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.
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.