Why Is the Mystery of Blast Force Brain Injury So Tough to Solve?

"Healing Our Soldiers," the cover story of the February issue of National Geographic, is a searching inquiry into blast-induced traumatic brain injurythe signature injury suffered by American veterans of the Iraq and Afghanistan campaigns.

Known as shell shock in World War I, the devastating malady leaves victims with symptoms that range from sleep disorders to problems with memory and cognition. Many of the symptoms of blast-related brain trauma resemble those of post-traumatic stress disorder (PTSD), complicating diagnosis.

Though a definitive means of diagnosing and treating these injuries remains elusive, medical researchers are pursuing various theories about how blast force, particularly that caused by improvised explosive devices (IEDs), results in brain damagein hopes of a breakthrough in understanding and, consequently, treatment.

Story author Caroline Alexander has just finished a 20-city radio tour that addressed issues raised by the article. From her home in New England, she explains her interest in the subject, responds to questions raised by the radio audience, and shares advice with veterans who worry that they may be suffering from the syndrome.

Tell us what inspired you to write about this subject in the first place.

From as far back as 2005, I was reading about and researching shell shock in World War I. This condition was originally believed to be the result of brain "commotion" caused by proximity to exploding shellsin other words, a physical injury.

But as the war progressed, it was remarked that many afflicted soldiers didn't appear to have been close to shells, nor were they visibly wounded. Shell shock was re-characterized as a "neurasthenic" condition, which is essentially a "nervous" condition.

I was steeped in research from this era when reports started coming out in the media about a problematic condition afflicting soldiers in Iraq. The symptoms were those of PTSDbut it seemed like something else was also going on and was somehow associated with exposure to IEDs.

I felt I was reading literature from a century before, and became very interested in this condition called TBI, or traumatic brain injurythe shell shock of our era.

By 2009, blast-induced TBI was starting to be understood as a distinct condition directly related to exposure to explosive force, and I felt it was time to jump in.

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Why Is the Mystery of Blast Force Brain Injury So Tough to Solve?