This is one of the big areas of research that is going to have to put some meat on the bone. Mild traumatic brain injury is another one of those cases in which the military has brought brain injury to the Canadian psyche. Until the military's MTBI. mild traumatic brain injury, issue, concussion in hockey players and football players was almost unheard of; nobody talked about it. We have actually brought this out, and they're learning from our experience also.
The fundamental difference between concussion in the civilian sector versus concussion in the military sector is that when a hockey player is hit, it is in the context of a game; the other person hopefully wasn't trying to kill the player. By contrast, in the military sector, the very incident that caused the concussion—a bomb or an IED—is in its very nature threatening the soldier's personal psyche and viability as a human being. The exact incident that could cause MTBI is also the exact precipitating cause that would trigger a PTSD. The question is which comes first, or do they both come at the same time?
Here, I would caution you a little bit. Even within the medical community I think stigma plays a part here. People are desperately trying to find a biological reason to explain why you might have PTSD. To me, there is an inherent potential stigma that the medical community itself applies, because the idea that somehow this huge, traumatic event, which is not normal for most people—somebody tries to kill you in a very horrific way—could not possibly be caused by psychological factors, but rather that you must have received some kind of unforeseen concussion, through some kind of traumatic, compressed air.... It may be, but I think we have to be very careful that if we go too vociferously in that one direction, we are not inadvertently further stigmatizing people.