the Telegraph. “You don’t need to see physical trauma to have inflammatory chemical change.”
“We know definitively, mechanistically, causatively the patterns, but we’re not acknowledging them as it’s easier to say ‘oh, he has depression’.”
“Psychiatrists are the wrong people for this area. They’re not doing it vindictively, but as a matter of not understanding what is going on in those exposed to combat traumas.”
Dr Gary Green, Emeritus Professor in the Department of Psychology at the University of York, said: “We need movement on this, we need a way forward to help people with head injury.
“MEG is an extremely good way of getting that on the table for diagnosis. People could then start researching management and treatment of these situations.
“A major meeting between scientists, clinicians and members of the defence medical group have all recommended that MEG is used in the investigation of head injury in military personnel. That progress though will be delayed until funding is found to make it possible.”
However, Mandy Bostwick, a Specialist Trauma Psychotherapist, says the science behind MEG imaging and neuroendocrinology is established and accuses psychiatrists in this country of “kicking the evidence into the long grass” to keep the focus, and the funding, in their field.
She says biomarkers (measurable biological conditions) exist to show MEG scans can reliably indicate brain injuries and there is no reason not to fund this area for veterans’ and the serving military.
“The threshold of this research has been met. It’s been peer-reviewed and validated,” she said.
Imperial College London hosted a meeting of experts in January 2020 to examine the potential benefits of MEG and neuroendocrinology.
In comments following the meeting, Professor Roland Lee of the University of California said MEG “has advanced to the point where a more definitive diagnosis of [Traumatic Brain Injury] is possible”.
His comments were not included in the final report.
In draft minutes from the meeting, seen by the Telegraph, Dr Lucy Foss of Imperial College London, said the threshold of evidence presented for MEG and neuroendocrine screening in the management of military cases with brain injury has been met.
However, in the final report these comments said only that there was “potential to incorporate neuroendocrine testing in a multimodal clinical research pathway” and that “MEG appears to offer the potential to aid in diagnosis” and differentiate between TBI and PTSD.
Professor Anthony Bull of Imperial College declined to be interviewed by the Telegraph.
An inquiry by the Commons Defence Select Committee is looking at this issue.
In recent evidence to the inquiry, Sir Simon Wessely, Professor of Psychiatry at King’s College London and an attendee at the 2020 meeting, said: “At the moment we do not have a definitive test for Traumatic Brain Injury. Neither we nor the Americans have one, but hopefully we will get one.”
Sir Simon declined to be interviewed by the Telegraph.
An MoD spokesperson said: “We are committed to the health and wellbeing of all our Armed Forces personnel and have a treatment programme for TBI at the Defence Medical Rehabilitation Centre. We are working on a national research programme to advance diagnosis, management and rehabilitation surrounding the complexities of TBIs and PTSD.
“The NHS and MoD have a responsibility to ensure technological advances such as MEG are clinically safe and effective for patients. While studies show promise, they have not yet received clinical clearance.”
CASE STUDY: Andrew Marr, US Special Operations Forces
‘I was told symptoms from a head injury after six months was due to a psychological component. I had a hard time swallowing that’
Andrew Marr was in US Special Forces for a decade. He was exposed to numerous low level blast waves but was only knocked unconscious once, for about five seconds.
“I came back up and we were in a firefight so it was back to business,” he said. He suffered no other injuries and did not feel traumatised by his military service.
Six months after his last combat deployment he started to have issues with libido and low energy. These developed into anxiety and panic attacks.
“My anger would go to rage without having anything really to trigger that type of response,” he told the Telegraph.
“I spiralled out of control. I couldn’t function. So, I asked for help.”
He saw a lot of doctors and was put on a multitude of medications, but nothing helped. He was eventually medically retired from the military labelled with over 30 disabilities but had no treatment pathway.
He says as a special operations soldier, screened through training for psychological and physical resiliency he didn’t believe the medical professionals telling him the problems were born of psychological duress.
“I was told if you still have symptoms from a head injury after six months, it’s not really due to anything physiological, it’s due to a psychological component,” he says. “I had a hard time swallowing that.”
He was introduced to Dr. Gordon through a neurology clinic in Dallas, Texas, in 2014. After blood analysis he was put on a treatment based on neuroendocrinology to reduce inflammation in his brain and rebalance the chemical mix in his body.
“Things just blossomed from there.
“How many times do we need to see somebody who has all these problems and say, ‘I’m not sure if this is a physiological thing or not’, but then we go and we run an objective lab analysis and we’re able to say ‘hey, you’re in a neuro inflamed state and you’re deficient in all this important chemistry. Therefore, we’re going to reduce your inflammation and we’re going to replace or replenish the chemistry’.
“When we do that, people get better and quality of life.”
Andrew has been symptom and medication-free since 2015 and now helps other veterans with similar problems.
“I’m back being able to do life on my terms, I have the energy to do the things that I want to do with my life. What more can you ask for?”
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