Concussed But Not Discussed

Imagine being so hopelessly desperate that you commit suicide. Now imagine the ways in which you might do so. It’s fair to speculate that shooting yourself in the chest wasn’t high on the list. So why did former NFL players Dave Duerson and Junior Seau choose this path? They did so because of CTE, which is short for Chronic Traumatic Encephalopathy. CTE is a progressive degenerative disease of the brain found in people with a repeated history of brain trauma. According to the Boston University Research Center, which is a leading research center in this field, repetitive brain trauma triggers progressive degeneration of brain tissue, and leads to the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement. The brain degeneration is associated with common symptoms of CTE including memory loss, confusion, impaired judgment, lack of impulse control, aggression, hopelessness and depression, suicidality, parkinsonism, and eventually progressive dementia.

Unfortunately, CTE can currently only be diagnosed post-mortem, which Duerson and Seau both knew, so they shot themselves in the chest to ensure their brain would remain viable for study. Duerson left a note pleading that his brain be sent for examination. Seau’s family sent in his brain on their own because they knew that’s what he wanted. Both men were confirmed to have CTE. Could they have preserved their brains by committing suicide in ways other than shooting themselves in the chest? Of course. But both men were alone in their final hours and it’s impossible to know their ultimate states of mind. Let’s not forget two of the symptoms of CTE are impaired judgement and impulse control. Increased awareness pertaining to concussions and CTE allowed Duerson and Seau to be fully aware of the cause of their individual struggles, even without an ability to be formally diagnosed. When you have it, you know. I know because I have it.

My first concussion occurred in the spring of 1995 at the age of ten. I was in the fourth- grade and a friend and I had ridden our bicycles down to a local stream. Passing over the diminutive, often trickling stream was a small overpass. The protruding vegetation along the road gave the overpass and stream enough cover that it’s possible one might fail to notice them when driving past. Always eager to show off my athletic ability, I had made a habit of stepping over the bridge guardrails and jumping off. It was a move I had done countless times prior in an attempt to impress various friends, and probably myself. A large tree resided on the edge of the stream with its branches reaching out over the water. I’d always take aim at one branch in particular, grab it with both hands, and swing freely over the water before shimmying over and climbing down onto the banks edge. This time however, things didn’t go as planned. I remember the moment my chin hit the sturdy limb, and then I remember waking up soaking wet in the front yard of the house next to the stream. I had fallen the ten-or-so feet, unconscious, and landed on a boulder in the middle of the stream. My friend pulled me off the rock, out of the water, and onto the bank while screaming to the nearby houses for help. The luck of landing on the rock, combined with that friend’s heroics, probably saved me from drowning. I still have the scar on my chin from the stitches I received later that day.

My second concussion was only a few months later. I was helping my sister tend her horse. Justin, a thoroughbred and former racing horse, was difficult to handle, especially for a twig-like ten-year-old kid. I was cleaning his rear-left hoof. This is done by positioning yourself facing in the opposite direction of the horse, picking the leg up backwards toward the rear-end, holding it with your left hand, and using a tool in your right hand to scrape out the hoof. I wasn’t strong enough to control his leg using only my hand, so I would cradle it tight using my entire arm so that the hoof rested just inside my armpit against my chest, similar to carrying a football. While this enabled me to gain a small amount of leverage over the horse, it’s not the proper way to accomplish this task. When I accidentally scraped the middle of the horse’s hoof too hard for his liking, he recoiled his leg like a shotgun kicking back. Because I was holding the leg firm to my body and leaning in with all my weight, I was launched headfirst into the wooden ladder fixed to the back wall of the barn ascending to the hayloft. I must’ve been out for only a few seconds, as I remember coming to in time to hear my sister yelling at me for spooking the horse. I had now suffered two concussions and was still a few weeks away from beginning my football career.

My third concussion was about two years later during the first few weeks of seventh grade and I was now twelve years old. I grew up in a country town with a relatively small population. We fielded a football team of maybe 20 kids. Though small in roster size, we were big in heart and we were good. Our coaches decided it would be a good idea to bring in a team from a nearby city for a scrimmage and let them humble us a little bit. It worked. They showed up with so many kids that they not only played against us, they also held their own inter-squad scrimmage beside the field we were playing on. There was no doubt about it, they were men and we were boys. They beat us down. I learned a valuable lesson that day, but it came at a cost. Never tackle with your head down. I remember looking at the other team’s star player thinking there was no way he was within the age or size limits for that level of play. He looked like a full-grown man. Intimidating bandana and all, he carried the ball and came straight at me as I lowered my head and attempted to tackle him. I woke up laying on my back surrounded by numerous coaches. They asked me my name. They asked me if I had a girlfriend and what her name was and when I responded they all laughed as they helped me to my feet and agreed that I’d be fine. I played in our next game the following week.

My fourth concussion occurred less than a month later. It happened while playing unorganized pick-up football with friends from the neighborhood. Always a vicious competitor, pick-up game or not, I ran down the field and dove headfirst for the ball. Unfortunately, the kid on the other side decided to slide feet first in his own attempt to recover the ball. Knee meet face. I was out for a long time. They thought I was dead. They said my eyes were rolling in my head and my body was stiff. When I came to this time, the first thing I remember was seeing that the kid whose knee I hit was standing off to the side crying, not from pain but from fear. My nose was bloodied and broken and has never been straight since. My eye was completely closed and the entire left side of my face turned black, purple, and blue. I remember a teacher stopping class at one point in the following days just to tell me they were having a hard time looking at me because my face was so mangled. I missed only one football practice. I played in a game three days later, using a single eye.

My fifth concussion was at the beginning of the next football season. I was now thirteen and in eighth grade. Two of our coaches, ten years our elders, often enjoyed reliving their glory days and running plays against us in practice. Though they didn’t have football pads on, they were still far larger and possessed superior strength. They put us in a no-win situation. If we were tentative about hitting them, they would yell at us. If we hit them too hard, they would yell at us. One practice, the coach came around the corner carrying the ball and I didn’t give an all-out effort at tackling him because as already stated, you never knew what kind of reaction you’d receive from them. The coach got upset and demanded that I make a more forceful attempt at the next opportunity. That opportunity came on the next play. Knowing that I was now going to hit him as hard as I could, just prior to contact the coach jumped slightly in the air and kneed me in the head. It was on purpose. I was knocked out. As with the horse hoof incident, it was a short knockout. When I regained consciousness, the first thing I noticed was the coach still laying on the ground himself grabbing his knee. If you’ve ever seen a fighter that’s been knocked down and is attempting to gather themselves while unsteadily rising to their feet, this is what I looked like. I remember voices being slow and my vision not being very clear, and I remember the coach standing up and angrily throwing the football at me, hitting me where else, but in the head. I missed no practices or games.

My sixth and final knockout concussion was that following spring during a baseball game. It was 1999 and I was now fourteen. There was no ball hit into the outfield in which I didn’t think I had a chance at catching. A ball was hit deep into left-center field and I turned and began the pursuit. Running to my right in a full-on sprint, I had to jump at the last minute in order to have a chance at catching it. The ball hit the inside of my glove, and then I woke up. The leftfielder had also been sprinting to catch the ball, and at the last minute he slid to avoid a head-on collision. In doing so, he went underneath me as I was in the air, but he clipped my feet and sent me head over heels. By all accounts, I flipped directly upside down and landed right on the top of my head. Once again, I was out for a while. By the time I came to, coaches from both dugouts had already made it to the deep outfield and were kneeling over me. “Did I catch it?”, I asked my coach. He said it was the most unbelievable catch he’d ever seen. He also said there was no chance I was staying in the game and that I was probably out for a full two or three minutes. This might’ve been an exaggeration, but the point is, I was out for a long time. They called my mother and recommended she take me to the hospital, which she did. I remember the shock on the young emergency room doctor’s face when we told him about all the concussions I had during the previous four years. He recommended that I sit out all sports for a calendar year. The recommendation was ignored, but this was the first time I truly realized how bad all these concussions were and how they could have a lasting impact. When Steve Young, a Hall of Fame NFL quarterback, retired that same year and cited an abundance of concussions being his primary reason for doing so, many others also began to realize that the seriousness and lasting effects of concussions were not being properly vetted.

Luckily, after eighth grade I only sustained a single “significant” concussion during my four high school years. It was in 11th grade and I only blacked out for a split second. By the time I hit the ground I had already come to. This was the result of a helmet to helmet hit and after kneeling for about twenty seconds to gather my surroundings, I was able to jog off the field without much notice. I used quotations around the word significant for a very important reason. As the study and awareness of concussions has become more sophisticated over the ensuing twenty years, researchers have realized that you don’t need to be knocked unconscious to sustain a concussion or for it to inflict lasting harm. Like many matters, concussions occur on a spectrum. According to the Boston University Research Center, anytime a blow to the head causes one’s state to be altered for any amount of time or causes even the slightest after-effects, you’ve sustained a concussion. Long term, these continued blows to the head, even though they don’t knock you out, can have the same negative impact as a severe knockout can, and sometimes be worse. This is a game changer. When I was growing up, if you didn’t get knocked out, it wasn’t considered a concussion. The numerous instances when you would hit another player helmet to helmet, or your head would hit the ground and you became discombobulated or get the spins for a few seconds, weren’t considered serious. As the term goes, it was simply “getting your bell rung”. As anybody who has played football knows, this can happen a countless number of times. In some cases, it could happen multiple times in a single practice or game. My friends and I used to joke that we developed stutters during the season due to these repeated blows that we thought were just par for the course. But as we now know, its no laughing matter. Rightfully, the NFL now removes a player from the remainder of the game if they are witnessed to suffer one of these hits that formerly a ten-year old kid wouldn’t have come out of a game for. That player then must pass a series of cognitive tests before they’re allowed to resume practicing or playing, which in certain cases can be weeks, if not months. This is great progress. Unfortunately for the millions of players, including myself, who played during footballs first hundred years of existence, these protocols didn’t exist and do us no good.

Concussions aren’t limited to football players. Patrick Grange, who played Major League Soccer for the Chicago Fire, died in 2012 at twenty-nine years old after being diagnosed with ALS, which has been closely linked with CTE. Throughout Grange’s career, he was seen as prolific when it came to heading the ball. When Boston University studied his brain, he was found to have Stage 2 CTE along with motor neuron disease. A recent study on dementia in the United Kingdom looked at the brains of six former soccer players. Four were found to have CTE, the cause of which was determined to be repeatedly heading the ball thousands of times over their careers. Cumulatively between the four, there was only two instances in which they believed they had experienced a concussion. This is another prime example of the small hits adding up. Anytime something hits a person’s head, their brain is going to rattle inside the skull. If your brain bangs against your skull, whether you experience symptoms or not, there’s going to be negative consequences. Over the course of a season, no matter the age or level, these repeated blows will and do have a negative impact and for many the result is CTE.

Curtis Baushke of Tennessee played Soccer from age five through his senior year in high school. He suffered multiple concussions in attempts to head the ball that resulted in him instead banging heads with other players. He wrote a paper for a college class in 2009 speaking about the concussions he sustained and how his research into concussions led him to believe he had CTE. In 2012 at age twenty-four, Curtis died from an accidental overdose in an attempt to medicate his problems away. His parents knew he would’ve wanted his brain to be examined, so they had it sent to Boston University. The results were clear. Curtis also had Stage 2 CTE. Upon receiving the news, his mother said, “I cried and cried. He was so right. Curtis wasn’t just making it up and talking crazy. He thought he had it, and he did.”

A Rolling Stone article published in 2018 speaks of Moroccan midfielder Nordin Amrabat and how he was unconscious for over a minute after knocking heads with an Iranian player during the 2018 World Cup. It was confirmed after the match he had lost all memory of the previous six hours. The article touches on the previous World Cup in 2014, and how Cristoph Kramer of Germany continued playing after a collision that initially left him unsure of where he was or what round they were playing in. It speaks of Taylor Twellman, one of the most accomplished scorers in the history of U.S. Soccer, who now runs a foundation advocating for concussion awareness after his own career was cut short due to recurring concussions and related symptoms. And finally, the article speaks of English soccer legend Jeff Astle, who was famous for scoring more goals with his head than with his feet, and how in 2002 when he died at fifty-nine years old, the coroner’s report linked his death to brain injuries.  

A new frontier of CTE study is now beginning pertaining to women’s soccer. These studies have a good chance at yielding frightening results. Concussion studies in female players have already found that women are more prone to concussions than men. Skinnier necks, resulting in less ability to combat the force of the ball or the head of another, are thought to be at the root of this increased susceptibility. Currently, only two women have ever been diagnosed with CTE. One was the victim of domestic violence, and the other had a developmental disorder which led to habitual headbanging. Boston University is again leading the way into this research by recently announcing they will begin the first female specific study of CTE. Former U.S. soccer stars Brandi Chastain and Michelle Akers have made their intentions to participate in the study public. I don’t think it’s a stretch to draw a line from women being more susceptible to concussions to women soccer players potentially having a greater risk of developing CTE. Time will tell.  

The fact that female soccer players are only now being asked to participate in the study of CTE, shows we are still in the infancy of understanding the totality of its effects, and what these effects ultimately mean for the whole of society. An extraordinary percentage of athletes, both female and male, who’ve played sports ranging from football to soccer, from hockey to basketball, and from rugby to lacrosse, have experienced some type of brain injury. In many cases, victims suffer multiple traumas. Automobile accidents are one of the leading causes of traumatic brain injuries in the U.S., and it only takes a single significant concussion to alter the brain. Military veterans with PTSD are now being diagnosed with CTE as well. Domestic violence and child abuse bestow their own contributions to the total numbers. Even simple mishaps such as falling in the shower or banging your head on a cabinet can have lasting effect. Add it all up, and the total number of people enduring symptoms caused by CTE form a consequential percentage of the population, most of whom suffer in silence, many being unaware of why life seems more difficult to them than to others.

CTE in professional football players is starting to become well documented. However, the total number of men to ever play professional football is in the low tens of thousands, compared with the multi-millions who have played in elementary school, middle school, high school, and college. It’s becoming common anytime a current or former NFL player commits an act of domestic violence or commits suicide to look at their concussion history and draw a direct correlation. The same cannot be said for the irrational forty-year old man who never played football after middle school but suffered concussions when he did. How often do we look at the woman in her mid-thirties who played high school soccer and think the reason for her depression stems from participation in this sport? We conclude that child abusers were themselves victims of harsh punishment and pass this off strictly as a learned behavior, but we’ve failed to acknowledge the role CTE might also play in cycles of abuse. Suicide, depression, domestic violence, and substance abuse are all more prevalent in society because of CTE, and not by an insignificant amount. According to the Center for Disease Control and Prevention, 2.5 million people suffer traumatic brain injuries annually in the U.S. If only two percent of those injuries resulted in CTE, that means 1 million people over the prior twenty years have developed the condition. It’s fair to say it could be less. It’s also fair to say that number could be much higher. One thing’s for certain, until there’s an increase in study, awareness, and prevention, many members of society will continue to live with the vices brain injuries bring, but few will recognize the foundation of those vices.

I live with these vices daily. I’ve been depressed for the better part of seventeen years. Moments of bliss often occur only after I’ve been able to rise out of an extended period of melancholy. Hopelessness is an emotion I’ve been unable to conquer but of which I’m well acquainted with suppressing. Marijuana has strongly diminished, but not eliminated, a continuous penchant for anger. Even with all these faults, I believe the most difficult aspect of living with CTE is not knowing if or when my body might start to breakdown. Most people live with this fear regardless of if they’ve had a traumatic brain injury, but having had so many, it’s impossible for me to ignore the probability of an expedited demise. One advantage I’ve had over many others is that I know and have known for a long time the cause of my ills. This has allowed me to consciously attempt to alleviate them, sometimes with success, sometimes without success. But knowing is better than not knowing. If knowledge is power, its imperative society put more effort into assessing the seriousness of this issue, giving unwitting recipients of CTE along with those who care about them the power to begin their own alleviation attempts. Until we shine a brighter light onto how very common CTE truly is, our friends and family members will continue to be judged unfairly for their deficiencies and unbecoming tendencies. Deficiencies and tendencies which are initiated and augmented by CTE.

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