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Stanford bioengineer uses his experience in Iraq to improve research of TBI and PTSD

In 2012, President Obama issued an Executive Order calling for better prevention, diagnosis and treatment of traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) and other mental health conditions. Third-year doctoral student Russell Toll is one of many who is doing research in these areas, and he brings a unique perspective to his work: He's both a bioengineer and an Army combat veteran.

In 2006, Toll was in charge of a combined tank and infantry platoon stationed in the Diyala River Valley, about an hour northeast from Baghdad, Iraq.

His unit deployed with 14 tanks; they came back with four. Within 15 months, 28 men in his batallion were killed and 132 were severely wounded. A third of his men earned the Purple Heart and his unit -- the 1-12 CAV in the 1st Cavalry Division -- earned the Valorous Unit Citation for extraordinary heroism.

Now, Toll is working with his graduate advisor, Amit Etkin, MD, PhD, an assistant professor in the Department of Psychiatry and Behavioral Sciences, to identify biomarkers associated with TBI and PTSD. Toll and Etkin will discuss their work at the West Coast preview of the film "Searching for Home: Coming Back from War" next Saturday, June 20, at Stanford's Cubberley Auditorium.

Recently, I spoke with Toll to learn more about his experience in Iraq and his research.

How did your experience in Iraq inform your understanding of PTSD?

As a platoon leader, all of your thoughts and efforts are focused on keeping your unit safe and getting them home. Only after you get home and decompress do you realize how much [weight] you were carrying.

This is a common experience for many soldiers and people that have lived through a traumatic experience.

At what point in your military career did you become interested in bioengineering and research on TBI and PTSD?

The pivotal point was in 2009 when I visited Walter Reed [National Military Medical Center] to check in on my men. The care they received at the center was excellent, but some of the equipment and technology that was being used to diagnose and treat them seemed like it hadn't changed since Vietnam.

When I returned to my hotel room at night, I found myself drawing up ways we could address this problem on the backs of napkins. I have a bachelors degree in systems engineering from West Point, and I decided to apply these skills as a graduate student in bioengineering.

What was it like to come to Stanford after spending 15 months in Iraq?

It was a stark transition from the Army to Stanford; I felt like I had just climbed off the tank and stepped straight into systems biology. It sounds funny, but in a way I was able to apply my military training to my graduate studies: I developed cooperative relationships with the "indigenous experts" so I could get help from my classmates. As evidenced by my friends, I'm good at surrounding myself with excellent people. Their tutoring, coaching and friendship -- especially that of Shrivats Iyer -- was a major reason I was able to make it this far.

What's the aim of your research and what do you hope to achieve?

The goal of my research as a graduate student in Etkin's lab is to identify biomarkers for TBI and PTSD so we can diagnose, understand and treat these conditions better.

I also want to change the way people perceive TBI and PTSD. When you hear that a person has broken a bone, there's no stigma attached to it. Yet the same is not true for people diagnosed with TBI, PTSD or other mental health issues, even though studies suggest these conditions may be seen as mechanical problems with mechanical solutions.

Lastly, I like to get more veterans into this field [of research], so I'm involved in Stanford 2 to 4 (a program that helps veterans transition from community college to a four-year university). As part of this program I led a class where I told my students, "Today you are going to learn to operate an MRI." My statement didn't even raise an eyebrow. Veterans are used to hearing things like, "Today you are going to operate a missile launcher."

I really endorse General James Mattis' perspective on post-traumatic stress: Veterans are not victims. They're reliable, resilient, dogged and capable of extraordinary achievement. For veterans, quitting is not an option and leaving anybody behind isn't an option. People with TBI and PTSD are essentially captured and we need to get them back.

Previously: Type of verbal therapy could reduce PTSD risk among trauma victimsTalking about "mouseheimers," and a call for new neuroscience technologiesNew frontiers for psychiatric illnessStanford/VA study finds link between PTSD and premature birthStudy shows benefits of breathing meditation among veterans with PTSD
Photo courtesy of Russell Toll

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