ABSTRACT
Dr. Charles Hoge, the foremost American researcher on traumatic brain injury (TBI), was writing about TBI and war veterans in a 2009 New England Journal of Medicine article. He went on to say that “psychological factors, compensation and litigation, and patients’ expectations are strong predictors of the persistence of symptoms.” Combat experience was conspicuously absent from his list. However, included in the “patients’ expectations” of which he spoke, were the “widespread use of the terms ‘signature injury,’ ‘invisible wound,’ and ‘silent epidemic’,” all arising out of the news reports on troops home from Iraq, not the professional mental health literature.
Hoge’s report was reminiscent of World War I veterans with the symptoms of shellshock who had never been exposed to exploding shells. In short, like shell and PTSD, TBI has proved to be a more important cultural and political notion than diagnostic. Like its antecedents, TBI’s rise to prominence was media driven. News coverage of the 1989 Central Park Jogger spectacle brought TBI to public and professional attention. Kept in view by news about football injuries, it made the cross-over to war-trauma discourse when celebrity newscaster Bob Woodruff was injured by an improvised explosive device (IED) in Iraq in February 2007. In March, retired general Paul Eaton dubbed TBI “the signature malady” of the war.
