CONFRONTING TRAUMATIC BRAIN INJURY
Devastation, Hope, and Healing
By William J. Winslade
Foreword by James S. Brady
New Haven and London: Yale University Press, 216 pages, $26.

The New York Times Book Review
August 9, 1998

Reviewed by Robin Marantz Henig

James Blakely seemed to be doing remarkably well after the car crash that nearly killed him. After five months of unconsciousness, the young man gradually emerged from his coma and slowly re-learned to speak, read, work a computer and get around in a wheelchair. But his astounding recovery masked the fact that his brain injury had changed Blakely, who had been a special ed teacher for the Tucson public schools, in profound and surprising ways. Before the accident, he had successfully juggled his teaching job with graduate work on a doctorate in education. Three years after the accident, he telephoned the police one morning to report a lost cereal bowl.

The long journey back from brain trauma is the focus of this powerful book. William J. Winslade, a bioethicist at the University of Texas Medical Branch in Galveston, captures our attention by making it clear that the horror stories he relates can just as easily happen to any one of us, or to someone we love, cleaving our lives indelibly into "before" and "after."

Today, medical heroics can bring back shattered bodies from the brink of death, leaving devastated accident victims in vegetative comas for months, and leaving relatives to sit in anguished vigil for any sign of hope. Often people find hope in the unlikeliest of places. They may misinterpret the grasping reflex, for instance, as a good thing, not knowing that when an adult responds to something touching his palm with an infantile curl of the hand, it signifies profound brain damage. But if you’re holding your comatose son’s or daughter’s hand, Winslade writes, "it’s comforting to interpret this very negative symptom as a positive responsive squeeze."

For the lucky ones who do regain consciousness, even a mild concussion can have surprisingly long-term consequences. Brain trauma can change a person’s life forever; like James Blakely, most victims of serious brain injury will never be the same again. Of the 2 million traumatic brain injuries in the United States every year, the majority of them in young people on the threshold of the rest of their lives, some 90,000 require extensive rehabilitation and never fully recover. A significant proportion – the numbers are hard to come by -- go on to live blighted half-lives for which the victims and their families pay dearly in terms of actual expenses, lost opportunities, and dashed hopes for the future.

"The average victim of severe brain trauma who is fortunate enough to survive and regain consciousness faces five to ten years of demanding, expensive, often frustrating rehabilitation," Winslade writes. "Even that investment carries no guarantee of ultimately achieving independence, much less complete recovery." And even those who recover physically and mentally might suffer changes in personality, attention span, memory, judgment, or sense of humor that are almost as debilitating for being so subtle and unexpected.

The author makes recommendations regarding, among other things, mandatory set-asides of taxes on cars, guns, or alcohol, and surcharges on fines for driving under the influence and other moving violations. These funds could be used to provide high-quality rehabilitative services regardless of an individual’s ability to pay. Such services can cost as much as $4 million over a victim’s lifetime, wiping out a family’s resources in a matter of months and leaving the rest of us to foot the bill. He also urges more stringent controls of seat belt and motorcycle helmet laws, and a reconsideration of whether people in persistent vegetative states should automatically be kept alive indefinitely just because it is medically possible to do so.

Winslade sees the epidemic of traumatic brain injury as a public health catastrophe. And he sees our collective response to it as a moral challenge. "We have to do more than pay the cost," he writes. "We have to retool our culture. We need to nurture rather than deny our impulses toward empathy, compassion, and fairness and restore these virtues as central values in our society." To do otherwise will lead to costs "[both] economic and emotional [that] will drive us not just to bankruptcy but to despair."