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GSN Magazine June 2016 Digital Edition

Hazmat Science and

Hazmat Science and Public Policy with George Lane Post-Traumatic Stress Disorder (PTSD) is Caused by Physical as well as Psychological Trauma By George Lane During World War 1, the psychological trauma of soldiers from concussions was attributed to the impact of exploding shells, causing “shell shock”, a term that first appeared in the British medical journal The Lancet in February 1915, only six months after the beginning of World War 1. “Shell shock” was characterized by “the dazed, disoriented state many soldiers experienced during combat or shortly thereafter”. 1 It was presumed that soldiers who experienced these symptoms were weak so treatment was brief with the “firm expectation that the soldier return to duty”. 2 However, even soldiers who were not exposed to exploding shells were experiencing similar symptoms. Because sixty-five percent of “shell-shocked” soldiers ultimately returned to the front lines, treatment was considered a success. However, another reason for this success was that if they didn’t return to the front, their own soldiers could kill them. Between 1914 and 1918, the British Army identified 80,000 men with what would now be defined as the symptoms of “shell shock”. Some who suffered from severe “shell shock” deserted. If caught they received a court martial and if sentenced to death were shot by a twelve-man firing squad. During In 2012, neuropathologist Dr. Daniel Perl was examining a slide of human brain tissue when he saw a distinctive pattern of tiny scars. 14 World War 1, 346 British and Commonwealth soldiers were executed for “desertion and cowardice”. 3 The use of executions as a form of discipline during World War 1 was summed up by British General Sir Horace Smith-Dorrien: “There is a serious prevalence of desertion to avoid duty in the trenches, especially in the 8th Brigade, and I am sure that the only way to stop it is to carry out some death sentences”. As many as 700 French soldiers were executed for similar offenses while only 48 of the 150 German soldiers condemned by military courts were shot during World War 1. Paradoxically the abolition of flogging, one of the few progressive features of British reforms, contributed to the use of execution in World War 1. 4 Until the conflict in Vietnam, psychiatrists believed that “shell shock” was the result of emotional problems rather than physical injury of the brain. However in 2012, neuropathologist Dr. Daniel Perl was examining a slide of human brain tissue when he saw a distinctive pattern of tiny scars. Perl had previously examined tissue from 20,000 brains for

Alzheimer’s and other degenerative disorders over four decades. He was an expert in the biology of brain disease, but this was unlike anything he had never seen. Perl had read a great deal about the men who suffered from “shell shock” during World War I and the doctors who struggled to treat them. He had seen a monument in central England called “Shot at Dawn,” dedicated to British and Commonwealth soldiers who were executed by a firing squad after being convicted of cowardice or desertion. 5 The monument is a stone figure of a blindfolded soldier in a military storm coat, with his hands bound behind him. Behind the monument are the names, ranks, ages, and dates of execution of all 346 soldiers. Perl believed some of these men probably had traumatic brain injuries from blasts and should not have been held responsible for their actions. He has begun looking into the possibility of obtaining brain samples of “shell-shocked” soldiers from that war, hoping to grant them the correct diagnoses they deserve. One brain Perl studied belonged to an American soldier who in 2009 had been five feet away when a suicide bomber detonated his explosives. The soldier survived the blast because of his body armor, but died two years later of a drug overdose after suffering effects familiar in the wars in Iraq and Afghanistan: memory loss, cognitive problems, inability to sleep, depression, and in many, suicide. Nearly 350,000 members of the military have been diagnosed with traumatic brain injury over the past 15 years, many from blast exposure. The real number is likely to be much higher, because so many are too proud to report an invisible wound. For years, many scientists have assumed that explosive blasts affect the brain in much the same way as 15 concussions from football or car accidents. Perl was a leading researcher on “chronic traumatic encephalopathy”, or C.T.E., which has caused dementia in N.F.L. players. Several veterans who died after suffering blast wounds have in fact developed C.T.E. But those veterans had other non-blast injuries too. No one had done a systematic post-mortem study of blast-injured troops. In 2010 the Pentagon asked Dr. Perl to conduct what would become a landmark study. The military gave him access to the brains gathered for research. Perl left his position as Director of Neuropathology at the Mount Sinai Medical School to come to Washington. Perl immediately recognized that the injury that they were looking at was not concussion. C.T.E. involves an abnormal protein called “tau”, which builds up usually over years throughout the cerebral cortex, but especially in the temporal lobes, visible across the stained tissue appearing like brown mold. Perl found scarring at the border between gray matter and where synapses connect white matter in the brain. Perl examined several more brains of service members who died after their blast exposure and all of them