Friday, May 4, 2012

Junior Seau: Mental Illness -- Not Brain Injuries -- Is Leading Suicide Risk Factor

The tragic death of football star Junior Seau has led to a renewed discussion of the relationship between brain injuries and football. Indeed, the first round of articles that reported his suicide raised the subject -- even though very few details surrounding his death were available.

This conversation will probably continue for at least a few more days (realistic thinking about the rapid media cycle) now that Ta-Nehisi Coates, a popular blogger for The Atlantic, has written on the subject. In his latest column, Coates announces that he has made the difficult decision to stop watching football, pointing to the failure of the NFL to address the subject of brain injuries: "What's fairly clear to me is that football and its surrounding apparatus--the players, the big media, the NFL--aren't really ready to think about all that brain injuries might mean." Coates says that he has no other choice but to give up the sport:
I now know that I have to go. I have known it for a while now. But I have yet to walk away. For me, the hardest portion is living apart--destroying something that binds me to friends and family. With people whom I would not pass another words, I can debate the greatest running back of all time. It's like losing a language.
Obscuring the Powerful Link Between Mental Illness and Suicide
Although the media has speculated about whether Seau had a brain injury, it has not looked at a more likely explanation for his suicide: mental illness.  Numerous studies show that at least 90 percent of people who commit suicide have a "diagnosable and treatable" mental illness, such as depression, bipolar disorder or schizophrenia. I could not find any studies that list brain injuries as a common risk factor.

Several studies, however, show a small but statistically significant correlation between severe traumatic brain injuries (TBI) and suicide. These studies, however, do not find a correlation between suicide and TBI standing alone. Instead, the studies that find a link between TBI and suicide also find that the vast majority of persons with TBI who commit suicide also suffer from major risk factors such as mental illness and substance abuse. In other words, even in cases where brain injuries make persons more vulnerable to suicide, mental illness remains a substantial contributing factor.

Dr. John Reed, the CEO of the Sanford-Burnham Medical Research Institute in La Jolla, California, is conducting research on neurological disease and traumatic injuries.  Reed cautions the public against rushing to attribute Seau's death to TBI.

Reed says that TBI together with mental disorders (including depression) can lead to suicide. He also states that Seau could have suffered from a mental illness unrelated to any brain injury: "It’s important to remember that it’s also entirely possible he could have had an unrelated mood disorder. . . . One in four Americans sometime in their life will develop clinical depression.”  Despite this reality, most media discussions focus almost exclusively on the possibility that Seau had a football-related brain injury.

At this point, it is unclear whether Seau had a brain injury. It is also unclear whether he suffered from a mental illness. But given the overwhelming data related to suicide, speculation should lead the media to a conversation about mental illness first, rather than brain injuries. At the very least, the facts about suicide should lead to a discussion of mental illness and brain injuries, since the two can act as co-risk factors. Instead, the media has chosen to focus on a topic that is more sensational: the victimization of innocent football players by a greedy corporation.

Mental Illness and Stigma
Many studies find that stigma deters people from getting help for mental illness. This stigma is most powerful among persons of color.

At least one psychiatrist has raised the possibility that stigma surrounding mental illness might have contributed to Seau's death. In a column written for the San Francisco Chronicle, Dr. Winston Chung, a psychiatrist at the prestigious California Pacific Medical Center in San Francisco, considers whether cultural factors that deter persons of color from seeking mental health services and that make toughness an asset in the NFL might have prevented Seau from receiving treatment that could have prevented his death.

Even if a brain injury played a role in Seau's death, Chung rightfully observes that the focus should remain on mental illness: "Whether it’s from brain damage, a genetic predisposition or environmental stressors, depression is a treatable condition and suicide can be preventable." The almost exclusive focus on brain injuries replicates the social stigma surrounding mental illness. It remains an issue to avoid.

Final Words
Returning to Ta-Nehisi Coates, I encourage him to discuss mental illness as he continues to struggle with his decision to abandon football. I also encourage other media commentators to overcome the social stigma associated with mental illness and use their coverage of Seau's death to educate the public about the factors that lead people to suicide. Although brain injuries are possibly relevant to a discussion of Seau, mental health is undoubtedly relevant to his death as it is to most other suicides.


Michael Isaza said...


Your article was spot on, I think next time rather than me trying spit it out on my blog, I will just say "What Darren Said" :) I am compelled to believe, and this is not an original idea, that MONEY and the pending litigation between retired players and the NFL has a lot to do with they way these suicides are being covered. That is actually shameful to me but none the less, hopefully the few voices on depression out here in the real world will be heard. Speaking of which, how in the world did you see my article? I love to write but really have no way of "promoting" my blog so I was tickeled to death that you read and responded. Thanks, and you definitely have a fan in me, I will check your page daily!


Darren Lenard Hutchinson said...

Hey, Michael. Send me an email. I have a few tips about getting more traffic.

Troeltsch said...

I really enjoy your blog, but I think you miss the potential causal connection when you state:

"Although the media has speculated about whether Seau had a brain injury, it has not looked at a more likely explanation for his suicide: mental illness. Numerous studies show that at least 90 percent of people who commit suicide have a "diagnosable and treatable" mental illness, such as depression, bipolar disorder or schizophrenia. I could not find any studies that list brain injuries as a common risk factor."

While there may not be a common risk factor across those three (mostly because the mechanism for schizophrenia is different)- there is a literature of brain damage leading to depression (or other disease) that then leads to suicide. It's difficult to disentangle the effects, but brain damage usually plays a role with mental illness for suicide.

Darren Lenard Hutchinson said...

Troeltsch - I think you are reading too much into the point that brain injuries can lead to depression. Yes - but that does not mean that brain damage "usually plays a role with mental illness for suicide."

Most people with depression do not have brain injuries. Depression exists outside of this context. Even if a causal connection exists between brain injuries and depression, this would not mean that brain injuries are the most prevalent or even a prevalent cause of depression.

This is exactly why I am critical of all the focus on brain injuries and suicides. I suspect that once that topic fades from public discourse, people will not focus on depression or suicides anymore. But these are still problems for millions of Americans.

Michael Isaza said...

Brain Damage can, and probably does lead to depression. When severe enough, that depression can, and sometimes does lead to suicidal ideations. Hearing loss is also being linked to suicide in some studies. Yesterday, I thought about all of the different scenarios that are believed to lead to depression. For example, hearing loss is believed by some to lead to depression and depending on the severity, suicidal ideations. When doing very quick research, I found the following "In one study conducted by the Geriatric Mental Health Foundation, 15% of participants over the age of 65 reported feelings of depression. These feelings are often linked to health concerns which include the onset of hearing loss".

If hearing loss can lead to depression, which leads to suicidal ideations, do we now think that Rock Singers may commit suicide based on their hearing loss? As Darren mentioned to me yesterday, will we study the link between IPod induced hearing loss and how it is related to suicide?

I guess my point is that I agree with Darren whole heartedly. We need to NOT focus solely on how head injuries lead to depression and/or suicide and try to find ways to combat DEPRESSION all together. This epidemic is not confined to NFL players and certainly reaches far more boundaries than the white lines on a field. Most, if not all of us will be touched by suicide in our lifetimes and when we are, the difficulty recovering is immeasurable. In 2007, one of my 19 year old Female Soldiers committed suicide, and in 2012 one of my dear friends did the same. Neither had head injuries, neither left a note, and neither Family has had one moment of peace since those tragic days. It is my hope that the untimely deaths of these football players will not get swallowed up in what is becoming a financially backed conspiracy for X-NFLers to get money from the league because of their predisposition to head injuries. What I hope everyone does, is put their time and energy into focusing on the BIG pictures which is depression and how we can intervene before it is too late. I hope that the focus is not solely on head injuries because the majority of depressed people that commit this horrific, selfish act DO NOT have a head injury, they are depressed.

This dialogue is great. Even though Troeltsch and I disagree, at least we are talking about it. Regardless of the cause, whether it be head injuries, hearing loss, or depression, we need to start educating ourselves on how to notice the signs and intervene before it is too late. The first step to that is talking about it, and I am glad we are.

Michael Carlos Isaza

Michael Isaza said...

Oh, and if Darren will allow me to market my own blog, please check it out @


I am a beginner and appreciate all constructive criticism.

Michael Carlos Isaza

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