We need to change the way we view the brain
The first time I ever heard of the debate regarding the NFL and chronic traumatic encephalopathy (CTE), I thought the lawsuits were ridiculous. My first thought was, “How did football players not know that multiple concussions may have long-lasting consequences?” It seemed like a pretty simple understanding of cause and effect to me, and it seems like many other people reading about the lawsuits came to that same conclusion.
My senior year of undergrad I volunteered at a local neuroscience research facility testing the cytokine levels and taking fMRI scans of football players before and after concussion. One day a football player came in for his third fMRI a week after getting concussed, and since this was my volunteer day, I sat in the back asking questions and watching the scans. One area of his brain caught my attention, and that was a giant black spot in his limbic system just under his corpus callosum (thick white matter in the brain that connects the left and right hemispheres). I asked one of the neuroscientists what it was, hoping it was a blood vessel I forgot about that “fed” that area of the brain. In reality, this twenty-year-old had a giant hole and, most likely, the start of dementia. Let me repeat that: the football player was twenty years old and most likely started developing dementia.
Since there are particular biological markers on CTE brains, it’s not something you can diagnose from an fMRI. Someone can only get diagnosed when his/her brain is physically cut up and observed under a microscope, so “diagnosing” a live individual with CTE is impossible. Regardless of diagnostics, we do know that a giant hole is not supposed to be there, and it was important to let him know. And the more I studied about CTE, the more angry I became on behalf of this young man who, while we stressed the importance of him quitting football, didn’t really understand the full extent of the situation. And I’m not highlighting his ignorance, I’m angry at why this was not perceived as a big deal. All we could do was cross our fingers and hope his didn’t progress quickly.
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Your body has many lines of defense. Some are on the very tiny microscopic level of DNA repair, some are in charge of various aspects of immunity, some are on a macroscopic level of protection against mechanical damage, the list goes on. Your brain, being an extremely vital organ, has more than one line of defense. If certain organisms actually pass the blood-brain barrier, a particular glial cell (special cells found among neurons that aid in homeostasis and support) called microglia will phagocytose (swallow and digest) the foreign particle. They will also attack tumor cells with phagocytosis and releasing necrotizing cytokines, toxins so-to-speak that cause a foreign/tumor cell to undergo apoptosis (programmed self destruction). The interesting thing that has been discovered about microglia is that they are very physiologically similar to another immune cell called a macrophage. And these microglia will, simply put, go back and forth between its activated macrophage stage and its off stage. Think of them like brain gremlins, pretending to be a cute little innocent glial cell, only to have them morph into a scary attack being and go on a destructive rampage.
Microglial Gremlin Mode ™ needs two factors:
1. Something needs to set it off in the first place (perhaps a passive-aggressive text from another microglial cell it once dated)
2. It needs time to calm down back into chill mode
It’s also important to point out that microglia are part of the innate immune system. This means that they are the TSA of immunity compared to the FBI of the acquired immune system, only the TSA, in this case, has actually caught people. Instead of looking for a particular “bad guy,” they go for traits most bad guys have. They’re judgmental. This also includes neurons who actually do need to undergo apoptosis after, let’s say, inflammation arises from a traumatic brain injury. And microglia have the ability to stay forever in Gremlin Mode™ if it didn’t have time to go back into chill mode before the situation recurred. This includes someone suffering with HIV who may develop AIDS encephalopathy (the microglia are consistently presented with the virus, causing them to stay in an “on” phase), and includes someone going back into a game and getting hit in the head again.
While concussions are horrible, experiencing a few concussions over the span of four years of college football doesn’t seem, according to research, to be the biggest problem. So those of you who have experienced a couple concussions over the course of your lifetime due to an accident, etc., most likely aren’t going to develop dementia as a result. What does seem to be the biggest factor, due to the function of microglia, is getting sent back into the game too early. If the person experiences even a slight head trauma when the microglia are still activated, this can keep the microglia in that “on” state, consistently releasing destructive chemicals that aren’t specific to a particular invader. This begins to kill the surrounding functioning neural tissue. In other words, having CTE be a direct consequence of experiencing more than one concussion puts most of the responsibility into the hands of the linebacker who signed up for that position, but having it be a direct consequence of when the linebacker plays after concussion puts most of the responsibility into the hands of the coach. And that right there is one example of a major piece of information the NFL didn’t exactly want to bring into light.
The brain is a vital biological organ. This is a statement about the human body most individuals (I’m assuming) would find comically obvious, yet society as a whole seems to treat it as 3 pounds of self-controlled weakness. The brain is so complex that science can draw a map and name every area, describe its function, and explain major pathways, yet come to a dead ends with so many explanations for a ton of biological phenomena that occurs in the brain. A lot of psychological disorders are wonderfully organized in the in the DSM-V, but not remotely understood biologically. Instead of acknowledging a lack of biological understanding in certain psychological disorders, today’s society still judges the crap out of people with conditions affecting the mind. Someone with schizophrenia or bipolar disorder has a biological condition just like someone with diabetes or Crohn’s has a biological condition. And the offense that arises after this is mentioned is exactly what is wrong with the world of mental health. If you are a psychologist, you may have a client with generalized anxiety disorder, depression, etc and hope you’ll see positive results after therapy just like a doctor may work with a patient with a particular chronic condition and hope to see positive results. But telling a person with an anxiety disorder to “just suck it up and relax” is similar to telling someone with arthritis to “just suck it up and open this tightly-screwed bottle for me.” The brain is not a 3-pound pile of wimpiness , it is just as biological as the rest of the body.
I went on that tangent to bring up the problem with telling someone to “man up” and get back out into the game when it may kill him later. Someone waiting for a neurologist to tell him when it’s safe for him to play football again is not being a wimp, but avoiding life-long consequences just like someone would avoid playing football soon after tearing his ACL. It’s a biological organ that needs time to heal. And when we find out that football players like Junior Seau and Dave Duerson tragically shot themselves in the chest instead of the head so their brains could be studied and prevent others from suffering the same long battle with the psychological consequences that ensue from holes scattered throughout the brain, we should probably actually try to prevent other deaths.
I’d like to explain that I’m not anti-football. Football is a favorite American pastime, and football players obviously enjoy playing it for a living. No one is trying to destroy it (for those of you holding pitchforks). In reality, spreading information about this really horrible, yet preventable, condition is showing respect for the dying wishes of NFL veterans and opens up the question of how we make the game safer. Even if you’re a parent and bring up frequently that nothing happened to you after years of playing football, I think (or I’m at least hoping) that you’ll be okay with waiting a little longer before playing if irreversible dementia is a possible consequence for your child getting sent out too early. Injuries always suck, whether a broken leg or a concussion. We just need to start taking brain injuries more seriously.
NSFW Biology 