How Football and Concussions Sack Hope

I first posted this blog in February, around the time of the Superbowl. This week PBS Frontline is airing "League of Denial". I thought it would be a good time to re-post this reflection on football, concussions, and hopelessness.

“Just look at the gladiators… and consider the blows they endure! Consider how they who have been well-disciplined prefer to accept a blow than ignominiously avoid it! How often it is made clear that they consider nothing other than the satisfaction of their [coach] or the [fans]! Even when they are covered with wounds they send a messenger to their [coach] to inquire his will. If they have given satisfaction to their [coach], they are pleased to fall. What even mediocre gladiator ever groans; ever alters the expression on his face? Which one of them acts shamefully, either standing or falling? And which of them, even when he does succumb, ever contracts his neck when ordered to receive the blow?”

The above passage, with the exception of two minor word substitutions on my part, was written by Cicero 2,000 years ago.

My point is that his description of the sacrificial gladiator of the ancient amphitheater can be applied all too easily to the players who currently do battle on the modern gridiron.

I am convinced that football, in its present form, cannot last. I will put aside the physical carnage that piles up every weekend, the torn cartilage, broken bones, blackened, bruised and ripped skin, the shredded muscle fibers I am not a physician. However, I am a psychologist. From my perspective, I believe that the greatest health crisis precipitated by football involves the brain and the mind, especially for those at the professional level, and particularly for those who are retired, and have suffered one too many concussions. For these former gladiators, there is a great risk of succumbing to severe, life-threatening forms of hopelessness.

The hopelessness that descends upon the retired professional football player should not be a surprise. It is understandable if you begin with some knowledge of what changes occur in a soft and mushy brain that has been repeatedly concussed, or more bluntly, tossed and smashed from side to side within a bony skull-box. Repetitive brain trauma can result in Chronic Traumatic Encephalopathy (CTE)

CTE has been detected in the brains of ex-football players well as former boxers. In CTE, there are signs of a spreading TAU protein that normally serves a stabilizing function but becomes dislodged, primarily from the axons which transmits nerve impulses. The floating Tau form a spreading tangle of tissue that disrupts brain function. Rare diseases can precipitate this pathological cascade but so can repetitive head trauma. CTE has also been found in the aged, and those stricken with Alzheimer’s disease. The most commonly affected areas include the frontal lobes (decision-making, planning, willpower), the temporal lobes (memory and speech), and the parietal area (sensory integration, reading and writing). The most common emotional symptoms in those suffering from CTE include depression, anger, hyper-aggressiveness, irritability, diminished insight and poor judgment.

On May 2nd, 2012 former football star Junior Seau shot himself in the chest with a .357 magnum. Eighteen months earlier, Seau had driven his SUV off a cliff following an arrest on charges of domestic violence. He claimed that he had fallen asleep. Back then, many in his circle of friends and family hoped and prayed it was the truth. His brain was sent to a team of researchers at the Boston University School of Medicine. Their tests revealed a brain besieged by CTE.

A little more than a year earlier, in February, 2011, Dave Duerson, also a former professional football player, similarly committed suicide by shooting himself in the chest. He had texted a message to his family indicating that he was “saving” his brain for research. Three months later BU School of Medicine confirmed “neurodegenerative disease linked to concussions”. In high school, Duerson had been a member of the National Honor Society and played the sousaphone, traveling Europe with the Musical Ambassadors All-American Band. He attended the University of Notre Dame on both football and baseball scholarships. He graduated with honors, receiving a BA in Economics. Duerson played eleven seasons in the NFL.

Whenever interviewed, the researchers at the Boston University School of Medicine are reluctant to affirm a cause and effect link between CTE and suicide. They provide the typical (and not unreasonable) response that multiple causes often underlie human behavior, including suicide. While generally true, a case such as that of Duerson seems to beg the question, what else besides CTE could have led a formerly intelligent, well-organized, responsible, and successful individual to morph into a desperate failure that ends his own life at the age of fifty?

I believe that the onset of CTE, in the context of a retired professional football player’s life, can be a deadly mix, leading to profound hopelessness and significantly increasing the risk of suicide.

Hope and Hopelessness

In my book, Hope in the age of anxiety (Oxford, 2009), I explain that hope comes from a perceived future ability to satisfy our four most important needs; attachment, mastery, survival, and spirituality. We hope: to connect, to realize various accomplishments, to cope with adversity, and to find a sense of meaning and purpose in life. What happens when we believe that one or more of these life domains is no longer within our reach?

Traumatic Brain Injury Essential Reads

The Impact of Head Injury on Brain Health

Traumatic Brain Injuries in the Modern Age

There are nine potential types of hopelessness; three result from a pure disruption of attachment, mastery, or survival needs (the individual feels alienated, powerless or doomed). The other six types of hopelessness result from a blended disruption of a primary and a secondary need. When the primary disruption is attachment, the individual may feel forsaken (if survival is secondarily implicated) or uninspired (if mastery is secondarily implicated). When the primary disruption is mastery the individual may feel oppressed (if attachment is secondarily implicated) or limited (if survival is secondarily implicated). If the primary disruption is survival, the individual may feel captive (if attachment is secondarily implicated) or helpless (if mastery is secondarily implicated).

Six of these types of hopelessness may plague former professional football players who develop CTE. Specifically, they may feel one or more of the following: alienated, powerless, doomed, forsaken, limited, or helpless.

Alienated – Hopelessness (disrupted attachment). Professional football players spend more than six months a year with teammates and coaches. They travel with the team, eating, sleeping and playing with and for each other. With retirement, it all comes to an end, and for most, the same level of camaraderie will never be duplicated. They are no longer part of the team, the fraternity of 53. With declining health comes further estrangement. In her classic work, Illness as metaphor, Susan Sontag wrote of the “kingdom of the well” and the “kingdom of the sick”.

Powerless – Hopelessness (disrupted mastery). When I think of powerful athletes with damaged brains who can no longer fend for themselves, much less run, jump, or battle as they once could, I think of the biblical Sampson. First he felt victim to an unsuspecting evil (Delilah), then his strength disappeared. He was blinded, and in the end, he sacrificed his life for a greater good. These modern gladiators once dominated the sandlots of their childhood; they basked in Friday night lights, they ruled the campus in autumn, and commanded the attention of millions every Sunday in prime time. As they begin to lose what psychologists refer to as “the executive functions”, they can no longer initiate, organize, control, or integrate basic behaviors.

Doomed – Hopelessness (disrupted survival). There is no known cure for CTE. Instead, there is the real prospect of experiencing less and less control, less and less clarity. There is no light at the end of the tunnel. Those born with gifts of talent, strength and speed often have an easier time defending against universal feelings of death anxiety by convincing themselves they are special, capable of death-defying feats. When the fall from this perceived grace is deep, fast, and premature, the feelings of doom must be especially strong.

Forsaken – Hopelessness (disrupted attachment and survival). Throughout their lives, these gladiators were the “chosen ones”; they were nurtured, given special favors, recruited, and contracted. They were brought into the fold from the first days that they showed promise. Fans adored them, surrounded them at home and followed them on the road. They were reminded again and again how much they were considered part of a team, a city, and perhaps an entire state or region. When they retire, they are the outsiders. Some become whistle blowers or even plaintiffs, forging an even deeper divide between themselves and their former league. For older veterans, there is the twin insult of woefully inadequate pensions and a perceived lack of gratitude on the part of the current generation for their part in building what is now a multi-billion dollar industry. It might be said that the retired NFL player has been “disenfranchised” in every imaginable way.

Limited – Hopelessness (disrupted mastery and survival). Some former players are fortunate. They leave the game with their cognitive skills relatively intact. They may start a business, get a coaching position, or land a spot as a radio to television commentator. However, all of these endeavors presume adequate levels of memory, attention, and judgment. What if those capacities are severely compromised? Players devote most of their lives to refining a limited set of skills. One day they discover that their non-transferable skills have eroded (speed, strength, etc.) while potentially transferable skills (knowledge of the game, discipline, social and business networking) cannot be carried forward because the mind is too weak to carry out the transfer.

Helpless – Hopelessness (disrupted survival and mastery): The active NFL player seems to have an embarrassment of riches, more resources than they could ever expend, more clout and leverage they could ever exploit. They have talent, money, fame, and access to multiple social and political networks. They can request and secure preferred seating at restaurants and shows, membership at exclusive clubs.

Now consider the example of former pro quarterback Jim McMahon who is in his early fifties. His brain appears to be aging much faster. McMahon suffered multiple concussions in his career. He regrets having chosen football over baseball. Laurie Navon, McMahon’s girlfriend was quoted "When you see a man that was so big and so strong and so nice and gentle, and he doesn't know the difference between a toothbrush and a razor. He could have cut his mouth wide-open. After [he] got progressively worse, I had to watch everything he did. I couldn't let him take a shower or do any of the things you need to do every morning without me being there.