It’s hard to explain how it feels to be behind an artillery piece when it fires. First is the roaring sound that no movie can ever match. Then comes the sight: the gun jerking violently, smoke billowing from its tube as the crew scrambles to load the next round. Finally, there’s the physical feeling of the explosion that threw a hundred-pound shell for miles, knocking the breath out of you and causing your bones to shudder.
Each firing left me with a dull pain in my head, like I had just gotten hit in the face. But then it would fire again. And again. And again. So imagine experiencing this feeling 1,000 to 5,000 times in the span of less than a year, as some service members on gun crews in Iraq and Syria did.
I was deployed in Iraq from 2016 to 2017 and served as an infantry officer and a journalist, assigned to cover artillery units. I know this experience intimately.
The kind of injuries I sustained don’t only occur in combat zones or with heavy weapons. Earlier this month we learned that Robert Card, a U.S. Army Reserve soldier who killed 18 people in a mass shooting in Maine in October, experienced high levels of brain damage. For around eight years, Mr. Card spent summers working as a hand grenade instructor at the U.S. Military Academy at West Point. Though grenades have a smaller explosive force than artillery, imaging shows the brains of those exposed to these blasts exhibit significant, potentially damaging changes in as little as five months. Mr. Card may have been exposed to over 10,000 blasts.
It’s clear now that each time people get hit by those shock waves from artillery fire, they pay a cost. These exposures increase the chance of what the Centers for Disease Control and Prevention now calls primary blast injury of the brain, which can cause symptoms shared with other types of mild traumatic brain injuries.
We can’t say with certainty what effect this damage had on Mr. Card’s behavior, though he was treated for two weeks in a psychiatric hospital after he said he heard voices and made threats to others. Ann McKee, the director of Boston University’s Chronic Traumatic Encephalopathy Center, which ran the study on Mr. Card, said in a statement that “brain injury likely played a role in his symptoms.” Regardless, increased research from the past few years shows that these blasts are bad for brain health and can lead to increased anxiety and depression. The Defense Department even believes blast exposure could potentially render whole gun crews unfit for duty.
Mr. Card was not assessed for a brain injury during his hospitalization. There may be thousands of others like him who are suffering from brain injuries they aren’t even aware of. Not all of the physical and mental costs will be readily apparent. Many of them will be invisible wounds that fester for decades after our current wars have ended. The insidious thing about mild traumatic brain injuries is that they can occur in both training and combat environments in routine operations. A service member can have his life irrevocably changed without even leaving the United States, and health care systems for active duty members and veterans alike are not prepared to protect and treat people.
In the aftermath of my deployment, I was forced to navigate an often uncaring military health care system that told me that these explosions hadn’t caused me lasting damage, even when I physically felt something was wrong. When I returned home, I had panic attacks, crying spells and issues sleeping. I was constantly depressed and anxious. There were and still are days when I feel like I’m not even in my own body. When I returned from Iraq in 2017, a military clinic for traumatic brain injury treatment turned me away because I hadn’t sought an evaluation quickly enough; Veterans Affairs turned me away from seeing a specialist, as well. I have had to find brain injury treatment elsewhere, and paid out of pocket.
Data taken from 2002 to 2018 shows that suicide rates are almost three times as high as the national average for service members diagnosed with even mild T.B.I.s. Those with moderate to severe T.B.I.s had suicide rates more than five times as high as the population as a whole. Soldiers with T.B.I.s suffer from worsened mental health conditions, too. An Army Times report published on March 11 showed that from 2019 to 2021, indirect fire infantrymen (whose job is to fire high explosive weapons that cause shock waves beyond normal atmospheric pressure) experienced a suicide rate that was almost 1.4 times as much as infantrymen who did not use these weapons. The same report shows higher than average rates of suicide for artillery personnel, tankers and combat engineers. I personally know of people who I served in Iraq with who have died by suicide or attempted to take their own lives.
The U.S. military can learn from these experiences and be at the vanguard for medical approaches and solutions so service members here and abroad don’t have to suffer. It starts with having the Defense Department and Veterans Affairs recognize exposure to blast as an occupational health hazard to make service members and their leaders aware of the health risks, and ensure these occupations are guaranteed specialized brain care. Blast gauges, which measure blast exposure, should be issued to every service member who encounters blasts to monitor them in real time. Information from these gauges should be in health records for both the Defense Department and Veterans Affairs for use by clinicians. And there should be more studies into the amount of mild traumatic brain injuries suffered from blasts in training and combat action, alongside more actions taken in response to evaluations of the current efforts of the Defense Department and Veterans Affairs.
In fact, Congress pressed the Defense Department on this issue just last month in a hearing on brain injuries and blast exposure in the military, and got only unsatisfactory responses about the challenges in gathering more research. In 2020, Congress asked the Defense Department to measure the blast pressure troops were exposed to and track blast exposure history routinely, but it has failed to fulfill that request four years later.
Blast exposure is killing members of the U.S. military, regardless of whether we see combat. The Defense Department and the nation owe our service members better care for their injuries, and should improve safety precautions to prevent such injuries in the first place.
Daniel Johnson served as an infantry officer and journalist with the United States Army in Iraq. He is currently a Roy H. Park doctoral fellow and adjunct professor in journalism at the Hussman School of Journalism and Media at the University of North Carolina, Chapel Hill. He is the author of “#Inherent Resolve,” a book on his unit’s experience in the war against ISIS. This article originally appeared in The New York Times.
