Major consequences seen for brain damage found in Maine shooter
Fragmented connections deep in the brain. Battered and scarred blood vessels that can no longer support neurons. Clumps of dead cell debris mark a long pattern of injury.
The results of the autopsy of Robert R. Card II, the Army reservist who killed eighteen people and then himself, in the deadliest mass shooting in Maine history, left little doubt that his brain was severely damaged. But the finding raises other questions that have broad implications for the military and for the nation’s millions of veterans.
Mr. Card was a grenade range instructor who was never deployed in combat. He is not known to have ever hit his head in a serious car accident, he has never played football and it appears he has had no other accidents that could explain the damage to his brain.
His only exposure came from routine training shots at the training range – at a level that should be safe.
If those blasts were still strong enough to seriously damage his brain, as it appears to have happened, how many other troops are exposed to the same risk? How many veterans may be struggling with similar injuries that have gone unseen or misunderstood? How should these veterans be treated if they seek mental health care or are accused of crimes?
“The implications are so great,” said Frank Larkin, a former Navy SEAL and U.S. Senate sergeant-at-arms whose son, Ryan, also a Navy SEAL, died by suicide and was found to have extensive brain damage from explosions.
“A lot of the problems the military thought came from the war,” Mr. Larkin said of veterans dealing with mental health issues. “We must now recognize that the weapons and the training are creating a major problem.”
Mr. Card’s brainwave shows that current Pentagon safety guidelines for blast exposure are likely inadequate, Mr. Larkin said.
The strength of blast exposure is often measured in pounds per square inch of the blast wave. The military says anything under 4 psi is safe for the brain. According to Army studies, shell range exposure for troops in training is typically around 1 psi.
The damage in Mr. Card’s brain suggests that 1 psi may be enough to cause serious injuries, especially after hundreds of exposures.
“That means we may have to rethink the way we design weapons and how we train,” Mr Larkin said. “The military needs to be able to carry out its mission, but they can become much smarter about preventing as much exposure as possible.”
The Army said in a statement that the laboratory findings on Mr. Card’s brain “underscore the need for the Army to do everything possible to protect soldiers from blast-related injuries.”
Blast exposure guidelines are being updated, the statement said, adding that the Army will soon launch a service-wide safety campaign to increase understanding of potential risks.
But in the meantime, large numbers of troops continue to train every day with weapons that could cause potentially damaging explosions.
To be clear: Mr. Card is an outlier in more ways than one. Since 2001, hundreds of thousands of veterans have been diagnosed with traumatic brain injuries, but few of them have committed murder. And there is no way to know with any certainty what caused the murder of these few, or whether their mental problems stemmed solely from the brain injury.
Yet it is well documented that veterans exposed to blasts while in service often have difficulty sleeping and have difficulty with depression, anxiety, substance abuse and regulating their mood. They often lose their jobs and miss out on promotions, see marriages break up, and experience other problems that rarely receive attention beyond the kitchen table.
Two soldiers who served with Mr. Card in the shell pits said in interviews that they now suffer from mental health problems and have not slept well in years. A third struggled with alcohol, was hospitalized for mental health issues in the fall, according to other soldiers, and told a local news station he was charged in Maine with domestic violence.
Many veterans exposed to blasts are diagnosed with post-traumatic stress disorder, and the underlying brain injury is often overlooked, according to Dr. Lee Goldstein, a neurologist and psychologist at Boston University who did some of Mr. Card’s analysis. brain.
“We know that so many people go to war and come back different,” said Dr. Goldstein. “This brain tells us that a lot of that may have nothing to do with war at all.”
The damage in Mr. Card’s brain should prompt the military and the Department of Veterans Affairs to reconsider their approach to treating PTSD, he said.
The connections between the frontal lobes of his brain, responsible for executive functions, and the parts of the brain that generate fear, anger, impulsiveness and violence, were severely frayed.
“If your frontal lobes are not online, you are not behaving like a normal adult who can exercise judgment and suppress aggression,” said Dr. Goldstein.
That’s a big problem, because it’s one of the most commonly used therapies for PTSD long-term exposure therapyrelies on revisiting trauma to try to train the frontal lobes to control fear and anxiety.
“If you don’t have fully functioning frontal lobes, that’s not going to happen and people aren’t going to get any benefit from it,” said Dr. Goldstein.
Large numbers of veterans treated for PTSD report little benefit from exposure therapy, or even worsening of symptoms, and drop out. In some of these cases, that may at least be an indication that brain injury may play a role in the symptoms.
Studies show that service members who work in military jobs that expose them to blasts experience more behavioral and health problems and drug and alcohol abuse than their counterparts in other jobs. They have a high divorce rate and their suicide rates are much higher than others in the military.
Among artillery crews who fired a large number of rounds during combat deployments, The New York Times found that some troops suffered from paranoia and delusions.
Once out of the military, blast-exposed veterans are more likely to commit crimes than others, according to Brock Hunter, a Minneapolis attorney who specializes in representing veterans accused of crimes. Mr. Hunter founded the Veterans Defense Project, a nonprofit organization that aims to work with courts to get veterans into treatment instead of prison.
He recently represented a Marine veteran who had been exposed to hundreds of artillery shelling and who had killed his neighbor.
During the wars in Iraq and Afghanistan, Mr. Hunter said, courts across the country began to recognize that many veterans were returning from deployments struggling with traumatic brain injuries and PTSD, and communities began establishing veterans treatment centers that offered deferred sentences to veterans that complete treatment.
“But I don’t think any of us understood the idea that a cumulative explosion could be so damaging,” Mr Hunter said. “This is a wake-up call that you don’t have to deploy to be seriously affected by military service.”
He said he had learned over the years to get into the habit of asking his clients about exposure to IEDs and traumatic experiences, but it had never occurred to him to ask about explosions during training. He now plans to ask the question to every customer.
Whether courts and prosecutors will be open to treating blast-exposed veterans with the same sympathy and support they provide to veterans with PTSD is an open question, Mr. Hunter said. But Mr. Card’s brain provides a stark example of the potential harm veterans can suffer even if they never deploy.
“This is new and I think it will take some time for people to understand the injury,” he said. “It took years for lawyers and courts to understand PTSD. I suspect it will take years here too.”