Grand Rounds

Why we do the things we do

It's All About Control

Why do shrinks like football?
I am 5'6" tall. I weigh about 148 lbs, though I'd like that to be closer to 145. I am balding, or bald, depending on your view of the world, and I wear tweed jackets and sometimes poorly matched ties. My socks do not always match, and I have yet to work out whether this is deliberate or unconscious. In short (no pun intended) if you were at a party and asked to pick the shrink from the crowd, 9 times out of 10 you'd pick me, which is a good thing, since this is what I happen to be.

I am in fact a shrink, and I am not just any shrink. I am a child shrink. The formal term is "child psychiatrist", a title I relish because it leaves available the ambiguity of whether I treat young people or am in fact a child myself. Like many things in psychiatry, the answer to this quandary is not always clear.

What is clear, however, is that many shrinks like football. I have no formal data with which to support this heartfelt assertion. In fact, it may be that the "many shrinks" to which I allude represents really only myself and my buddy Stephan Heckers, the chief of psychiatry at Vanderbilt. I suppose a word or two about Dr. Heckers would be useful about now.

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Stephan Heckers is the smartest guy I know. This is a big deal, given that I work at Harvard, live in Boston, and hang out with a lot of really smart people. There may be people as smart as Stephan, but no one is smarter. You can bet on this.

Stephan is from a small down in Germany, near the Dutch border. He came to this country after medical school and trained in psychiatry at Massachusetts General Hospital and Harvard Medical School. We met when he served as one of my chief residents when I was training in psychiatry at the same institutions. Eventually we became very good friends, and he would often wax poetic about soccer, about its flow, it continuity, the beauty of the brain's capacity to work in synchronicity with the crowd to create excitement despite a rousing score of 3 to 1. "You must go to a game in Europe," he would advice, in his precise German accent, his large Teutonic forehead wrinkled with nostalgia.

Bullshit. Nobody in this country gets excited, truly excited, about a score of 3 to 1. We can get philosophical about a score like that (there is no shortage of philosophy in baseball writing) or we can get cosmopolitan, as we do in our recent embrace of soccer. But this is America. And though I am not prone to patriotic excess, football is uniquely American. (The Canadian version is also uniquely American, but played with greater civility up North, with more passing and less anger, as befits our more subtle neighbors. After all, you can't get too worked up watching football from a chesterfield. You sit on a couch, dammit. But I digress...)

It was Stephan who helped me to appreciate how unique and uniquely American football really is. I took him to his first NFL game (my beloved Kansas City Chiefs lost to the then all powerful Patriots), and he could not get aggression out of his mind. Like an anthropologist, he studied the game and the crowd. "It is all so limbic" he smiled, gulping his beer and wiping the froth from his short well tended mustache.

I smiled back. The limbic region of the brain is sometimes called the "alligator brain" - the part of the brain that pretty much every reptile, bird and mammal enjoys, and for some of the "lower animals" it is about all they got in terms of brainpower. For Humans, however, it is the Limbic system that controls the basest of emotions. Fight, flight, fear, lust, the visceral desires - they all live like caged beasts in this region of the brain. If we were only alligators, it would end there. But as Humans, we rely on a seamless conversation between the Limbic machinery and the higher cortical functions:

"I want to scream at the cop who is harassing me"- that's my limbic system. "But I shouldn't scream at him because he is a cop and there could be repercussions." That's my higher cortical processes. Both are human responses, and we Americans place special and unique emphasis on knowing whom to listen to when. Do I let my Limbic system rule? Do I let my higher brain, my cortex, do the talking? There are times for both, but Americans and their rugged individualism love the idea that we control our responses with a moral code, a higher set of rules. Just go watch a Western. The good guy can look pretty bad, but he's in control. He can reign in his Limbic thuggery just as readily as he can unleash it. We admire his capacity for aggression as much as his talent for restraint.

So, when my friend Stephan smiled and drank his beer and remarked at how "Limbic" this brutal game appeared, what he meant was that it gives the players and by extension the fans the opportunity to wrestle with our ongoing struggle between higher and lower brain. And this is why we shrinks love football. What could be more enticing to a shrink than an expose of controlled aggression?

Football is all about turning on the rage and turning it back off again. The true game is most beautiful when the outside linebacker delivers a bone crushing hit, when the fullback who moves with a net force of 500 plus Newtons, crumbles to the ground from that hit, and then that same linebacker admires the fortitude of that same Fullback and the fullback respects the aggression of the linebacker, and they help each other up, slap each other on the ass, and go back to their tribes to plan how to do it all over again. It is the Hatfields and McCoys after they become tentative friends but remain rivalrous at the summer softball game. It is the North and the South learning to respect each other. It's about control, man. That's what Stephan's was saying. It's all about control.

As you might guess, I love football. I played throughout high school, even got myself knocked out a few times. I was a little Jewish guy among blond Aryan giants in the Kansas City Suburbs. I even got recruited to some small colleges. The Dartmouth coach came to my high school and asked to meet some guys that our coach thought could get into Dartmouth and could also play for him. Our coach called a bunch of us to his office, and the Dartmouth steward smiled at me and said only "no." I don't know to this day whether he was smiling from amusement or admiration. I suspect a little of both.

I still dream about football. I offer and will demonstrate my three point stance to my daughters on any occasion, and I wear religiously a red sweatshirt with a stitched circle on the front. It once displayed the arrowhead of the Kansas City Chiefs, but I tore it from my chest, I literally wrent my garments, when the chiefs missed a crucial field goal in a playoff game in the 90's.

But, as a psychiatrist, I have the luxury of asking why. Why the affinity for the game among my fellow Americans? Why do I love the game with such religious devotion? Why do millions of Americans surrender gorgeous Fall afternoons, paint their faces, pound their chests, and watch muscle bound mutants pound the hell out of each other for 3 or so hours?

And, as a psychiatrist, I think I can answer all of these questions in a unique way. To paraphrase Stephan, its all in the brain, man. It's all about the brain. That's what this book is about.

 

Steven Schlozman, M.D., is an Associate Director of Medical Student Education in Psychiatry for Harvard Medical School.

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