I don't know what's happened. Maybe it's all the attention generated by the number of brain injuries in the Iraq War. Maybe it took a celebrity speaking out (and writing a book), like Bob Woodruff, to finally focus widespread attention on this pervasive condition. But whatever the reason, I can only say it's about time.

If you've been reading this blog for any length of time, you probably know that Jack wants Harvard to do a study of brain injury in the homeless population. He believes, as do I, that TBI is more widespread among the homeless than most people think. He also believes that such a study, coupled with appropriate medical and rehabilitative intervention, could reduce homelessness. And it could serve as a pilot project for other areas across the country to follow.

Another of Jack's concerns is TBI in our prisons. There have been many discussions about the number of brain-injured people on Death Row -- some believe all are brain injured while others acknowledge that most probably are.

In Jonathan Pincus's excellent book Base Instincts, he advances the theory that ethics and morals originate in the brain. Pincus re-tells the story of Phineas Gage, a 19th century railroad worker who sustained significant frontal lobe damage when a tamping iron shot through his head. Gage survived the injury without losing consciousness. Although Gage’s cognitive ability was unaffected – he could still read, write, and do arithmetic -- his behavior, by some accounts, changed dramatically, in ways characteristic of a loss of ethics and/or morals. Gage began drinking, fighting and carousing, ending his life as a vagrant. The medical museum at Harvard obtained his skull because the idea that a lesion to the brain could affect ethics and morality, especially when cognitive functions were left intact, was quite shocking at the time.

Pincus further theorizes that 3 distinct elements combine to cause violence. The first of these is brain damage. The second is mental illness. And the third is child abuse. Abuse here is defined as treatment that leads to a legitimate and daily fear of injury or loss of life.

Pincus notes than none of these three components by themselves leads to violence; 80-90% of abused children do not commit abuse in adulthood. And we certainly know that only a small minority of mentally ill persons or those with one or more TBIs commit violent crimes. But if some of the violent crimes being committed are caused by a medical condition, does it make sense to put that person in prison? To punish him for having a brain injury or some form of mental illness?

There have been various studies done over the years, but they've been infrequent and, to my knowledge, not much ever came from them. Now, however, the Department of Justice and the Centers for Disease Control are jointly and publicly discussing TBI in prisons, more so than they've done in the past. For example:Of the more than 2 million people in America's prisons and jails, 25% - 87% report having had a head injury or TBI compared to 8.5% of the general population.

As anyone familiar with TBIs know, many of its symptoms can lead to additional problems for sufferers in a correctional facility. Memory deficits, irritability , anger, slowed verbal and physical responses, uninhibited behavior -- if misinterpreted, these can lead to disciplinary action by guards and/or altercations with other inmates. In 2006, the Commission on Safety and Abuse in America's Prisons issued a report recommending increased health screenings, evaluations and treatment for inmates. However, TBI experts and even some prison officials want more, like routine screenings for history of TBI.

We'll be posting more about this major step forward in the coming week, and we'll look at the Justice Department's TBI guide for criminal justice professionals.

If you'd like to read more about Phineas Gage, the Wikipedia site has a long list of additional references.