'I just didn't feel right': The hidden reality for veterans living with Traumatic Brain Injury
This report contains distressing details
ITV News' Correspondent Geraint Vincent reports on the hidden physical injuries devastating the lives of war veterans and their families, while Science Correspondent Martin Stew answers why Traumatic Brain Injuries can be so hard to diagnose.
Words by Paul Tyson, ITV News Senior News Editor
Craig Harrison is rightly proud of his army career. In 23 years with the Household Cavalry he qualified as a parachutist and sniper, fighting in Bosnia, Kosovo, Iraq and Afghanistan, where his achievements as a marksman became the subject of newspaper articles, podcasts and a book.
But, alongside the medals and accolades, there is a darker legacy of his service; scars to his arms and body, a mental health condition and an invisible injury to his brain.
While fighting in Afghanistan, Craig was shot in the head. His helmet saved his life, but the kinetic energy from the bullet knocked him out.
"I stayed the night in an ambulance and I was being sick basically, concussion symptoms from this round," he told ITV News.
"In the morning I felt really bad you know but I wanted to join my men, wanted to get back in the fight.
"I remember jumping off the back of the Mastiff [British Army vehicle] and it was like my head wouldn't stop vibrating, you know my head was pounding. I just didn't feel right in myself."
Despite the symptoms of brain injury, Craig told medics he was fine and returned to action. But days later, with his brain still in a vulnerable state, Craig's vehicle hit a huge roadside bomb, causing multiple injuries.
Flown back to the UK, his visible wounds were treated, but something had changed.
He said: "Something in my head, I had really bad headaches, I didn't feel, I just felt foggy in my actions and I was thinking about stuff from previous tours and I'm like, 'why am I thinking this?'"
Others noticed something was wrong, including Craig's wife.
"Tanya noticed, massively yeah," he said. "She noticed it before I did. She noticed my change you know, my isolation, my argumentative side, not sleeping right, just everything, but she knew my love for the army so she wouldn't argue or tell me about it."
But the army saw nothing wrong.
"I remember going into the Ops [Operations] room in camp and I said, 'I didn't feel right in myself,' and they said, 'you are fine now, we are going to send you back out'.
"So that was the discussion and in the army you don't really argue you know, you just get told what to do."
It was not until he returned from Afghanistan that he finally received a diagnosis; Mild Traumatic Brain Injury (TBI) - the most misleading of all medical nomenclature. There is nothing mild about it.
Have you heard The Trapped? Listen as Daniel Hewitt exposes the UK's dirty secret
Symptoms include memory loss, dizziness, inability to concentrate, sleep problems, mood swings, irritability and headaches.
There's a higher risk of suicide and, in later life, the risk of severe neurological or neuro-degenerative disorders, including dementia, Parkinson's and motor neurone disease (MND).
Craig was also diagnosed with Post Traumatic Stress Disorder (PTSD), a psychological syndrome that commonly occurs alongside TBI.
The relationship between the two conditions is poorly understood, but the symptoms overlap, making diagnosis and differentiation between the two problematic.
"With the flashbacks, the nightmares and stuff like that, yeah that's PTSD, but when it comes to the migraines, when it comes to depression, when it comes to not wanting to be around people, bright lights, noises and stuff like that, I put that down to the TBI," Craig said.
"You are getting hit twice really."
TBI can be caused by a blow to the head or by exposure to the blast wave from an explosion, but it can also be caused by repeated exposure to blows or blast waves over a period of time.
Dr Clara Limbaeck, Consultant Neuropathologist at Oxford University Hospitals Trust, told ITV News: "We know that injury is more likely to cause long-term symptoms when it's a repeated injury... there is more and more evidence that even a moderate injury can actually cause long-term changes in the brain and this can be seen morphologically under the microscope.
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"The conditions that are associated with this repeated trauma belong to the category of neurodegenerations, where the cells, the neurons die, essentially degenerate and die.
"There are some that are specific to trauma, we have probably all heard of CTE, but they can also be quite similar to more common conditions, like Alzheimer's disease, which most times are completely unrelated to trauma, but in some cases actually a very similar condition is seen in association with repetitive trauma."
These symptoms often appear many years after the trauma that caused them, making the injury hard to diagnose - especially since service members may be veterans by then, reliant on civilian doctors without experience of blast related TBI.
The result, campaigners say, is a hidden health crisis in the veteran community.
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In the US "warfighter brain health" is a growing concern. The Department of Defence report TBI at a far higher rate than the British military, despite similarities in the way the two nations train and fight.
As a result, the Pentagon is changing policy. All recruits to the US military must now undergo cognitive baseline testing against which further tests can be compared, should there be a concern about exposure to blast on operations or in training.
They have also increased stand-off distances for certain types of weapons training to minimise exposure to blast.
Some British scientists believe US medics over-diagnose in order to qualify veterans and their families for lifelong healthcare, leading to an exaggerated concern about the scale of the problem. But could the reverse be true?
Are British veterans being diagnosed with psychological conditions like PTSD, when in fact they have a physical injury to the brain?
Roughly 40% of veterans under treatment for PTSD do not respond to therapies that are normally successful. They are diagnosed with complex PTSD, but some experts are asking whether, in at least some of those patients, something else might be at play?
For veterans, many exposed to repetitive blast waves over years in training and on operations, the answer to that question can't come soon enough, nor for their families.
Kate England is the mother of three school-age boys and a full-time carer for her husband, James - an Iraq veteran with TBI.
Struggling to get his condition recognised, his symptoms properly managed or to access help as a carer, she began to lobby doctors, scientists, ministers - anyone who might listen and help.
Through adversity she is now an expert on the condition and a one-woman campaigning force.
"I just had enough," she told ITV News. "Because it had broken down my family completely and it was either me speak up or my family were going to be gone completely, and James was going to be in the justice system or dead."
The Ministry of Defence (MoD) say they are aware of the problem and investing in research.
A spokesperson told ITV News: "The health and wellbeing of our armed forces is critical and we provide specialist medical treatment for Traumatic Brain Injuries at the Defence Medical Rehabilitation Centre.
"Using the latest research and advanced technology the UK and our international partners are actively working on advancing the diagnosis, management and rehabilitation of patients with Mild Traumatic Brain Injury.
"This includes over £4 million in funding for the latest advanced research which will help both military and civilian patients."
If you've been affected by the issues in this article and would like to share your experience, email investigations@itv.com
If you've been affected by any of the issues raised in this article, help is available
The charity Samaritans operate a 24/7 helpline (116 123) for anyone who needs somebody to talk to. Further resources can also be found on its website.
Concussion Legacy Foundation supports British current and former serving members and their families
The Concussion Legacy Foundation also provides a personalised helpline for those struggling with the outcomes of brain injury.
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