Bringing Traumatic Brain Injury into Focus

Army veteran and documentarian Justin Springer tells the story of four service members who struggle in the wake of blast-related brain injuries.

BrainLine: Why did you want to make this documentary?

Justin Springer: During my second deployment in 2007 in Baqubah, my unit spent most of its time driving in four-vehicle patrols looking for and cleaning up after explosions. It was very hazardous. Our vehicles took a lot of hits; we were often protected from the effects of shrapnel, but not from blast waves. I started to notice changes in a lot of my buddies.

At this time, at the height of some of the most intense fighting in Iraq, no one really knew or talked about traumatic brain injuries, especially those resulting from blast waves. The Army had not yet implemented the concussion screening and care protocols that are now in place. Guys were getting 5-6 concussions in addition to the regular sleep deprivation and intense stress that came from our missions. Sometimes they’d get to rest for a day or a few; some went right back on a mission; others were evacuated. The effects of TBI were clearly affecting our missions. There were no standards, no guidelines; no one really knew what to do to help these soldiers in a consistent and effective manner.

Once stateside, I kept noticing how brain injury had changed these guys. Many of them were in denial. They insisted they were fine, when it was clear that cognitively and behaviorally they were not. They sloughed off questions about not being able to sleep for more than 1-3 hours at a time, they were supervigilant, and they tried to push their nightmares and fears into boxes deep inside themselves. Other guys knew they were different. One guy I knew from patrols had been a real hard-charging guy. Back in the states, he was no longer that guy. He was quieter, less intense. He said he knew he wasn’t so sharp anymore. He wondered where his old self had gone. Many soldiers with brain injury didn’t know where to get help, or didn’t want it. Most didn’t even know what they’d ask for even if they did seek care. Some became suicidal.

Since I had been lucky enough to have avoided a direct hit while in a vehicle, I started to wonder what these guys were going through — physically and emotionally. Coming home after being in combat is hard enough, but with a brain injury on top of that … well, I started to think about TBI as a major issue and I wanted to document it on film. What’s it like for a guy to go through this “signature” wound of the war? 

BL: How did you find your four subjects?

JS: In 2008, I put together a proposal to get permission from the Department of Defense (DoD) to film at Brooke Army Medical Center (BAMC). It took a few months, but finally, the Army gave me the go-ahead and completely opened their doors to me. Initially, I spent time in the clinics, working with the doctors and staff who shared the evacuation lists with me. From there, I was able to find four guys with different levels of injury who would be emblematic of the myriad short- and long-term challenges of brain injury.

BL: When you chose your four subjects and started filming, did you have certain expectations or thoughts on what story the film would tell?

JS: I didn’t start with any expectations of what the film would end up like. That worried me, but I just followed these guys and their families and let the stories tell themselves. I did start capturing their stories from the beginning of their journey with TBI. I thought that was important. I started filming each guy less than a month after his injury; three of them had been evacuated out of Iraq.

BL: What did you learn while filming these stories?

JS: When I was filming, I thought a lot about where these guys were in their lives. They were all 19-20 years old when they deployed to Iraq. Most kids that age are in school, coming of age, figuring out who they are and what they want to be. For these guys — for a lot of soldiers fighting in Iraq and Afghanistan — to experience that trauma, that intense stress in conjunction with the rush of hormones and youth … well, war is one long, crazy emotional event. Part of recovery, I learned, is being able to come to terms with what you have seen and done. But having a TBI can make that process significantly more painstaking.

BL: How did your background in the Army help you work with your four subjects and their families while filming?

JS: I started making this film with an ominous feeling. I pictured going to BAMC and finding soldiers with horrible, life-long issues from brain injury. But by educating myself and talking to a lot of doctors, rehab specialists, and patients and their families, I learned more about what TBI is and what it can do. I also learned, most importantly, that the more positive outlook a soldier is given, the more support, the more individually tailored his strategies, the more positive his outcome. It is difficult for anyone to be patient, to let time help in the healing process, but especially so for a soldier who is conditioned to be a disciplined doer 24/7. But ironically, that time and patience are crucial in the recovery process.

BL: What did you learn about how people deal with TBI and PTSD? Is one issue worse than the other, or is the combination of them the hardest?

JS: There still seems to be a lot of controversy about these two conditions in the medical community. Should you treat one and not the other? What is causing these symptoms — TBI, PTSD, or both? How do you differentiate the two? Is that differentiation necessary?

Soldiers are lucky at BAMC because TBI and PTSD are treated like an umbrella issue. The symptoms overlap and there is less emphasis on putting labels on why someone is depressed or anxious or unable to sleep and more emphasis on simply figuring out how best to treat all of the symptoms.

BL: Following around these four soldiers for 1-2 years — at BAMC than then later at their homes or new posts — what did you learn about resiliency? Are there certain personality traits that help some people be more resilient than others? Also, how did the influence — positive or negative — of family and friends in the wake of a brain injury affect the person’s resilience?

JS: I think one of the main reasons some soldiers are able to be more resilient is family support. People can cope much better if they have a wife, a mother, a good friend present to help them work to move forward positively in their recovery. Josh Kinser, one of the subjects of the documentary, is a good example of resiliency and the power of family support. He had been in critical condition when I first started following him. He had sustained nine concussions. Invariably proactive and positive, Josh was able to adapt his soldiering energy into his recovery. It also helped that he and his fiancée, Casey, were so close. She was optimistic and together they were able to keep things light, most of time, to joke, and to enjoy the sweet moments that life offered, even in the wake of brain injury.

Torrey Kramer, on the other hand, had a bit of a harder time. He was more of a quiet guy to start with. He’d been a bull rider before joining the Army; someone who felt more comfortable in his own company. After his brain injury, he and his wife were not able to save their marriage. They lived in a small town in Texas where there was no military community, no support system. I don’t think Torrey’s wife knew what to do. Torrey also suffered intense chronic pain in his neck. But with time —  with the love of his son and with better pain management — Torrey found higher ground.

BL: Post-traumatic growth is the positive psychological change experienced as a result of the struggle with highly challenging life circumstances. Did you see this in the service members you filmed or in any of your buddies from Iraq?

JS: I don’t know what it is that allows some people to move forward while others don’t. I wish we knew. I’ve kept in touch with a couple guys from my battalion who struggled with the effects of TBI. One is still quite stuck. He’s divorced, he has messy family issues, and he is heavily medicated. Another guy went onto graduate school in psychology and finds that helping other vets like him is the therapy he needs to continue to deal with the long-term issues of TBI and PTSD. Each person is unique, and every person with a brain injury is unique, so it’s not fair to judge. But it does seem apparent that some people are more able to grow and find positive opportunities from adversity, while others tend to remain stuck.

BL: What do you think about the care service members received for TBI and PTSD in the short- and long-term?

JS: BAMC is the Army’s best. It’s one of the military’s flagship hospital for burns, amputations, and brain injuries. Care at BAMC, from my point of view — the guy with the camera — was amazing. These soldiers’ every possible need or want was taken care of. I did witness frustration, though. Doctors and patients could be frustrated, and understandably so, because to date there is no magic course of treatment for traumatic brain injury.

Overmedication is also a top issue. The media seems to jump on the worst case scenarios saying soldiers are taking 30-40 medications, there is drug abuse, overdoses, suicide. And yes, these happen, certainly, but it is not the whole story. BAMC has spearheaded an effective system to monitor multiple drug use. It’s called the One Prescriber System and basically, it entails one pharmacist or one doctor who oversees ALL the medications that a soldier receives. With this system, this one doctor knows if one drug or a combination of druges can interfere with others, if there is overuse of a certain pain killer or anti-psychotic, and so forth. BAMC is trying to push this initiative military wide.

In Iraq when I was there, there were definitely a lot of pills being prescribed — Ambien, Seroquel, other anti-psychotics. Some guys took whatever they were prescribed. Some sold or gave them away, others stopped taking them abruptly because of side effects. The issue of medications, especially when it comes to TBI and PTSD, is a catch-22. Pills can definitely help, but they have to be monitored. I sometimes think that doctors just can’t win. I hope to see the One Prescriber System make an important sea change across the military and even into the civilian arena.

BL: What advice would you give someone who has just returned stateside with a TBI?

JS: Be proactive when getting treatment. Lose the tough-guy mentality, it only gets in the way. Accept your injury, get the help you need, and move forward with your strengths in focus, not your deficits.

BL: What about these service members’ families?

JS: Seek support for yourself and learn as much as you can about TBI so you can help your loved one recover and keep your family on as even a keel as possible. These spouses or primary family members are the therapist and caregiver to their loved one and that can be very hard and overwhelming. I’d say, make time to care for yourself … though this is clearly easier said than done.

BL: What did you learn about relationships after a TBI?

JS: I learned that it is essential that a couple not blame each other for the issues that come with a brain injury. Be gentle. Be patient. Realize that there is no enemy; there is no one to blame. TBI is incredibly challenging for the person hurt and for the whole family. But taking action, gaining knowledge, asking questions, and being positive and patient will pay off. I think it has got to be difficult to believe that things will get better when a soldier and his family are in the first, scary, overwhelming steps of dealing with a military-related TBI.

BL: What message do you want to share with your documentary?

JS: I want people to be aware of these injuries. Brain injury is clearly a complicated injury and there is no standard, no one-size-fits-all diagnosis or treatment plan. The public needs to learn what the symptoms are and why people with TBI can act they way they do. These guys are not crazy war veterans. They are going through an incredible physical and mental struggle that may never end entirely. They may be cranky because they have an intense migraine most of the time. They may say inappropriate things because the filter in their brain no longer functions. People often look fine, but they are not. People need to understand that and be kind.

BL: How do you look at life differently after fighting in Iraq … and subsequently, after making this documentary?

JS: I was 23, a little bit older than my four subjects and many soldiers who have fought in Iraq and Afghanistan when I deployed. I was ROTC so I had college under my belt. But the experience definitely forced me to mature more quickly. Living much of your 20s in a third-world war zone would force change in anyone. How could it not? People tell me I am more serious than I used to be before Iraq and before I did this documentary.

Being able to follow these four soldiers and their families, plus see the doctors and rehabilitation staff working to put these guys back together, was an incredible gift. I realize that these four soldiers started and ended with a mostly positive trajectory, and I know that this is not always the case with a diagnosis of TBI (and/or PTSD). But I hope the film will help keep the dialogue going so soldiers with TBI get the care they need — in the short and long term.

I will always remain humbled by the strength of character of these four guys and how, at the end of the day, they were able to use their soldier-spirit to face down despair and come out stronger and more alive.

Watch trailer of Along Recovery.