by Bennet Omalu
Yet it seems very odd to me that a parent will strap their child into a protective seat and then drive them to football practice, ice hockey practice, or rugby practice or allow that child to participate in mixed martial arts, boxing, or wrestling. Up until I discovered CTE, most parents assumed that the biggest risk their children faced when playing a high-impact, high-contact sport was a broken bone or perhaps some scrapes and bruises. We now know that those are the least of the dangers. Bones will mend, and scrapes will heal, but the damage done to the brain through concussive and subconcussive hits will last a lifetime.
My son, Mark, is almost seven years old at the time of this writing, but he already loves to use big words. Every now and then, he uses a new four- or five-syllable word on me, words like gargantuan, duplication, or obtundation. “Where did you learn such a big word?” I ask with wonder. He will just stare back at me with a look that says, What are you talking about, Dad. These words aren’t big. They are just my vocabulary. I love to watch his intellectual curiosity grow. Why, then, would I take a chance on letting him play a game that might change his brain and make him incapable of fully realizing the gift of his mind that God has given him?
Some parents think I am overreacting. “We now have greater awareness about concussions,” they say. “Coaches now teach the safe way to tackle on the football field or check another player in the hockey rink,” they argue. These arguments do not hold water. Blows to the head are an integral part of games like football. You cannot take them out of the game. I know. I have watched football. During my research into CTE while writing my first paper, I watched high school teams practice. In those practices, young men lined up opposite each other and threw themselves into each other. The loud, clacking sound of plastic helmets hitting each other echoed across the field. Such was not an unusual sound. It is football.
“Your experience was a long time ago,” some will say. “Over the past few years, football has changed. The game has become safe,” they argue. This is the lie football leagues want you to believe. It is also a lie American culture is eager to believe. Football is more than a game; it is the centerpiece of many of our cultural events.
I know this from experience. I attended my first football game in the fall of 2013 at the invitation of a close friend. The two of us had been involved in a successful meeting, and all the participants were invited to attend the game at a nearby major college campus. The first thing I noticed when I arrived at the stadium was that this was not just a game. The pomp and pageantry of the event expressed the celebratory exuberance of America like nothing else can. I made my way to the VIP box reserved for our group. All of the conversations revolved around what was about to happen on the field. An excitement filled the air—a festival feeling that reminded me of the Brazilian carnival. The lights and the music and the seductive, undulating dances of the cheerleaders all fed the party atmosphere. I felt myself getting caught up in it.
The same mood permeated the VIP booth. Of course, alcohol and food flowed. This was a party no one wanted to miss. I found a seat and focused on the players on the field. I noticed most were young black men. They jumped around the sidelines with excitement. I knew these poor college kids believed they were doing something good. To be the center of attention at such an event had to be intoxicating for them. The young men all came to attention as the national anthem played and the flag was unfurled on the field. This was a truly American experience, where love for country and love for sport come together in one place.
Then the game started. The noises and sounds of the hits—head to head, helmet to helmet, body to body, head to body—they were simply unbearable for me. I could not believe that the sounds of the impacts were so loud, especially the crackling noises of helmet-on-helmet collisions. Early on, one player staggered after a hard hit and fell. He stayed down for about thirty seconds to a minute, stood up, and then ran about shaking his head and body with his upper extremities held out in a way that reminded me of a ritualistic dance to show he was potent and strong. I wondered how strong his brain was after that hit. Every human brain is equally vulnerable, whether you are a six-foot-six, 350-pound giant or a lovely four-year-old girl. This player showed how strong he was, even though his head was obviously foggy. I felt sick for him, while everyone around me was yelling and cheering on his aggressive play. Thank God I had to leave early to catch a flight back to California.
Unfortunately, before I left, I had to go down to the sidelines to meet and greet some people. The collision noises that seemed loud high up in the luxury box were now nearly deafening up close, and they surprised me by their sheer violence. I could not believe the brutality, and yet people cheered. During my few minutes on the sidelines, the microscopic images of the injured brains of all the players I had autopsied flashed through my mind. I was overwhelmed. My chest tightened, and I found it difficult to breathe. I had to leave before I suffered a cardiac arrhythmia. The healer in me as a physician and the compassion in me as a Christian were repulsed by what I was experiencing. I had had enough. Standing there was mental and intellectual torture for me. You may call me a weakling of a man, and I freely accept that, for I am what I am. Yet strength does not mean watching young men, primarily young black men, inflict possible lifetime mental and psychological problems upon themselves for the sake of the entertainment of the thousands in the stands and the millions watching on television.
At what price are we to be entertained?
All of the young men who participated in the game I attended were over the age of eighteen. I would never restrict their right to choose to play this violent, brutal sport. However, as a father, when my underage child asks if he can play football, it is my duty as a father to say no. That does not mean I am saying no to sports. My children and my wife and I all watch the Olympic Games when they come around every four years. Those games are, to me as a dad, like taking my children through an endless buffet line. If they want to play a sport, the Olympics present them with so many choices of noncontact and less-contact sports. From track and field and swimming to volleyball and basketball; from badminton, lawn tennis, and table tennis to kayaking, rowing, and even cycling—the choices are all there. Do these sports draw the same crowds and garner the same passion from their fans as football in America? No, but does that matter? Sports are for those who play and enjoy them, not for the fans watching on the sidelines. As a father, I want to help my children find a sport they enjoy and one in which they can excel—and then to stand back and cheer them on. If no one else attends their game, so be it. These games are for my children’s enjoyment, not to entertain others.
• • • •
To be honest, my children have not yet asked about playing football or other high-impact, high-contact sports. The questions I most often receive are like the one in the email I received early one Sunday morning. I got up that day later than I usually do, around 6:00 a.m. After reading my Bible and spending time in prayer, I made myself a cup of strong tea and went into my home office to review emails before my children woke up. At the top of my email in-box was a message from a name I did not recognize. In it, I found a long letter from a father and a leader in his community. He told me the story of his son, who was away at college—a son who was also a very successful football player. The dad described his son as a good boy from a good family who has had a very good life. The son’s future looks promising, the father said, with the boy standing a very good chance of being drafted to play in the National Football League.
But there was more to the story.
The son had begun playing football in middle school and continued on through high school and now in college. A few years ago, the father began to notice changes in his son. The boy showed increasing impulsivity, anger control issues, and violent tendencies. Although all of these had never been present in his son’s personality before, the dad dismissed them as the permissible excesses of a successful athlete. But over time, the symptoms became progressively worse. The boy, now a young man, becam
e verbally and physically abusive at home. The dad also noticed subtle memory problems in his son. The dad passed off the memory issues as a sign of a very busy young man who had too much going on to remember every little detail.
Then the dad watched the movie Concussion. That was why he emailed me early on a Sunday morning. “I fear for my son,” he wrote. “Could football have irreparably damaged his brain? What can I do to help him?” Yet this plea for help was followed by a reaffirmation of the son’s bright future and his prospects of having a career in the NFL. This dad was very proud of his son and all that he had accomplished—proud, but also conflicted. He wanted his son to play professional football and enjoy the fame and money it might bring, but he also feared that if his boy continued to play, the damage to his brain might become even worse. “Please, Dr. Omalu, what should I do?” he asked.
I replied to his email right then. His son was not my son, and I had no say in what his son should or should not do. However, as a fellow father, I saw his son like my own. I told him that if this was my son, I would not let him play any longer. Even if damage has already been done, getting him off the football field will prevent more blows to the head and even more damage. We do not know exactly how many blows to the head will cause brain damage or which blow will be the one to make that damage irreversible and permanent. Since we do not know, the best thing this parent could do is to protect the future brain health of his son. If that means walking away from a possible career in football, so be it. When you consider the alternative, isn’t it worth it?
I also advised this dad to encourage his son to engage in positive and healthy living. He should be careful about what he eats and drinks. If there is the possibility of brain damage already, he should avoid alcohol, which exacerbates the problems. I also told the dad to have his son take brain-friendly multivitamins and micronutrients like omega fatty acids. Finally, I advised him to take his son to see a neurologist in a university hospital that has a competent brain injury program. They should run a battery of tests to evaluate the level of any possible brain trauma and advise them on whatever steps are necessary for further treatment.
There’s also one other piece of advice I give to dads like this one: forgive yourself. I have met parents and coaches who sob, some on my shoulders, who cannot get over what they “did” to their children or players. A youth football coach I know stopped coaching after he saw the movie Concussion. His two sons played football from the time they were big enough to strap on a helmet. Both sons today have serious memory, academic, mood, and behavioral problems. They are in their twenties. Their dad broke down as he began to talk to me about what life might be like for them in their thirties and beyond. “If I had only known,” he said through his sobs.
But that is the point: he did not know. How could he have known? The truth of the inherent dangers of high-impact, high-contact sports to brain health had not been widely disseminated. Up until recent years, concussions were passed off as the mildest of brain injuries, as nothing to worry about. We know better now, and we should have known then. The truth was out there, but the truth was hidden and denied by those who had an interest in suppressing it. “You must forgive yourself,” I told this father, “or else you will be so burdened by guilt that you cannot help your sons today.”
As we now move forward as moms and dads and as children of the living God, it is foolhardy for any of us to ignore what we now know. I pray that the light of Christ may shine upon us, open our minds and hearts, and enlighten us in the path of truth. Let us protect, celebrate, and live our lives in the abundance of His truth and His love. Amen.
Afterword
“I Bet My Medical License That O. J. Simpson Has CTE”
Around the time of the Golden Globe Awards, which I was privileged to attend with Will Smith, I did an interview with People magazine. The journalist who interviewed me informed me that a new television series about O. J. Simpson was going to premiere soon. He asked if he could discuss the series with me. I said, “Sure.” I then added, without even giving it a thought, “I bet my medical license that O. J. Simpson has CTE.” Within a matter of hours, the interview was out, and my phone began to ring. It did not stop ringing for days. I think every journalist in America must have called, and those who didn’t call must have emailed me because my in-box filled up. Talk shows wanted to have me on as a guest, and news shows wanted to do follow-up interviews—all to discuss the case of O. J. Simpson. Many people accused me of defending O. J., as if I was saying he was not responsible for his murderous acts. That was not my intention at all.
When I made the statement about O. J. Simpson, I made it on the basis of scientific facts. Not many people know it, but in the United States today, a large percentage of the prison population has a history of traumatic brain injury. When a person is exposed to any type of traumatic brain injury, their risk of engaging in criminal activity increases. Traumatic brain injuries increase one’s disinhibition, making it more difficult for persons to control themselves and their emotions, especially in stressful situations. It also increases one’s risk of exhibiting exaggerated reactions and responses to daily life stressors and situations. In addition, brain trauma increases the risk of impairments to judgment and engaging in risky behavior, including sexual improprieties, to say nothing of the cognitive impairment and impaired executive functioning. This is not just my opinion; these are scientific facts.
My statement about O. J. and CTE is based on the facts I just cited. People have asked how O. J. could go from one of America’s most beloved sports icons to an alleged murderer (although a court of law acquitted him of all charges). The same holds true of many current and former sports stars, especially football players. Every week, a story appears in a newspaper about a current or former player who committed domestic abuse or sexual assault or any number of other violent crimes. Many of these have had no history of violence. And people wag their heads and talk about these bad apples who have disgraced the programs for which they play.
I believe these are not all bad apples. I believe many are good men who have been changed as a result of brain trauma. The problem is that our culture does not want to admit that the games with which we are intoxicated could exact this toll on those who play them. The problem cannot be the game, we tell ourselves. The problem must be with those bad men who have been indulged all their lives because of their athletic talents. They are bad. The game is good. Our conformational intelligence and cognitive dissonance will not let us accept any other explanation.
It is time we admit the truth. The New Testament book of Romans tells us, “Do not conform yourself to this age but be transformed by the renewal of your mind, that you may discern what is the will of God, what is good and pleasing and perfect.”1 This is what we must do. We must allow truth to transform our minds and change the way we see the world around us. I wrote this book to bring the truth to light. Now that you know the truth, you must act upon it. It is not enough to just be aware of the truth. In America, we do many things to raise awareness. Driving down the street, I see pink ribbon magnets on the backs of cars to raise awareness for breast cancer, and yellow ribbons to raise awareness for our troops overseas. January is National Codependency Awareness month, while April is Autism Awareness month and Sexual Assault Awareness month, and the list goes on and on and on. We set aside months and have symbols to raise awareness for anything and everything.
But awareness is not the same as action.
The country of my birth was embroiled in a bitter civil war when I came into this world. Stories about the crisis in Biafra made worldwide headlines. News magazines like Life and Time featured photographs of starving children in Biafra. Yes, the world was aware of the plight of my nation and my people. I was one of those children, born malnourished. Only by the grace of God did I survive until the end of the war. The world knew all about the crisis through which I lived. But the world did nothing. Awareness is not enough, for, as God’s Word teaches us, “wisdom is vindicated by her works.�
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When you become aware of the truth, you must act upon it. Only by taking action can the truth truly set us free. So what action do you need to take in response to all you have read in these pages?
First, value your brain. Your mind and your memories make you who you are. Treasure your mind. Protect your brain. Do not take your mental health for granted. Take steps to protect it.
Second, protect the brains of your children. Do not allow your underage children (younger than eighteen years old) to engage in high-impact, high-contact sports, which can cause brain trauma and brain damage. Take precautions in other less-impact, less-contact sports, as well as in noncontact sports where incidental and accidental brain trauma may occur. I tell soccer parents everywhere, “Do not let your children do headers, and do not let them play soccer or lacrosse until they are about twelve to fourteen years old.” If you are involved in a soccer league as a parent or coach, help pass rules that will take headers out of the game for children under eighteen. The best and most appropriate sports for children under the age of eighteen are the noncollision, nonimpact, noncontact sports.
Third, let us love one another, for love is of God.3 To love my fellow human being means I see them for who they truly are—a person made in the image of the living God. Too often our sports heroes are not human beings in our eyes. They are gladiators, putting their bodies and minds at risk for our entertainment. When I begin to see them through the eyes of God, I cannot continue to be a party to their pain. I simply cannot.
• • • •
May we always have the grace and wisdom to know when we are called to stand by the truth, to fight battles in defense of the truth and light, no matter how insignificant and inconsequential we may think our lives are. God is the only truth and light, and the truth does not take sides. And in Him and by Him, all things are possible in our lives; the impossible becomes possible, if we only believe. And let us act on our beliefs and act on the truth. Let us do the little, good things in life—one person at a time, one act at a time—to improve the lot of all our fellow human beings. Together, our small acts add up to become a force that improves the lot of all of us and all mankind. We are all members of one another; what happens to the least of us, happens to all of us.
