Traumatic Brain Injury: The Hidden Epidemic Nobody Wants to Talk About
This is a special in-depth look at traumatic brain injury (TBI) during Brain Awareness Month.
“Right after the hit I was in the back of the ambulance feeling really good, letting go of all my problems… the world seemed so far away,” Keith explains of his near-death experience.
“I could hear the EMT screaming — he said he thought he lost me — but it sounded like I was in a bubble. The feeling reached an amazing point where if I already had done the things that I wanted with my life, I would have let go.”
He points out the injuries on his face, including an eye patch that he wears since his motorcycle crash last summer. An outgoing and successful 30-year-old software engineer, the traumatic brain injury (TBI) from his accident caused brain swelling that left him with cranial nerve damage and other life-altering symptoms. His ambulance experience may have been part of the hallucinations that occur as your brain and body are failing, but Keith looks back at that moment as much more.
“The day before the accident my thoughts were around needing more money, getting a bigger place, getting more girls – things that don’t matter. I was in typical young, single guy mode,” he says openly.
“It sucks to be in this position, but I’m a better person because of my accident. It made me see that my life can end at any moment and I have more self-respect now.” Since then, he has tried to learn more about his TBI following a surprising hospital experience. “I was disappointed by the fact that they couldn’t fix me at the hospital. Even though I have a really good doctor, they don’t even fully know what’s going on in my brain now.”
This dramatic tale may seem like something from fiction, but it’s actually more common than most realize, especially considering that every twelve seconds a person in America sustains brain damage. You didn’t misread — count to twelve and someone, somewhere in the U.S. has experienced a traumatic brain injury.
The math is quite simple. There are 31.5 million seconds in a year. When you divide this by the 2.5 million civilians and military members who are diagnosed with a new TBI annually, your result is the same as the number of cranial nerves in the human brain – twelve. , 
A traumatic brain injury occurs when an external force impacts the brain and impairs certain functions. In a fraction of a second after a car collision, the driver and passenger’s heads can smash into the windshield at the same speed that the vehicle was moving, even as the car frame is buckling. It’s no surprise that the majority of reported TBIs are results of motor vehicle crashes, with almost half of those hospitalized experiencing long-term disability. ,  Accidental falls, rough play, and contact sports may also lead to TBI, and research has shown that 50 percent of all injuries killing children in the U.S. and Canada include a brain injury. 
Memory Lapse: Have We Forgotten Our Brains?
Why is a condition that seriously affects your body’s most important control center — your brain — this prominent yet hardly discussed? Many sources say that it is considered to be a rather taboo topic, even by those who are intimately affected. Brain damage is extremely scary, and most who have it feel misunderstood. Unfortunately, many of these individuals quietly slink away into the shadows, overwhelmed and ashamed of their symptoms.
This hidden underworld of brain injury is vast. Recent tallies show that there are one million more traumatic brain injuries annually than all combined cancer diagnoses and more yearly deaths than drug overdose, breast cancer, prostate cancer, or HIV. ,  Since a picture is worth a thousand words, here is a visual:
It is believed that TBI figures are grossly understated because of misrepresented data. There are an abundance of injuries that are just “shaken off” and not reported at all. The notion of ignoring a brain injury happens during playtime and in competitive sports quite often. Although urgent care is required, it is common for a blow to the head not to be evaluated as a serious medical situation. Certain individuals are even pressured to forego treatment, especially those subject to domestic violence.
Many of the varying symptoms of mild brain damage may be subtle and go unnoticed at first, but gradually gain momentum until they interfere with everyday life. One day you notice that your memory is just a bit more faulty than usual. Then you realize that your attention is distracted quite often. The words don’t roll off your tongue anymore, and sometimes you want to say something and it simply doesn’t come out the way you imagined. You feel sad or disassociated from others, and anxious more than you would like to admit.
The Ripple Effect of Brain Injury
These could just be natural imperfections, the small faults of our individual bodies and personalities. On the other hand, they could be signs of secondary progression from TBI. Dr. Anlys Olivera, a Brain Injury Unit Researcher at the National Institutes of Health, explains that the difficulty in identifying symptoms of TBI until they worsen is partially why early signs go unnoticed.
“Doctors sometimes can’t get to the root cause because there is no protocol specific to TBI treatment over time. Symptoms can come six months, two years, or 10 years after injury, and patients are not aware that more issues can follow. Insurance will only cover immediate ‘standard’ care, but may not cover alternative care strategies for chronic post-concussive symptoms. This is a huge problem as well,” she remarks.
Dr. Olivera ties this to the serious oversight in military protocol, where certain soldiers are receiving a dishonorable discharge regardless of behavioral changes that could be related to TBIs experienced during training or combat operations.
“It’s a shame. There is no consideration for the chronic impact that TBI has on these soldiers and the effects on their judgement and reasoning skills, or even their personalities,” notes Dr. Olivera.
“Patients are often not even aware of these alterations because of their brain injuries.”
One out of three military service members are returning home with a traumatic brain injury in addition to other mental health issues such as PTSD. 
The truth is, disabling and potentially life-threatening brain injuries are happening to your children and friends on a regular basis. Every kid taking a nasty skateboard fall or jumping from a rooftop in a popular YouTube video is not actually going to the hospital after the camera stops rolling. For those who are, roughly 90 percent of reported TBIs are considered to be “mild” during clinicians’ ER assessments and they are sent home that same day. 
Don’t let this classification fool you — even “mild” injuries can be quite life-changing. There are often multiple symptoms coexisting, with common types including memory, problem solving issues, speech disorders, and emotional instability.  Although in most cases, there is not much that hospital staff will do unless there is immediate bleeding or swelling in the brain.
Lies, Neglect, and Flawed Healthcare
TBI remains somewhat under the radar regardless of bold headlines that include the concussion-related death of a young college athlete whose teammates anonymously sent details of coaches’ extreme neglect to the player’s parents. The NFL settled a $1 billion lawsuit with 20,000 former players in 2013; however, the case never covered depression, mood disorders, and CTE (chronic traumatic encephalopathy), the brain disease that has been featured in the recent movie “Concussion.” 
Up until a few days ago, the NFL claimed that there was not enough scientific evidence to support CTE. This changed drastically when the NFL’s vice president of health and safety became the first representative ever to publicly acknowledge a link between head trauma from football and degenerative brain diseases, including CTE. His comments mark a pivotal turning point in the ongoing trials.
There was also an attack earlier this year against helmet maker Riddell because of uncovered evidence that the league was hiding sensitive information.  Flawed data from the NFL is becoming a trend, as on March 24, 2016, the New York Times disclosed that over 100 diagnosed concussions were omitted from more than a decade of confidential NFL research. This finding contests the validity of the scientific studies that used these data, namely research claiming that TBI did not cause long-term health issues.
Players continue to fight back after years of dismissals of their symptoms, and another suit relating to the 2013 settlement was just filed in late 2015. Depression and anxiety are mentioned in many TBI assessments, as they have high comorbidity rates with brain injury, but that seemed to get ignored during the NFL court proceedings. Interestingly, this blind eye to mental health care for the TBI population is also being turned in hospitals and treatment centers.
Three years of data collected from 10 U.S. brain injury rehabilitation facilities shows that there is a focus on physical, speech, and occupational therapy, but psychological well-being seems to be greatly overlooked.  While these therapies were each given to almost every patient for four to five hours per week, only 50 percent of patients received psychotherapy or behavior intervention, and treatment was given for an average of 20 minutes per week. Even more troublesome is that 70 percent of the 2,000 individuals studied were given anti-depressant medications regardless of not receiving regular professional psychotherapy.
Cardinale, A. (2018). Traumatic Brain Injury: The Hidden Epidemic Nobody Wants to Talk About. Psych Central. Retrieved on July 2, 2020, from https://psychcentral.com/blog/traumatic-brain-injury-the-hidden-epidemic-nobody-wants-to-talk-about/