Tulsi Gabbard interview with Chet Cooper discusses TBI, PTSD, Aloha and more

Tulsi Gabbard
US Representative Tulsi Gabbard

UPDATE: 3/19/20 Tulsi Gabbard drops out of the race and endorses Joe Biden

2/07/20 — The first female combat veteran running for President of the United States, US Representative Tulsi Gabbard (D-HI), brings a unique perspective to the 2020 race. Rep. Gabbard took a break from her Presidential campaign in New Hampshire to talk with ABILITY Magazine and shared how her lived experience and front-line, active duty service lead to her run for the President of the United States.

Rep. Gabbard and ABILITY’s Chet Cooper discussed the lasting effects of war, including the steady rise of invisible disabilities like Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD)—that may not be identified until long after the trauma, if ever. As we recently learned, 64 US service members are being treated for (TBI), weeks after an Iranian missile attack on Al Asad Air Base in Iraq. Veteran suicide rate remains alarmingly high.

Rep. Gabbard believes the consequences of endless war are not getting the full attention they deserve from the US government. She cited greater needs to support of veterans, healthcare, education, disability and much more.

Tulsi Gabbard and Chet Cooper connected via a video link while Tulsi was on the campaign trail.

Chet Cooper: I just realized over the multitude of years and the many politicians, including Presidents — I’ve never interviewed somebody in a current presidential race.

Gabbard: Oh, wow!

Cooper: So, it’s a little bit more serious because of what you’re trying to accomplish. So let’s talk about the gray in your hair?

Gabbard: (laughs) Yes! I do have a good chunk of gray.

Cooper: I just saw another study linking stress to gray hair.

Gabbard: I actually started getting this gray chunk during my deployment to Iraq. And I kept it as a reminder.

Tulsi GabbardCooper: With that daily reminder does it help you connect with your Aloha message?

Gabbard: Well, I tell you, Washington is in desperate need of aloha. The world is in need of aloha. It’s such a beautiful thing that I take with me everywhere I go and share with everyone wherever I go. It’s mistakenly often thought to mean “hello” or “goodbye,” but it means neither. The reason why we greet each other with “aloha” is because of the powerful meaning this word expresses.—“I come to you with respect and with an open heart and with love,” and with the recognition that no matter where we come from or the color of our skin or how we work or if we worship—It cuts right through and recognizes that we’re all connected, we’re all brothers and sisters, all children of God. And therefore, we’re inspired to treat each other with that most deep respect and care that inspires us to take action to care for one another.

Cooper: Where did this philosophy originate?

Gabbard: This comes from Hawaii. We call it “aloha” in Hawaii, but it’s something that I’ve experienced in so many different places where I’ve gone. They may call it different things, but it’s something that in our home state of Hawaii—where we have the most diverse state in the country, people who’ve come from all different parts of the world—and a very strong native Hawaiian culture where this “aloha” spirit originates from. It is what enables us to have this melting pot without the divisiveness and the vitriol, and even some of the violence that we’re unfortunately seeing in some parts of our country.

Cooper: With this philosophy, how did you deal with going into harm’s way when you enlisted and were deployed?

Gabbard: Well, you know, it’s understanding that as we’re going into these other countries, in other parts of the world with different cultures we may not have been exposed to before, and that even in those situations—especially in those situations—having this aloha and respect and empathy for others is a powerful thing. This is something that we experienced directly when I worked in a medical unit. We were deployed to Iraq in 2005. It was the height of the war. When we first got there, the unit we were replacing was experiencing very high casualties; and we had a brigade combat team that was close to 3,000 soldiers from all across Hawaii, Polynesia and the Pacific.

One thing they noticed that was different when they got there was, rather than immediately having an adversarial posture when they went on patrols through these different communities, our folks from Hawaii just started waving out to people as they were driving by and saying, “aloha” or “’talofa lava”. People started to drop their guard and say, “Hey, wow, you’re treating me with respect,” and (started) reciprocating.

Having this relationship enabled our soldiers. The people started saying, “Hey, don’t go down that road. We saw someone digging there last night planting an IED, a roadside bomb. Be careful. Don’t go there.” They were giving (US soldiers) pointers on how they could be safe and where they could find those terrorists, or those who were seeking to do harm to others. In any of these situations, leading with aloha is the most powerful thing, and it’s driven by love.

Cooper: That’s a strong message, especially when it’s coming from people in uniform during battle time. What was your background that brought you into a medical unit?

Gabbard: I had no background in any medical field before I entered the military. I was basically trained in administration and logistics and operations. So I worked to serve our medics, our doctors, and our entire brigade combat team. I served to ultimately ensure that our troops were getting the care they needed—that they had everything possible if they were injured or if they were casualties—and to get that care as quickly as possible, to evacuate them out as quickly as possible, and also to support some of the humanitarian missions that our soldiers took on.

Cooper: Do you have any—

Gabbard: Excuse me one second. (pause for important political business) All right. All set.

Cooper: You didn’t have mute on. I’m kidding, you did have mute on.

Gabbard: (laughs) I was saying all kinds of things about you.

Cooper: (laughs) Well, that’s understood. Where was I?

Gabbard: About the medical unit that I served in in Iraq.

Cooper: I was going to lead into was TBI, traumatic brain injury. And then just recently with this attack in Iraq. There’s now reporting that 40 or so of our people have a TBI. Is there anything connected to that story line that you feel like sharing?

Gabbard: It’s something we’re seeing in so many of my brothers and sisters in uniform who have served or are deployed to these different wars in different parts of the world. They’re having these traumatic brain injuries that went undiagnosed for a long time. There’s still a huge lack of awareness and information about the impact that this is having on people.

Tulsi GabbardI was deployed in 2005 when they weren’t testing for TBI in the way that they are today. I think, even more importantly, they’re now doing tests before and after deployments, or before and after significant attacks or events take place. So now you’re able to measure the differences in someone’s cognitive ability and other things to be able to best diagnose TBI. I think there’s a long way to go to help prevent these situations as much as possible, but where it’s not preventable, to be able to treat them in the way that’s needed. This is something I think we need to push forward further in the military, but also within our country.

A friend of mine whose son is in high school playing football—he’s also a wrestler and an amazing athlete—has experienced a few concussions and what is now being diagnosed as TBI. He fell into a seizure and was unresponsive for a few hours. Now he’s going through therapy because he’s having difficulty doing the most basic things, like counting and identifying colors and shapes and doing jumping jacks—the things he used to be able to do without any issue whatsoever. He’s now working through this, and thankfully, there’s a facility that’s able to help him. I think there are a lot of folks who may have these same issues, but who are either going undiagnosed or don’t have access to the kind of treatment they need.

One area where I know there’s a lot of research being done towards this—and where I think there’s so much potential—is in the area of CBD and cannabis treatment. There are studies being done with NFL football players where if they’re treated immediately with CBD after a concussion or the impact takes place, it drastically reduces the negative impact on their brain that that injury would have had otherwise. We’ve got a lot of work to do in this area.

Cooper: I came close to having a neurosurgeon who’s part of our team on this call (his TBI sidebar below). The other issue is post-traumatic stress disorder. Can you talk about the experiences you’ve had or the issues you’d bring to the forefront if you became president?

Gabbard: I think the VA is an organization that has a mission to protect and to serve the needs of our veterans, those who go and are willing to sacrifice all for our country. And, unfortunately, what we’re seeing is that even after all these years, both in the post-9/11 era of veterans and also the Vietnam and Korean war veterans, the services are still falling short. This area of post-traumatic stress is one of the main areas where that’s true. There continues to be a stigma around this, whether people are willing to it admit or not, both within the military and also of people who transition back to their civilian lives.

I’ve experienced it through some of my friends who have come home really struggling and having a hard time finding the best place that can help them. This is one of the drivers behind the continued rate of veterans’ suicides that we’re seeing in our country and shows that we have to take a more holistic approach.

Tulsi GabbardThis is what I would lead as president where, as a veteran, I understand in a deeply personal way who pays the price for war and how heavy that price is. I will ensure that our VA leaves no veteran behind, that every single veteran gets the care they need. And as we look at post-traumatic stress, there are many different levels of how it impacts people on a whole spectrum—some very extreme situations, some maybe less extreme—but every person heals and finds their therapy and their path forward in a different way.

As a VA, as a government, as a society, we need to be able to help support that journey. I had a woman who worked for me in my congressional office who’s a military spouse and her husband had many deployments and had been exposed to some of the most extreme environments and situations that had deeply impacted him. He got to the point where he couldn’t fly. He couldn’t travel. And they didn’t know what to do to help him. He didn’t want to just take drugs to try to numb the pain.

For him, their breakthrough happened when they had a plant that was dying on their front steps. He was home and started watering the plant, taking care of the plant, trimming the plant, and started to bring this plant back to life. And he experienced—as well as his wife—saw that that was awakening something in him that had been lost for a long time. Long story short, now they have a farm with many acres. He has found his path toward peace by working the land and is inviting other veterans there to come and join him and finding that connection with the earth and growing food and plants as a way forward for them.

Meditation is something others are finding helpful or working with animals, horses, dogs, and other animals. Even through surfing, actually. I’ve been surfing with severely wounded warriors, disabled veterans, and others who are finding their empowerment once again in the ocean. It’s an incredible thing. We’ve got to support this holistic approach to treating the root cause rather than just seeing mental health treatment and treatment for PTSD as something that can only be responded to with more drugs.

Cooper: Can you share again about your gray and the stress issue that we talked about earlier?

Gabbard: I get asked about the gray in my hair. It started to go gray during my first deployment, and over the years I’ve decided to keep it because of the reminder that it brings to me of those who pay the price for war, the cost of war. We’ll never forget.

Cooper: FYI, one of the things that our nonprofit does is to work with Habitat for Humanity. We build homes for families with disabilities of low income, and we access volunteers with disabilities to build the homes.

Gabbard: Awesome!

Cooper: We’ve done one on the Big Island and one on the North Shore. And then we access military people with post-traumatic stress disorder, amputation, limb loss, and the benefits that they get from volunteering, sharing, and giving to others, which is what our psychiatrist talks about: the healing aspects of volunteering.

Gabbard: Yeah, absolutely. I can see that.

Cooper: At some point, we’ll come back and do some more work in Hawaii, so I hope we can stay connected.

Gabbard: I would love to be able to contribute and be a part of that in any way I can.

Cooper: It’s an incredible multiple-win situation, for the community, for the families getting a home, and for the people we access who come out for the first time doing something as tangible as building a home. In Baltimore, there was an organization dealing with people who are blind. They had a lot of volunteers come out who were blind. We literally had people on the roof who were blind building the roof. It’s amazing what can be done if people put their minds to it.

Gabbard: That’s right. And you provide the opportunity. There’s nothing more rewarding and empowering than being of service to others. And what an incredible way to be able to invite people with all different abilities to be able to help contribute and experience that same sense of deep happiness and rewards. That’s beautiful.

Cooper: I couldn’t have said it better! (laughs) You should be our ambassador.

Gabbard: Not a problem! (laughter)

Cooper: Anything that you could share about the people with disabilities within your platform?

Gabbard: Sure. I think there are some broad areas where we need to do better as a country for those who have different abilities. Employment is a big one. We have someone in our own family who is currently employed at Goodwill, but her options and opportunities are very limited given the construct and the laws that we have now—both in the limitations of pay and in what she and others are allowed to be paid. In many cases, they can’t even earn a minimum wage, which therefore then limits a lot of the other opportunities that they would like to be empowered themselves.

Unfortunately, we still see a lot of discrimination in the workplace. These are things that we’ve got to be able to tackle. Employment, housing, education, and healthcare, and even our criminal justice system. Unfortunately, we have more and more situations where those who are dealing with different challenges or mental health challenges get caught up in our criminal justice system because our law enforcement officers are not trained to recognize these different issues and to be able to divert people in need to get the help they need. They instead get caught up in a system that is ill-equipped to provide the services necessary.

I think recognizing the lack of awareness and the lack of resources and training needed to deal with them is the biggest shortcoming across the board in all of those areas I mentioned, rather than just saying, “Those who have different abilities, OK, we’ll take care of you.” But you’re segmented off on the side of the room or at a different table in a different room, rather than recognizing the contributions they have to offer our country—just the same as every other American should be recognized and provided those opportunities to do so.

Cooper: Even with first responders. Do you know the actress Camryn Manheim?

Gabbard: I don’t.

Cooper: If you see her, you’ll recognize her. When she was in college she was on a scene of an accident. The person was on the ground and people were trying to communicate with this person. And then it dawned on her, “maybe they’re deaf.” Camryn had just taken sign language as a second language college requirement. She went over and signed ,’are you deaf?’ and sure enough, he responded.

Gabbard: Wow!

Cooper: So there’s a whole issue of not only the police, but in all aspects of our society of how we have a tendency not to think beyond what’s in front of us. It’s a big issue, whether it’s deafness, blindness, whatever the case may be.

Gabbard: That’s a good point.

Cooper: We got something from Elizabeth Warren and Pete Buttigieg about what they would be doing around disability policy. Have you been able to put anything together on this issue?

Gabbard: We’re still working on putting together on paper, in each of these areas, what my vision is for the kinds of changes we need to see as a presidential platform. These are issues that I’ve been closely involved with and working on with legislation in Congress—both cosponsoring bills like the AIM HIGH Act and others and bringing voice to those who are my constituents and others in the country who are still not being represented at the table where a lot of these decisions are being made.

Cooper: Can you talk to us about the AIM HIGH Act?

Gabbard: The AIM HIGH Act [H.R. 1772, the Accessible Instructional Materials in Higher Education Act], as well as the Disability Integration Act (DIA) [S. 117 and H.R.555], are two bills that we’ve been pushing forward. I was proud to support the ABLE Act [Achieving a Better Life Experience Act of 2014] that was signed into law. Each of these bills help to improve the situation, but I don’t think they go quite far enough to address the problems we’re facing.Tulsi Gabbard

Cooper: One of the issues I was thinking about—because I know a lot of your key issues that separate you from the other candidates— is the nuclear threat, and how we get to these potential tipping points of destroying each other. Yours is different and unique because of your experience just recently with the alerts in Hawaii. I don’t think many people on the mainland are able to put their minds on what everyone on the island was experiencing. While it was a false alarm, it also was real to you and everyone. It was, in reality, what could happen.

Gabbard: It was real because the threat’s real. That’s why everyone reacted in the way they did. On that Saturday morning in 2018 when this alert went out from our civil defense agency saying, “Missile incoming to Hawaii. Seek immediate shelter. This is not a drill.”

At that moment, I think we all thought, “There’s just 15 minutes to live.” It said, “Seek immediate shelter. This is not a drill.” Where is shelter to be found? I was in DC that morning, but my parents and my family were in Hawaii. I immediately started thinking, “Where can they go?” And just like everyone in Hawaii, we had college kids sprinting across their campus trying to think about where there was shelter, not knowing where to go, looking for a concrete building, something of this sort, but not really knowing. It probably wouldn’t be enough to protect them from a nuclear missile incoming to our state.

A father lowering his little girl—probably seven or eight years old—down a manhole, thinking maybe that would be the only place they could find safety. And being confronted with the reality of how our leaders have failed us in putting us all, not only the people in Hawaii, but people across our country, in a situation where we are on the brink of a nuclear catastrophe.

We’re seeing escalating tensions between the US and other nuclear-armed countries like North Korea, Russia and China, and yet even as the fancy civil defense system tells us to immediately seek shelter, there is no shelter. No shelter to protect us from the immediate blast. There’s no shelter to protect us from the nuclear fallout. No shelter to protect us from the years of nuclear winter that would follow.

This brings us to the point you’re talking about, this true wakeup call that we had in Hawaii, and that the whole nation, and frankly the world, needs to recognize. Most importantly, this is the reality we’re facing. It doesn’t have to be this way. It will take strong leadership to exercise diplomacy, to de-escalate these tensions and walk us back from this brink of nuclear catastrophe so that what happened to us in Hawaii does not have to be the reality for every person, every family, every child in our country. This event in Hawaii was the major thing that started to get me to think about running for president. It’s the reason why I decided to do so.

Cooper: It’s definitely a moment, a realization. Just the fact that the system was wrong, that there was a glitch, and that somebody on our side might respond and therefore trigger the whole domino effect, it’s like something out of a movie. What movie was that—Peter Sellers?

Gabbard: Oh, gosh, I know what you’re talking about. I can’t think of the name of it. But look at—what was it, four days ago now?—The Bulletin for Atomic Scientists just set the Doomsday clock 100 seconds before midnight because they recognize that whether it’s intentional or accidental, an unintentional start to a nuclear war, a nuclear attack launched, it pushes us to the point where we will see the destruction of our planet.

Cooper: We work with the UN on the CRPD, the Convention for the Rights of People with Disabilities. I was at a private event where the ambassador to Israel was speaking. We were talking about—and I’ve been to Israel and Palestine and I see how the medical doctors out of Israel are working with Palestinian doctors to help children with CP on both sides of the fence, if you will, because kids are a common denominator for everyone. We all want to care for our children.—And when he started his speech, the ambassador said that he thinks that maybe the common denominator to start all peace dialogues are our children. And the fact that as adults we get jaded and we think they’re the enemy. But when you start digging deeper into the idea that we all love our children and want the best for them, finding that common denominator will always be difficult, but children with disabilities seem to be the most heartfelt because parents want to do their best for the quality of life for their children.

Gabbard: That’s a great point. That helps to see past the polarization and the conflict and the tensions that in some of these countries have been going on for generations, if not centuries. And that once we see through all of these barriers, when it comes right down to it, all parents do want to see their kids grow up and be safe and have opportunities and live a good life.

tulsi surfingCooper: This was fun. I hope we stay connected, and we’ll build something in Hawaii and you can be part of that as well, and maybe I can go surfing with you and your husband. I’m sure you’re definitely better than I.

Gabbard: What kind of board do you use?

Cooper: I have a custom board that is thicker and wider because I’m older now. It allows me to be outside where the longer boards would be yet it’s small enough that I can catch a faster break wave and still maneuver a little bit. But I can’t get air or do anything like that. Can you get air?

Gabbard: No, I don’t. I’m more of a fun surfer than a trick surfer or anything like that. I don’t get too fancy. But a long-time family friend of ours—I’ll close on this story before we go—he was in a motorcycle accident when he was probably 18 or 19 years old and lost the use of his legs completely. He’s a hard charger throughout his life—very successful entrepreneur, small business owner—and he basically created a moped or motorcycle that he could roll his wheelchair up onto and goes 45, 50 miles an hour over the highways in Hawaii. Maybe they do this now everywhere, but he did this like 20 years ago. He’s created another thing where he basically just hooks an engine onto his wheelchair and is able to go anywhere using that.

Long story short, in the last few years, he began to join this organization I’ve been supporting for a long time called Access Surf in Hawaii. They have different days for veterans and others with disabilities. He started going out with them, and in his early sixties, he discovered a love of surfing in the ocean that he’d never experienced before. Now he’s doing all the research, coming up with his own custom boards and catching waves and eating it. He’s sending me pictures of himself with a GoPro with this look of stoke on his face. He looks like an 18-year-old boy, experiencing that sense of freedom and fun and pure joy. You know that feeling you get when you’re out in the water and you catch an amazing wave? It’s incredible.

Cooper: So when this dust settles, if you don’t become the president, where do you go from there? What are your intentions? Have you thought about that?

Gabbard: I have not. My life is centered around finding the way that I can best be of service to our country, and no matter what happens, that’s what I’ll continue to do. And maybe I’ll be your spokesperson, who knows?

Tulsi Gabbard

About US Representative Tulsi Gabbard

Born on American Samoa’s main island of Tutuila in 1981, Rep. Gabbard’s family relocated Hawaii, where she grew up. She became the youngest woman, at age 21, elected at the time to the US state legislature, as well the youngest person elected to represent the 42nd district of the Hawaii House of Representatives. She’s also the first Hindu member of Congress and the first American Samoan voting member of Congress.

In 2004, Rep. Gabbard enlisted in the Army National Guard and deployed to Iraq for a 12-month tour and later served in Kuwait. Upon returning home, she resumed her career in politics, first being elected to Honolulu’s City Council and later re-elected to the House of Representatives. Rep. Gabbard is currently a Major in the Army National Guard Reserve.

brain scans TBI

Trauma Brain Injury (TBI) due to BLAST Effect…Even in a Bomb Shelter

[W net = 12mv2? 12mv20 = ? KE W net = 1 2mv2 ? 12mv02 = ?KE]

Wait! Come back! There is an easier way to understand “blast effect” than the complicated equations that describes the energy involved.

It’s all about forces and how they behave. (For the physics geeks, I’m not getting into the relationships between energy, momentum, and forces; let’s just call it “forces” for the sake of this discussion.) Many of us have seen the Indianapolis 500 race car that rolls over 3 times, wheels flying off and landing in a crumpled heap; then the driver gets out and walks to the pits mostly unharmed. Yet, when that guy didn’t stop at the stoplight running into the back of our car only denting the rear quarter panel, our back and neck was in crippling pain for weeks!?

Forces behave unpredictably and counterintuitively in “systems” like car crashes and bomb explosions. When there is a change in the system (cars in a collision or bombs striking a target) forces are redistributed, say from moving the car down the road to crumpling the rear quarter panel and injuring the tissues of the driver’s body. Why in some situations more of the forces go into one as opposed to the other is difficult to explain in any given system (car crash, bomb explosion), but that’s how it happens. Some systems, like safer cars, are designed to direct more of the forces into destruction of the vehicle rather than the driver (warning: don’t get in a major collision driving a ’65 Cadillac – the car is likely to fare much better than you will.)

Now, let’s examine the brain and the bomb shelter. The extensive forces imparted by an exploding megaton warhead are mostly obvious (i.e., a big hole in the ground or a destroyed building), but the “blast effect” created is a significant part of the forces imparted. The intense compression of the surrounding air moves faster than the speed of sound. These “forces” can be sufficient to transmit through the thick cement walls of some bomb shelters and sufficient to pass through the individuals inside. (For this discussion we are not including the secondary effects of shrapnel; surrounding debris and parts of the bomb that are turned into penetrating items like so many bullets that cause “penetrating” injury.) In a confined space, the forces may toss the individuals about, resulting in bodily injury. This may include vigorous shaking of the head causing injury to the brain. The brain is both one of the most easily injured body tissues and is suspended in a thin layer of fluid inside the skull allowing for it to “float about” striking the inside of the skull causing damage.

However, with blast effect, no movement is required. Even if a soldier is relatively shielded from the blast, massive forces like those of ballistic missiles are sufficient to transmit through bunker walls, through the skull, and directly distort the “Jello-like” tissue of the brain, resulting in injury to the cells (neurons) and thus symptoms of a concussion, including cognitive impairment.

While most post-concussion symptoms get better with time and can be managed with simple things like Tylenol for the headaches. There are many potential symptoms of a concussion other than headaches, such as blurred vision, ringing in the ears (called “tinnitus,” pronounced “tini-tus”), and nausea, amongst many others. As for the “cognitive dysfunction,” this includes difficulty with short-term memory and concentration. This often does not get much better and the soldier is left with substantial impairment that precludes anything approaching a normal life. There is little effective treatment for brain injury and in general one just must remain hopeful that things will get better with time, but cognitive therapy is often provided and beneficial.

by Thomas Chappell, MD


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