I’m thinking about brain injuries today. On Sunday one of my son’s teammates got carted off the diamond after falling on his head while trying to make a play. Though scary, it seems he did not sustain an injury other than a headache. At least that what the initial scans suggest. Then today I heard a story on NPR about brain injuries of soldiers experiencing a “concussive” event–those who survived roadside bombs. These soldiers may not have been pierced by shrapnel and may not have had their heads slam into something (two obvious causes of TBI) but may have experienced injury from the impulse of the blast of energy hitting their brain. Pro Publica explains the injury and has the larger story about the many soldiers who fail to be properly diagnosed and treated in military care centers.
It stands to reason why this would happen. Minor brain damage is hard to quantify. Brain scans may not pick up these minor changes. The person isn’t missing a limb which visually reminds others of injuries. Some of the symptoms are similar to other mental health problems and so providers may wonder whether injuries are physiological or psychological.
Some of you have been around long enough to remember MBD or minimal brain dysfunction. This was a term used in the 1960s for a wide variety of problems that now go under the name of ADHD. MBD was a way of signaling that something wasn’t right in the brain even though no one could actually pin point where the problem lay. At this point we may not have ways to identify damage to cells (rather than whole structures) and cell communication and so much use the term concussion or minor TBI (mTBI).
Worse than missing the diagnosis is not having great solutions to deal with the wide variety of symptoms. Our best solution for civilian sports related concussions is to avoid having a second, even minor, head bump. We do so by banning participation in sports for a couple of weeks. It is often these second or third bumps that do the worst of the damage. But I suspect that having a soldier sit in Iraq for a couple of weeks after being dazed by a blast will not be anyone’s desire.
Musings on Faith and Psychology 
My daughter has fetal alcohol syndrome — brain damage that occurred prior to birth. She doesn’t have a missing limb to remind anyone that she has it. She doesn’t have a distinct philtrum. Her eyes, if they are measured are further apart than they should be. A practitioner would classify her as having classical facial features. She is stunning. I am not just saying that because I parent her. She really is beautiful. When people learn she has FAS, I often hear that she doesn’t look like she does.
And, you are right, we don’t have great solutions, patience, experience or services that we need to deal with invisible disabilities. Upon hearing that my daughter will be receiving services as an adult with a disability, my sister remarked, “That will mean she won’t have to try.” We don’t make people who are visually impaired try harder to see. We give them a red tipped cane and accommodate their disability. We don’t make people confined to a wheelchair try harder to climb stairs, we install ramps. But, our society does expect my daughter, and others who suffer brain injuries to try harder to act and think normally.
Mild traumatic brain injury is a challenge, both for the person injured and for those trying hard to help. There is some research that supports an education intervention – you tell people early on what symptoms to expect, so they don’t think they’re going crazy, and you also tell them that the natural course of recovery lasts about three months at most (a few outliers take longer). Again, this is mild TBI, not more moderate or severe. The danger is that without education and ongoing support, symptoms then spike the person’s anxiety, which further reinforces the idea that something is wrong, etc., and you can end up with a syndrome that is as much a mental health issue as it is an “organic” one. The good news is that newer research is starting to get better at imaging the effects of mild TBI, and this helps to verify those mysterious symptoms that patients often suffer. This is better than the old days, when a clean MRI usually meant that the doctor just said that it was “all in your head” (i.e., psychological).
Hey Lisa! Long time, no talk. Hope all is well with you. Thanks for your comments here.
To resurect MBD as the new ADHD tag is simply wrong!
I was diagnosed with MBD at 4 years of age. I am now late middle age (some might say elderly!) and I do not , nor have I ever, had ADHD OR ADD.
MBD was/is closer to childhood schizophrenia or even borderline personality disorder.
Is this a move to make the term ADHD/ADD seem more ‘clinical/medical/special’ when in fact it is more of an environmental/parenting (yes, PARENTING) issue.
zzdiana,
While I agree with you that equating MBD and ADHD is a huge mistake, I disagree with two other comments by you. First, MBD is not closer to childhood schizophrenia or BPD. Second, to equate ADHD with parenting is downright wrong. We have ample evidence that children with ADHD have brains that function differently, especially in the frontal cortex. To equate that with parenting is without empirical evidence.