Football, Concussions, CTE and Suicide: The Truth Behind the Hysteria
Are you ready for some football?
And with the return of football – from the NFL and high-level college football all the way down through Pop Warner levels – concussions return to the national consciousness.
In recent years, the plight of NFL players has made headlines, particularly the debilitating injuries suffered by former players, now struggling in retirement with physical disabilities, such as bad hips and deformed fingers, but also mental and emotional ones, such as dementia and severe depression. In fact, the psychological effects of the game outweigh any physical problems; several players have even committed suicide after retirement, most attributed to depression or other mental disorders.
The media has used these tragedies as an opportunity to speak out about concussions. Chris Nowinski, co-founder and executive director of the Sports Legacy Institute, appears on television throughout the football season to speak about the dangers of football, specifically with regard to concussions, chronic traumatic encephalopathy (CTE) and traumatic brain injury (TBI). Nowinski, a former football player and professional wrestler, focuses on increasing awareness of concussions and the potential long-term effects of brain injuries. His institution also collects donations of brain tissue from athletes who have died to be used in scientific research. In an eerie twist, some of the donations have been made through suicide notes, as was the case with former Chicago Bear safety Dave Duerson, who deliberately shot himself in the chest in 2011 in order to preserve brain tissue.
To clarify, CTE is a form of "neurodegeneration believed to result from repeat head injuries… originally termed dementia pugilistica because of its association with boxing," according to a 2011 report in Clinics in Sports Medicine. Essentially, it is the dementia that is often associated with suffering too many concussions or receiving inadequate treatment for head trauma. A concussion is a single act, whereas CTE is the potential long-term result of concussions.
Despite the severity of the condition, are the aforementioned suicides directly related to concussions and CTE? Certainly a number of correlations can be made between concussion and depressive symptoms, but according to Dr. Jeffrey Kutcher, Director of Michigan NeuroSport, Clinical Associate Professor of Neurology at the University of Michigan and member of the American Academy of Neurology, CTE is more of a clinical syndrome. "CTE is brain dysfunction that you can measure; you have to be very careful when describing CTE," Kutcher explained. He continued, "To me, athletes who were thought to have CTE but didn't have clinical symptoms may not actually have CTE." As a point of comparison, Kutcher noted how, in an autopsy, many people have plaque in their arteries, but this does not necessarily mean that the person died of heart disease; the same can be said for CTE.
Dr. Kutcher would certainly know the differences in these conditions. He is a sports neurologist and an expert in neurological injuries from sports (including concussion, peripheral nerve injury and "stingers," among others), where roughly 90 percent of his time is devoted to concussions.
According to Kutcher, CTE does not necessarily cause suicide, either. CTE affects cognition, memory, programming executive function, attention span, depression and mood swings, in addition to many other symptoms. However, he noted, "Head trauma is a risk factor for CTE, which is a risk factor for depression, which is a risk factor for suicide." He added: "What I see every week is people forgetting that depression is common to begin with – there are factors that lead to an increased rate of suicide." Kutcher feels that, unfortunately, the media has contributed to the football/head trauma-suicide connection by oversimplifying the message.
"What is more likely to decrease life expectancy – football or riding in a car? We know how dangerous cars are, but we do it all the time. The risk we're experiencing with regards to football is a reaction to finally understanding that there is a risk, and people are having a difficult time framing that risk to wrap their heads around," Kutcher stated. He believes that parents should be more concerned about children playing with the proper equipment, that children are taught to avoid head-to-head collisions and that coaches and parents are better able to identify head injuries.
Despite downplaying concerns about a connection between concussions and suicide, Kutcher emphasizes the importance of finding a properly trained doctor if a concussion has occurred. "You should really try to seek care from a physician who is trained at doing this," he said. "Everyone is trying to say they can manage this injury, but these are medical questions that require someone who understands the depth and breadth of brain function over time."
Christopher Regal with Dr. Jeffrey Kutcher. Telephone Interview. August 23, 2012.