The danger of traumatic brain injury, which afflicted U.S. troops after Iranian attack

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• Judy Woodruff:

  U.S. tensions with Iran peaked earlier this month, when U.S. forces killed a powerful Iranian general, and Iran responded by firing missiles into bases in Iraq, with hundreds of U.S. troops on site.

  No Americans were killed that night, but the Pentagon is now saying that 50 U.S. service members suffered traumatic brain injuries.

  Why did it take so long to announce that number? And what makes brain injuries so difficult to diagnose and treat?

  Here's Nick Schifrin.

• Nick Schifrin:

  Three weeks ago tonight, American service members braced for impact. At 11:00 p.m., the first of five barrages of ballistic missiles hit the Al Asad Air Base in Iraq.

  This was the aftermath: containers that had been bedrooms incinerated, the remains of a building where drone operators were still working. Soldiers who have been through a lot of combat called it the biggest attack they'd ever seen.

  Sergeant 1st Class Larry Jackson.

• Larry Jackson:

  In my 16 years in the Army, I have never seen one of that magnitude coming from an opposition force.

• Nick Schifrin:

  We now know many of those service members suffered traumatic brain injuries, which can include anything from mild concussions to serious injuries that affect a person's sight, balance, and cognition.

  To talk about this, I'm joined by retired Brigadier General Steve Xenakis, a psychiatrist who previously advised the chairman of the Joint Chiefs of Staff on the physical and psychological effects of blast concussion.

  Dr. Xenakis, welcome back to the "NewsHour."

• Nick Schifrin:

  These service members were exposed to large explosions when these Iranian missiles hit that base. Explain the challenge of treating brain injuries that you can't see.

• Stephen Xenakis:

  Well, there's no significant or black-and-white diagnostic test.

  And we have to use just clinical judgment all the time to be able to determine how much exposure there was and how bad the exposure was and what the impact is having on the soldiers.

  And you have to monitor them for some period of time. These are very serious. This has been the signature injury of the fighting in Iraq and Afghanistan, and there's been hundreds of thousands of soldiers and service members who have been exposed to it.

  And it gets very important for us to identify them and then get them into treatment as soon as we can.

• Nick Schifrin:

  So, you mentioned no diagnostic test that can definitely, definitively determine the kind of traumatic brain injury this had.

  And you mentioned you have to monitor. That's because, what, the symptoms can take days or weeks to come out, right?

• Stephen Xenakis:

  Right. They can take a while to emerge.

  And the soldiers — the impact occurs. The service members, they will have a headache. Maybe they will lose their hearing. They will have ringing in the ears. They will feel dizzy, they will feel confused, and then some will feel better, and then a day or two later, they will start feeling very bad. And they will have recurrent headaches.

  And, if they progress, I mean, that's a sign that they could have a long-term injury that could really affect them very seriously for years.

• Nick Schifrin:

  And the Pentagon has been questioned, hey, why don't it takes so long?

  That is one of the reasons, right, that some of these symptoms can take a while to emerge.

• Stephen Xenakis:

  Right.

  And you don't want to, right at that point, say, hey, look, you're badly injured, right?

• Nick Schifrin:

  You have mentioned this a couple times, but I think it's important to put a point on it.

  These are injuries that we can't see. But they can be extremely serious, medium- and long-term.

• Stephen Xenakis:

  Absolutely.

  I mean, I have had patients who have had — feel so bad that they have tried to kill themselves. And I have had patients who feel so bad, and it's so disorganized them, I have had one that committed murder. And I have others that have committed very terrible crimes.

  So, these are debilitating.

• Nick Schifrin:

  It is something that the military, I know, has taken very seriously. And you know that more than most.

  I remember, back in 2011, I did a story in Afghanistan, and the military talked then about how they were trying to change the culture.

  I mean, how far has military culture come or not come from the days where it was, hey, look, soldier, you have got all your arms and legs, go back to the front lines?

  How much has that culture changed, or not?

• Stephen Xenakis:

  I think it has.

  And I think that people recognize that it's a problem, just like they do now in football. And they know that this is one of the very serious injuries you can have.

  But service members want to be out there. They want to do their job. They want to fulfill their duties. They want to be with their other soldiers and airmen and so forth.

  So, it's a very tough thing to do. And it's a hard call to say, you know, I think we have got to take you off the field right now.

• Nick Schifrin:

  And it's not just a call, right?

  At one point, the military decided that this had to be mandatory. There was a diagnostic test established so that, if certain soldiers or Marines or airmen were close enough to a bomb blast, they were actually forced to leave the front line.

• Stephen Xenakis:

  Yes.

  We set up — we set in place a set of procedures that, if you were 25 meters or so, sometimes a little bit more, and it was serious, we were going to take you offline for 24 hours at least, maybe a little bit longer, because we also know that your brain has to rest after it's been exposed to this kind of impact.

• Nick Schifrin:

  Has the military gone far enough?

  And one question about culture is also diagnosis. To properly diagnose traumatic brain injury, you have to have a baseline. Is the military doing enough to require or get these baselines for its service members, so that it can later diagnose possible brain injury?

• Stephen Xenakis:

  I think there's a lot of work that we could do, and we should be doing it.

  And I think we should be — get the assessments right up front. We should be tracking people. We should know that they're going to have long-term problems. And I think we need to develop better tests.

• Nick Schifrin:

  Immediately after the attack a few weeks ago, President Trump and military officials said that there were no casualties.

  A week ago, when the number of these traumatic brain injury victims was at least publicly about 30 or so, President Trump was asked about these injuries, and said this:

• President Donald Trump:

  I heard that they had headaches. I don't consider them very serious injuries, relative to other injuries that I have seen.

  I have seen what Iran has done with their roadside bombs to our troops. I have seen people with no legs and with no arms. I have seen people that were horribly, horribly injured in that area, that war, in fact, many cases, put — those bombs put there by Soleimani, who is no longer with us.

  I consider them to be really bad injuries. No, I do not consider that to be bad injuries, no.

• Nick Schifrin:

  "I do not consider that to be bad injuries."

  Veteran groups have criticized the commander in chief. Does that language downplay the severity of some of these injuries?

• Stephen Xenakis:

  I think it does, and I think it has.

  And I think it really downplays how — this impact that this can have in these members' lives for — service members' lives for years.

  So, they know that they have been injured. They know that it really will be a problem, many of them for the rest of their lives, as they try and get into civilian life and with their families.

  And I think, even though there are other injuries that are more visible, like amputations, this is serious, and we should respect that.

• Nick Schifrin:

  And it is important for the military to do that institutionally, but also for all of society to realize that not all injuries are visible.

• Stephen Xenakis:

  Well, and that's kind of the challenge with mental health, right?

  We don't see the problem as visibly as we do if you have had some kind of other physical trauma. And we have got a lot of people out there that are really suffering because of depression, anxiety, all sorts of problems.

• Nick Schifrin:

  Dr. Steve Xenakis, thank you very much.

• Stephen Xenakis:

  Thanks for having me.