The Concussion Panic
Why are we so convinced that football head injuries lead to suicide?
By Al Messerschmidt/Getty Images.
When ex-NFL star Junior Seau took a shotgun to his sternum last week, commentators called it a "sobering wake-up call" for the league. How could a never-say-die athlete, a proven winner on the field, give up his own life? My Slate colleague Josh Levin wondered whether this latest football suicide would finally change the way we think about the consequences of repeated head trauma.
That wake-up call may have arrived Wednesday morning. News outlets (including this one) have suddenly became aware of some surprising and important CDC research published in January in the American Journal of Cardiology. At the request of the NFL Players Association, government scientists compared the death rates for almost 3,500 of the league's retirees to those for age- and race-matched non-athletes over the same years. The football players had much longer lives: Just 334 of them had passed away, compared with an expected total of 625.
What does this have to do with Junior Seau? The CDC study was designed to look for fatal cases of cardiovascular disease among the athletes. (It found one-third fewer than expected.) But the researchers also compiled numbers for more than a dozen other categories of disease and injury, including suicide. Former players were 42 percent less likely to die of cancer, 86 percent less likely to die of tuberculosis, and 73 percent less likely to die from digestive problems. And among the athletes who regularly played professional football between 1959 and 1988, a total of nine perished as a result of "intentional self-harm," compared with an expected number of about 22. The sample size was small, but the effect is large: Ex-NFLers were 59 percent less likely to commit suicide.
This is, so far as I know, the first major attempt to compare suicide rates among former football players with those in the general population. And while it's risky to draw too many conclusions from a single study—just a handful of deaths, really, among players from a bygone era—the news from the CDC challenges the prevailing narrative about Junior Seau and all the other aging athletes who killed themselves in recent years. It's now speculated, assumed, and even asserted outright that repeated knocks to the head leave football players with a condition called chronic traumatic encephalopathy (CTE), and that this form of brain damage—diagnosed in the autopsied remains of ex-players like Dave Duerson and Andre Waters—might have caused their downward spiral into depression and suicide.
We don't need the CDC numbers to tell us that the national debate over head trauma and suicide has long since outpaced the scientific evidence. Just a handful of cases so far support the notion that repeated head injuries (concussive or otherwise) can lead to drug abuse, aggression, and self-harm. No one knows the baseline rate of chronic traumatic encephalopathy among athletes, let alone the general population. No one knows whether the pathological signs of CTE—microscopic spots in the brain, found after death—relate to behavioral symptoms like dementia and depression. And no one can explain how repeated knocks to the head might produce CTE, or how CTE might produce suicidal thoughts. Yet in spite of our near-total ignorance, a moral panic has taken hold: Elaborate explanations are concocted when simple ones will do. Faced with the regrettable facts—a troubled man dies a lonely death—we resort to hocus-pocus theorizing about tau proteins and fibrillary tangles. It's a form of denial: By obsessing over hidden trauma, we ignore what's right in front of us. Many ex-NFL players have sad and difficult lives.
As for Junior Seau, the theory that concussions—a few big ones, 1,500 tiny ones, whatever—led to his death is not merely speculative; it's willfully ignorant. Seau was beset with a smorgasbord of risk factors for suicide, regardless of the state of his brain. He spent part of his childhood sleeping on the concrete floor of the family garage and was beaten vigorously with a wooden paddle. Seau's parents were immigrants from Samoa, where suicide rates are among the highest in the world. He had relationship problems—he'd suffered through a divorce, then got arrested for domestic abuse in 2010. As a hard-hitting linebacker, one could argue that he had a history of aggressive behavior. Like many football players, perhaps, he had access to a gun.
Physical and mental problems endemic among ex-athletes may have increased the burden on Seau. In 2007, researchers from the University of Michigan sent questionnaires to several thousand retired football players and found that half were experiencing severe pain on a regular basis; 15 percent said they were either moderately or severely depressed. For a more recent study, Linda Cottler, then of Washington University, called up 644 former NFL players, and learned they were using prescription painkillers at four times the rate of the general population. Three-quarters said they "had severe pain," and almost as many described themselves as suffering from moderate to severe physical impairment.
Chronic, physical discomfort happens to be a major risk factor for suicide. People on painkillers are also more likely to be addicted to drugs—a risk factor in itself—and they're also known to have a higher success rate when they do attempt suicide. Even just the feeling of poor health can make people more inclined to hurt themselves.
Permanent injuries may be even more devastating to former athletes, who once relied on their superior physical conditioning to make a living. One-time tennis star Jennifer Capriati didn't suffer much head trauma on the clay and grass, but repeated injuries to her shoulder and wrist eventually forced her out of the game. In 2010, she experienced what was described as an "accidental overdose" on painkillers; according to one friend, she'd been "in tremendous pain physically and mentally" since retiring.