Saturday, September 18, 2010

Brains, Behavior and Football

In psychiatry, we've had a hard time drawing precise links between brain pathology and psychiatric disorders. We can do it for groups of people: Disease X is associated with changes in brain structure of Brain Area Y or metabolic changes in Brain Area Z. But it's groups, not individuals, and it's an association, not a cause>effect, or a definite. We still can't use this information for diagnosis, and there are still patients with any given psychiatric diagnoses who will have brains where Area Y is the same size as those without the disorder.

We're learning.

From what I read in
this New York Times article, Owen Thomas was a bright, talented young man with no history of psychiatric disorder, and no history of known concussion. In April, he committed suicide-- a tragedy beyond words. Sometime people commit suicide and every one is left to wonder: there was no depression, no obvious precipitant, no note left behind, and every one is left to wonder why. The guilt toll on the survivors is enormous, as is the grief for their families and communities. In this case, according to the Philadelphia Inquirer, the young man was apparently struggling with the stress of difficult school work and concerns about his team and employment.

Owen's family donated his brain to Boston University's Center for the Study of Traumatic Encephalopathy.

They discovered that Owen's brain showed damage similar to that seen in older NFL players who've-- he had a condition called Chronic Traumatic Encephalopathy. In terms of Owen's suicide, it's hard to know what this means: did the brain injury contribute to or cause a psychiatric disorder, such as depression, that led to his suicide? Did it make him more impulsive, so that he was more likely to act on suicidal thoughts? It's hard to say: suicide is a common cause of death among young people who die. This is the first documented case of chronic traumatic encephalopathy in a college football player. It's not, however, the first suicide of a college football player.

The only way to know if encephalopathy causes depression which causes suicide, is to keep studying it. It's horrible to lose a child, and I applaud this young man's parents for contributing his brain to a research project, and for making his situation public. Millions of young people play football each year: maybe we need to be doing more to protect their brains, though that will not be popular statement among die-hard football fans (some of whom are my relatives). When it comes to sports and driving, we tend to minimize the risks. On the other hand, it's hard to live life with the shutters drawn.

If you're an athlete, help the cause and donate your brain here.