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<div class="timestamp">April 25, 2012</div>
<h1>Veterans and Brain Disease</h1>
<span><h6 class="byline">By <a rel="author" href="http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/nicholasdkristof/index.html?inline=nyt-per" title="More Articles by Nicholas D. Kristof" class="meta-per">NICHOLAS D. KRISTOF</a></h6>
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<p>
He was a 27-year-old former Marine, struggling to adjust to civilian
life after two tours in Iraq. Once an A student, he now found himself
unable to remember conversations, dates and routine bits of daily life.
He became irritable, snapped at his children and withdrew from his
family. He and his wife began divorce proceedings. </p>
<p>
This young man took to alcohol, and a drunken car crash cost him his
driver’s license. The Department of Veterans Affairs diagnosed him with
post-traumatic stress disorder, or P.T.S.D. When his parents hadn’t
heard from him in two days, they asked the police to check on him. The
officers found his body; he had hanged himself with a belt. </p>
<p>
That story is devastatingly common, but the autopsy of this young man’s
brain may have been historic. It revealed something startling that may
shed light on the epidemic of suicides and other troubles experienced by
veterans of wars in Iraq and Afghanistan. </p>
<p>
His brain had been physically changed by <a title="An explanation of the disease" href="http://www.bu.edu/cste/about/what-is-cte/">a disease called chronic traumatic encephalopathy</a>, or C.T.E. That’s a degenerative condition best-known for affecting boxers, <a title="A Times article" href="http://www.nytimes.com/2011/05/03/sports/football/03duerson.html">football players</a> and other athletes who endure repeated blows to the head. </p>
<p>
In people with C.T.E., an abnormal form of a protein accumulates and
eventually destroys cells throughout the brain, including the frontal
and temporal lobes. Those are areas that regulate impulse control,
judgment, multitasking, memory and emotions. </p>
<p>
That Marine was the first Iraq veteran found to have C.T.E., but experts
have since autopsied a dozen or more other veterans’ brains and have
repeatedly found C.T.E. The findings raise a critical question: Could
blasts from bombs or grenades have a catastrophic impact similar to
those of repeated concussions in sports, and could the rash of suicides
among young veterans be a result? </p>
<p>
“P.T.S.D. in a high-risk cohort like war veterans could actually be a
physical disease from permanent brain damage, not a psychological
disease,” said <a title="A pdf" href="http://www.braininjuryresearchinstitute.org/wp-content/uploads/Bennet-Omalu.pdf">Bennet Omalu</a>, the neuropathologist who examined the veteran. Dr. Omalu <a title="Read an abstract here" href="http://www.ncbi.nlm.nih.gov/pubmed/22044102">published an article</a> about the 27-year-old veteran as a sentinel case in Neurosurgical Focus, a peer-reviewed medical journal. </p>
<p>
The discovery of C.T.E. in veterans could be stunningly important.
Sadly, it could also suggest that the worst is yet to come, for C.T.E.
typically develops in midlife, decades after exposure. If we are seeing
C.T.E. now in war veterans, we may see much more in the coming years.
</p>
<p>
So far, just this one case of a veteran with C.T.E. has been published
in a peer-reviewed medical journal. But at least three groups of
scientists are now conducting brain autopsies on veterans, and they have
found C.T.E. again and again, experts tell me. Publication of this
research is in the works. </p>
<p>
The finding of C.T.E. may help answer a puzzle. Returning Vietnam
veterans did not have sharply elevated suicide rates as Iraq and Afghan
veterans do today. One obvious difference is that Afghan and Iraq
veterans are much more likely to have been exposed to blasts, whose
shock waves send the brain crashing into the skull. </p>
<p>
“Imagine a squishy, gelatinous material, surrounded by fluid, and then surrounded by a hard skull,” explained Robert A. Stern, <a title="His bio page" href="http://www.bu.edu/cste/about/leadership/robert-a-stern-ph-d/">a C.T.E. expert</a>
at Boston University School of Medicine. “The brain is going to move,
jiggle around inside the skull. A helmet cannot do anything about that.”
</p>
<p>
Dr. Stern emphasized that the study of C.T.E. is still in its infancy.
But he said that his hunch is that C.T.E. accounts for a share — he has
no idea how large — of veteran suicides. C.T.E. leads to a degenerative
loss of memory and thinking ability and, eventually, to dementia. There
is also often a pattern of depression, impulsiveness and, all too often,
suicide. There is now no treatment, or even a way of diagnosing C.T.E.
other than examining the brain after death. </p>
<p>
While <a title="A Times article" href="http://www.nytimes.com/2011/12/06/sports/hockey/derek-boogaard-a-brain-going-bad.html?pagewanted=all">the sports industry has lagged in responding</a>
to the discovery of C.T.E., and still does not adequately protect
athletes from repeated concussions, the military has been far more
proactive. The Defense Department has formed its own unit to autopsy
brains and study whether blasts may be causing C.T.E. </p>
<p>
Frankly, I was hesitant to write this column. Some veterans and their
families are at wit’s end. If the problem in some cases is a
degenerative physical ailment, currently incurable and fated to get
worse, do they want to know? </p>
<p>
I called Cheryl DeBow, a mother <a title="My April 15 column" href="http://www.nytimes.com/2012/04/15/opinion/sunday/kristof-a-veterans-death-the-nations-shame.html">I wrote about recently</a>.
She sent two strong, healthy sons to Iraq. One committed suicide, and
the other is struggling. DeBow said that it would actually be comforting
to know that there might be an underlying physical ailment, even if it
is progressive. </p>
<p>
“You’re dealing with a ghost when it’s P.T.S.D.,” she told me a couple
of days ago. “Everything changes when it’s something physical. People
are more understanding. It’s a relief to the veterans and to the family.
And, anyway, we want to know.” </p>
<div class="authorIdentification">
<p style="text-align:center">•</p>
<p>I invite you to visit my blog, <a href="http://www.nytimes.com/ontheground">On the Ground</a>. Please also join me on <a href="http://www.facebook.com/kristof">Facebook</a> and <a href="https://plus.google.com/102839963139173448834/posts?hl=en">Google+</a>, watch my <a href="http://www.youtube.com/nicholaskristof">YouTube videos</a> and follow me on <a href="http://twitter.com/nickkristof">Twitter</a>.</p>
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<br clear="all"><br>-- <br>Art Deco (Wayne A. Fox)<br><a href="mailto:art.deco.studios@gmail.com" target="_blank">art.deco.studios@gmail.com</a><br>