For the past several weeks I’ve been discussing the effects of Chronic Traumatic Encephalopathy (CTE), concussions, and brain trauma on athletes. I wanted to finish up by talking about the complexity of what is happening in the minds of many athletes suffering from CTE. In order to do so we must start by looking at the functions of the effected parts of the brain and then place that into the existing psyche of an athlete. There are three functions of the effected brain that are particularly interesting in this discussion: 1) Emotion and emotion regulation, 2) Empathic response, and 3) flexibility. I highlight these three because of their importance for the mental stability and health of a person, especially a person who has undergone extreme stress, trauma, and abuse and is trying to transition into a new phase of life. This last part feels particularly important to note because I believe this may be where we see the impact of brain injury come to life.
Our brain is divided into different regions that have different functions for our overall health and well-being. One of the regions of our brain is called our reptilian brain and it is responsible for our most basic needs and desires. This “reptilian brain” tells us to eat, sleep, have sex, and warns us protects ourselves when in danger (fight or flight). It is the first part of our brain to develop and we have it in common with all animals. In comparison, the neo-cortex and limbic system develop later and give us the ability to be controlled, to be mindful (empathetic) and to change our minds (beliefs) among other things. A subsection of these two latter areas is called the frontal lobe which is located behind our forehead and is connected to other important parts of our brain that narrate emotions and help us understand our identity. CTE primarily effects the frontal lobe and these surrounding areas of our limbic system and neo-cortex. The impact of CTE, then, effects some very important facets of our mental health.
I believe the effects of CTE are most visible when a person is going through a season of disruption or transition. In athletics some of the most notable disruptions and transitions happen when an athlete can no longer perform due to injury or lack of ability. Through understanding how our mind functions to cope with disruption we get a fuller picture of what an athlete is up against.
In seasons of disruption or transition our sense of who we are comes into question. Who we have believed we are is countered with evidence to the contrary. In order to make sense of the ego-dystonic information we are faced with a choice to either integrate this new sense of who we are into our pre-existing identity or we have to protect and barricade our pre-existing identity from a perceived “threat” in order to ensure its’ survival.
[Theological Side Note: The work of integration is often about facing our own idolatry (our belief that we are/can be God). In facing idolatry, we must come to terms with the frailty and fragility of our humanity in the face of our inability to produce a desired outcome. In the language of the Apostle Paul, the process of Integration begs us to mentally “die” to self in order that we might be “raised” into a new identity. The process of mentally dying is something akin to the experience of a depression in that it destroys our hope and ability to imagine goodness and life. We feel lost, frustrated, and unsure of the point of our lives in the face of a major identity-disruptive event. However, our desire to avoid this painful process during disruption most often leads us towards an attempt to salvage ourselves and escape our identity’s “death”. We try whatever we can to hold onto what we believe about ourselves and our identity. The mental pain involved for an individual will vary depending on how important that aspect of their identity is to their self-worth and perceived value.]
For most athletes their sense of self-worth is directly tied to their ability to perform in athletics. Sports has afforded them a type of attention and adoration that many are starving for in their lives (see: “Now I have your eyes…). Like I’ve said before, the madness of sports is that it fosters this belief and provides feedback that you are only loved when you play well. This drives most athletes to great lengths in order to survive disruption and transition. It also drives many athletes to seek out people and places that provide ego-syntonic feedback to affirm their sense of self. There are few things more painful than the realization that you are not who you thought you were, so the logical thing to do is avoid this pain at all costs. Unfortunately, every single athlete that has ever lived has had to come to terms with this bind. The unavoidable reality of this bind often leads to an identity collapse for those who have made it to high levels of competitive athletics and who find themselves unable to perform any longer. The subsequent firestorm of emotional turmoil is as varied as each athlete’s story, but the most common struggles manifest in feelings of anger (first step toward grief a loss), depression, addiction, insecurity, and even suicide.
The good news is that the brain is naturally built to help an individual along in this process of integration in three primary ways: 1) A healthy brain helps us deal with and regulate our impulses and emotions, 2) A healthy brain allows us to connect with and understand others through empathizing, and 3) A healthy brain is malleable and allows for us to integrate new experiences into our internal world and identity. Some of the primary functions of a psychotherapist is to help an individual begin to progress in these three areas of functioning. The enemies of these markers of mental health are each person’s experiences of trauma, abuse, and neglect. Trauma, abuse, and neglect essentially create internal pockets of bondage and fear that begin to guide our behaviors and relationships. These pockets, informed by our past experiences and relationships, come together to form our internal world which in turn directs our behavior, beliefs, and style of relating to others. In other words, our internal world, if left unknown and unexplored, will influence and guide our actions and beliefs in the external world. Our ability to understand the narratives that have shaped our internal world in the present gives us the ability to act, believe, and respond in new ways. [Spiritually this work is the process of putting on the Spirit of freedom and putting off the spirit of the flesh/bondage]. Needless to say, the ability for us to do this work is paramount to our mental health and we need our brain to help us in this process. Like I said earlier, the good news is that our brain is built to integrate and change….the bad news for sufferers of CTE is that the hardware essential to the process…just so happen to be primarily in our frontal lobe.
What brain researchers are beginning to find in patients with CTE is that Tau proteins are acting as a tar of sorts that inhibits our frontal lobe. In other words CTE effects a persons’ ability to deal with their emotions, understand and connect with others, and integrate new experiences into their internal world and identity. Anger is multiplied because we can’t mediate it normally, our ability to connect empathetically with others is impaired, and our ability to integrate our identity during seasons of Self-disruption is impeded. The mental effect is like asking a runner to run a marathon with a sprained ankle. It can be done but it will be very, very difficult.
The normal process of integration for an athlete is hard enough as it is and requires a lot of love and support from a caring community (therapists, family, friends, etc…). The problem with the disease of CTE is that it damages the parts of our mind that we need in order to begin doing this hard work of integration in community. The combination of all these things are leaving athletes stranded in a mental health “perfect storm” in which they are often unable to survive. I don’t believe that it is actually the disease of CTE alone that causes player decline and suicide. Most players would attest to the fact that there are a whole plethora of other issues that seem more causative when it comes to player decline and death. I wonder, though, if the most debilitating factor of CTE is that it makes the sufferers ability to regulate emotions, understand and empathize with others, and integrate new experiences into their internal world and identity extremely challenging. The part of our minds meant to respond can’t because of traumatic brain injury. And since the enemy is inside of a players head, the presence of self-condemnation and shame will be very powerful. An athlete’s difficulty in conquering these obstacle will only serve as a reminder that they are not who they thought they were…a fact that may lead many into a type of death that won’t allow for a resurrection.
[If you or someone you love is struggling with any of the above symptoms please call Knox Burnett @ 425-202-5716]