Tuesday, August 14, 2012

The Failure of Informed Consent and the Football Brain Trauma Debate

The new football season looms before us. Olympic memories linger, but the countdown to football dominates sports radio and ESPN. Fans and media cannot wait for the game and the carnage. But before we jump in to enjoy the sport, let’s remember the shadow that hangs over every football player and game as well as our support of it.

Football can kill the soul of players.

Junior Seau, a NFL icon, shot himself in the chest in May. He joins three former professional football players who committed suicide in the last two years. Several were diagnosed after the fact with mental illness caused by brain damage related from repetitive head trauma. Seau’s brain has also been diagnosed as suffering from CSE a progressive disease resulting from repeated head trauma. It contributed to his erratic behavior and suicide.

Football kills the soul by destroying brain functioning. The brain suffers from the generation of webs of plaque in the brain that destroy neural communication and processing. These plaque entanglements seem to be caused by repetitive head injuries, mainly traumatic concussions. Repetitive impact alone may also do as much damage in creating the nodes of tau proteins that anchor these tangles. The tangles lock up neurons and disrupt the brain’s neural ability to communicate and sustain a bioelectrical balance.

In July 2012 over 3000 former players consolidated their law suit claiming the NFL “deliberately and fraudulently” withheld and discouraged knowledge about the damage football was doing to the brains of football players. The law suit reflects accumulating knowledge about the cognitive impacts of injury as well as a widespread and belated recognition that while football is a violent and dangerous game, its damage lay far deeper and more sinister than destroyed knees, brutalized ACLs, wrecked shoulders and crippled players late middle age.

I have written about this often. I talked of Achilles Revenge where athletes choose to risk their health for glory and wealth in exchange for physical pain. The brain trauma goes beyond physical pain. The neural damage undermines judgment and manufactures erratic emotional responses. Players can suffer from dementia, chronic traumatic encephalopathy. CTE induces depression, loss of memory, unpredictable emotional swings and aberrant decision-making. Player’s emotional and judgmental resources erode. The more we know the more we understand the issues may be underreported.

This erosion of judgment, emotional stability and resilience combines with the normal physical pain and status loss retired players face. The loss of their locker room camaraderie and support compounds this isolation. Roman Oben a 12-year veteran puts it this way, “they spend the rest of their lives being shadows of who they were at 25.”

The result?

The rash of suicides by retired football players augments the compelling evidence that a significant percentage of football players may struggle with declining cognitive limits and depression in rates beyond the regular population. After Jay Easterling killed himself with a handgun, his wife Mary Ann commented, “He felt like his brain was falling off…He was losing control. He couldn’t remember things from five minutes ago.” Earlier Dave Duerson had shot himself in the chest to preserve his brain for further study.

No other sport spawns this level of suicide. Sometimes suicide can be contagious as a way out of the emotional and spiritual pain of watching your personality slip away and losing control of all you value. No one knows how many ex-players struggle with mental illness induced by the brain trauma. No one knows the causal pathways. No one knows much about it because the NFL worked hard to discredit any research in this area.

The country will not outlaw football. Many present and former players resent efforts to mitigate the violence and long-term harm. They represent the classic commitment psychology of someone who has invested in the trauma and identity of the sport. They experience this as a form of initiation for them and the sport. If they did it, so should the young players. A number of players and commentators have already attacked the new NFL contract that places strict limits upon the level of contact in camp to protect the long-term welfare of players. They bitterly complain that drawing down the level of violence limits the ability of young players to demonstrate their toughness and beat out veterans. Others just say, “I’d do it all again.” So the players’ law suit focuses upon informing players and not regulating the game.

This solution flows from the  free choice defense. The players and league want to ensure that the new draftees have adequate information about the threats. The players can make “informed” choice.

Let’s look at what this informed consent might look like. We have to ask a person to make a decision to risk potential loss of their personality when they are 22 years old. We need to remember that human begins tend to overestimate catastrophic consequences but underestimate small losses. People also tend to be over optimistic in their own projections about how they will avoid statistical dangers to themselves. The informed negotiation leading to the brain trauma deal might look like this:

Drafted Player (DP)
“I have a chance to live my dream. I got drafted! This is incredible.”
Advisor/Agent (AA)
“Fantastic. Now we can negotiate with the teams to get you're a contract that matches your slot.”
RP    “How soon can we start?”
AA   “I meet with the team in two days, but before I begin we need to talk about something that a recent settlement with the league mandates.”
DP    “Got it. What’s up?”
AA   “Well, I need to alert you to the fact that football can be dangerous to your health. Here is a list of the dangers. I also have a video you can watch.”
DP    “Come on man. Of course I know that. I have three surgeries to prove it. This is news?  Football is a violent and dangerous game, I know that.”
AA   “Well I need you to read this disclaimer and check the part of about brain trauma, dementia and compromised judgment.”
DP    “Yeah, I’ll read it, but I know this stuff. I’m not afraid of this. My bonus will cover it all. Besides, this stuff is a hundred years in the future.”
AA   “Well actually, it’s about 20 to 30 years in the future, but you are right, most of these injuries start to impact you in your late forties. Sadly Chris Henry suffered it when he was 26. I also want to remind you that we may need to set aside some funds for this just in case from your signing bonus or your first year.”
DP    “Look, this is stupid. I am 23. I will be fine and besides I owe it to my mom and friends to take care of them. I promised my mom a new house, and I want her out of where she lives. Man, I suffered for this, and I want my return. She deserves this. I can take care of the stuff later. I’ve got a lot of money. Right now, just get the money so I can take care of my family.”
AA   “I just want to be clear. Football is dangerous and brutal and violent. We both know that.  Well, the court settlement does give you the option of talking to some guys, watching videos or going to a panel to talk about how to think about these injuries and prepare for it.”
DP   “I know what I’m getting into. I have the scars on my knee and shoulder to prove it. Besides I’m a lineman, and I’ve never had a concussion so I’m not that worried about it.”
AA   “Well some doctors think it’s not about concussions, but it about repetition. A number of players have had serious brain issues without any real concussions.”
DP   “Ok, OK. I’ll think about it. But I’ll take the risk. This is my one shot, my one chance. Football is what got me here. I owe it to myself and to my family. Besides I’ve read the interviews. Most of the guys say they’d do it all again even if they have sore knees.”
AA   “Well, OK. But remember you have been duly notified as required by the terms of the court settlement.”
DP    “By the way, what do the guys who have suffered brain damage say about how they are handling it.”
AA   “Well it’s kind of hard to figure out.”
DP    “What?”
AA  “Well. You know for some of the guys. Well, you know. Well, it’s like this.”
DP    “What are you getting to? Come on, spit it out.”
AA   “Well. A lot of them are not compos mentis.”
DP    “Come on. I’ve got a degree, but I did not take French.”
AA   “Well they aren’t really all the able to talk about how they are doing. You see, well. You see. Well a couple are living with tubes in their throats and respirators. Some of them are not all that stable or coherent all the time.”
DP    “This is getting a little weird.”
AA   “Look I’m trying to help. Think of it this way. You get wealth, privilege, fun and status for awhile.”
DP    “Yeah. I know. That’s the whole point of this.”
AA   “Well the other side is. You potentially give them your soul.”
DP    “This is a little metaphysical man, are you sure you are OK?”
AA   “I just want you to know. Their wives do most of the talking.”
DP    “Well I read about some other guys who were big names like Seau and Easterboork who were struggling with this. What did they say?”
AA   “Well, they can’t say much. They committed suicide.”
DRP   “Your’e shitten me, man. Look man, this is getting us nowhere. What do you expect me to do, go manage a car rental office?    ---         This won’t happen to me. Let’s make this happen.”

So much for informed consent changing decisions of players.

Every one of us entering a career embarks on a path that will change us. We seldom know what our future self will look like when we enter a job world. Sometimes we discover that our path is destroying what we value in ourselves, and we change jobs or change careers. Sometimes ten years down the road we look in the mirror and no longer recognize the person we have become. 

Throughout our life we negotiate over the person we are and the person we are becoming. None of us really knows how we will end up, but we do know that the person we become will be is shaped by the work we do. No different with football, but the impact can be  a little more severe.

No person easily or rationally risks his or her personality and capacity to be a human decision maker. The core of our humanity lies in our ability to feel, think and shape our life; it depends upon our brain working. The stealthy soul death brought on the brain trauma induced by impacts condemn players to a living death, far beyond their imagination.

Expecting informed individual choice option to address the brain damage threat is an illusion. It makes as much sense as the older argument that coal miners made a free choice to enter the mines and accept black lung disease compared to unemployment. The solutions remain similar. The sport and unions need to continue aggressive and continued research and interventions to minimize the long-term damage. The other path should involve joint contributions to a fund to support later life victims of the brain damage and soul loss that no one should have to bargain away.

The odds are that individual players will not build up a fund. Mary Ann Easterling, whose husband committed suicide, summed it up, "I'd also like to see the NFL take care of the players that do have symptoms or could possibly have symptoms."

The league and union need to do this. It is the least they can do for the sentence that some players will consign themselves to.


  1. Excellent piece. I am very glad I discouraged my son from playing football (though I think baseball left him with elbow damage I wasn't quick enough to stop).

    Not only at the college or pro level, but at the lowest levels, we need to re-examine our culture of "being manly," "playing through the pain," and "getting in there," because MOST kids do not grow up to cash a professional athlete salary.

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