While some of these reasons are readily identifiable, there are also underlying factors that serve as a block for those who have sustained this injury.
To demonstrate these factors, I want to reference a 14-line core Army doctrine called the Soldier's Creed because it is central to who soldiers are.
I will not include the whole creed but I want to provide the four-line "Warrior's Ethos" that is embedded within the document.
It is this ethos that has been drilled into every soldier from the moment they step of the bus; it is this ethos that is the underpinning of their survival in combat.
The Warrior's Ethos: "I will always place the mission first.
I will never accept defeat.
I will never quit.
I will never leave a fallen comrade.
" What I intend to do is answer the question of how this ethos obstructs many service men and women from seeking help for their traumatic brain injury.
My method will be simple as I will break this ethos down into its elemental parts to simplify discussion.
In doing so I expect to illuminate some of the concerns that encompass traumatic brain injury so that neuropsychologists, neurologists, and front-line care providers have better information to develop screening measures, education programs, and treatment plans.
Mission First; Self Last This is essential to the safety and success of any military operation.
It compels the soldier to regard his unit and its mission as greater than him or herself.
Many of the soldiers in the combat arms not only agree with this superficially but live it instinctively.
It has become an integral part of who they are to the extent that even casual decisions are influenced by this principle.
The problem with this type of mentality is that it prevents many from seeking help because the mission or unit will suffer from a potential loss in manpower.
"Isn't this subversive treatment or dangerous indoctrination?" Yes and no.
On the one hand battles cannot be won with everyone looking out for their own welfare, yet on the other, it can cause those who strongly embraced the concept to unwittingly shrug of the symptoms of TBI in order to fulfill his or her mission.
Defeat is not an Option This tenant is not only central to the armed forces but is a trait characteristic of most men in particular.
Defeat shows weakness and speaks against what men think men should be.
We see this readily in sports.
No one likes to win or admit defeat because it somehow means that we were inadequate in our performance.
In the novel The Old Man and the Sea, Ernest Hemingway spoke of defeat this way, "But man is not made for defeat.
A man can be destroyed but not defeated.
" This is a common view that enables warriors to endure the hardships of combat and continue fighting; however, it is this trait that prevents many from seeking help because it can feel as if you're accepting defeat.
What compounds the issue is the fact that many with TBI have no visible marks of their injury.
It is one thing to go to the medic for a gunshot wound and totally another to seek help for problems that make you look mentally unstable.
I Never Quit To quit is to remove your standards and expectations for success.
This is one principle that is physically implanted in the soldier through various exercises and drills that are usually painful in nature and the option to quit even more so.
Quitting becomes unacceptable.
When I was in basic training it was winter, and I was training in temps of around 10 degrees.
I soon developed pneumonia and even though I struggled to breathe on our four-mile runs and ten-mile ruck-marches, I refused to quit.
I had the choice to, but it wasn't an option.
It is the same for many with TBI because to risk being pulled from your duties because of an "invisible" injury feels too much like quitting.
It may also appear to your peers that you are too weak to endure and so you find an excuse to quit.
Never Leave a Fallen Comrade As far as TBI goes, this state of mind is not a barrier to treatment but a consequence for those who wind up leaving their unit for lighter duty or medical discharge.
Before being removed from my unit, I had a particular soldier in my squad that was good at heart but gave me grief for the decisions he made.
I spent countless days working with him to make him a more disciplined soldier.
A year later, my unit deployed back to Iraq for the third time, a deployment I should have been on.
I received word from a friend that Zapasnik, my soldier, died in combat along with three others from my platoon.
It was at that moment that I truly felt I left a fallen comrade because I should have been there with him.
Traumatic brain injury is a complex issue, one that affects multiple areas of life and is influenced by many factors.
It is an injury that lies in stark contrast to the way the military is trained because the majority of cases lack substantial visible evidence of injury.
Many, if not all, of the points I have made may happen on a latent level that those with TBI may not even realize.
Understanding these points will enable those in the related health fields to develop better programs to educate and treat those that may be apprehensive in seeking treatment.