Introduction: Brain Trauma: The Invisible Epidemic

Each year, more than 1.5 million Americans sustain traumatic brain injuries, caused mostly by motor vehicle accidents, falls and similar mishaps, violence, and sports injuries. Such injuries can be as mild as a concussion or as severe as having a foreign object, such as a shard from a broken window, penetrate the skull and lodge in brain tissue. The more serious the injury, the more likely it will cause permanent brain damage which can impair the victim’s ability to speak, think clearly, or otherwise function normally. In the most traumatic cases, head injuries can be deadly.

The risk of traumatic brain injury, or TBI, is particularly high among young people because this age group is more likely to engage in activities and behaviors that expose them to head injuries. Adolescent boys, for example, are very prone to TBI because they often ride bicycles or motorbikes without helmets or participate in contact sports. Many young people do not even perceive the risks of head injuries when performing wild stunts or playing a hard-hitting football game.

George Zitnay, a neuropsychologist who treats people with mental illnesses that result from brain injuries, calls TBI an “invisible epidemic”¹ because the American public knows little about them. He also claims that mental disability is often stig- matized in our society, so many people don’t know how to deal with the consequences of brain injuries and even turn away from those who suffer them. “You get a brain injury in this country, you keep it quiet because here we value intellect so much,” Zitnay says. “It’s a very frightening thing to think about the psyche, to think about the mind. If you were brain injured, would you want people to know about it?” ²

The Sad Saga of Andre Waters

Sometimes, it is immediately evident that someone has suffered a brain injury. Paramedics who arrive at the scene of an auto accident usually can quickly determine whether the victim’s head has been injured. Likewise, doctors or trainers who respond to an injury on a football field quickly suspect brain trauma if the player is confused, glassy-eyed, suffering from neck pain, or exhibiting other symptoms that make it clear he took a blow to the head.

In other cases, though, it may take weeks, months, or even years before the effects of brain trauma appear. Andre Waters is one well-publicized example. Waters played professional football for eleven years, earning a reputation as one of the National Football League’s (NFL) hardest-hitting defenders. During his career, Waters suffered numerous concussions, which are bruises to the brain. He once told a reporter, “I think I lost count at fifteen. I just wouldn’t say anything. I’d sniff some smelling salts, then go back in there.” ³

After retiring from pro football, Waters held a number of coaching jobs at small colleges. Throughout his life, Waters had been an amiable, friendly, and outgoing person, but his failure to find a coaching job with an NFL team clearly troubled him. Each year, his friends and family members noticed that he was growing more distant and depressed. Finally, in late 2006, Waters committed suicide at the age of forty-four.

After his death, an autopsy concluded that Waters’s brain resembled that of an eighty-year-old patient afflicted with Alzheimer’s disease, a progressive brain disorder that affects mostly people over age sixty-five, associated with loss of memory and other cognitive abilities, mood swings, and ultimately dementia. According to physicians, the numerous concussions Waters suffered throughout his career caused the condition and was also responsible for his depression and suicidal tendencies. Said Chris Nowinski, a former professional wrestler and now an author and advocate for athletes with brain damage, “I can only imagine with that much physical damage in your brain, what that must have felt like for him.” ⁴

“Tired and Numb”

Throughout his career, Waters ignored the symptoms of brain trauma and kept returning to the field. Other athletes have heeded their doctors’ advice, giving up their playing careers rather than risking the long-term consequences of brain trauma. Among the professional football players who have retired early with a history of head injury are Steve Young, Troy Aikman, Wayne Chrebet, Al Toon, Bill Romanowski, Ed McCaffrey, Chris Miller, Stan Humphries, Dan Morgan, and Merril Hoge. All suffered numerous concussions on the playing field.

Hoge spent eight seasons in the NFL as a fullback for the Pittsburgh Steelers and Chicago Bears. As a fullback, Hoge’s primary responsibility was to block for the halfback—to throw his body into bigger linemen, clearing the way for the ball carrier to gain yards up the field. It is a gritty, physical position that requires the player to sacrifice his body and endure pain for the good of the team.

In 1994 Hoge suffered a concussion while playing for the Bears. He left the game but days later showed up for practice to prepare for the next game on the schedule, even though he still felt groggy and lightheaded. The following Sunday, Hoge took the field and found himself unable to remember the plays. He also suffered another concussion. “I went to the locker room and actually stopped breathing,” he recalled. “They thought they lost me. I spent two weeks in the intensive care unit, and then I spent thirteen months just trying to relearn how to read, how to drive. For those thirteen months I had no drive and no feeling—I was just tired and numb.” ⁵

Even after all that, Hoge hoped to return to his team but was unable to convince a doctor to clear him to play. Reluctantly, Hoge retired from football. In 2006 Hoge said that if he had known as much about concussions then as he does now, he would have retired much earlier in his career: “Someone should absolutely be telling [players] about the links they’ve found between multiple concussions and Alzheimer’s disease, depression and those other problems, and that each concussion increases [the] risk. We do that with hips and knees all the time, except you can replace hips and knees. You can’t replace the brain.” ⁶

The examples of Waters, Hoge, and many others illustrate how TBI can alter people’s lives. While their cases have become well known because of their status as celebrities, across America thousands of people out of the spotlight live with disabilities caused by traumatic brain injury. Even such simple, routine tasks as brushing their teeth, riding a bus, and reading a book become challenges as they adjust to daily life at home and at work following traumatic brain injuries.