Today’s column is about brain injuries.
The first time I watched my pet mantis eat a cricket, she deftly ripped its head off and wore it like a little helmet while mowing through its soupy innards. Hovering over her plastic habitat, I was so very pleased with my tiny murder friend. The spectacle of violence is one of nature’s most compelling shows.
In owning a mantis, I am complicit in a specific kind of sanctioned violence. If I were pitting fighting cocks against one another in my backyard, such bloodshed would be frowned upon, despite the cocks’ furious urgency. Were I catching small charismatic mammals and gifting them to a cat for torture, someone would undoubtedly start a file on me. But no, I am merely creeping around my yard at night in my pajamas, catching beautiful and unsuspecting moths and watching with rapt attention as my delicate pet plucks their wings away and devours their bodies alive while they convulse against their inevitable passing.
Violent, but largely bloodless; thrilling, yet seemingly inevitable; all of it very fun to watch: Feeding my mantis feels like watching football.
When watching violence as entertainment, be it NFL or MMA or America’s Funniest Home Videos, it is easy to convince myself that the act of observation is passive, that by merely watching I do not contribute, but that’s not true, certainly not in the age of ad revenue. In watching, there is a tacit acceptance of whatever is happening, even approval, that holds even more so if I enjoy what I witness. This makes watching repeated head trauma a pastime with which I am growing ever more uncomfortable.
By now, I’d hazard a guess that even the casual fan is aware of the brain damage concomitant with ramming your head into someone over and over again, what with lawsuits and scientific papers and journalistic deep-dives aplenty. In a recent study examining 111 brains belonging to former NFL players, all but one showed the tell-tale protein tangles of football’s elephant in the room: chronic traumatic encephalopathy, known as CTE.
Your brain is a soft thing, mushy like toothpaste but less spreadable. It is delicate, slippery, and full of blood, floating in its dark cave amid a warm bath of cerebrospinal fluid. This fluid acts like a cushion, protecting the brain from its unyielding container, while bones, tendons, and muscles help stabilize the head.
However, hit the head hard enough, or jerk the head fast enough, and the inertia of the floating brain overcomes its cushion. When the head stops moving, the brain itself doesn’t, slamming into the skull. This is called a coup. When the brain ricochets away from the site of impact, it flings itself in the reverse direction, hitting the walls again; this is called a countercoup. Sometimes the brain can also twist in its shell. These impacts cause damage to the brain, and the mildest type of this kind of traumatic brain injury (TBI) is called a concussion.
Unfortunately, there’s no definitive test for a concussion. When someone gets hit in the head, doctors look for the signs of a brain injury like headache, nausea, dizziness, and tiredness, to start. Symptoms of more severe TBI include vomiting, seizures, inability to wake up from sleep, slurred speech, a lack of sensation in the limbs, and dilated pupils. And the treatment for concussions is something I find to be fucking wild: brain rest! Patients are encouraged to avoid making big decisions or thinking strenuously about things; also, no screens, no reading, and please try to rest that short-term memory.
(My brain is a mess of florid activity at the most quiet of times.The idea of making this beast rest gives me the sweats.)
So how does one get from TBI to CTE? There has never been a recorded case of CTE resulting from a single traumatic incident. No, this pathology spawns from repeated trauma, and it’s not limited to damage from concussions. Research suggests that sustaining many subconcussive hits to the head is the biggest factor in developing the disease.
Only after the patient has died can CTE be diagnosed for certain. Then the brain can be examined for the tell-tale skeins of dark tangles that dapple an otherwise pale slice of brain tissue. These are called Tau proteins, and their presence alongside damaged brain tissue meets the diagnostic criteria for chronic traumatic encephalopathy. Normally, these proteins act as structural scaffolding inside nerve cells, but in CTE, they form clumpy deposits, killing brain cells as they grow.
Alive, doctors arrive at a pre-mortem suspected diagnosis of CTE through patient history and symptomatology. According to the Mayo Clinic, symptoms of CTE include: difficulty thinking, impulsiveness, depression, short-term memory loss, difficulty carrying out tasks, emotional volatility, substance abuse, and suicidal thoughts or behaviors. Other suspected symptoms include aggression, motor impairment, difficulty speaking, a hard time swallowing, and dementia. Early symptoms can be seen in the patient’s late 20s and 30s. It typically starts with mood and behavioral changes, followed by cognitive decline. Sometimes symptoms get worse, sometimes they don’t. Sometimes symptoms stay the same for years and then get worse. Hard to know.
I don’t usually watch football anymore, not really. If it’s on at a relative’s house or at a neighborhood pizza joint, I am still dazzled by the raw power and polished production value. It’s a beautiful sport. But the adrenaline jolt of witnessing an expert sack or hearing the crunch of a pile of dudes, as compelling as ever in its violence, has been forever tempered with the knowledge of unseen damages. I think about all the times my sweetheart got his bell rung on the field in high school, wonder if his dip into the American Football Industrial Complex has seeded his brain with tangles of Tau proteins. I think about player suicides, of brains floating in fixative, about how the NFL pulled out of their partnership with the National Institute of Health to study concussions with $16 million dollars left unspent. I think about the women off the field, partners to these men, and I consider the risks they face as the effects of CTE threaten to turn their husbands and loved ones into dangerous people. I think about all the money involved.
But mostly I think about that pale pink organ, the consistency of soft tofu, enclosed in leathery tissue and bone and shiny helmet, slamming directly into the container of its safe keeping. And I wonder if it’s worth it.