Foreword

In 2006, our world was moving forward as most people's do. Bob was traveling overseas for his job, Lee had work deadlines, kids to get to school, the stuff of everyday life.

And then, as happens to so many others who experience a traumatic event, life changed in an instant. For some, it is an unexpected fall or sports injury, a car or bicycle accident; for others, an act of violence. For our family, it was a bomb in the middle of an Iraqi war zone.

Bob had newly been named the co-anchor of ABC's World News after the untimely death of Peter Jennings. He was in Iraq to report on the progress of the coalition forces.

The 155-mm shell exploded about 20 feet from the armored personnel carrier when Bob was filming above the hatch. Hundreds of rocks packed around the shell blasted into his face, neck, and back, and the power of the explosion shattered his skull. The prognosis was grim, and as is often the case with a traumatic brain injury (TBI), the extent of the concussive effects of the injury, the shearing of neurons within the brain, and how that would affect Bob was impossible to know initially.

Our family began to travel on the rollercoaster that too many others know so well, experiencing the many octaves of pain, suffering, grief, frustration, expectation, disappointment and, on good days, small blessings. We learned to hold hope for ourselves on the days when the medical community wouldn't or couldn't offer it. We adjusted to life in "the new normal."

Most people with TBI would tell you that the injury or the accident is the easy part. After five weeks in a medically induced coma, Bob did wake up, and he began the most difficult portion of his journey—the journey to return to himself through recovery. This involved an excellent medical and rehabilitation staff, including cognitive work with a neuropsychologist. Through a combination of determination, sheer will, repetition, rest, focus, the love and support of family and friends, and the sheer power of the human spirit, Bob drove his recovery.

Each year, 1.5 million Americans receive a brain injury, and 5.4 million live with this injury every day of their lives. These are often the people whom one doctor referred to as "the folks that live in the back of the house." They are often mistaken for the mentally impaired, socially unacceptable, inebriated, or simply inappropriate and "off." TBI can result in a range of emotional, behavioral, and/or cognitive impairments, among them a quickness to anger, loss of executive function, depression, emotional highs and lows, inappropriate behaviors, or colorful language when the filter is gone from the impact. These differences often lead to vast changes in relationships; one statistic places the divorce rate after TBI at more than 80%.

In the past few years, with the wars in Iraq and Afghanistan, the number of TBIs has risen dramatically, making it the signature injury of this war. In previous wars, soldiers did not survive the more severe kinds of head wounds. Those who did were diagnosed with "shell shock" with little or no treatment prescribed. Medical technology and intervention, as well as better body armor, have increased survival rates. In the sixth year of the war, a new study confirmed that at least 325,000 of U.S. returning troops have some form of a brain injury with or without concomitant posttraumatic stress disorder, combat stress, and/or personality disorder.

Severe TBI is often obvious. The person may live for months, before the cranioplasty, with part of their skull missing, or the resulting scars may be visible. But many brain injuries are hidden. Once the person heals on the outside, the damage remains on the inside, which is why the brain injured are often referred to as the "walking wounded."

Sadly, we are welcoming home a new generation of wounded with our returning veterans. This has placed TBI somewhat more prominently in the public's eye. But there is so much more work to do in the areas of public awareness and education, scientific research, long-term rehabilitation, and insurance reimbursement.

The good news is that the war is rewriting what we know about TBI in many ways. It used to be believed that after almost two years a person was mostly finished healing. Now, with a better understanding of the power of cognitive rehabilitation and the brain's keen abilities to rewire itself, we are seeing progress in ways that could only have been hoped for decades ago.

It is critical that TBI be recognized as a major health problem, and resources must be devoted to educate psychiatrists, rehab specialists, and other mental health professionals about all the various aspects of this serious and life-changing epidemic.

We were honored to write the foreword for the Textbook of Traumatic Brain Injury because information is the key to understanding TBI and bringing about the critical support that millions of families need. It is our hope that this text will aid in understanding the very complex and individual nature of TBI and help to educate and inform professionals who are often not trained in this critical area. The authors are well known in the field, and the variety of topics provides a comprehensive resource housed in one volume.

This second edition of the Textbook of Traumatic Brain Injury, published by American Psychiatric Publishing, Inc., is a comprehensive, up-to-date book co-edited by three neuropsychiatrists with extensive academic and clinical expertise in the assessment and treatment of people with brain injury. It comprises 39 chapters that are divided into five sections that cover, comprehensively, the assessment, pathophysiology, signs, symptoms, and treatment of those who with TBI. This is a lively, practical, and interesting book that will be of vital help to professionals of almost every medical specialty, as well as the full range of mental health professionals who care for those among us who have suffered from this disabling condition. We who know, first hand, the painful and disabling effects of TBI derive hope from the science and treatments described in this book and are grateful to Professors Jonathan M. Silver, M.D., Thomas W. McAllister, M.D., and Stuart C. Yudofsky, M.D., for editing and organizing this remarkable text.

Bob and Lee Woodruff