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Monday, December 31, 2012

NY Times: Game Not Known for Ferocity Claims a Casualty Who Was

A spate of suicides and diagnosed cases of dementia involving retired N.F.L. players has prompted research to determine whether there is a correlation between constant blows to the head, which are endemic to football, and a degenerative brain disease known as chronic traumatic encephalopathy.

Testing of brain samples drawn from deceased former players by the Boston University Center for the Study of Traumatic Encephalopathy has found that 33 from the N.F.L., along with 17 who competed at other levels, suffered from C.T.E.

With [Ryan] Freel, the center enters the realm of baseball, a sport not usually associated with head trauma. His parents approved the donation of tissue to search for evidence of C.T.E., which might partly explain his decline as a consequence of the injuries….

Based on the recollections of the player’s mother and Ryan Freel’s own statements, his stepfather, Clark Vargas, estimated that Freel may have sustained 15 concussions, 10 as a professional ballplayer…

Freel’s former wife said she found no fault with his teams or their medical staffs, concluding that they diagnosed his condition properly and insisted that he abide by the stipulated recovery period…

Freel had consulted with doctors and had had examinations, mostly psychological, according to his former wife, and even became aware of the C.T.E. studies. “He sought answers to his problems,” she said.

Yet he did so reluctantly, according to his mother. She indicated he would not always heed her advice to seek help from doctors or counselors and was especially reluctant to carry through with follow-up appointments…

Freel’s mother dropped by his home on the Friday before Christmas and, noticing that he was not feeling well, urged him to visit a counselor. He agreed to do so the next Monday, she said. His body was discovered the next day…

Christie Moore Freel acknowledged that the head injuries might not fully explain why her former husband took his life. “Ryan had a lot of battles, fought a lot of demons,” she said.

He was arrested at least once for drunken driving and on another occasion for disorderly intoxication.

The District Attorney Posted: December 31, 2012 at 01:12 PM | 26 comment(s) Login to Bookmark
  Tags: blue jays, concussions, cubs, health, orioles, reds, royals, ryan freel

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   1. Ray (RDP) Posted: December 31, 2012 at 02:00 PM (#4335439)
Is there an actual link between concussions and suicide, other than if a person kills himself because he is upset with his medical situation and resultant quality of life, which is a separate issue?

This has become the popular line given the NFL's situation.
   2. DJS and the Infinite Sadness Posted: December 31, 2012 at 02:25 PM (#4335467)
Is there an actual link between concussions and suicide, other than if a person kills himself because he is upset with his medical situation and resultant quality of life, which is a separate issue?

Indirectly, it seems. Repeated concussions are connected with chronic traumatic encephalopathy, which can cause dramatic changes in behavior and dementia. So you'd probably have people that are depressed and killing themselves "voluntarily," and people who just have no idea what they're doing. The Benoit family donated his brain to West Virginia university and the neurosurgeon that dissected it compared it to that of a late-stage Alzheimer's patient.

[Checked the quote, was 85-year-old Alzheimer's patient, not late-stage Alzheimer's patient. Same point though. -DS]
   3. Ray (RDP) Posted: December 31, 2012 at 02:32 PM (#4335473)
So the upshot is that you would have normal people, who otherwise would live depression-free and free from mental illness for decades and decades before dying of old age, but the concussions and head injuries they suffer from playing sports turns them suicidal/murderous?

Okay, I can see that. It's not an unreasonable or implausible premise. I'm just wondering where the medical community is on it. I'm hesitant to just "accept" it simply on the basis that it sounds plausible.
   4. Forsch 10 From Navarone (Dayn) Posted: December 31, 2012 at 02:46 PM (#4335484)
About to head out the door, so I don't have time to dig up links, but IIRC there's also evidence that repeated sub-concussive impacts (such as those that occur along the line of scrimmage on pretty much every play) are also linked to this kind of neurological degradation.
   5. J.R. Wolf Posted: December 31, 2012 at 03:00 PM (#4335498)
Correlation does not imply causality. For all anyone knows, being a former football player might result in someone both having long-term damage from concussions while they are also suicidally depressed over no longer being part of the game, no longer being famous and/or no longer having a huge income. There are an enormous number of assumptions being made here, and concluding that sports concussions lead to suicide is at the very best both tenuous and premature.

Disclosure: I have been hospitalized for sports concussions.
   6. Rickey! trades in sheep and threats Posted: December 31, 2012 at 03:07 PM (#4335504)
About to head out the door, so I don't have time to dig up links, but IIRC there's also evidence that repeated sub-concussive impacts (such as those that occur along the line of scrimmage on pretty much every play) are also linked to this kind of neurological degradation.


The most recent studies show this, yes. It's not a concussion problem. It's a repeated brain trauma - even low grade hits - problem.

Correlation does not imply causality.


This is the last argument of people who desperately want to avoid staring reality in the face.
   7. Ray (RDP) Posted: December 31, 2012 at 03:10 PM (#4335507)
I think it's clear that head trauma leads to brain damage. That head trauma would lead specifically to suicial or murderous or violent tendencies is less clear to me, but, as I said, certainly plausible. Under the assumption that suicidal/murder/violent tendencies are a subset of brain damage or developed mental illness brought on by head trauma.
   8. jmurph Posted: December 31, 2012 at 03:10 PM (#4335508)
There are an enormous number of assumptions being made here, and concluding that sports concussions lead to suicide is at the very best both tenuous and premature.


They're not giving online surveys to ex-athletes and tabulating results, they're looking at actual brains and observing physical damage. But yes, absolutely, this stuff is pretty early, just a few years old, and my understanding is they're still learning as they go. The research isn't super cheery so far, though.
   9. RoyalsRetro (AG#1F) Posted: December 31, 2012 at 03:33 PM (#4335520)

Correlation does not imply causality. For all anyone knows, being a former football player might result in someone both having long-term damage from concussions while they are also suicidally depressed over no longer being part of the game, no longer being famous and/or no longer having a huge income. There are an enormous number of assumptions being made here, and concluding that sports concussions lead to suicide is at the very best both tenuous and premature.


I agree, but the early evidence seems to suggest at least a link. If there was definite casuality, heck, I'd want to shut the sport down until they reform the rules, and I'm a big pro football fan. But as #8 suggests, the early research doesn't look good.
   10. Pasta-diving Jeter (jmac66) Posted: December 31, 2012 at 03:41 PM (#4335525)
Until they study an equal number of brains from suicide cases who were NOT ex-athletes, I would take these claims with a grain of salt.
   11. Ray (RDP) Posted: December 31, 2012 at 03:45 PM (#4335531)
Until they study an equal number of brains from suicide cases who were NOT ex-athletes, I would take these claims with a grain of salt.


This is basically the source of my skepticism. A lot of non-athletes exhibit these tendencies, and what bothers me is that every time an athlete does so, people conclude "Oh, it's because of the sports-related head injuries."
   12. zack Posted: December 31, 2012 at 03:48 PM (#4335532)
Until they study an equal number of brains from suicide cases who were NOT ex-athletes, I would take these claims with a grain of salt.


How does that follow? They aren't saying that all suicides have CTE, they're saying that people with CTE are more inclined to suicide. The problem is finding CTE brains that aren't suicides, because people usually need their brains.
   13. RoyalsRetro (AG#1F) Posted: December 31, 2012 at 03:58 PM (#4335544)
because people usually need their brains.


You haven't been following the HOF voting compilation have you?
   14. beer on a stick Posted: December 31, 2012 at 05:21 PM (#4335590)
Until they study an equal number of brains from suicide cases who were NOT ex-athletes, I would take these claims with a grain of salt


That may not be that hard. I bet most people probably go through life with at least a couple of undiagnosed concussions. Everyone bangs their head or gets bopped by something from time to time.

I've had two diagnosed concussions, one from playing ball and one from a car wreck. I have no idea how many other times I ran into something or got hit accidentally over the years, but I can tell you that at least a few of those times I felt a lot worse than when I was diagnosed as being concussed. Two aspirins and an ice bag and all that...

I suspect that these repeated little incidents are the norm for most people who lead active, if not necessarily athletic lives. Think about how many times you clonked your head against someting and saw stars, got your bell rung, etc.

I figure there's no shortage of civilian cases to study. They just need to start looking more closely at suicides in all walks of life, and not just athletics.
   15. Howling John Shade Posted: December 31, 2012 at 05:58 PM (#4335608)
Correlation does not imply causality.


This is only true if you're using "imply" in the strict logical sense. Correlation is certainly evidence of causation.
   16. AndrewJ Posted: December 31, 2012 at 06:56 PM (#4335634)
IIRC there's also evidence that repeated sub-concussive impacts (such as those that occur along the line of scrimmage on pretty much every play) are also linked to this kind of neurological degradation.

Didn't some doctors recently theorize that Lou Gehrig's ALS was triggered by beanings or baserunning collisions?

EDIT: Yes, some did.
   17. starving to death with a full STEAGLES Posted: December 31, 2012 at 07:40 PM (#4335654)
This is basically the source of my skepticism. A lot of non-athletes exhibit these tendencies, and what bothers me is that every time an athlete does so, people conclude "Oh, it's because of the sports-related head injuries."
being a huge pro-wrestling fan, i'm fairly sure there's another aspect to the concussion=suicide epidemic, and that's substance abuse. there are a ton of athletes who have chronic brain trauma, but when you add an addiction to alcohol or pain killers or steroids (or all of the above, in the case of many a pro-wrestler) that becomes a lethal cocktail.



also, the issue with the NFL isn't just that concussions=brain trauma=depression=suicide, it's also that the NFL was aware of those connections for decades and they actively sought to keep that information away from the players it affects.
   18. theboyqueen Posted: December 31, 2012 at 07:56 PM (#4335656)
There are no good studies on the chain that runs from sports-related head trauma to CTE to suicidality. There are many studies (none of which are great but in aggregate are probaly instructive) of other forms of dementia including traumatic brain injury, Huntington's disease, Lewy Body dementia, Parkinsonian dementia, Alzheimers, etc. The evidence suggests that especially in the time shortly after diagnosis, dementia of all of these forms is associated with increased suicidality. Given that CTE is one of many forms of dementia and generally considered analogous to early onset Alzheimers, it would/might follow that there is an increased risk of suicidality in this especially in the time shortly after diagnosis. I certainly think this is plausible for various reasons (coping with a terminal, progressive disability +/- increased impulsivity from the dementia itself, + we are talking about a population of young to middle aged males who are at increased baseline risk to begin with), but it is definitely true that the actual evidence is not clear. Certainly Ryan Freel's struggles with substance abuse and possibly other psychiatric problems muddy things in his individual case, but I would not rule out the fact that adding brain injury to this stew may have made things somewhat worse for him. Perhaps for someone like Steve Young, a Mormon law-school grad whose mental and emotional baseline seems much more sound, repeated head injury and some degree of brain injury does not pose the same degree of risk.

Some pubmed reference numbers for those interested: 18066936, 19368760
   19. Jack Carter, calling Beleaguered Castle Posted: December 31, 2012 at 08:07 PM (#4335661)
This is basically the source of my skepticism. A lot of non-athletes exhibit these tendencies, and what bothers me is that every time an athlete does so, people conclude "Oh, it's because of the sports-related head injuries."

being a huge pro-wrestling fan, i'm fairly sure there's another aspect to the concussion=suicide epidemic, and that's substance abuse. there are a ton of athletes who have chronic brain trauma, but when you add an addiction to alcohol or pain killers or steroids (or all of the above, in the case of many a pro-wrestler) that becomes a lethal cocktail.


Not sure why we care about what ignorant "people conclude". It has nothing to do with seeking the truth, which does need to account for drug use. Even prescribed pain killers can easily lead to addiction, and withdrawal can lead to depression. Problems with prescription drugs alone could account for a substantial part of the depression and suicide we're seeing in former players.

I'm sure other people have dealt with this: once you're in your late 20s, if you're still playing, you're almost always in some kind of pain.
   20. Fancy Pants Handles lap changes with class Posted: December 31, 2012 at 08:11 PM (#4335666)
Disclosure: I have been hospitalized for sports concussions.

That explains a lot.
   21. Ray (RDP) Posted: December 31, 2012 at 08:15 PM (#4335667)
also, the issue with the NFL isn't just that concussions=brain trauma=depression=suicide, it's also that the NFL was aware of those connections for decades and they actively sought to keep that information away from the players it affects.


Evidence?

Regardless, this sounds like the tobacco lawsuits, which were ridiculous.

Playing football and taking repeated blows to the head is dangerous, may cause brain damage, and is potentially detrimental to one's health. That shouldn't come as a shock to people. And it's impossible for the NFL to "hide" that.
   22. A big pile of nonsense (gef the talking mongoose) Posted: December 31, 2012 at 08:56 PM (#4335678)
Until they study an equal number of brains from suicide cases who were NOT ex-athletes, I would take these claims with a grain of salt.


As well as a nice chianti, with fava beans on the side.
   23. cardsfanboy Posted: December 31, 2012 at 09:34 PM (#4335691)
Okay, I can see that. It's not an unreasonable or implausible premise. I'm just wondering where the medical community is on it. I'm hesitant to just "accept" it simply on the basis that it sounds plausible.


Isn't this something that is in the early stages of study? I don't think there is a consensus yet, but there are several working theories that more studies will help clarify.
   24. Bug Selig Posted: December 31, 2012 at 10:04 PM (#4335705)
Regardless, this sounds like the tobacco lawsuits, which were ridiculous.


Or gun lawsuits - now you can be successfully sued because your legal product performed exactly as intended.
   25. something like a train wreck Posted: January 01, 2013 at 11:39 AM (#4335859)
The causality skepticism treats causality as a Sociology 101 experiment. As is always the case with reality, there are likely a lot of things going on for any given person: (1) the retirement challenge faced by most elite athletes -- coming to peace with the fact that you are no longer extraordinary for what matters for the rest of your life;(2) a loss of community; (3) physical pain; (4) mental confusion; and (5) traumatic brain disease that exacerbates the pain of 1-4 and interferes with rational thinking. To frame the issue as whether it is 5 or 1 - 4 that leads to suicide is silly.
   26. bigglou115 Posted: January 01, 2013 at 12:39 PM (#4335898)
The way I see it, the question isn't whether or not the depression comes from the head blows or the retirement or any substances the players ingested. Depression can cause suicidal thoughts, but rational thought is what prevents people from acting on those darker impulses. Sometimes the bad thoughts become so strong they outweigh the rational ones, but if the rational thought process is compromised it becomes that much easier, which is why bipolar disorder and schizophrenia have a much higher suicide rate than unipolar depression. If the head injuries can cause that drop in rational thought (which seems like a reasonable assumption based on the available research) then I would believe the head injuries create an uptick in the probability of suicide.

All that said, nobody is calling to suspend football or baseball. The question is should teams be doing more to prevent or treat concussions. I think so long as even the rudimentary research points in that direction (which it most assuredly does) then the answer to that has to be yes.

1) you can't make the argument that the players signed on for this. Yes they signed up to get beat up and knocked around, but current crop of players couldn't have been expected to understand that the physical abuse they suffer could lead to long term psychological consequences, that just wasn't on the table a decade ago when most of them went all in on sports. 2) you'd have to be pretty cold to give greater weight to teams not being marginally inconvenienced than the mental health of the people playing the game (this assumes there actually is something that the teams could do).

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