Mild Traumatic Brain Injury a real condition

John Welch seems to think that knee-jerk name-calling and immediate dismissal equates to scientific consideration. His constant ridiculing of many conditions with psychological components amounts to narrow-minded materialism. For those of us who have worked with severe cases of Post-traumatic Stress Disorder (PTSD) it seems bizarre to deny that the symptoms reflect a real underlying pathology of brain and emotional functioning. And of course, shell shock has been described since early in human recorded history. Denying its reality as a condition and disputing any need for treatment simply relegates those affected to ongoing suffering, but will not cause the condition to evaporate.

John describes as “absurd” the diagnosis of Mild Traumatic Brain Injury, found to occur after exposure to roadside blasts. I have no doubt that such a condition is real and reflects actual brain injury. I suspect it is a version of Postconcussional Disorder, long recognised by psychologists but as yet described in the Diagnostic Manual of Psychiatric Disorders only as a condition requiring further research. This condition is associated with subnormal scores on tests of information processing speed and other intellectual functions. Significant emotional, psychological and memory symptoms are always present, and they do not result from the patients being “coached into supplying the right symptoms of this disorder”. The predicted pattern of subnormal performance on timed tests could not be faked by most people. For that matter, disruption to stereopsis in vision is a measurable, permanent effect of significant concussion. Postconcussional disorder seems to result from insufficient rest and recuperation after a closed head injury, and I predict that is what happens in proximity to explosions, the brain being compressed in the skull but the victim having to continue full physical exertion under stressful conditions, including riding in trucks on bumpy roads causing further brain assault.

John Welch’s railing against both new and well-established sydromes does no credit to the Skeptics. Identification of syndromes is important to begin to reduce real suffering and as a basis for further investigation that will often result in understanding of the physical basis of those syndromes.

Hans Laven

John Welch responds:

My opinions are based on years of historical study as well as 15 years’ military service.

Hans Laven writes: “For those of us who have worked with severe cases of PTSD it seems bizarre to deny that the symptoms reflect a real underlying pathology of brain and emotional functioning.” There is no scientific evidence of any brain ‘pathology’. There is a lot of evidence that counseling and the like is actually harmful for people who have been involved in something unpleasant. The history of science and medicine is full of examples of beliefs and practices which have been discarded, for example N Rays, canals on Mars, crop circles, alien abduction, gastric freezing for the treatment of peptic ulcer. Psychiatrist Dr John Mack popularised alien abduction but could not gain enough ‘consensus’ to have it included in the DSM.

PTSD was an invention by consensus. As far as scientific processes go, consensus is the lowest form of evidence, right at the bottom of the list with the randomised placebo controlled trial at the top. The popularisation of PTSD is well outlined in Edward Shorter’s History of Psychiatry: “In the years after 1971, the Vietnam veterans represented a powerful interest group. They believed that their difficulties in reentering American society were psychiatric in nature and could only be explained as a result of the trauma of the war.”

Similar pressure by the gay lobby group lead to the deletion of homosexuality as a psychiatric disorder, so one deletion and one inclusion! Shorter commented “Given such antics, it would be difficult to take seriously any official psychiatric pronouncement about problems surrounding sexual orientation, the psychiatry of stress…” Shorter is also critical of the ethnocentricity of the DSM and points out that anorexia doesn’t exist in some countries and if the DSM had been written in India it would have to include demonic possession!

I graduated with little knowledge of medical history and have been making up for it ever since. I recommend that the following books which I have studied will help Hans Laven understand the evolution of fad diagnoses:

  • Edward Shorterli-A History of Psychiatry and his History of Psychosomatic Illness
  • Elaine Showalter-Hystories
  • Ian Whitehead-Doctors in the Great War
  • Ben Shephard-A War of Nerves
  • Anthony Babington-Shell Shock

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