Future of veterans

By Ruth Lanius and Andrew Peterson
November 16, 2012

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VeteransIllustration by Scott Woods

 

Editor's Note: On Nov. 15, 2012, Western News celebrated its 40th anniversary with a special edition asking 40 Western researchers to share the 40 THINGS WE NEED TO KNOW ABOUT THE NEXT 40 YEARS. This is one of those entries. To view the entire anniversary issue, visit the Western News archives.

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How do we care for the growing population of young military veterans after they return from combat deployment? An answer to this question is not as simple as one might presume.

For one, the obstacles faced by this population – both social and medical – are largely heterogeneous. Some veterans of the recent conflict in Iraq and Afghanistan, for example, may incur highly complicated psychological or physical injuries that preclude their ability to seamlessly reintegrate into civilian life. For these young women and men, advancements in medical and psychological therapies are needed to mitigate the barriers preventing them from recapturing elements of health and wellbeing.

Other veterans, however, who return from deployment with a clean bill of health, may still struggle to find their new role in the civilian world. Despite being medically unaffected by their battlefield experience, these young veterans will often not be able to reintegrate successfully due to a variety of social barriers. Lack of employment or educational opportunities, as well as stark cultural differences between civilian and military worlds, are only some of the obstacles that prevent happy and fulfilling lives after military service. A feeling of isolation often results from this, and veterans are frequently left feeling alienated from their friends and families.

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In brief, there are no universal causes to the struggles that veterans face. Nor are there any quick fixes.

This complexity, though, has not stopped pioneering researchers from seeking innovative solutions to these problems. The results of this research will likely change the way we care for our veteran population now, and as they age, over the next 40 years.

A major component of this new enterprise into veterans’ health involves the rapidly growing body of scientific knowledge related to the brain and its reaction to internal and external stressors. Experimental measures of these phenomena have grown exponentially since the advent of sophisticated neuroimaging techniques, like fMRI, which have benefitted the fields of psychiatry, neurology and neuroscience in variety of ways.

One recent application of these methods by researchers at San Francisco’s Veterans’ Health Research Institute has helped to narrow the etiology and long-term impact of combat related traumatic brain injuries. Given today’s wars are largely fought with unconventional weaponry, namely improvised explosive devices, researchers have asked how blast impact and non-impact concussions compare as potential causes of mild to severe injuries to the brain.

Strikingly, findings of these investigations suggest non-impact concussions from explosions can, in fact, precipitate similar neurophysiological changes resulting from typical blast injuries. Being physically hit by explosive material, as opposed to the shockwave of a blast from 10 metres away, makes little difference in the likelihood of developing traumatic brain injuries soon thereafter.

These brain injuries have also recently been correlated with several neurological and psychiatric conditions related to the aging brain. Of the aging veteran population of the Vietnam era, it has been shown that the occurrence of mild traumatic brain injury may lead to a significantly increased risk of early onset dementia. Likewise, such injuries may also be causally related to sleeping disorders and post-traumatic stress.

As young veterans begin to age, time will tell whether or not their brains have been affected by the various experiences they have had in combat. Over the next 40 years, both new therapies for traumatic brain injury, as well as new methods of early intervention, will likely be introduced to mitigate the long-term neurophysiological effects of combat related brain trauma.

Another scientific program on the horizon, which is related to this growing interest in the brain’s reaction to stressful environments, is the search for genetic, environmental, and neurodevelopmental variants that predict the onset of certain combat related psychiatric conditions. Researchers have recently been curious as to why some military personnel will develop psychiatric injuries while others do not despite identical exposure to combat stimulus. What makes the difference in these cases?

Though experimental findings are still preliminary, studies conducted at Western, University of California San Francisco and Harvard suggest a combination of genetic predispositions and developmental environments stunt the normal growth of certain cortical networks, which engenders a compounded vulnerability to psychological injury. Interestingly, this research has also been used to make reverse inferences about the ideal genetic, environmental, and neurodevelopmental conditions for mental resilience.

Research of this kind has also been conducted in populations distinct from military personnel. At Emory University, for example, neuroscientists and psychologists are closely examining familial relationships in historically violent demographics as an added variable for predicting the development of psychiatric conditions. These studies have found that a lack of strong, secure attachment relationships, namely a disturbed emotional relationship between parent and child, in combination with early exposure to violence, may substantially increase the risk of psychiatric problems later in life.

It would be far from accurate to assume all military veterans who suffer from battlefield related psychiatric injury come from less than ideal developmental environments. Nevertheless, these new revelations about initial pre-traumatic causes of psychiatric injury highlight the importance of understanding the lives of young military personnel before their enlistment papers were signed.

These areas of research will likely offer exciting methodological advantages over the next 40 years for understanding the cause and treatment of both brain injuries and psychiatric conditions. However, there may be an added benefit to identifying the biomarkers that are unique to the current veteran population, and may be the most profound change in the enterprise of veterans’ health in the near future.

For military personnel from all walks of life, the modern advances of neuroscience have offered the amazing advantage of making the invisible psychological wounds of war visible. This has, in recent years, eroded much of the stigma associated with neurological and psychiatric conditions caused by war, and has encouraged many veterans to seek medical therapy when warranted.

The women and men of the armed forces are often stoic, proud, and always “good-to-go” regardless of the stress and fatigue endured during war. The new science of the brain holds great potential to develop highly sophisticated therapies for this commendable population. Yet it also presents the very simple benefit of cutting through many of the cultural assumptions surrounding combat related brain and psychiatric injuries.

For these reasons, we anticipate the contributions of brain science will continue to change the way medical practitioners think about veterans’ health, and provide effective tools for serving this community for many years to come.

Ruth Lanius is a Psychiatry professor at Western’s Schulich School of Medicine & Dentistry. Andrew Peterson is a doctoral student member of the Rotman Institute of Philosophy in the Faculty of Arts & Humanities.

 























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