Brain Injuries and Implications for Successful AOD Treatment

“They Keep Telling Me I’m Crazy: A Navy SEAL’s Desperate Search for Answers About His Own Brain Injury & His Family’s Cause Now.” A People Magazine article describing the suicide of a former U.S. Navy SEAL (Amy Eskind, 3-14-20). This article describes a once remarkable sailor’s downward spiral from elite Special Forces Operator to discharge for ‘disobeying a direct order’ to complete an AOD Rehabilitation program. Yes, his alcohol and drug use were problematic, but without addressing his traumatic brain injury (TBI/BI) symptoms, his BI behaviors remained. His unrecognized BI(NLD) symptoms, not lack of program participation, were responsible for his dismissal from AOD Treatment. His dismissal and military discharge were closely followed by his suicide. His story is not unique nor is it confined to military treatment programs. Why weren’t his needs recognized? Do your clients show these symptoms?

The story involves a Navy SEAL’s glaring NLD/BI symptoms and his statement: “They keep telling me I’m crazy!” “I need treatment for PTSD/TBI!” And the government’s failure to diagnose his NLD/BI. Despite medicine’s inability to detect his NLD/TBI on MRIs, his TBI related nonverbal learning disability (NLD) symptoms were screaming to be recognized. Most individuals with TBI don’t realize they possess its symptoms. As a warfighter, this SEAL was aware he was exposed to trauma and he knew something was physically wrong, yet his pleas fell on deaf ears. He was so sure he had TBI that he insisted his brain be left for science. Following his suicide, his brain was dissected and his TBI discovered. There is much data available definitively describing BI/NLD symptomatic behaviors. Most disorders are detected and diagnosed by their symptoms. Why not TBI?

Non-Verbal Learning Disabilities (NLD)

My background is Educational Psychology. I’ve been in practice over 25 years. Early on I attended a presentation by Byron P. Rourke, Ph.D. in which he discussed the findings of his 30 years of research into the neuro-cognitive effects of various types of brain injuries and brain diseases. He emphasized the consistency and diagnostic predictability of his findings. He delineated the symptoms displayed by research subjects and the consistencies of their assessment results. Dr. Rourke outlined the assessment instruments he used and his discovery that, if certain criteria were met, behavioral observations and psychological test results alone could accurately diagnose neurocognitive disorders (BI) despite the absence of other medical findings.

In my career, I have assessed over 2000 clients. Clients are usually referred for reasons other than BI. Inevitably however, those who display NLD/BI behaviors and evaluation patterns described by Dr. Rourke, are discovered to be victims of neurocognitive disorders (NLD/TBI). These clients were often referred for assessment because their difficulties did not respond to normal intervention techniques. If undiagnosed, NLD/BI symptoms manifest as undesirable behaviors which become more severe over time, as do their consequences. Alcohol and other Drug (AOD) use becomes a prevalent coping mechanism. Then, to others, AOD abuse is wrongly viewed as the root cause of their undesirable behaviors.

Dr. Rourke named the pattern symptoms caused by BI: “Non-Verbal Learning Disabilities (NLD)” because his research concerned the implications to learning produced by BI and/or white matter tissue damage. Nonetheless, the array of symptoms that connote NLD, directly correlate to TBI and virtually all other neuro-deficiencies that entail white matter brain tissue degradation.

Some common causes of BI/NLD include white matter destructions due to: oxygen deprivation, sustained high fever, electrical shock, certain diseases and/or infections, exposure to concussive forces, TBI, etc. These factors are usually not overtly apparent and often occurred years prior. Assistance is not sought until deficiencies or behaviors become intrusive. Referral is often made by others seeking help for a loved one’s uncharacteristic behaviors.

When the brain of the Navy SEAL was dissected, white matter damage was discovered. Could not his combat history and behavioral changes, consistent with NLD, been indication enough to diagnose him with TBI/NLD? Such a diagnosis could have validated his feelings, let him know that he wasn’t “crazy,” and perhaps saved his life.

Some symptoms of NLD/BI include:

• Visual-spatial orientation difficulties. Motor skills are ‘off;’ (sports, writing, etc.)
• Non-verbal problem-solving difficulties. Can’t ‘look-and-learn.’
• Verbal explanation required for new concepts. Difficulty grasping “the big picture.”
• Becomes overly Verbal. Talks much but says little.
• Takes language literally. Confused by sarcasm, idioms, figures of speech, abstract concepts, etc.
• Visual Misperceptions of environmental-social cues. [note: ‘Perception is Reality.’ If reality is misperceived, then it is not reality]. NLD
reality vs. true reality. Socially awkward. Social reactions are inappropriate to the situation. Societal retaliation for improper reactions can
be catastrophic. Such consequences may be: job loss, loss of family & friends, legal problems, frustrated/angry reactions, social ostracism,
• Mental Health (MH) disorders: Depression, Anxiety, etc. [Misdiagnosed? NLD symptoms often mimic MH symptoms.]
• AOD abuse (prescribed drugs included). Exacerbates NLD symptoms.
• Thinking is Linear, Concrete: No Big-Picture, No ‘Cause & Effect’ recognition.
• Misinterpretation of Nonverbal Communication. Includes: body language, facial expressions, tone of voice, personal space, knowing when “enough
is enough.” Causes social rejection & withdrawal.

Do your clients exhibit some of these symptoms? NLD/TBI sufferers develop symptoms slowly over time. Few develop all symptoms, but each symptom results from declines in non-verbal skills combined with compensatory verbal overtures.

The Navy SEAL knew he had a physical (BI) problem. Most who suffer from BI are unaware of their symptoms. For him, medical tests were conducted. Despite his glaring NLD/TBI symptoms, all imaging tests were negative. Thus, it was determined that he did not have TBI. As such, his symptoms must all be imaginary or ‘in his head.’ Interestingly however, based only on symptoms, he was diagnosed with depression and anxiety disorders (which are also symptoms of white matter destruction) and prescribed medication. His NLD/TBI symptoms persisted and he began drinking along with his medications. Predictably, his behaviors worsened, and he was ordered into his second AOD treatment program.

His symptoms, as described in the article include:

• While in initial AOD treatment for ‘addictions,’ he stated: “They keep telling me I’m crazy!” “I need treatment for PTSD/TBI!” He interpreted
his dismissed plea for help as: ‘They think it’s just all in my head. They think I’m crazy!’

Prior to his last deployments his family and girlfriend described him as: even-keeled, quiet, contemplative, slow to anger, and intelligent. After his final deployment and failure in AOD treatment, the following behavior changes were observed:

• Irritable, angry, impulsive, short-fused, paranoid, and threatening.
• Memory loss. Wrote notes to help remember simple things.
• Family comments of: “It’s not him. It was somebody else in him.”
• Lost interest in loved hobbies.
• Ordered into Psychological treatment for ‘Behavioral Health.’
• Declining vision and hearing.
• Balance was ‘off.’
• Verbal. He ‘talked fast’ rambled about senseless plans. Lost track of conversations.
• Disoriented. Missed appointments.
• Distrustful. Alienated from peers.
• Increased AOD abuse. NLD/BI Symptoms increased.
• Unpredictable behaviors & irrationality. Alienated family and girlfriend.
• Flat affect. Blank stares.
• Depression & Suicidal ideation.

These behavior changes, when examined through the NLD lens, exhibit many of the classic symptoms of BI/NLD. He was diagnosed and treated for Depression and Anxiety based on symptoms alone, why not TBI/NLD?

Is there a Solution?

Is there a solution? Could he have been helped? Yes. There is no cure, however, there are effective assistive techniques. There are three basic areas of consideration beneficial in assisting TBI/NLD sufferers to help themselves:

1) Awareness and knowledge of their condition!
2) Use of recommended coping skills.
3) Building a network of Trusted others.

Practical use of these three areas can greatly assist individuals with BI to regain their ability to function, even thrive, in society. This Navy SEAL’s girlfriend was correct when she observed: “If one doctor would have validated his feelings, if people weren’t all telling him it was behavioral, I would imagine it would be different.” The first step in assisting NLD/TBI sufferers is informing them of their condition. Next, is educating them of actions to take to ameliorate their symptoms. Armed with such information, clients begin taking corrective actions and establishing new patterns of existence. Lastly, clients develop trusted relationships within significant ‘life’ areas. These trusted ‘partners’ are people who know of the client’s NLD/TBI symptoms and can provide them with accurate feedback regarding their social behaviors and provide information about their physical and social environments. Psychologically, it’s far more therapeutic for BI sufferers to think: “I feel the way I feel because I’m broken. But there are things I can do to fix it;” Than to experience the hopelessness of thinking: “Your feelings aren’t real. You’re imaging them. You’re just crazy!”

Implications for AOD Treatment

Typically, most sufferers of NLD/BI are not aware of their condition. Even those with head trauma in their past often don’t equate that injury to their current symptoms. As such, the full force of NLD behavioral consequences, such as societal alienation, impact them without warning. Alcohol and other drug (AOD) abuse frequently becomes the ‘go-to’ solution to escape their harsh misperceptions of reality. It is said that: “Alcoholism is a disease that tells you that you don’t have a disease.” The same can be said about white matter brain destruction (BI). Sufferers are unaware that their perceptions of reality are inaccurate. They are utterly oblivious of their symptoms and puzzled and resentful at their increasing societal estrangement.

AOD abuse greatly exacerbates the debilitating symptoms of NLD/TBI. When individuals with NLD/BI symptoms enter AOD treatment programs, remediation of AOD abuse/addictions, prior to addressing behaviors symptomatic of BI, is the first priority. If BI is suspected, then speculation becomes: “If a client is the victim of BI, is there actually a problem with AOD addictions? The answer to that question is: It doesn’t matter! Sobriety is an essential part of BI/NLD remediation. Whether or not the client is truly addicted is irrelevant. Sobriety alone will not eliminate BI/NLD symptoms, and the progress of remediation on BI/NLD symptoms is defeated by AOD use/abuse. As such, successful AOD treatment and sustained sobriety are essential if clients wish to reclaim control of their lives. NLD/TBI sufferer’s will require sustained sobriety to stave off the intensifying effects of AOD abuse on their NLD/BI symptoms. As with alcohol and other drug addictions, a relapse into NLD/BI behaviors can be catastrophic.

The introduction of 12 step programs in remediation is highly beneficial. For such programs, the only requirement for membership is a desire to stop drinking or using. The advantages of 12 step programs for those with NLD/BI symptoms are that they: are perpetually available, offer fellowship, offer a design for living, assist with societal reintegration, are spiritually uplifting, offer opportunities to serve others, are voluntary, offer suggestions - but no rules or mandates, have no dues or fees, etc. To be clear, clients entering AOD treatment may be totally unaware they suffer from symptoms of NLD/TBI. In consideration of the Navy SEAL in the article, it is incumbent upon AOD counseling staff to monitor the behaviors of all clients for difficulties other than drug and alcohol abuse. An AOD recovery center’s counseling staff should be aware of these debilitating symptoms and watch for indicators of them in clients.

Assessment for suspected BI

People enter AOD treatment for various reasons. Rarely do they present for help with BI. However, if a BI is present, it is usually the underlying causal factor of their difficulties. As such, it is incumbent upon counselors to watch for signs and symptoms of BI and assess further if necessary. In my practice, I use an extensive battery of assessment instruments designed to encompass and measure a broad spectrum of abilities and disabilities. If NLD markers are present, they show up across the full range of results. However, symptoms are clearly manifest in certain instruments. As such, if BI is suspected, therapists should administer, or have an educational psychologist administer, a full spectrum intelligence test that measures both Verbal and Performance (Non-verbal) IQ’s. There are several instruments available, those with manipulatives may prove more diagnostic to NLD/TBI.

To be clear, it is not the IQ of the client that is of interest, but rather the point spread between the Verbal IQ and the Performance/Non-Verbal IQ. To explain, an ‘Average’ IQ standard score is 100. Ideally, for an average individual, their Verbal IQ (VIQ) and Performance/Non-verbal IQ (PIQ) ‘standard scores’ should both be 100, indicating that they can think and reason equally well within both the verbal and non-verbal realms. Those with neuro-cognitive (BI) anomalies will typically display significant difficulty in the Performance/Non-verbal (visual-spatial-motoric) problem solving area and score higher in the Verbal area. In general, a PIQ that is 10 or more points below that of the VIQ, is a significant indicator of possible white matter deterioration (BI). If this pattern is present, it is then appropriate to review the client’s health history for BI and probe into the other types of previously noted causal factors. Often these factors are not annotated on intake questionnaires. If these scores, health history, and behavioral symptoms are present, then a diagnosis of NLD is warranted. At present, NLD is not listed the DSM-5/ICD-10. However, it is finally under review for inclusion. However, regardless of its official classification, knowledge of the presence of this condition and its remediation processes will prove exceptionally helpful to the client’s recovery.


Had the Navy SEAL in this article been evaluated for NLD/TBI, it’s likely that he would be among us today. His father stated that: “Had I known that he was dealing with a ‘physical issue,’ that would have changed everything.” One heartening revelation resulting from this SEAL’s suicide is that the Navy has commenced cognitive testing of Special Operations personnel, with follow-ups required every two years. I pray that these efforts will prevent future occurrences of such needless and heartbreaking events. It is also my hope that AOD counselors will gain and understanding of NLD/TBI symptoms and formulate caring remediations for those who suffer unknowingly from the consequences of this debilitating disorder. Such remediation will help prevent relapse and assist with successful reintegration into society.

People Magazine article:

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