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Is Football to Blame for Players’ Suicides?

The views expressed are those of the author and are not necessarily those of Scientific American.


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High-profile suicides of professional football players have mounted in the past several years—Terry Long (2005), Andre Waters (2006), Dave Duerson (2011) and Ray Easterling (2012) all killed themselves following retirement and bouts with diagnoses likely related to the thousands of hits they fearlessly underwent as players. The conditions vary but have overlapping qualities: post-concussion syndrome, depression, other mood disorders, personality changes, memory problems and dementia. Now with the loss of Pro Bowler Junior Seau, dead at 43 earlier this month by a self-inflicted gunshot wound to his chest, a suicide has occurred in a Hall of Fame-bound player who reportedly never exhibited emotional pain. His body will be examined for signs of chronic traumatic encephalopathy (CTE), a condition proposed to explain the football suicides and underlying mental illness.

Nedra McClyde and Ron Canada in Headstrong at the Ensemble Studio TheatreThe issue of professional football’s responsibility for these conditions and player suicides is explored in Headstrong, a play running this month at the Ensemble Studio Theater in Manhattan. The theater has a long-standing sponsorship from the Alfred P. Sloan Foundation to produce shows that deal with science. (Last year with this funding, EST mounted Photograph 51, which explored the role of Rosalind Franklin in the discovery of the structure of DNA.)

In the past few years, the terms “brain injury” and “traumatic brain injury” have replaced the all-encompassing but limited categorization of “concussion.” Examinations by pathologist Bennet Omalu, now at the University of California, Davis, have led to a connection between high-impact sports and CTE, a condition diagnosed after death and marked by degenerated brain tissue and an accumulation of tau proteins in the brain. Injuries may result from rapid deceleration whether that involves a blow to the head or not.

One of the main social questions emerging in the past few years is whether the National Football League is doing enough to protect players from brain injuries and the mental illnesses and cognitive problems that can follow. Scientifically, it is still unclear if CTE itself explains players’ declining mental health and suicides.

The league has responded so far with a ban on helmet-to-helmet hits, educational campaigns and new rules governing when a concussed player may return to the field. And the NFL has initiated scientific investigations into brain injuries—although questions of bias will plague any league-sponsored research. The league might be seen as having an incentive to minimize concerns about traumatic brain injuries.

All these issues come up in Headstrong. The play dives straight into this tangle of causality and ethics, focusing on the family aftermath two weeks after fictional NFL running back Ronnie Green kills himself at age 35 by drinking antifreeze (a “coward’s way out,” his ex-NFL father-in-law Duncan Troy calls it). His character had suffered from erratic behavior and depression prior to his death. (The story line is similar to the real-life case of Steelers lineman Terry Long who drank antifreeze to end his life at age 45 in 2005 following problems with depression.) Green’s estranged wife Sylvia is asked to donate her husband’s brain to science to look for signs of CTE, but the choice pushes her smack up against the bullet-proof, tough-guy, play-hurt culture that is sacred to football and her father.

As Sylvia notes near the end of Headstrong, football often pays players handsomely for their careers (the average NFL career lasts somewhere between 3.5 and 6 years). It pays for players’ homes and their children’s college tuition, clothes and so on. “Now we have to pay for football,” she notes with bitterness, referring to the death of her estranged husband and more, adding that she has decided that her son will not play football. (“Why don’t you just stab me in the heart?” her father responds.)

The paternal Duncan Troy represents classic, suck-it-up, all-or-nothing football—if you admit or indulge any weakness in players or the game, you ruin football. “Hitting is part of the game,” he says. “Take hitting away and you have checkers.”

Stone Phillips, Hall of Famer Harry Carson and pathologist Bennet Omalu at EST panel discussionBack in real life, Omalu now has permission to study Seau’s brain, but is it hard to imagine that the pathologist will fail to find evidence of brain injury. That assumed finding raises a question about the robustness of the link to suicide: how many players who have not shown evidence of degenerative brain conditions might also show signs of brain trauma related to repeated hits? Until such studies are done, the connection between hits and the most negative outcomes will remain a subject of debate. [Click here to listen to a Science Talk podcast featuring a post-performance panel discussion of these issues on May 12 with Omalu, Hall of Famer Harry Carson (center in photo), who suffers from post-concussion syndrome, and NBC journalist Stone Phillips (at left in photo).]

Meanwhile, reports such as The Concussion Crisis: Anatomy of a Silent Epidemic (Simon & Schuster, 2011) and others make it clear that the NFL and other bodies have balked for years at looking squarely at the issue of sport-caused brain injuries and embracing efforts to protect players. And many other researchers are now finding strong links between traumatic brain injuries and mental decline among athletes of all ages (the hits to young people might do the most damage, especially those that occur back-to-back) as well as among servicemen and women afflicted by ordnance blasts.

Would future insights that might nail down the role of CTE in players’ mental health reduce “America’s game” to a bland ballet? The nation’s love of football and the powerful football industry are bigger than these fears just as it was bigger than the steroid panic of several years ago.

But who can look at the retirement years of many professional football players and say that everything possible is being done for them, that they were made aware of all the risks? As David Epstein notes in his “Depression in Football” story in the May 14 issue of Sports Illustrated, brain trauma experts he interviewed hope next for renewed research efforts to track players and their various medical issues, including depression and concussions, in order to tease out the connections among them.

At the least, the NFL, NCAA and other governing bodies should be held to the task of providing care for these remarkable athletes throughout their lives, not just during the halcyon years when they sacrifice their long-term health, physical and mental, to dazzle us on field.

“A win is a win,” Duncan Troy says in Headstrong. “That’s the only thing that matters.”

He’s wrong.

Image credits: Gerry Goodstein, Ensemble Studio Theatre; Steve Mirsky

Robin Lloyd About the Author: Robin Lloyd is the news editor at Scientific American, where she assigns and edits online stories, oversees the Web site's home page and rewrites a lot of headlines. Follow on Twitter @robinlloyd99.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. geojellyroll 6:24 pm 05/16/2012

    I knew at the age of 6 that banging my head wasn’t healthy. I also knew that smoking was bad. I knew to wear a seatbelt.

    “Duh…I’m an adult and I’ll play a sport in which I bang my head as hard as I can….over and over. Gee whiz…now I’ve wrecked by brain.”

    Link to this
  2. 2. DrDavidGeier 8:27 pm 05/16/2012

    Robin,
    That is a very interesting article. I think that much research needs to be done in the coming years about the link between contact and collision sports, concussions, and CTE and suicide. I knew very little about the dangers of repeated blows to the head, especially mild ones, until I interviewed our sports neurologist for an article I wrote for my blog and The Post and Courier. In it, Dr. Jonathan Edwards talks about the often unrecognized personality changes that can develop in young athletes with these repeated blows to the head. I’m including the link not to promote my blog but to add to this important discussion. Thanks for the article!
    http://www.drdavidgeier.com/hidden-dangers-concussions/

    Link to this
  3. 3. ironjustice 9:21 am 05/17/2012

    It is known a deposition of iron in the brain causes suicidal depression. It is well known head impacts cause a deposition of iron in the brain. Is depression from concussions ? It is pretty obvious to anyone who knows their Science.
    They have shown iron deposition in the brain causes suicidal depression , reversed by iron reduction , phlebotomy.
    “From a previous study on suicidal depression victims, a clear correlation between iron level and strand breaks in the brain regions could be observed”

    When you take a ‘hit’ , you get a ‘bruise’ / spilled blood / broken red blood cells.
    This blood contains the metal iron.
    This blood is NORMALLY ‘mined up’, dealt with by the body.
    When the body doesn’t remove this iron it is deposited in a long term storage form known as hemosiderin to be used when needed.
    Normally it would be removed.
    This failure to remove the iron is what is causing the problem as in Parkinson’s , Alzheimer’s and tardive dykinesia and other neurodegenerative diseases like Multiple Sclerosis.
    “Increasing evidence indicates that iron deposition in the brain might play a role in cognitive dysfunction associated with neurodegenerative disorders and aging.”

    Low iron diet and targeting of the iron in the brain is what is being tested in neurodegenerative disease.
    “Cognitive declines therapy by iron burden reduction”
    “Cognitive impairment is associated with subcortical magnetic resonance imaging grey matter T2 hypointensity in multiple sclerosis”
    “Iron chelators that can cross the blood-brain barrier may have the potential to treat cases where abnormal iron accumulation in the brain is associated with the degenerative processes”

    Link to this
  4. 4. curmudgeon 10:22 am 05/17/2012

    Ah, yes, just what we need ironjustice. Unfounded speculation, quotes from unnamed sources, and making 2+2=5! If ‘it is known’ that iron is implicated in suicidal depression it certainly isn’t known to me and, as a lifelong sufferer (who, incidentally, has never had a single concussive injury!), I would kinda expect it to be. There is still a very long way to go to prove that depression in ex-professional athletes is in any way related to injury when there are so many emotional issues involved in retirement (loss of status and recognition, change of routine, new dependence on family relationships, self-examination and re-assessment of ‘achievements’, and many more). Frankly, given this very real trauma it amazes me that so few ex-sportsmen take their own lives and any study of brain injuries must take the ‘silent majority’ who do not into account. It is almost inconceivable that there is a major difference in the number of potentially concussive collisions experienced by a linebacker, say, who has a happy retirement and one who does not.

    Link to this
  5. 5. marclevesque 2:16 pm 05/17/2012

    Numbers?

    Suicide rates appear to be much lower for NFL players than the general public:

    http://www.ajconline.org/article/S0002-9149%2811%2903387-X/fulltext#tbl2

    Link to this
  6. 6. thermopraxis 7:27 pm 05/17/2012

    There is something that can be done now and your help is needed to spread the word about it. Thermopraxis has created a revolutionary in-helmet device that can be used to drastically reduce the devastating consequences of concussions using therapeutic hypothermia (cooling). The sooner this product reaches the market, the sooner these types of injuries can be reduced in helmet-wearing athletes. For more information, please see the “Concussion Crisis Solution Campaign” on YouTube and http://www.thermopraxis.com.

    Link to this
  7. 7. ironjustice 1:07 am 05/20/2012

    Quote: If ‘it is known’ that iron is implicated in suicidal depression it certainly isn’t known to me and, as a lifelong sufferer (who, incidentally, has never had a single concussive injury!), I would kinda expect it to be.

    Answer:
    TWO CASES OF HEMOCHROMATOSIS ASSOCIATED WITH SEVERE DEPRESSIVE EPISODES

    Case Study Case Rep. 2012; 2(1): 4-7
    Koch HJ, Hausn P, Nanev D, Zellmer H, Hönicke.

    A B S T R A C T
    Abstract
    Hemochromatosis is a severe autosomal recessive disorder caused by iron overload and primarily affects liver function, pancreas or heart. Although hypophysis iron deposits may also be involved, the association between psychiatric disease and hemochromatosis is less common. We present two patients, a female aged 76, and a male aged 49, in whom depression in combination with increased ferritin levels and transferrin saturation lead to the diagnosis of hemochromatosis. In both cases interdisciplinary treatment with antidepressants, psychotherapy and phlebotomy was successful. Although, the exact pathophysiology of this association between hemochromatosis and depression remains to be elucidated, physicians should be aware of this co-morbidity.

    Key words: Hemochromatosis, ferritin level, transferrin saturation, depression, association, case report

    These findings show oxidation / rust to be linked.

    “There was a significant increase in serum SOD, serum MDA and decrease in plasma ascorbic acid levels in patients of major depression as compared to control subjects”

    “When depressed patients were compared with control subjects, the patient group demonstrated greater putamen nuclei iron,”

    “It can tentatively be suggested that the antioxidant system is impaired during a mood episode in patients with affective disorders, normalizing at the end of the episode.”

    Link to this
  8. 8. ironjustice 11:58 am 05/28/2012

    THIS may be an example of the outcomes OF this unrecognised problem of iron in the brain.
    “Maintenance electroconvulsive therapy in a man with psychotic depression and Parkinson disease”
    Parkinson’s has been closely linked to elevated iron levels AND depression has been linked to elevated iron AND schizophrenia / psychosis has been shown to be induced by iron.
    Iron reduction in ataxia , “her gait returned to normal” , iron reduction in depression and psychosis.
    “Phlebotomy can result in dramatic improvement of neuropsychiatric symptoms”

    “We describe a 21-year-old woman”
    “Schizophrenia-like psychosis”
    “Magnetic resonance imaging showed bilateral iron deposition in the cerebellar dentate nuclei and thalami, frontal atrophy, and periventricular white matter hyperintensities.”
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671953/

    Link to this
  9. 9. ironjustice 8:17 pm 05/28/2012

    “We report 5 cases with palatal tremor and ataxia. Four cases had evidence of intraparenchymal hemosiderin deposition on T2-gradient-echo imaging. Three cases had a brainstem vascular malformation. In two cases the hemosiderin deposition was likely due to prior trauma.”

    http://www.sciencedirect.com/science/article/pii/S135380201100112X

    Link to this

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