In 2021 Vincent Jackson, a 38-year-old wide receiver for the Tampa Bay Buccaneers killed himself in a hotel room just a few days after his team won the Superbowl.

In 2017 Aaron Hernandez, a 27-year-old tight end for the New England Patriots killed Odin Lloyd, a famous soccer player, allegedly killed 3 other people, was sentenced to life in jail for murder, and then hung himself with a bedsheet in his cell room.

In 2007, O. J. Simpson, a former NFL player, wrote a book about how he would kill his wife and best friend, if he did, and then led an armed robbery and kidnapping to steal his own memorabilia. 

In 2021, Phillips Adams, a 32-year-old former NFL cornerback, brutally shot six people with two different firearms and then took his own life. 

Just a few weeks ago, 25-year-old Malik McDowell, a Cleveland Browns defensive tackle, walked around naked in front of a preschool and beat up the police officer who tried to arrest him for public exposure; the police officer may sustain life-altering injuries to his eye from the attack. McDowell remembers nothing of the incident. Over the years he has been arrested 4 times, 3 times for behavior associated with alcohol misuse. 

All of these events were a shock to the nation and the NFL player’s families and friends. But what do these incidents and so many others have in common? They may be instances of CTE (Chronic Traumatic Encephalopathy), a form of brain damage that results from tau buildup in the brain caused by repetitive head trauma. But is this really an adequate and accurate explanation for all these bizarre and tragic events? Let’s dive deeper to try to understand what is happening. 

Firstly, why can’t we know for sure whether or not all of these players are affected by CTE? For the living cases, it is purely an assumption that these individuals are suffering from CTE; it is a conclusion formed on the basis of incomplete information. This is because, at this moment in time, CTE can only be diagnosed posthumously, meaning after death, when a neuropathology autopsy is performed, and, at this moment, CTE has no cure. However, even if CTE cannot be diagnosed for certain while a person is still alive, CTE may still be an adequate explanation for these players’ behavior.

First we should look at the environment each player has been in. All of the possible CTE cases listed at the ​beginning of this article had another thing in common; all individuals were part of the NFL at some point in their life. This begs the question: Are football players particularly susceptible to CTE? The cause of CTE shows that the answer to this question is a resounding yes. CTE results from repetitive head trauma, making football–a high-intensity, rough sport–one of the most common sources for the condition. In 2017, Boston University’s CTE Center published the result of their study on deceased NFL players’ brains: “CTE was neuropathologically diagnosed in …110 of 111 former National Football League players (99%)” (Mez, 2017, para. 2). Only one NFL player’s brain did not have CTE. Additionally, when they studied the general commonality of CTE in football “across all levels of play,” they found that out of “202 deceased players…CTE was neuropathologically diagnosed in 177 players (87%)” (Mez, 2017, para. 2). This shows football’s undeniably dangerous impact on the brain. 

It is also important to note that football is not the only area in which people develop CTE. CTE is also common in other sports such as boxing, hockey, and soccer. Recently surfing has also been a contender for the list as researchers have begun to question whether the impact of the water onto surfers’ bodies and heads is causing brain inflammation/head trauma. Another area that CTE is commonly seen is in military personnel. According to Dr. Mckee, director of Boston University’s CTE Center, there is “a similar pattern [to NFL players] in deceased veterans who experienced a different kind of head trauma — combat blasts. Of the 102 veterans’ brains Dr. Mckee’s examined, 66 had CTE” (“Combat Veterans Coming Home with CTE”, 2018.). Mckee explains, “Blast injury causes a tremendous sort of– ricochet or a whiplash injury to the brain inside the skull and that’s what gives rise to the same changes that we see in football players, as in military veterans” (“Combat Veterans Coming Home with CTE”, 2018.). 

At first, it might make sense to use the number of concussions each player has had as a means to determine their likelihood of CTE, but this can be misleading. In reality, CTE can develop from repetitive minor head injuries, not just concussions. According to Boston University, “chronic traumatic encephalopathy (CTE) is caused by head injuries, not by concussions” (Boston University, 2018, para. 1). Even impact to the whole body can contribute to CTE. CNN reports, “In football, CTE can happen not just from hard hits that result in concussions but from the constant rattling of the brain inside the skull that happens during tackles and other plays. These repeated hits are known as subconcussive hits and can result in the tau buildup in the brain” (Burnside et al., 2021). Furthermore, even a build-up of minor head injuries can lead to the development of CTE. According to the Department of Neurology and Stroke Medicine at Yokohama City University’s Graduate School of Medicine, “Comprehensive analysis of post-mortem brains from individuals who experienced repetitive mild TBI [Traumatic Brain Injury] revealed a strikingly high frequency of CTE (68/85 cases)” (Katsumoto et al., 2019).  

You don’t even have to play professionally to sustain life-altering damage to the brain. Michael Keck and Owen Thomas are shocking examples of this. Michael Keck played tackle football for 16 years, beginning at age 6, and died of a heart attack at 25-years-old after doctors failed to investigate his strong concern of having CTE. He begged his wife before he died to donate his brain to Boston University’s CTE Department where later Dr. Mckee reported, “It was one of the worst cases I’ve seen in a young individual (Swetlitz, 2016).” Keck only played 2 years of college football.

Similarly, Owen Thomas, a lineman for the University of Pennsylvania, hung himself abruptly after “a sudden and uncharacteristic emotional collapse (Schwarz, 2010).” He had no previous history of depressive tendencies. Thomas’s parents recount how he “never had a diagnosis of a concussion on or off the football field or even complained of a headache” (Schwarz, 2010). However, this is not a good indication of whether he sustained a concussion or adequate head trauma. The New York Times reports, “they acknowledged he was the kind of player who might have ignored the symptoms to stay on the field” (Schwarz, 2010). This brings up the second issue, athletes ignoring symptoms and faking concussion protocols in order to keep their name on the field.

The number of concussions on an athlete’s medical file, especially a professional athlete, is very likely incorrect. This is due to multiple reasons: athletes faking concussion tests, athletes ignoring symptoms in order to continue playing, nonfeasance in the medical staff, and sport and coach pressures (the feeling of having to play when given the platform, and the expendability of rookie professionals in the professional sports world).

It is very important for concussions to be diagnosed because if they are not, a lot more damage can be done to the brain. According to the Mayo Clinic, “individuals who have had one concussion are more likely to have another head injury. The current recommendation to prevent CTE is to reduce mild traumatic brain injuries and prevent additional injury after a concussion” (Mayo Foundation for Medical Education and Research, 2021).

However, according to Doug Baldwin, a wide receiver for the Seattle Seahawks, “the ability to cheat is ‘relatively known around the league,’’ and he notes that he could’ve easily cheated the test” (Bien, 2017). The obvious question to ask is why would athletes cheat on a protocol test that is there to keep them safe? Among other reasons, the unfortunate reality is that players can feel like they are expendable due to their short-term contracts, and often risk their health and safety in order to show their coach that they should be kept on the team. SB Nation explains, “The NFL in many ways encourages players to stay on the field however they can, and perhaps none more significant than non-guaranteed contracts. A player with no dead money left on his deal can be cut at a second’s notice and, in theory, never make another dime in the league if he has lost his utility to teams. Those contracts may make owners and general managers happy, but they may also be hastening the league’s demise by incentivizing players to squeeze everything they can out of their short and brutish careers.” Arizona State head coach Herm Edwards gives us some insight into how these rookie athletes must think when they are faced with injury: “‘I was one of those guys who could be terminated… We didn’t have that luxury of safety. We didn’t have the luxury of, ‘OK, some doctor wants to protect our brain.’” 

As a disclaimer, I am not saying that every coach and medical team will pressure their athletes to continue to play, or miss symptoms that indicate concussion and let the athlete back on the field, or that every player cheats the concussion protocol test; all I’m saying that these things can and do happen. Additionally, there is an extraordinary amount of pressure on athletes to play through injury and this can have severe long-term consequences on players.

Back to the bizarre incidents involving NFL athletes that were mentioned at the start of this article. So we realize that the CTE probability in NFL players is extremely high, even more so given undiagnosed concussions, but we still need more evidence to be able to use this condition as an umbrella explanation for these players’ wide array of bizarre actions. Next, we turn to symptoms. If we can’t know for certain whether these players have CTE until a posthumous autopsy, can we reverse engineer a diagnosis by looking at their symptoms? 

Symptoms of CTE

Memory Loss

Confusion

Difficulties with thinking (cognition– planning, carrying out tasks) and emotions

Behavior changes (aggression, impulsive and explosive behavior)

Depression

Substance misuse

Suicidal thoughts

Parkinsonism

Motor neuron disease

Personality changes

Stage I	Stage II (additional symptoms)	Stage III (additional symptoms)
Headaches	Depression/Suicidal thoughts	Memory loss
Loss of attention	Mood swings	Executive dysfunction
Loss of concentration	Aggression	Cognitive impairment
Some may experience short-term memory loss, confusion, depression, aggression, or explosivity	Impulsivity/Explosivity	Difficulty with attention and concentration
	Short term memory loss	Visuospatial difficulties (difficulty reading)
	Language difficulty

Working our way down the CTE stages symptom chart, we see short term memory loss and confusion in the case of Malik McDowell, as well as aggression and explosivity, possibly a result of stage I or stage II CTE, according to Dr. McKee’s study of the symptoms of each stage of CTE. Furthermore, the likelihood that Malik McDowell has sustained head injuries within his lifetime is very high. As a defensive tackle, full force collisions with others is a regularity. He also was in a jarring ATV crash in 2017, in which he suffered a head injury, which may have put additional impact on his brain and advanced his chances of retaining CTE. Reggie Wynns, who assisted McDowell with his college recruitment says, “I just think that we need to figure out a way to get some treatment and get something to happen. Because if we don’t know we’re going to lose him. I’m worried. I’m really worried about him…He’s not the same person since the accident of that 4-wheeler. It could be CTE issues, it could be concussion. We don’t know. He was not a troublemaker, not a troublemaker at all (Wisely, 2019).”

Vincent Jackson’s case aligns with the symptoms of depression and suicidal tendencies, probably falling into the category of having stage II CTE. Vincent Jackson first started playing tackle football when he was 12-years-old and continued to play for 24 years. According to research from Boston University, the earlier someone starts playing tackle football, the earlier they may develop CTE symptoms, compared with those who start later. After Jackson’s death, neurologist Dr. Ann Mckee confirmed that the athlete was indeed suffering from stage II CTE. Mckee stated that people “who start playing tackle football before age 12 will, on average, develop cognitive and emotional symptoms associated with (CTE) much earlier than those who start later” (Benjamin, 2018).  

Aaron Hernandez’s case shows a likelihood of having severe stage II CTE or stage III CTE due to aggression, impulsivity, depression, and suicidal actions, as well as executive dysfunction in the form of having trouble controlling impulses. It is important to analyze both sport-related injuries and trauma and non-sport-related trauma–especially trauma that has occurred during the developmental phase. Aaron Hernandez was physically abused by his father when he was a child (Levenson, 2018). Domestic abuse is another leading cause of CTE that is not commonly spoken of. According to research from the Family & Community Health journal, “injuries from domestic abuse can result in brain damage in 60 percent of survivors” (Landsbaum, 2016). The research team at Boston University diagnosed Aaron Hernandez with stage III CTE, noting that it was the most severe case of CTE they had seen in an individual under the age of 46. Aaron Hernandez was 27 when he hung himself.

OJ Simpson’s case is the most confusing of the bunch. For one, he is still alive at the age of 56, which is older than all the other NFL players addressed in this article. Secondly, he has not injured himself and it is unconfirmed whether he has harmed others; however, he threatened to do so when he held people at gunpoint during an armed robbery and kidnapping, and was accused of killing his wife, Nicole Brown Simpson, and her best friend, Roland Goldman. He was found responsible for the deaths in 1997 during his civil trial but was acquitted during his criminal trial. He has written a book on how he would’ve killed his wife and her best friend if he had done it, after being accused of being the culprit of their murder case. He has shown signs of impulsivity, aggression, and behavioral changes, and he has mentioned that he believes he has CTE due to disturbing memory loss, and his doctor agrees with him. He also recalls suffering two concussions during his 11 seasons in the NFL. Because of this, it seems like he may be suffering from severe stage I CTE or stage II CTE. There is also an increased chance that he suffers from CTE since he repeatedly did not stop playing after sustaining head injuries. OJ Simpson comments,  “I was knocked out of games for such head blows repeatedly in the 1970s and other times I continued playing despite hard blows to my head during football games” (Veeravagu & Li, 2017).

Lastly, we see extreme aggression, suicidal actions, explosivity, and impulsivity in Phillip Adams’ case where he shot and killed 6 people with two different guns and no apparent motive and then killed himself. From the chart, we see that these symptoms align with severe stage II CTE. He began playing football at the young age of 7 and played for 21 years (Hernandez, 2021). In addition to early exposure to bodily impact​​, he “suffered two concussions over a three-game stretch” during 2012 (Dys, 2021). After his brain was examined it was confirmed that Adams had stage II CTE. 

So we know football players are getting concussions and aren’t being treated or diagnosed properly. They often choose to or are allowed to keep playing, exposing themselves to an environment that can make their problems considerably worse when the brain is in a concussion state, and heightening their risk of developing CTE. With all of this in mind and the symptom analysis done in the last section, it seems reasonable to conclude that the athletes mentioned at the beginning of this article may be suffering from CTE.

This led me to wonder, how is this affecting our local community? I spoke with Loni Smith, a senior here at Mendocino High School. She’s played soccer and basketball most of her life, and when she was 13-years-old she suffered 2 concussions. Both times, when the medical staff/nurse diagnosed her with a concussion, her coach proceeded to tell her that they needed her to go back in the game. 

What does this mean for a society in which its most popular sport causes such serious problems? Is America’s greatest sports obsession our greatest athletic safety downfall? What can be done about the dangers of American football when it is such a patriotic symbol? Who would allow the necessary safety measures to be taken? Will the NFL improve concussion protocols to decrease cheating on concussion tests, or begin to chart non-concussion head injuries? While I’m noting what should be done, it is good to note what is being done, and that is developing technology that can determine whether a person’s brain has CTE while the person is still alive. According to the Mayo Clinic, the development of PET scans may be the answer. “A positron emission tomography (PET) scan uses a low-level radioactive tracer that is injected into a vein. Then, a scanner tracks the tracer’s flow through the brain. Researchers are actively working to develop PET markers to detect tau abnormalities associated with neurodegenerative disease in people who are living… The hope is to eventually use a range of neuropsychological tests, brain imaging such as specialized MRI tests and biomarkers to diagnose CTE. In particular, imaging of amyloid and tau proteins will aid in diagnosis” (​​Mayo Foundation for Medical Education and Research, 2021). If we can diagnose individuals with CTE before the condition causes them to act in harmful ways to themselves and others, then perhaps coping and management methods can be developed to decrease the destructive symptoms of this condition.

References

Mez, J., MD. (2017, July 25). Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. Traumatic Brain Injury | JAMA | JAMA Network. Retrieved February 18, 2022, from https://jamanetwork.com/journals/jama/fullarticle/2645104

60 Minutes – Combat Veterans Coming Home with CTE | CTE Center. (2018, January 7). © 2022 Boston University. Retrieved February 18, 2022, from https://www.bu.edu/cte/2018/01/07/60-minutes-combat-veterans-coming-home-with-cte/

Boston University. (2019, June 25). BU-Led Study: CTE May Occur without Concussions | The Brink. Retrieved February 18, 2022, from https://www.bu.edu/articles/2018/cte-caused-by-head-injuries/

Katsumoto, A., Takeuchi, H., & Tanaka, F. (1AD, January 1). Tau pathology in Chronic Traumatic Encephalopathy and Alzheimer’s disease: Similarities and differences. Frontiers. Retrieved February 28, 2022, from https://www.frontiersin.org/articles/10.3389/fneur.2019.00980/full 

Swetlitz , I. (2016, January 4). After concussions, Young Football Player’s plea: Donate My Brain to Science. STAT. Retrieved February 28, 2022, from https://www.statnews.com/2016/01/04/michael-keck-cte/ 

Schwarz, A. (2010, September 13). Suicide reveals signs of a disease seen in N.F.L. The New York Times. Retrieved February 28, 2022, from https://www.nytimes.com/2010/09/14/sports/14football.html 

Mayo Foundation for Medical Education and Research. (2021, May 25). Chronic traumatic encephalopathy. Mayo Clinic. Retrieved February 28, 2022, from https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921 

Bien, L. (2017, April 18). The NFL concussion protocol cannot save football. SBNation.com. Retrieved February 28, 2022, from https://www.sbnation.com/2017/4/18/15213420/nfl-concussion-protocol-cheating-test 

Veeravagu, A., & Li, A. (2017, April 13). Did brain trauma make O.J. Simpson violent? The Daily Beast. Retrieved February 28, 2022, from https://www.thedailybeast.com/did-brain-trauma-make-oj-simpson-violent 

Levenson, E. (2018, October 18). Aaron Hernandez was beaten and sexually abused as a child, ‘spotlight’ team reports. CNN. Retrieved March 1, 2022, from https://www.cnn.com/2018/10/15/us/aaron-hernandez-spotlight/index.html 

Dys, A. (2021, December 14). SC mass shooting: Phillip Adams. The Herald. Retrieved March 2, 2022, from https://www.heraldonline.com/news/local/crime/article250529334.html 

Landsbaum, C. (2016, August 23). Domestic abuse victims suffer the same brain injuries as football players. The Cut. Retrieved March 1, 2022, from https://www.thecut.com/2016/08/domestic-abuse-victims-can-suffer-permanent-brain-damage.html 

Hernandez, J. (2021, December 14). An ex-NFL player who killed 6 people and then himself had CTE, doctors say. NPR. Retrieved March 2, 2022, from https://www.npr.org/2021/12/14/1064130612/phillip-adams-nfl-player-killed-6-people-cte 

Wisely, J. (2019, July 29). Malik McDowell’s dreams crashed on his ATV: ‘he’s not the same person’. Detroit Free Press. Retrieved March 1, 2022, from https://www.freep.com/story/sports/college/michigan-state/spartans/2019/07/28/michigan-state-football-malik-mcdowell-seattle-seahawks-nfl-atv/1747958001/ 

Benjamin May 1, C. (2018, May 1). New study: Kids who play tackle football before the age of 12 get CTE symptoms ‘much earlier’. CBSSports.com. Retrieved March 1, 2022, from https://www.cbssports.com/nfl/news/new-study-kids-who-play-tackle-football-before-the-age-of-12-get-cte-symptoms-much-earlier/ 

Mayo Foundation for Medical Education and Research. (2021, May 25). Chronic traumatic encephalopathy. Mayo Clinic. Retrieved March 2, 2022, from https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/diagnosis-treatment/drc-20370925