Doing things a little out of order this week; I hope nobody minds. For this week’s book review I chose Once A Warrior Always A Warrior: Navigating the Transition from Combat to Home Including Combat Stress, PTSD, and mTBI. As you can tell from the full title, the book addresses mTBI in the context of the broader category of transition. However, I chose to review it this week because TBI is generally not a singular experience, meaning that individuals who have endured a brain injury often face a host of issues, to include PTSD, and looking at the linkage between TBI and these other facets may provide insight that looking at TBI alone would not.
Once A Warrior was written by retired Army Colonel, and Iraq veteran, Charles W. Hoge. Hoge is also a medical doctor who specializes in psychiatry, spent time as an attending physician at Walter Reed, and directed a key Department of Defense research program on the neurological and psychological effects of the wars in Iraq and Afghanistan. Given his medical background and his twenty-year military career, he is knowledgeable about both the warrior mind and the ways in which the weapons of war can impact and alter it.
His unique perspective is what makes the book such a refreshing break form much of the current literature about TBI. While Hoge understands the clinical aspects of his topics – PTSD, TBI, and their associated causes and symptoms – he explains them in terms a military person can understand. In fact, he specifically uses terminology that diverges greatly from that usually associated with topics such as PTSD and TBI. For starters, he doesn’t use terms like “suffering.” Instead, he chooses “navigating” to describe a veteran’s experience with these topics. A lot of times, we think specific words don’t matter, but they do, and this word change takes the veteran from a victim (suffering) to a position he is more comfortable with, that of someone leading the way into unknown or difficult terrain (navigating).
This difference in perspective is apparent throughout the book. For example, Hoge explains that many of the reactions that can be associated with PTSD and TBI, such as hypervigilance, are natural survival skills. Natural survival skills. These are reactions your body used to keep you alive in combat. The problem isn’t that you’re “abnormal” or weird; it’s that your body got used to a new, extremely dangerous environment, and hasn’t figured out how to gear down to the mundane, relatively safe environment civilians inhabit. In fact, Hoge says, “Society believes that a warrior should be able to transition home and lead a ‘normal’ life, but the reality is that most of society has no clue what it means to be a warrior.”
Hoge doesn’t pull any punches when he talks about any of the topics in the book. For example, he gives a realistic idea of how, once a warrior decides to seek help, the mental health process can be slow and aggravating, how not all of the clinicians will know how to help, and he even includes a nice little section where he tells those clinicians that fake-it-until-you-make-it it is the wrong approach to take with veterans. And, if Hoge’s words aren’t honest enough for you, they are underscored by chapter-ending inputs from retired First Sergeant Michael Shindler, a Vietnam veteran who puts a very personal face on the issues Hoge discusses with vocabulary that will make you feel like you’re still in the military.
In addition to TBI, which, he clarifies, has been inaccurately grouped as one condition with no gradations (there are, in fact, mild, moderate, and severe TBIs), Hoge discusses such topics as difficulties with sleep, grief, survivor’s guilt, and how loved ones can help the transition process. Hoge also goes in depth on such topics as medications (which ones do what for which symptom) and PTSD therapies, provides a list of various resources, and gives worksheets and exercises to help reinforce the information in the book.
Overall, whether you have TBI, love someone with TBI, treat individuals with TBI, or are just plain interested in what your fellow veterans are coping with, Once A Warrior Always A Warrior is a book you should be reading. You’ll learn a lot and, unlike some of the stuff I’ve read this week that made my eyes glaze over, this one will keep you turning the pages.
You can find out more about both book and author here.
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