TRANSITION INTERVIEW #19: Shannon Connell Ph.D.

A Candid Conversation on Traumatic Brain Injury, Special Operations Culture, and the Need for Upstream Change.

A big part of what makes the veteran community great is the willingness of people to come together, find resources, form nonprofits, and provide for those in need. Where gaps exist in VA healthcare, the vet community shows up. They figure it out.

Shannon Connell is the founder and CEO of the Invisible Wound Foundation, whose mission is to - “Advance science to prevent, diagnose, and treat traumatic brain injuries among special operations forces.”

In the pursuit of well-being and our efforts to decrease veteran suicide, we too often accept brain injury as an unavoidable cost of military service.

The reality is, more can be done. More can be done to improve diagnostics, develop treatments, and create policy that reduces the likelihood of repetitive blast injury.

Shannon and the team at Invisible Wounds are willing to take that on.

I hope you enjoy our conversation on TBI, the culture surrounding brain injury, research, and what it will take to move the needle.

Thanks for doing this, Shannon. You have a PhD and have led an impressive career. I'm curious how you arrived at Invisible Wounds? Why Traumatic Brain Injury (TBI) research?

I started my career at a large corporation, Procter & Gamble, where I traveled a lot. At 25, I was working in Guangzhou, China, managing brands in the hair care industry. I loved it.

Eventually, work took me to Venezuela, Brazil, Mexico - throughout South America. I also started my own company on the side. I was interested in Chinese antique furniture, collected a lot of it, and eventually started importing it with my brother. We called it "Asian Accents."

After 10 years at Procter & Gamble, and many years spent working abroad, I took a job in Houston with Shell Oil. Shortly after, I hired consultants to conduct a market analysis, and one of them was a professor at Rice University. One day, he asked me if I'd be interested in doing a guest lecture in the MBA program. I did that a few times, and eventually it led to a faculty position. I spent the next eight years teaching in the Jones Graduate School of Business at Rice. A tremendous opportunity to learn, teach, and develop my academic chops.

I was an adjunct professor while working at Shell at the same time. Still traveling a lot. At some point, there was some pressure to take a job in London. At the same time, Rice was encouraging me to get a PhD, and I remember thinking… Nobody has time for that.

Eventually, I decided to take a step back. Move back to Chicago, the Midwest, back to my roots.

What I realized in doing that is what I really enjoy is collaborating with people to solve complex problems. So, I decided I would pursue a doctorate in Organizational Psychology.

I wanted to study the way organizations solve complex problems.

And in large measure, as you well know, Invisible Wounds Foundation is focused on addressing a VERY large, very complex problem.

Good for you. And so in your opinion, what makes TBI, and specifically military TBI a complex problem? Is it getting the attention it deserves?

No. I don't think so. The attention it gets is disproportionate to the scale of the problem.

I would argue that it is not receiving enough attention. That being said, I think it is getting more attention now than it has in the past. But, if we look at the numbers around veteran suicide and our ability to understand repetitive blast exposure, concussion - all the brain injuries our military members are exposed to - I don't think it gets near enough attention.

There is a lot of meaningful work being done, but so much of it is downstream, addressing symptoms. Sleep disorders, depression, self-medication. That's important work – my own family has benefitted from that work. But it's mostly, "How can we make you feel better right now?"

We owe it to ourselves to understand the root cause. Many organizations are hesitant to tackle it because it seems impossible. It's also incredibly expensive.

All kinds of reasons to stay away from that side, but we need to stay with the problem and not turn away from a seemingly impossible challenge. And it can be even more daunting to think about addressing at root cause, upstream, where it all starts.

When you say "upstream," we're talking about at the point of injury? Within DoD? I suppose there are enemy-induced injuries, and there are training-induced injuries. You're referring to the training we subject ourselves to?

The Department of Defense (DoD) and the military are critical components in all this, obviously, and they are aware of the issue. But they also don't move very fast. There's also a lot of turnover in that organization. People come and go. New administrations, new leadership.

So, who is going to fix this? It doesn't have to be the non-profit or private sector, but I'll say there are numerous examples where the community affected comes together and creates systemic change. Or, at a minimum, re-invent their understanding of the problem.

This has been a problem for decades - billions of dollars have been spent. And yet here we are. We're still not having the conversation about the lack of FDA-approved diagnostics and a whole host of other treatment interventions that require further research.

We have a very experienced Board of Directors. People like VADM Szymanski (ret.), Frank Larkin, and Dr. Brian Edlow with a lot of years in this space who've been able to access conversations with leading experts. I often hear things like, "A lot has been done, but a lot more needs to be done." To that I always ask, “what do we mean by MORE?”

There’s a belief that this breakthrough solution will come at the intersection of public and private funding - in cooperation with the DoD, VA, NIH. But that won’t happen on its own. It requires leadership, coordination, bringing people and organizations together to generate a common agenda - a collective impact.

That's hard to disagree with. Perhaps I'm thinking about this incorrectly, but all the treatment and diagnostic interventions are certainly complex. However, at least to me, the way people are getting injured - it really isn't that complex.

My guess is that most operators can think of three or four examples, certain days from their careeer, and they know… That was too much.

Is there mystery as to what's causing these injuries?

I suppose it's not ideal for the Special Operations brand to acknowledge awareness of how this hapens. To admit how harmful some of the training can be.

It's not great. However, it demonstrates a level of compassion and leadership if you're willing to discuss it. At least it provides agency and honesty to the community.

We all take risks based on what it is we're looking to get out of life.

For a lot of you guys, it's helpful to be aware of these things. I think that transparency would create trust and, eventually, a culture shift that would allow us all to openly acknowledge the cost of combat.

Doesn't have to be one or the other. Let's show a level of care and ownership in such a way that tells service members, "This is what we're working on. This is how we're mitigating these risks."

Until there's more transparency around the topic, it's hard to progress the science. To make any advancements, people need to understand why those advancements are necessary.

That's exactly right.

I think folks like yourself, David Phillips, people who are bringing this topic to the forefront. We need more of that.

In most cases, you have to acknowledge a problem in order to collect the resources necessary to fix it. Right?

How much of this conversation, how much of what we're talking about is cultural? In the sense that perhaps there's a hesitation for vets to even consider themselves worthy of care?

When I checked into the SEAL team, the way the timing happened to be, the whole team was still in Afghanistan; they had about three weeks left on their deployment.

Two SEALs from that rotation were killed on that deployment, and in retrospect, that had a tremendous impact on our culture as a team – the way we trained, the way we carried ourselves, the entire world was set against the backdrop of going back to war and that some amongst us might not come home.

It shaped everything. And part of that is the way you think about pain, injury, these types of things. A lot of things.

How does my circumstance compare to those I serve with? I think a lot of people are asking that question when it comes to brain injury.

I wonder if the military could do a better job here?

You hear of these suicides, and sometimes it's not the case that they have a single enemy-inflicted injury. Sometimes, it's the case that they have a dozen repeat exposures. You wonder if these guys feel legitimized in asking for help?

Yes. You've probably heard the saying, "You can play hurt; you can't play injured." While I think that's true of broken bones - it's not the case when it comes to the brain.

Unfortunately, you can play injured; many, many operators are playing injured.

Right. I've not thought about it in that way. If you snap your femur, you're out, but there is this ability to endure the day-to-day after concussion.

And that opens you up to more injury and repetitive exposure, and that's where we can really start to see someone lose themselves. Unfortunately.

Things compound. I know folks go on for a decade like that.

It doesn't always take you away from everyday tasks. It can be a dull pain for a long time.

That's why the need for TBI diagnostics is so critical. We can do a better job treating if we know when and what to treat.

All of the prevention, all of the changes to DoD policy, the rockets, mortars, breaching, all of that - it all requires knowing what's happening. When a TBI has occurred.

Are there diagnostics or tools that you're excited about that are not FDA-approved?

We see all kinds of things related to biomarkers, saliva testing, ocular, auditory – these solutions feel within reach. I think, ultimately, a wearable solution is exciting. There are so many variables when it comes to what's happening during a blast exposure. The power of technology telling us what has occurred to our brain, the mechanism and location of injury, and immediate possible interventions to treat and perhaps reduce the extent of the injury – this is exciting to me.

Two operators can stand side by side and have two totally different outcomes from a blast. So we need personalized and precise diagnostic solutions.

At the current rate of change, I'm optimistic that we could have one in the next few years.

What's more exciting, at least to me – once we find a way to diagnose and measure - that immediately turns to… So what? What the hell are we going to do about it?

That's where we will start to see breakthroughs in treatment, prevention, and eventually eliminating the problem. Prevention and eradication is the ultimate goal.

I've been out of the military for five years now, but when I think about this topic, the training aspect, it all just seems sort of unnecessary. Half of it is sort of bullshit.

Say more about that.

Well, a lot of things, skydiving, for example, you have to practice if you’re going to do it in combat. There's a lot like that. Combat really can't be learned in PowerPoint. But a lot of the explosive stuff – the rockets, mortars, breaching, maybe you can? Or at least in some hybrid way.

If we really think about the risks vs. rewards, is explosive breaching, live rockets, and this sort of thing, is it really productive? In specific units, maybe it is.

I probably would disagree with that argument when I was active. If your number one priority is lethality, you're going to do what you're going to do.

You’re right. Lethality, force readiness - these are the priorities. And I don’t think this is paradoxical: we can focus on those priorities AND the longevity, health, and well-being of warfighters at the same time. These are not mutually exclusive.

TBI almost always ties into psychiatric issues: sleep, depression, anxiety, PTSD, self-medicating, the list goes on, and unfortunately, that includes suicide.

You hear some guys say, "Well, nothing came up in my scan." And there will not be a treatment option for a brain injury if one is not detected. So instead, we proceed with a mental health protocol because those are the symptoms that are presenting. However, the facts are that the majority of research on this topic, examining astroglial scarring, primarily takes place post-mortem – after we've already lost the warrior.

I couldn't agree more. It's very complex. Lifestyle changes and mental health strategies do help. But are we teaching ourselves to dismiss the underlying physiological problem?

You start to get a hold of your life, you stop drinking as much, you make a few changes, and you do feel better. It's all connected.

You're right. More than one thing can be true and probably is. We need to discuss the comorbidity of mental health issues such as depression, anxiety, sleep issues - and brain injury.

So let's acknowledge that we're currently only treating half of this. Yes, we treat depression, anxiety, and sleep issues. However, at the same time, let's strive for a proper diagnosis for TBI.

Much of this is about holding conversations that drive a deeper level of understanding. We need to talk about “what’s going on here” and not live with our heads in the sand. We need to acknowledge what happened during the Global War on Terror.

Too often, when we discuss the level of blast exposure, the common response is, "We didn't know how bad it really was."

But now we do. So, let's discuss it. Let's research it.

I couldn't agree more. It's a lot of people doing the best with the cards they've been dealt, unfortunately.

The long-term mission of Invisible Wounds is clear to me. What are some of the short-term wins you see on the horizon? What are you trying to accomplish this year?

We try really hard to keep our mission simple. You hear that term "mission creep," which can become a problem in corporations and non-profit organizations, but it is a huge watch-out for non-profits. Keeping the mission focused is a priority for us, even if that means we are not of interest to certain donors.

We're currently working in partnership with the RAND Corporation to produce a study focused on understanding the existing work in the field of TBI among Special Operations. This will provide us with a blueprint of what has been done, what is being done, and create a gap analysis what needs to be done.

We are interested in what the ecosystem looks like, and importantly, where the money is being spent – on what research objectives, and by which funding sources.

Again , when people say, "More needs to be done", this study is to answer the question of what is the “MORE” that needs to be done.

That study will lay the groundwork for what we're calling the Special Operations Brain Health Initiative. This initiative will bring together top neurological researchers, clinicians,SOF stakeholders and thought leaders around a common agenda: to accelerate the science that gets at the root causes of military TBIs. It will be led by a medical science advisor with the mission of guiding the future of research – based on that GAP analysis. We are taking a data-based approach to address this complex problem.

We're also working on partnering with several organizations to create a shared agenda. We, and by "we," I mean our community, need to be bigger than we are. This will require a collective effort to achieve systemic change.

How much of this depends on financial support from the federal government?

First and foremost, I believe we need a seat at the table. We're raising a fund right now to get moving, regardless of the public sector.

And I think once the public sector sees that, once they see how much people care about this issue, they'll get involved. But you know, we're not waiting for a grant from NIH; we're not waiting years for a grant from the DoD. We don't have time.

We pursue all these things, of course. But we're not going to be dependent on that.

Many people who read this will be spouses, parents, and family members of veterans. What do you hope they understand about this topic?

Good question. I hope they understand that brain health is a life-long undertaking. Rarely, is a person going to go in with these issues, and they're presented with a fix.

You want to understand as much about a service member's brain as early as you can. Doing so retrospectively can be difficult and seemingly impossible.

Understanding your brain or your loved one's brain is a journey that can provide early insight, take away some of the mystery, make everything far less unsettling, and contribute to a better quality of life.

Shannon, thank you very much. I have tremendous respect for the work you do. The clarity and the focus of the Invisible Wounds Foundation. It's impressive and truly important. Thank you.

It’s been my pleasure.

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