Obama and McCain urged to Attend Military Head Injury Conference

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Posted on 12th July 2008 by Gordon Johnson in Uncategorized

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From the Brain Injury Association of America:



Dear Advocates:

BIAA issued a press release today urging both presidential candidates to attend the 2008 Fort Hood Presidential Town Hall and engage in an in-depth discussion of the increasingly complex issues facing America’s military and veterans community, including the rate of traumatic brain injury among returning service members. BIAA is a member of the 2008 Forth Hood Presidential Town Hall Consortium, and the event is tentatively scheduled to occur on August 11, 2008.

In other news, in a welcome and surprising turn of events this week, the Senate voted by a veto-proof margin to pass a key Medicare bill (H.R. 6311), which the House and Senate had previously been unable to agree on before the July Fourth congressional recess. The final Medicare package, which will prevent deep cuts in Medicare payment rates for physicians which had been scheduled to begin on July 1, was previously passed by the House on June 24.

The Medicare bill also contains important delays in the implementation of Medicare’s competitive bidding program for Durable Medical Equipment (DME), and an extension of the Medicare outpatient therapy cap exceptions process.

It is anticipated that President Bush will veto the bill, however, and although the Senate passed the bill with a veto-proof margin earlier this week, the White House needs only three Senators to switch their votes in order for a veto override to fail. Thus, it is extremely important that advocates visit BIAA’s Legislative Action Center to take action TODAY to urge their Senator to vote to override the President’s expected veto. To do so, please visit http://capwiz.com/bia/callalert/index.tt?alertid=11604356.

The Fiscal Year 2009 appropriations process to be stalled, as the House Appropriations Committee does not plan on marking up any more bills this summer after a partisan dispute erupted in recent weeks over amendments on energy policy. And while the Senate Appropriations Committee plans to have all 12 of its bills approved by the panel by the end of this month, Senate Majority Leader Harry Reid (D-Nev.) said this week that action on appropriations in his chamber will be very limited during the next few months.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.

To sign up to receive future BIAA Policy Corner E-Newsletters and Legislative Action Alerts, please go to http://capwiz.com/bia/mlm/signup/
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BIAA Urges Presidential Candidates to Participate in Fort Hood Town Hall Event

BIAA issued a press release today urging both presidential candidates to attend the 2008 Fort Hood Presidential Town Hall and engage in an in-depth discussion of the increasingly complex issues facing America’s military and veterans community, including the rate of traumatic brain injury among returning service members. BIAA is a member of the 2008 Fort Hood Presidential Town Hall Consortium, and the event is tentatively scheduled to occur on August 11, 2008.

The Consortium planning the event includes a diverse group of military, veterans and community-service organizations, including Disabled Veterans of America, the Brain Injury Association of America, and Sentinels of Freedom. These groups are working in partnership with the military, the Department of Veterans Affairs, state and local governments, and faith and community-based organizations to deliver services and support to our military, veterans and families.

In the press release, BIAA President and CEO Susan H. Connors states, “Traumatic brain injury (TBI) is a common consequence of any war. TBI is recognized as the ‘signature wound’ of the current conflict; yet, accessing the right treatment, right now remains a challenge for many wounded service members and veterans. Our troops and the millions of civilians who sustain TBIs here at home need proper screening and diagnosis, expert rehabilitation, and ongoing community-based services. Family caregivers need information, training and support, and voters everywhere need to let the presidential candidates know where we stand.”

To view BIAA’s press release in its entirety, please visit our website at http://www.biausa.org/policyissues.htm.

Surprise Appearance By Senator Kennedy Pushes Senate to Pass Medicare Bill

In a welcome and surprising turn of events this week, the Senate voted by a veto-proof margin of 69-30 to pass a key Medicare bill (H.R. 6311), after a unexpected, dramatic appearance and “aye” vote by Sen. Edward M. Kennedy (D-MA) on Wednesday. Sen. Kennedy had not been in the Capitol for six weeks, as he is recovering from surgery in early June to remove a malignant brain tumor.

The House and Senate had previously been unable to agree on a Medicare package before the July Fourth congressional recess. The final Medicare bill, which would prevent deep cuts in Medicare payment rates for physicians which had been scheduled to begin on July 1, was overwhelmingly passed by the House on June 24, but before Senator Kennedy’s appearance had been unable to gain Senate passage.

In addition to replacing a 10.6 percent cut to Medicare’s physician payment rates with 18 months of stable payments, the Medicare bill also contains an 18-month delay in implementation of Medicare’s competitive bidding program for Durable Medical Equipment (DME), as well as an 18-month extension of the Medicare outpatient therapy cap exceptions process.

It is anticipated that President Bush will veto the bill, however, and although the Senate passed the bill with a veto-proof margin earlier this week, the White House needs only three Senators to switch their votes in order for a veto override to fail. If the President delays acting on the bill, or Congress is unable to override an expected veto, the physician payment cuts and DME competitive bidding program will go into effect, and the outpatient therapy caps exceptions process will continue to be expired (as of June 30, 2008). Thus, it is extremely important that advocates visit BIAA’s Legislative Action Center to take action TODAY to urge their Senator to vote to override the President’s expected veto. To do so, please visit http://capwiz.com/bia/callalert/index.tt?alertid=11604356.

Fiscal 2009 Appropriations Process Still Stalled

The Fiscal Year 2009 appropriations process continues to be stalled, as the House Appropriations Committee does not plan on marking up any more bills this summer after a partisan dispute erupted in recent weeks over amendments on energy policy. And while the Senate Appropriations Committee plans to have all 12 of its bills approved by the panel by the end of this month, Senate Majority Leader Harry Reid (D-Nev.) said this week that action on appropriations in his chamber will be very limited in the next few months.

There continues to be widespread speculation that this year’s appropriations process will eventually become stagnant this fall, as Democrats may wait for the president to leave office before completing work on the funding bills in order to avert a promised veto.

CQ Today reported earlier this week, “Reid (D-Nev.) said his chamber will likely consider, at the most, two fiscal 2009 appropriations bills this year before passing a continuing resolution (CR) in September that would keep the government funded at current levels into early next calendar year, when a new president takes office. The new fiscal year begins Oct. 1” (CQ Today, David Clarke, 7/10/08).

The full Senate Appropriations Committee has approved the Labor, Health and Human Services (HHS), and Education funding bill, which provides the same funding amounts for several TBI programs as last year. This includes $5.7 million for TBI programming within the Centers for Disease Control and Prevention (CDC) and $8.754 million for the HRSA TBI State Grant Program.

The House Labor, Health and Human Services (HHS), and Education Appropriations funding bill has only been passed by the House Subcommittee and not the full House Appropriations Committee. The House Subcommittee markup contains increased funding for some federal TBI programs compared to last year. The bill includes $11 million for the HRSA TBI State Grant Program (+$2.246 million over last year) and $6.6 million for TBI programming within CDC (+$0.9 million over last year).


We agree that one of the most pressing issues for the next administration, is better care for returning vets, and also for all brain injury survivors.

Return of the Soldier, Commentary on the Rebecca West Novel

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Posted on 8th June 2008 by Gordon Johnson in Uncategorized

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Editor’s Note: I owe my discovery of the issues with respect to Shell Shock in the World War I literature to a good friend, Kara Harton. Kara wrote the following paper while attending Yale.


Shell Shock in Rebecca West’s Return of the Soldier
History 255 – The Experience of War in the Twentieth Century
Professor Bruno Cabanes
7 March 2007


Kara S. Harton

Shell Shock in Rebecca West’s Return of the Soldier
Set in 1916 at the Baldry family estate outside London, Return of the Soldier is the fictional story of Chris Baldry, a veteran of The Great War, who is discharged from the military due to shell shock-induced amnesia. His only memories are expressed as flashbacks of his pre-war life. After leaving the front, Chris returns home to Kitty, Jenny, and Margaret, the most important people in his life. Kitty, Chris’s wife, is an extremely poised, genteel English woman who is perfectly content maintaining the household. During the war, she remains confident that as soon as her husband returns home, they will resume their comfortable, pre-war lifestyle. Kitty’s life seems to be dictated by her social obligations, and she cannot accept anything which intrudes upon her perfectly cultivated, socially-acceptable world. Chris’s cousin Jenny is Kitty’s companion at Baldry Court during the war. Jenny is probably the character with whom it is easiest for the reader to identify, and as the narrator of the story, Jenny has the most influence over the readers’ perception of the other characters’ actions. Her façade – that of a well-mannered English woman – is quite similar to Kitty’s, but she seems much more understanding of Chris’s difficult situation.

Kitty and Jenny become acquainted with the other major character, Margaret Grey, during the course of the novel. Margaret is Chris’s old flame and, apparently, his first love. Oddly, Chris’s amnesia seems to have erased all of his memories, with the exception of the recollections of his relationship with Margaret, which occurred many years before. Margaret is of a lower class than the Baldry family, which adds a significant amount of tension to her interaction with the Baldrys. These three women are linked by their connection to and concern for Chris, and together, they must decide how to handle his enigmatic condition and come to terms with the way that his role in their lives has changed as a result.

Clearly, Return of the Soldier is not the typical “war novel.” There are no battles or images of warfare. In fact, the reader never sees the enemy. However, this novel still makes a provocative statement about World War One. Although the novel takes place on an English estate, far from the trenches of the Western Front, it offers a vivid portrayal of the war by illustrating one of its most important themes: the phenomenon of shell shock. West’s portrayal of shellshock in The Return of the Soldier highlights two key aspects of the condition: the medical and psychological explanations of the phenomenon, and the way that it forced British society to adjust.

The idea of shell shock is introduced in the novel before the main character actually appears. Kitty and Jenny are at Baldry Court, nostalgically reminiscing about the past, when Margaret arrives with news about Chris. She informs the women that Chris has experienced some sort of misfortune on the battlefield but is somewhat hesitant to reveal the details. When Kitty asks if he is wounded, Margaret responds with, “Yes . . . he’s wounded,” but soon corrects herself by explaining, “I don’t know how to put it, he’s not exactly wounded. A shell burst –.” “Concussion?” Kitty asks. Margaret clarifies that Chris has shell shock and is “not dangerously ill.” After her explanation, the women share an awkward silence; they are obviously uncomfortable, and it is clear that neither of them is certain of the implications of the news. (23)

This scene is extremely important because it introduces the idea of shell shock in the novel and serves as an important illustration of the uncertainty with which shell shock was discussed during and after the War. Just as the characters of Return of the Soldier are not quite sure how to classify this condition, most Europeans, including medical and psychological experts, were unsure of the exact cause and characteristics of shell shock. There was an extensive debate about whether the nature of the condition was physical or mental, and whether it could legitimately be classified as a “wound.” The inability to pinpoint Chris’s injury in the previous passage is an excellent illustration of this uncertainty. It is not a tangible injury, and no one can decide exactly how to refer to it. The women seem uncomfortable using the term “shell shock,” which shows their lack of familiarity and understanding of the condition.

This theme reappears numerous times throughout the novel. Kitty has an extremely difficult time accepting the authenticity of Chris’s amnesia. After his first dinner back at Baldry, Kitty becomes extremely upset about Chris’s behavior. Jenny attempts to console her by reminding her that she is “taking things all the wrong way,” and that his conduct is due to the fact that “Chris is ill.” However, Kitty insists that Chris is merely “a man like other men,” and asserts that, “This is all blind. . . He’s pretending.” (60) Instead of accepting that Chris suffers from a condition which is beyond her comprehension, Kitty would prefer to assume that he feigning amnesia in order to continue an extramarital affair with Margaret. Kitty’s refusal to accept the authenticity of Chris’s wound reflects society’s hesitation to accept shell shock as a legitimate injury.

In order for the condition to seem more valid, the stigma of psychological disorder had to be surmounted – a significant obstacle to a society in which the mentally ill were considered outsiders. Therefore, it could not be attributed to fear or nervous breakdown due to the atrocities of war; medical experts had to assert that shell shock was caused by proximity to an exploding shell. This explanation was offered by British physician Charles S. Meyers in 1914 when he first observed shell shock in France, and it was accepted for the duration of the war. (Mosse 103) According to Colonel J.F.C. Fuller, “the sapping of morale by sudden or prolonged fear subordinates a man’s power of will to his instinct of self-preservation and ultimately reduces him to a state in which he cannot control his emotions.” (103) German medical experts agreed and tended to associate “war neurosis” with lack of will rather than concrete trauma, but this explanation was unacceptable to British society at the time. (103) In order to be considered a valid war wound, shell shock had to be attributed to something tangible.

In addition to providing an excellent illustration of the uncertainty with which people approached shell shock, Return of the Soldier also contains numerous examples of the way that this condition disrupted society during and after the War. After Chris’s return, Kitty wants their lives to return to normalcy because as members of the upper echelon of society, they both have important responsibilities and obligations to fulfill. Jay Winter, a notable World War One historian, calls shell shock “a code to describe the shock of the war to the ruling elite, whose sons and apprentices, being groomed for war, were slaughtered in France and Flanders.” (Winter 10)

In this war, unlike other wars, the higher a man’s socioeconomic status, the greater his chances of becoming a casualty. This fact was very real to the social elites, and the phenomenon of shell shock provided “a symbol . . . of the effect of the war on both their own social formation and British society as a whole, which many of them took to be interchangeable.” (10) Officers were expected to be shielded from the danger of emotional breakdown by their superior competence and judgment, their position of responsibility, and the need to set an example for their inferiors. The awareness that officers were more likely to become casualties (both due to shell shock and more conventional injuries) was an uncomfortable reality for society.

The way that shell shock is presented in Return of the Soldier also highlights another important aspect of the condition: the way that it forced reconsideration of accepted stereotypes, particularly those concerning accepted gender roles. Mosse points out the rigidity with which masculinity and manhood were defined at the time; in most of the Western world, there was an undisputed understanding about the function that a man was expected to fulfill as “exemplar and guardian of the society’s values and coherence in an age of accelerated change.” (Mosse 101) He should be dispassionate, controlled, and moderate, both physically and psychologically. Mosse points out that men whose behavior placed them outside the bounds of ideal manhood were relegated to the ranks of “outsiders, on the margins of established society.” (102) These were men who were nervous or unstable; criminals, ethnic minorities, and homosexuals were often placed in this undesirable category. Nervous disorders, often referred to as “hysteria,” were typically considered women’s afflictions, but now, society had to decide what to do with men who were exhibiting the same symptoms.

This theme is not presented explicitly in Return of the Soldier, but it is certainly implied. The Chris that Kitty knows is strong, organized, masculine, and stoic. He is a perfect example of the ideal upper-class British man: responsible, balanced, hard-working, and self-controlled. When he returns to Baldry Court, he is extremely polite, which shows that he still understands the importance of etiquette. Yet much of his conduct is now governed by emotion rather than logic. Instead of behaving rationally and dutifully taking his place in society, he has become emotional, compulsive, and needy. It is suggested that before the war, Chris is not entirely satisfied with his life, especially after the death of his son Oliver, but his emotional expression is stifled by his obligation to manage a comfortable, efficient manor. When he is affected by amnesia, he reverts to a time when he was less refined – before his manhood had fully developed. When he returns to Baldry Court, Kitty and Jenny are taken aback by his passion and depth of emotion; it seems as though they have never seen him express such strong feelings. His “wound” has forced him to revert back to the behavior of his boyhood. Many Europeans of this era, particularly those in the middle and upper classes, considered war “a true test of manliness,” and after World War One, society was forced to decide how to cope when many of its men were unable to “pass” this test. Mosse explains that this was extremely traumatic to British society because “shattered nerves and lack of will-power were the enemies of a settled society and because men so afflicted were thought to be effeminate, [which] endangered the clear distinction between genders which was generally regarded as an essential cement of society.” (103)

Although West’s Return of the Soldier is entirely fictional, it has an immeasurable degree of historical relevance, particularly in its depiction of shell shock. Even though West never presents scenes of battle and destruction, this book still presents an accurate picture of the disastrous effects of World War One, both in the military and the home front. This novel presents shell shock as a legitimate war injury without overlooking the uncertainty of its nature and diagnosis. Because the events in the novel occur within a few days, West’s focus is not the narrative, but the interaction of its characters. Therefore, it is crucial to analyze their relationships, and not the characters themselves. A careful analysis of these relationships reveals a great deal about the nature of shell shock, and the way that it affected soldiers, their families, and wartime society as a whole.

©2007, Kara S. Harton

Brain Injury Association Urges Support for Wounded Warriors Act

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Posted on 8th May 2008 by Gordon Johnson in Uncategorized

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From the Brain Injury Association of Wisconsin:

Dear Friends:

Take Action!
Urge Your Senator to Cosponsor The Caring for Wounded Warriors Act of 2008
BIAA (Brain Injury Association of America) has endorsed The Caring for Wounded Warriors Act of 2008 (S. 2921), legislation introduced on Monday, April 28 by Senator Hillary Rodham Clinton which would increase support for family caregivers of servicemembers with TBI. Several recommendations made by BIAA during the legislative drafting process were incorporated into the bill.

BIAA encourages you to urge your Senator to sign on as a cosponsor of this important legislation.

The bill would require two pilot programs to be implemented through the Department of Veterans Affairs, improving the resources available to those caring for returning service members with TBI.

The first pilot program, which would provide for training, certification, and compensation for family caregiver personal attendants for veterans and members of the Armed Forces with TBI, is very similar to a provision in last year’s Heroes At Home Act of 2007, which BIAA also strongly endorsed.

The second pilot program would leverage existing partnerships between Veterans Affairs facilities and the nation’s premier universities, training graduate students to provide respite care for families caring for wounded warriors suffering from TBI.
To urge your Senator to become a cosponsor of S. 2921, click on the ‘Take Action’ link in the upper right corner of this email.

The Brain Injury Association of Wisconsin and the Brain Injury Association of America support this legislation.

If you have trouble with the “Take Action” button at the top, please let BIAW know. To “Take Action” visit www.biausa.org. Click on Policy & Legislation, then Legislative Action Center, and then Take Action.

Sincerely yours,

Pat David
Brain Injury Association of WI
For those not in Wisconsin, your Senators and Congressmen can be found at http://www.senate.gov/ and http://www.house.gov/

TBI Act Reauthorization

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Posted on 15th April 2008 by Gordon Johnson in Uncategorized

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From the Brain Injury Association of Wisconsin

  • TBI Act Reauthorization Update: Last week the US Congress passed legislation to reauthorize the Traumatic Brain Injury Act! The bill appears ready to be sent on to President Bush for his signature. In addition to authorizing ongoing CDC, NIH and HRSA TBI programs, the bill also authorizes a new study by the CDC and NIH in collaboration with the Dept. of Defense and the Dept. of Veterans Affairs to identify the incidence of brain injury among our veterans, especially veterans of Iraq and Afghanistan. Again, THANK YOU to all who took time to share their opinions with Congress regarding this legislation during the past year.
It takes a war or two, and badly thought out wars, to get some attention to brain injury and brain injury research. Congratulations to those advocates who got this bill passed. Certainly, the TBI act is important and helping our veterans with brain injury is important, too.

But how come the tail of the brain injury animal, war injuries, gets all of the research and attention? There are a million Subtle Brain Injuries© a year in the U.S. and perhaps, a few thousand in Iraq. What about all the civilians who have brain injuries? Isn’t it time we did some major research on those most likely to be disabled by brain injuries, those over 40 – especially women over 40, those with prior head injuries and those with co-morbid issues such as other neurologic or emotional disorders?

A Subtle Brain Injury is a complicated synergistic maze. Limiting our research to young jocks and war casualties is not going to enlighten us as to why some people have apparent full recoveries and others never get better. It is not an accident that there is consistently 10-15% of those with concussions who wind up with persistant post concussion syndrome. Let us start screaming louder so that the real pathology in those cases is understood, and treated.