06/18/2021
Racism, Brain Injury, and the CDC
J K Dilks
A 2016 Proceedings from the National Academy of Sciences cited a University of Virginia study that found 50% of medical students believed African Americans did not feel pain the way Whites did. The students' belief that African Americans required more radiology came out of the 19th Century. Who is to say an untruth about persons diagnosed with brain injury hasn't also sifted through to medical schools?
For example, the baseless theory that a fixed number of time-dependent recovery plateaus that, over time, have transformed into social identity and social connectedness plateaus being the primary foci of rehabilitative care, monopolized brain injury recovery schedules for years and is wrong. Erstwhile law-abiding citizens diagnosed with brain injury stuck in a justice system that upbraids survivors of brain injury mooring themselves to a catch-as-catch-can recovery approach that prizes the punitive over the rehabilitative is where the downfall begins. Hundreds are powerless and voiceless for every one of us who is not. Exposing survivors of brain injury to the harsh punishment and treatment given by the criminal justice system as though they are the feral few is inappropriate. Time and dedication to recovery, undeterred by plateaus, are positively related and independent of social virtue.
The plateau theory created an environment where recovering survivors of brain injury subserve economic privation when a person lacks the basic skills to maintain an acceptable standard of living as a by-product of brain injury. Economist Joseph Stiglitz expresses this market failure relationship in a different form: economies with imperfect information concerning qualities of individuals differ in fundamental ways from economies of perfect information.
What was once the world's most deregulated medical community, nimble enough to offer quality brain injury rehabilitative care, has failed. Beginning in the 1980s with the founding of the National Head Injury Foundation, the witting complicity of organizational brain injury leadership ultimately described in 1992 by the New York Times article, "Treating of severe brain injuries is profitable, but not for patients," exposed a cascading crisis, which denied hundreds of thousands of survivors their only opportunity ever to re-enter their community.
Every day that passed without science and modeling to provide any guide to understand the abstract brain injury recovery concept, the US Centers for Disease Control and Prevention became less relevant because it couldn't make common-sense recommendations. The CDC's overly timid approach plus the 1970s reported memoir of positive brain injury recovery I brought to national prominence through the 1976 Washington Post article, "Paralysis No Bar to Dilks," about an Olympic pole-vaulting hopeful who had arranged his entire life around developing an athletic skill he no longer had creates a troubling contrast.
The latter meant that by 1992 when NIDRR Director, Dr. William Graves, asked me to join the CDC team to help develop the CDCs brain-injury definition, the incredible sojourn in collegiality and comity associated with the 1970s contours of brain injury rehabilitation directed by Roger Gisolfi, MD, Neil Medoff, MD, and Occupational Therapist Alice Burton was lost.