Bill Dwyre, sports writer for the Los Angeles Times, took up the cause of Dave Duerson in an emotionally piercing piece on February 25. Duerson shot himself in the heart in order to preserve his brain for head-injury research. What Duerson clearly did not know, along with nearly everyone in the field of medicine, is that his death obliterates most of the evidence of traumatic brain injury that one might ever hope to find. Traditional structural imagery cannot tell the difference between a living brain and a dead one, so it can hardly tell the difference between a functional and a dysfunctional one. One must resort to the more modern functional imaging, whether PET, SPECT, or functional MRI. Now it is too late for that, and Duerson’s contribution must be at another level, namely his impact on the institutional conscience of the NFL.
To understand traumatic brain injury one has to look beyond the obvious structural features that may be present, even though these will likely rivet one’s attention. The problems lie largely in the functional domain, and must be tested for directly. This is only starting to be done now that functional imaging is becoming commonplace. As a first consequence, we are starting to recognize that a problem exists. But this recognition is propagating only slowly into the realm of actual practice.
Consider that “blast injury” among our servicemen is dealt with as a novel problem. Here we have the phenomenon of a sudden loss of function in the absence of any clear physical insult to the brain. There may not even have been loss of consciousness. But surely this phenomenon is nothing new. First of all, this must have occurred in prior wars. Even more commonly similar things are seen in civilian life in connection with automobile injuries. Major deficits manifest after apparently minor brain insults. In fact, it is estimated that some 3 million Americans suffer what are called ‘minor’ traumatic brain injuries per year, a number comparable to all the people who have ever served in Iraq and Afghanistan.
‘Minor’ here is a matter of definition, not severity. It includes all those who have not suffered skull fracture. There has in fact been a case of massive denial about the lingering deficits of ‘minor’ traumatic brain injury. Only now, with blast injury victims showing up in droves, has the wall of denial finally started to come down. We know that quite commonly the symptoms remediate all by themselves over the course of time, so that has become the expectation. Even to this day, people with minor head injuries are told that the symptoms will simply subside on their own. There is no medical treatment.
The only thing modern imagery accomplished was to put evidence on the table regarding ‘minor’ traumatic brain injury that could no longer be dismissed. It could not lead us to a remedy. Years ago a neurologist came to the national biofeedback conference to relate the case of a ‘persistent patient’ who kept badgering the docs about her symptoms. They found nothing wrong and told her that there was nothing wrong with her. This went on for years, until they finally gave her a PET scan on their new instrument and found evidence of a brain lesion that could indeed explain her symptoms. Asked what remedies were then brought to bear, the neurologist just shrugged and said that all they were in a position to do was to reassure the person that her symptoms were real. But of course the poor woman never had any doubt on that score at all. She literally got nothing out of the exercise beyond the docs’ renewed sympathy.
And this is where we still are with regard to head injury. Medicine has essentially nothing to offer beyond sympathy for the lingering symptoms of minor traumatic brain injury (mTBI). Of course there is EEG neurofeedback, by means of which functional recovery has been attained in TBI cases for some forty years now. For most of that time, such evidence might as well not have existed at all. As far as mainstream thinking went, we had a non-remedy for a non-problem. Whatever we thought was being done likely was nothing more than spontaneous self-recovery.
This was indeed correct with respect to the self-recovery part. Neurofeedback offers nothing more than self-recovery. But it is wrong with respect to the spontaneous aspect. In fact, a real scientist should never talk about anything happening ‘spontaneously’ at all, as we believe that all effects have causes. So what is the ’cause’ of neurofeedback-induced recovery from TBI? It is the recovery of functional connectivity in our neural networks. This process goes on naturally as well, but it can also be induced, stimulated, augmented, and accelerated with EEG neurofeedback. The evidence for that is now plentiful.
As just one example, I cite the informal study by Jonathan Walker, MD, neurologist in Dallas, Texas, who tracked the outcome of sixteen successive TBI patients who had all been declared totally disabled, and were all at least two years post-trauma, by which point ‘spontaneous recovery’ is usually over. The average recovery experienced by these clients through neurofeedback was to 85% of their level of function prior to the trauma. Every one of them who held a job prior to their injury was able to return to work. This study was done in the mid-nineties, and since then the story has just gotten better.
Now the issue with Dave Duerson was not one traumatic brain injury, but rather the cumulative impact of an entire career in professional football. By now retired, the question was whether he was suffering from Chronic Traumatic Encephalopathy (CTE). The problem is that the effects of minor head injuries are cumulative if they are not remediated. This phenomenon is well known, and it is particularly appreciated by the insurance companies, whose legal beagles will always be inclined to blame the effects of any head injury on prior conditions. To a certain extent they will be correct. Past neurological history matters here a great deal. But every successive traumatic event is more hazardous than the one before. The process of progressive functional deterioration is highly nonlinear.
The obvious ethical implication is that we should limit exposure. This means limiting the years of play of football players. It certainly means not lengthening the football season. It also means not sending our younger generation to repeat tours of actual combat duty. And finally, it means giving our football players and our servicemen the possibility of functional recovery with neurofeedback throughout their periods of engagement—between missions in theatre and between ball games at home.
After Albert Einstein’s death in 1955, his brain was also committed to science, much like Dave Duerson’s. Actually what happened was more mundane. His brain was removed from the body, placed in formaldehyde, and taken home by the pathologist. Years later this rogue pathologist, Dr. Thomas Harvey, took Einstein’s brain with him across country in the trunk of his car, safely preserved in its ‘Tupperware reliquary.’ Over a number of years slices of Einstein’s brain were carefully examined. We did not gain much from that opportunity. Nothing in Einstein’s dead brain could tell us what made his living brain special—except possibly for one thing: Einstein’s brain was a healthy brain. In the late eighties it was realized that Einstein’s brain was well supported by healthy glia, part of what was understood to be the support machinery for good neuronal function.
Chances are that Einstein never suffered head injuries—or severe emotional traumas, either. So his brain had an opportunity to exploit—and further develop—its full potential. Perhaps the riskiest thing Einstein ever did was to ride his bicycle at the Princeton Institute of Advanced Study without a helmet. Nobody wore helmets in those days just to ride a bicycle.
The distinction between Einstein’s and Duerson’s brain is undoubtedly significant in the following sense. Children who tend toward the intellectual life are first of all those who have run the gauntlet of birth trauma and early childhood minor injuries successfully. Their memory function and in particular their working memory are wholly intact. Hence they actually enjoy intellectual pursuits and these are for them largely effortless. Other children have not been so fortunate, and in time they notice that it would be a struggle for them to go to college.
If such children do well in sports, then that is an avenue for them. And certainly the military career beckons as an alternative to college. A good many servicemen are volunteering now because of calculations such as these. And such calculations may be traceable ultimately to birth trauma, to early childhood minor traumatic brain injury, or to emotional trauma early in life.
These people are set up for further traumatic brain injury during combat or on the football field. They are also set up for further emotional trauma, for substance abuse, and for criminal behavior. When one looks in more detail at those who ‘spontaneously’ recover from traumatic brain injury and compare them to those who don’t, a single bald fact stands out: Those with a questionable or clearly troubled early emotional history are least likely to recover on their own from TBI. The same holds true for PTSD. This brings us finally to the common ground of both TBI and emotional trauma. Both disturb network functional integrity, and if anything emotional trauma disturbs it more pervasively and more globally. It is therefore no mystery why a large fraction of NFL players are also felons, or why Mike Tyson could bite the ear of his adversary in a disinhibited moment.
The availability of neurofeedback early in life might have totally rewritten these scripts. Given what we now know about the vulnerabilities in early childhood, nothing known to man is comparable to the potential of neurofeedback to facilitate functional recovery for both early physical and emotional trauma. The same holds for later in life as well. We would do well to make neurofeedback training of brain function available to our servicemen abroad and to our sportsmen. At a minimum, that would be a good start.
