Veteran’s Day 2014

by Siegfried Othmer | November 11th, 2014

by Siegfried Othmer, PhD

Veterans Day
W hy is it that our nation has not made more progress in dealing with PTSD and TBI over all these years? Admittedly, the whole concept of PTSD only dates back to about 1980, which is rather astounding. But matters are even worse with regard to TBI. We’ve been living with automobile-involved head injuries in huge numbers for nearly a century; there are in addition the common occurrences of minor head injuries among children; and at the other end of the age range we confront all those falls among the elderly leading to minor traumatic brain injury. And yet there has been no real coming to grips with this problem until we confronted the conundrum of blast injury—injury without apparent direct impact on the brain—among our service members. One could well say that the field of medicine essentially ignored what is called ‘minor’ traumatic brain injury until the 21st century.

Implicitly the field of medicine relied entirely on self-recovery for both issues. When it comes to the recovery of nervous system function, we have had very little else. Whereas we have had the ability to cut out parts of the brain that were causing seizures, for example, there have been no surgeries to restore neural function until we recently had the breakthrough in the reconnection of a severed spinal cord.

The only available option has been to try to augment the self-recovery capacity in some manner by means such as pharmacology and/or through electro-magnetic stimulation. Pharmacology has been a dud in recovery from both TBI and PTSD, and the electro-magnetic stimulation methods remain in a state of immaturity and of scarce availability. And yet the field of medicine persists in plying victims with these medications. Insofar as problems of the brain are involved, we are effectively in a state of medical monoculture. It’s medication or nothing.

Service members appeal to the VA for help; they are given drugs that do not work for them; and they abandon the VA for what will eventually be the life of the street. We are now replicating what we went through after the Vietnam War—the slow progression into dysfunction due to the cumulative ravages of TBI and PTSD. Both are progressive in their medical consequences. Present trends lead one to project that over the course of their lives our service members are more likely to die by their own hands than to succumb to combat-related wounds.

Suicide is the visible tail of the distribution of misery. In the larger perspective, all those service members who refuse the help they clearly need can be said to be slipping into dysfunction by their own hands.

All this is so unnecessary. The remedy is available, and the evidence lies before us. Clearly most cases of TBI and PTSD do recover, and they do so essentially on their own, by the mechanisms of self-recovery. In the vast majority of cases, the brain finds its own way back to better function. So the field of medicine has correctly observed that the best remedy for both TBI and PTSD is the tincture of time. Just allow our natural capacity for self-healing to take effect.

In the face of this, somehow the proposition that this self-recovery process can be aided by a variety of means other than meds has been thoroughly rejected at the same time. This is just bizarre. In our field, we have been demonstrating the facilitated recovery from TBI now for four decades, and the facilitated recovery from PTSD has been documented over the past ten years. Self-recovery had plateaued in these cases, so the further gains could only have been produced by means of explicit facilitation of self-recovery. All we need here is existence proof, and we have it by the thousands for PTSD. By now literally thousands of service members and veterans have had their functional capacities restored through augmented self-recovery through feedback. For TBI, the evidence base extends into the tens of thousands, and goes all the way back to the 1970s.

It remains true, however, that in offering neurofeedback training at no cost to veterans for any combat-related PTSD or TBI, we are not overwhelmed by those seeking care. We are seeing only a trickle in our private practice. I can only surmise that the barrier to entry is self-imposed. Seeking out brain training means acceptance of the notion that something is amiss with one’s brain. That’s a difficult thing to accept, perhaps, but that has to be the starting point.

There may be one way to ease the path of entry into neurofeedback, and that is the resort to Heart Rate Variability training as the entry portal to brain training. Bob Grove told me at the recent BSC meeting that HRV training was the one thing that a group of servicemen gravitated to when given the opportunity.

We have the history of the work in prisons by the Menninger group, of the work by Eugene Peniston with his alcoholic veterans, and of the work by Douglas Quirk, all of which testifies to the utility of getting clients used to the idea of physiological regulation through reliance on peripheral physiology. Of course it is the brain that is being trained here, but the matter remains somewhat obscured. One can then introduce neurofeedback, where the heavy lifting gets done, and the trainees can continue with the HRV training on their own.

Siegfried Othmer, PhD

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