Government bureaucracies don’t like to be told they are getting something wrong. When faced with criticism from outsiders, the typical response is to ignore or obfuscate.
They will protect their “flagpole” at all costs because of an institutional fear that addressing serious and cogent challenges will open the proverbial Pandora’s Box, that an avalanche of issues could be exposed, which will bring on greater scrutiny and inevitably result in diversion of resources, funding and brainpower away from favored initiatives.
The dynamic is at work as it pertains to warfighters and veterans and the insidious health threats they have faced through the years. From Agent Orange and the Gulf War Syndrome to burn pit exposure. Government bureaucracies don’t move fast until they get hit in the face by overwhelming evidence and public pressure from those actively suffering or injured by a health condition or occupational threat.
Today, we are witnessing something similar play out with the Departments of Defense, Veteran’s Affairs and Health and Human Services in relation to brain injuries, a signature injury the last two decades of persistent conflict. The bureaucracies acknowledge their prevalence — nearly 500,000 service members are believed to suffer from them. But they don’t acknowledge that their prevalence might also explain the tragically high suicide rates among veterans and servicemembers, despite growing evidence.
This reluctance comes as the military branches are facing recruitment and retention challenges impacting force readiness. And most certainly, an exacerbating factor is that many young Americans express concern about physical injury and health issues, sexual assault and the possibility of PTSD and related trends and question whether our military is out of synch with its society.
Slow to invest in studying blast impact on brain health
The Pandora’s Box syndrome helps explain the slow and uncoordinated investment from the Department of Defense and related agencies in brain health research around military blast overpressure, environmental contamination that impacts brain health and directed energy exposure.
And investment is sorely needed, especially to develop more precise diagnostic tools. As evidence builds from the results of post-mortem examinations, many from military suicides, it has illuminated a gap in our diagnostics. Findings show brain injuries among military members are occurring at the microscopic level, beyond current diagnostic imaging technologies and further handicapped by the lack of blood markers that may identify chemical or hormonal shifts from a brain injury or illness.
Without effective diagnostics to detect microscopic brain injuries, the medical enterprise continues to default to a psychiatric or mental health diagnosis off the DSM-5 diagnostic guidelines. In most cases, that is the mechanism for practitioners to get compensated for their services through the convoluted state of medical insurance reimbursement.
The mental health default has dominated since World War I, when high explosives were first introduced on the battlefield. Over the past 100 years, experts have invented multiple labels to explain abnormal behavioral changes in warrior and veteran populations, such as battlefield fatigue, bullet air, soldier’s heart, battlefield psychosis, shell shock, operational exhaustion, combat stress reaction and now PTSD.
But the tide is turning on mental health and psychiatric conditions explaining the totality of suicides.
As our returning warriors and veterans confront the challenges associated with so-called invisible wounds, largely defined as a complex rubric of post-traumatic stress disorder, moral injury and substance use disorders, we are learning that these conditions are further complicated by diagnosed and undiagnosed traumatic brain injury. A growing body of evidence has illuminated that a person impacted by a TBI has a greater risk of suicide ideation and suicide, which the government bureaucracy has yet to embrace.
Big change needed to instill a unity of effort
As a veteran and a father of a Navy SEAL who took his life while suffering from undiagnosed microscopic brain injury from military blast exposure, I am not receptive to the endless excuses offered by the institutions that we depended on to do the right thing for our men and women who have served.
As a taxpayer, I am appalled at the amount of money spent over the past two decades on mental health programs, suicide prevention and brain health related programs that have resulted in little positive impact while suicide rates have climbed. All along the way, there has been little accountability for legislative directives issued by Congress during this time, which have fostered and enabled unilateral boutique projects and research that do not follow a common research roadmap or sense of direction leading to a defined end state.
At the same time, public-private partnerships between government and academia, industry and veteran non-profits to tackle the suicide issue are born to fail because of the inherent need for control by the government over projects that almost always involve fencing off of government data. That in turn impedes information sharing and interagency coordination, which could help solve these tough research and health challenges.
The failures of government bureaucracy
The bureaucratic failure for me was driven home back in 2010, when I served in the Department of Defense as a senior leader for the Joint Improvised Explosive Device Defeat Organization, the office tasked with fast-tracking projects to counter deadly roadside bombs U.S. forces were encountering in Iraq, Afghanistan and Africa.
I can still vividly recall the day when Congress told us to cease and desist our efforts to explore the health consequences of IED blasts on our warriors, where we had a particular concern for brain injuries following these horrific blast exposures. We were told it wasn’t our job to pursue that line of effort and that our organizational funding would be suspended if we continued.
That decree cost our warriors and veterans over 10 years of lost effort. I suspect the Pandora’s Box syndrome was in play at that time, but those responsible for that fateful decision will never be held accountable.
I’m left wondering, would my highly decorated Navy SEAL son and so many others still be alive today if we had the courage to push forward to confront the brain injury threat to our force?
The nation needs — and the breadth of the problem demands — a priority of effort enabled by a unity of effort stitching together both government and non-government entities. We have lost too much time at the expense of too many valiant men and women who depended on us to take care of them. Let’s not fail any others.
