A severed connection deep within the brain. Damaged blood vessels that can no longer support neurons. A mass of dead cell debris showing a long pattern of damage.
Autopsy results on Robert M. Card II, the Army reservist who killed 18 people and then himself in the deadliest mass shooting in Maine history, leave little doubt that his brain was severely damaged. There wasn't. But the findings raised other questions with far-reaching implications for the military and the nation's millions of veterans.
Mr. Card was an instructor at a grenade range, but was never sent into combat. He is not known to have hit his head in a serious car accident, has never played football, and does not appear to have had any other accidents that could have caused damage to his brain. .
His only exposure was from a routine training blow-up at a training range at a level that was supposed to be safe.
If the explosion was still strong enough to seriously damage his brain, as it happened, how many other soldiers would be at the same risk? How many veterans suffer from similar injuries that have been overlooked or misunderstood? How should these veterans be treated if they seek mental health care or are charged with a crime? Or?
“The impact is huge,” said Frank Larkin, a former Navy SEAL and Sergeant at Arms in the U.S. Senate. His son, Ryan, also a Navy SEAL, died by suicide and was found to have extensive brain damage. explosion.
“The military thought a lot of the problems were due to war,” Larkin said of veterans facing mental health issues. “We now have to admit that weapons and training are causing a huge problem.”
Mr. Card's brain shows that the Pentagon's current safety guidelines for blast exposure are likely inadequate, Mr. Larkin said.
The intensity of blast exposure is often measured in pounds per square inch of pressure wave. The military says anything below 4 psi is safe for the brain. According to Army research, grenade range exposure for soldiers during training is typically about 1 psi.
Card's brain damage suggests that 1 psi may be enough to cause serious injury, especially after hundreds of exposures.
“That means we may need to rethink how we design and train weapons,” Larkin said. “The military must be able to accomplish its mission, but it can be smarter to prevent possible exposure.”
The Army said in a statement that the results of experiments on Card's brain “support the need for the Army to do everything in its power to protect soldiers from blast-related injuries.”
Guidelines on blast exposure have been updated, the statement said, adding that the Army will soon launch a force-wide safety campaign to increase understanding of the potential risks.
But in the meantime, large numbers of troops continue to train daily with potentially harmful explosive weapons.
Let me be clear: Mr. Card is an outlier in more ways than one. Since 2001, hundreds of thousands of veterans have been diagnosed with traumatic brain injuries, but very few of them have committed homicide. And there's no way to know for sure what caused those few people to kill, or whether their mental problems were solely due to brain damage.
Still, it is well documented that veterans exposed to blast waves while on duty often struggle with sleep and have problems with depression, anxiety, substance abuse, and mood regulation. They often lose jobs, miss promotions, see marriages break up, and experience other problems that rarely receive attention outside of the kitchen table.
Two soldiers who worked at the grenade pit with Mr Card said in interviews that he now suffers from mental health issues and had not slept well in years. Other soldiers told local news outlets that the third person struggles with alcohol, was hospitalized in the fall for mental health issues, and has been charged with domestic violence in Maine.
Dr. Lee Goldstein, a neurologist and psychologist at Boston University who worked in part on Mr. Card's analysis, said many veterans exposed to the blast were diagnosed with post-traumatic stress disorder and had underlying symptoms. It is said that brain damage in patients is often overlooked. brain.
“We know that so many people go to war and come back different,” Dr. Goldstein said. “This brain tells us that a significant portion of it may have nothing to do with war at all.”
He said the damage seen in Mr. Card's brain requires the military and the Department of Veterans Affairs to rethink their approach to treating PTSD.
The connections between the frontal lobes of the brain, which control executive functions, and the parts of the brain that produce fear, anger, impulsivity, and violence were severely frayed.
“If your frontal lobes aren't online, you won't be able to act like a normal adult who can use judgment and control aggression,” Dr. Goldstein says.
This is a big problem. That's because chronic exposure therapy, one of the most widely used treatments for PTSD, relies on revisiting the trauma to train the frontal lobe to control fear and anxiety. Body.
“If the frontal lobes weren't fully functioning, that wouldn't happen and people wouldn't get any benefit,” Dr. Goldstein says.
Many veterans receiving treatment for PTSD report that they have little benefit from exposure therapy or that their symptoms worsen and they drop out. At least in some of those cases, there may be some indication that brain damage may be influencing symptoms.
Studies have shown that service members in military jobs that expose them to blast waves have more health problems and drug and alcohol abuse than members in other jobs. Their divorce rate is high and their suicide rate is much higher than other military personnel.
The New York Times found that some artillery crews who fired large numbers of shells during combat deployments experienced paranoia and paranoia.
Once they leave the military, blast-exposed veterans are more likely to commit crimes than other veterans, said Brock Hunter, a Minneapolis attorney who specializes in defending veterans accused of crimes. is said to be high. Mr. Hunter founded the Veterans Defense Project, a nonprofit organization that works with courts to get veterans into treatment rather than prison.
He recently represented a Marine Corps veteran who was hit by hundreds of shells and killed his neighbor.
Hunter said courts across the country began to recognize that during the wars in Iraq and Afghanistan, many veterans returned from deployments battling traumatic brain injuries and PTSD, and communities established veterans treatment courts. The government has begun granting suspension of sentences to the following types of veterans: complete treatment.
“But I don't think any of us understood the idea that a cumulative explosion could cause so much damage,” Hunter said. “This is a wake-up call, and no one should be deployed to be seriously affected by military service.”
He said he had learned over the years the habit of asking customers about exposure to roadside bombs and traumatic experiences, but never thought to ask about explosions during training. He is now going to ask all his customers questions.
Hunter said it's an open question whether courts and prosecutors will treat veterans exposed to the blast with the same compassion and support as veterans with PTSD. But Mr. Card's brain provides a clear example of the potential harm veterans could suffer even if they never deployed.
“This is something new and I think it will take time for people to understand the injury,” he said. “It took many years for lawyers and courts to understand PTSD, and I suspect it will take many years again.”
