[Pictured above: Dr. Bennet Omala, neuropathologist of Nigera, from TIME magazine, photo by Jim Spellman of Getty Images]

{Dislcaimer: “Sports Head Injury Induced Dementia” is as far as I know…my own term]

Two days from now the documentary-movie Concussion starring Will Smith based on the ever worsening story of America’s addiction to football and the unceasing drumbeat of the incredibly high risk and now perhaps the predictable high risk of a new form of dementia, about the research and quest of Dr. Bennett Omalu, the Nigerian neuropathologist pictured above [from the current issue of TIME magazine] will be shown in theaters.

TIME’s current issue, features the article: “Concussion Expert: Over 90% of NFL Players Have Brain Disease,” perhaps not so coincidentally, at this time of America’s gluttonous feast of football bowl games, the New Year’s Day all day sports gorge, is highlighting this issue and reminding us all of the risks involved in head contact sports. It goes way beyond football though. The worst example sport in my still undemented mind in spite of being in my sixties, is boxing. One can only remember the sad public dementia of many a prize fighter reduced to being bouncers and childlike ‘greeters’ at Las Vegas casinos and night clubs in the 1950’s and 1960’s when the Mob was king of Vegas and many a boxer owed their early successes to the backing of the Mob who ran boxing for decades. Think of Joe Louis and Muhammed Ali, the former truly demented, and the latter, Ali who has suffered so sadly from extreme debilitation from Parkinson’s disease evident so poignantly when he lit the Olympic torch years ago. The phrase “punch drunk” like so many sayings in our language exists for a reason and now modern neurological medical science has verified incontrovertibly the folk wisdom in that phrase used so much with thought that means brain damage.

Now it is called CTE or chronic traumatic encephalopathy, but make no mistake about it, this is a newly recognized of dementia, albeit quite different from Alzheimer’s disease and the other dementias. Dr. Omalu found it in the brain of Mike Webster, whom i am old enough to remember as a player and name. The issue started to mushroom out of the control of those who wished it would go away when Dave Duerson, lineman for the then St. Louis Cardinals suicided by purposefully shooting himself in the chest, and specifying in his will that his morbidly preserved brain by his mode of suicide, be examined by science as he knew something was very wrong with him. This story and other forced the NFL and organized sports especially football to stop ignoring and perhaps obscuring the growing body of medical research that was hinting at a growing tragedy. The NFL just a few years ago had to fire its then neurologist chairman of its committee on the head injury issue and settled a class action suit for, if memory serves me approximately somewhere in the neighborhood of either $700B or $900B with the very unusual legal stipulation as part of the settlement that this would NOT be the last class action suit about this issue. Sarcastically speaking, and pardon me all you football fans, I can just see the litigation lawyers groups of this country and others, salivating and going into training seminars in the next few years  as they did with asbestos and mesothilioma. Then they will start to advertise for ex-football players on television who suspect diminishing cognitive-intellectual and odd psychiatric and behavioral alterations in themselves, to call those toll free numbers. More class actions will result that could make the first one look trivial. The clients with deep pockets to whom the legal agents of “redress’ will be the hallowed big sports business entities, the NCAA, the NFL, the NHL, the boxing associations, universities, high schools, where will it all end? [Disclaimer: I grew up on football, my father played football in high school, loved to watch football, and was from Texas where Football Is God.].

My first case was that of a relatively still young corner back, that I was called to another state over two decades ago to render an opinion in the nursing home in which he had been placed. I was asked to do so because of one of those third degree connections that somebody knew somebody who had heard of me and the family contacted me to see their son. He had played very aggressive football all his life as a defensive back as he was not big enough to play any other position in football. He had started in middle school, played through high school, caught the attention of college scouts, had a moderately well known career in college and was easily drafted by the pro’s. He played on one of the reigning teams of the decade but suddenly one summer in the near waning years of his career, he suddenly could not remember the pass routes and other elements of the finer points of his position. He was found to be displaying memory problems, and forgetting things, misplacing things

, missing the team planes and trips, starting and being inattentive in practices and on the sidelines and at times could not retain what coaches had just told him. His memory functions drained like hole in a balloon but quietly and slowly and he was used more and more sparingly. He was well liked and no one wished to face up to the inevitable until he became openly confused and had to be benched and cut from the team. At home his family immediately could tell he was not the same person. He was inattentive, apathetic, moody, surly, then quiet for long periods and forgetting the names of persons he had grown up with. His vocabulary started to melt away slowly and he would use verbal gymnastic to try to describe things instead of naming them. Finally he started to wander a bit, not pay attention in church, not retain what he had been told seconds or minutes before, forget appointments or errands and could not work in more and more simple jobs as the family tried to sustain him. To shorten this tale of true woe, he deteriorated to a tragic state, had to be placed in a true nursing home with the best of care, depleting his life’s earnings as he had no health insurance by then, and the last time I saw him before he died he was spending most of his time secured gently to a wheelchair to prevent falls, could not walk and slept  on a floor surgace bed in case he fell to the floor to prevent injury, was totally incontinent, in diapers, could not care for or feed himself and was totally nonverbal before he died. His downward course was far briefer than the usual 7-10 years or so of an Alzheimer’s patient but not rapid enough to break the hearts of all the knew him. Brain biopsy was refused by his guardians, so an exact diagnosis was not possible and was not performed after his death so anything I saw is speculative. I felt that back then given what we as a diagnostic team were able to glean from his state and the insufficiently precise studies we could perform, was that he had had onset of his brain function loss as I preferred to term because it was NOT any typical dementing process and the family had no history of such, but that it most closely resembled Pick’s Disease but was very atypical even for it.

I had all along suspected years of brain damage from his football days and this was more than a decade before the whisperings about CTE started. He had played “Ronnie Lott” defensive back style play, who was known for being the hardest hitting most feared defensive back in all of pro football. This young man evidently overcame his smaller size, emulated Ronnie Lott and others and worked his way into the pro’s, as the writers would say in their hackneyed, clich’ed manner, “against all odds.” He was said to have taken pride in the ferocity of his tackles and bringing down the new type of pro football receivers, who were much bigger and taller, trend that continues. He was said to have done this all his football career to prove himself as he was slightly small being shorter on average than most of his defensive back colleagues. He died a few months later after I last saw him and faded in memory of all but his family and close friends, well before the phenomenon of CTE came along and may have explained at least part of what overtook him, and robbed him of life before “middle age.”

Dr. Omalu’s work led to this blunt and ominous statement which he has apparently repeated in voice and letter and written pleas for years.that:

“In my opinion, taking professional football players as a cohort, I think over 90% of American football players suffer from this disease. Over 90% of players who play to the professional level have some degree of this disease. I have not examined any brain of a retired football player that came back negative.”

I began my career not in psychiatry, but in the neurosciences, in labs working exclusively in animal and primate brain science, then trained briefly in neurosurgery until I decided psychiatric was my calling. I did brains autopsies for  a sustained period on brains of the mentally retarded in a Midwestern state care facility for the severely mentally disabled who died there, and became quite familiar with common and bizarre abnormalities in brain developmental, mental retardation (severe forms), now called intellectual disability severe, brain malformations and the early research on Downs syndrome and the later risk for development of Alzheimer’s.

So I had more than my share of “accidental preparation” for entry into this case and the last decade of controversy over head injuries in our hallowed dangerous sports before I knew what I was “getting into.” These kinds of anomalous events of the last decade, mixing IED injuries and its immediate and undeniable pathology perplexed me no end.I knew that many physicians, neurophysiologists, neurosurgeons, neuroanatomatists, neuroradiologists, neuropsychologists and others, that something very different and frightening was growing and taking shape in front of our eyes. It was unfortunately helped by the Defense Department’s growing concern over the large cohort of IED (improvised explosive devices) that developed in the last 15 years of the sectarian tribal civil wars in the Gulf War on Terror. As we “grew” hundreds of thousands of opium addicts in the Civil War, drug addicts in the Vietnam War, the DOD’s research efforts, slow at first but never wavering, have given us funding and more tools [and unfortunate patients] to care for, study, research and refine our initial primitive understanding of the repetitive severe concussive phenomenon.

This entailed many changes in knowledge paradigms. We had to get rid of the mindset that concussions were brief trauma [a contradiction in terms if I ever heard one], and like repetitive emotional trauma like repeated rape or brushes with death in WWII or modern warfare concentrations camps, resulted in a progressive, unrelenting, cumulative damaging effects on the brain. “Getting your bell rung” did not stop after the bells in your head stopped.

I only have drastic, immoderate things to say about all this:

• We will generate tens, if not hundreds of thousands of person in a new cohort of damaged brains in the coming decades from our wars involving IEDS
• We must view the similar coming brain damaged large cohort of brain damaged athletes in the very same light, as a blight, a preventable one that requires drastic action
• I am skeptical that the ‘window dressing’ spin currently used to defend this state of affairs of better protection, better helmets, new rules outlawing “spearing,” is in my biased opinion, just bunkum, hooey, and not the answer. I am not sure we can adequately protect players’ brains in these dangerous sports sufficiently to prevent these cumulative injuries without ending up with a blood lust sport without the Roman Coliseum blood lust that attracts so many fans; our players will have to play in gargantuan inflatable suits that will change the game into a laughable game of giant human bouncey-balls careening randomly around the field perhaps. I offer as evidence, a figure from my childhood, Tivis E., a country woman if there ever was one, who loved to go watch semi-professional wrestling in Chilhowie Park arena in east Knoxville Tennessee back in the days of Wahoo McDaniel and young Rick Flair. She would get so worked up she would yell in true wrestling fan rabid fervor, “I want to see blood on the mat,” and if the match was not violent enough, she would charge the ring and THROW her DENTURES at the offending wrestler! And she was only five feet tall and usually soft spoken…
• I can foresee an end to this part of American culture, the demise of football, hockey and boxing ultimately. Sports perhaps as lacrosse, that do not have as a common mode of play, using the head as a weapon or the frequent recipient of violence, might survive. Soccer, will have to ban the use of the header.
• The rules now regarding protecting and “quarantining” players from further play once they have survived a concussion for a period of time as a start. But the monitoring of them should be very strict, repetitive neuropsychological cognitive tests for the rest of their careers, separation of the monitoring functions and personnel completely from the interests and influence of the teams’ hierarchy, owners, etc., and ongoing periodic regular transparency of findings, though pooled and confidential in perpetuity or as long as these sports are played.

I would hate to live to see the day where the results of our ignoring this national epidemic is shown by the everywhere presence of childlike, intellectually shortchanged former gifted athletes are reduced to menial jobs, greeters, sweepers in barber shops, newspaper hawkers, cargo truck loaders and other jobs that do not require thought or much brain power. America may have to ready itself for a different world of entertainment, perhaps more virtual than actual…