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Tim Smith
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Conceptualizing Brain Injury as a Chronic Disease

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“Man is not a rational animal, he is a rationalizing animal.”—Robert A. Heinlein

As a species we naturally try to find patterns out of chaos. From the Biblical story of Adam’s attempts to name all the animals, to Plato’s ideal Forms, to the classification systems of modern biology and botany, one of the ways we attempt to control our surroundings is by classifying them. The upside to this of course has been the tremendous scientific progress of the past five centuries, made possible in large measure by the regularization of knowledge.

A downside to it is that often, when we encounter something new we attempt to fit it into existing categories. Or, when we learn something new about an existing idea, many of us prefer to leave it in its assigned category. Sometimes this leads to bitter quarrels; we begin to fight over the borders of categories while ignoring the new knowledge itself. Some examples of this sort of ludicrous controversy include arguments over whether Pluto is or is not a planet or disagreements over how to classify the platypus. In any event, there seems to be something reflexively contrary in human nature which leads us to resist any effort to move things from one conceptual pigeonhole to another.

One of the modern day bugbears concerns medicine. Namely, what constitutes a disease or sickness? Are the flu, cancer, and tuberculosis diseases? Almost everyone would agree that they are. How about alcoholism, depression, and attention-deficit-disorder? It is not difficult to find folks who do not believe that any of this last list are diseases. Much of the debate is merely semantic; is a condition acute or chronic? However, those semantics can have consequences. Much care of long-term disability has been pigeonholed as mere rehabilitation. This has led to decreases in research funding for many areas.

One of the more important medical areas that has lagged due to this sort of pigeonholing is the long-term care of traumatic brain injuries (TBI). Lay people tend to see brain injuries as an event rather than a process. Moreover, many assume that those with traumatic brain injuries either die almost immediately or recover. In reality, this condition can persist for years, with only gradual if any improvement. As trauma medicine advances, injuries that would have been fatal even a few years ago are now survivable. This trend will accelerate, and as it does we are likely to see increasing numbers of patients coping with significant long-term brain injuries.

It is with these facts in mind that the Brain Injury Association of America (BIAA) is attempting to change the way we think about traumatic brain injuries. Long-term brain injuries carry with them whole hosts of effects which carry over into every area of human health and have been little researched.

It is the position of the BIAA that only by ‘rebranding’ brain injuries can we escape the mental categories in which we have placed traumatic brain injuries. If this is so, and we can begin thinking of these injuries as something that we may someday be able to fix, then we can redirect our research efforts toward helping the millions of Americans living with TBI.

A very interesting approach, indeed.

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    The debate over Pluto is not “ludicrous.” It reflects the inability of many in the astronomical community to come to terms with the fact that there are more than two types of planets in our solar system. The new information does not indicate Pluto is not a planet but that our solar system has a third category of planets, the dwarf planets, in addition to the terrestrials and gas giants. Instead of recognizing and welcoming this, the four percent of the IAU who voted on the controversial definition stating that dwarf planets are not planets at all made a political decision based on an artificial need to keep the number of planets in our solar system low and now want the world to blindly accept their definition even though it makes little sense.