The NFL and Mental Illness

It's a shocker: getting hit in the head by enormous men running at high speed is bad for your brain. The NY Times today has a riveting article chronicling the retirement travails of Ted Johnson, a former middle lineback for the Patriots:

Ted Johnson helped the New England Patriots win three of the past five Super Bowls before retiring in 2005. Now, he says, he forgets people's names, misses appointments and, because of an addiction to amphetamines, can become so terrified of the outside world that he locks himself alone inside his Boston apartment in bed with the blinds drawn for days at a time.

Ted Johnson says that his behavior has become so erratic that "I can't even let myself have a job right now. I don't trust myself."

"There's something wrong with me," said Mr. Johnson, 34, who spent 10 years in the National Football League as the Patriots' middle linebacker. "There's something wrong with my brain. And I know when it started."

Mr. Johnson's decline began, he said, in August 2002, with a concussion he sustained in a preseason game against the New York Giants. He sustained another four days later during a practice, after Patriots Coach Bill Belichick went against the recommendation of the team's trainer, Johnson said, and submitted him to regular on-field contact.

There's a large body of evidence documenting the dangerous long-term effects of repeated concussions, especially when the concussions occur within a few days of each other. After the impact, the arteries in the brain constrict, reducing the flow of blood and oxygen to the brain. At the same time, however, the injured brain increases its demand for glucose, since cellular repair requires energy. The end result is a "metabolic crisis," which leads to reduced brain metabolism for an extended period of time. The brain shuts itself down out of self-defense.

Dr. Cantu, his neurosurgeon, said he was convinced that Mr. Johnson's condition was primarily caused by successive concussions sustained over short periods of time. He said that M.R.I.'s of Mr. Johnson's brain were clear, but that "the vast majority of individuals with postconcussion syndrome, including depression, cognitive impairment, all the symptoms that Ted has, have normal M.R.I.'s."

The most conclusive method to assess this type of brain damage, Dr. Cantu said, was to examine parts of the brain microscopically for tears and tangles, but such a test is done almost exclusively post-mortem. It was this type of examination that was conducted by a neuropathologist at the University of Pittsburgh, Dr. Bennet Omalu, on the brain of Mr. Waters after his suicide, revealing a condition that Dr. Omalu described as that of an 85-year-old with Alzheimer's disease.

Unfortunately, Ted Johnson isn't only suffering from the after-effects of multiple concussions. He's also addicted to Adderall:

"Welcome to the glamorous life of a former N.F.L. player," he said. A half-hour later, he stepped into his Range Rover and drove to his local CVS to pick up another bottle of Adderall. The 72 pills of 30 milligrams each are supposed to last nine days, but he knows he will blow through them in four or five.

This is where the story gets complicated. It's hard to know which of Johnson's symptoms are due to his prescription amphetamine addiction, midlife depression or brain damage suffered while playing football. The afflictions all run together.

What is clear is that Johnson needs help.