Archive for the ‘Mental Health’ Category
Steve Fainaru and Mark Fainaru-Wada report for ESPN:
ONE DAY IN April, the NFL asked Chris Borland to take a random drug test. The timing of this request was, in a word, bizarre, since Borland, a San Francisco 49ers linebacker, had retired a month earlier after a remarkable rookie season. He said he feared getting brain damage if he continued to play.
Borland had been amazed at the reaction to his decision, the implications of which many saw as a direct threat to the NFL. And now here was an email demanding that he pee in a cup before a league proctor within 24 hours or fail the test. “I figured if I said no, people would think I was on drugs,” he said recently. That, he believed, “would ruin my life.” As he thought about how to respond, Borland began to wonder how random this drug test really was.
What did the NFL still want with him? Nobody could have held out much hope that he’d change his mind. On Friday, March 13, when Borland retired via email, he attached a suggested press release, then reaffirmed his intentions in conversations with 49ers officials. Instead of announcing Borland’s retirement, the team sent him a bill — an unsubtle reminder that he’d have to return most of his $617,436 signing bonus if he followed through. That Monday, Borland, knowing he was forgoing at least $2.35 million, not to mention a promising career, made the announcement himself to Outside the Lines. He has since elaborated on the decision to everyone from Face the Nation to Charlie Rose to undergraduates at Wisconsin, where he was an All-American.
Borland has consistently described his retirement as a pre-emptive strike to (hopefully) preserve his mental health. “If there were no possibility of brain damage, I’d still be playing,” he says. But buried deeper in his message are ideas perhaps even more threatening to the NFL and our embattled national sport. It’s not just that Borland won’t play football anymore. He’s reluctant to even watch it, he now says, so disturbed is he by its inherent violence, the extreme measures that are required to stay on the field at the highest levels and the physical destruction he has witnessed to people he loves and admires — especially to their brains.
Borland has complicated, even tortured, feelings about football that grow deeper the more removed he is from the game. He still sees it as an exhilarating sport that cultivates discipline and teamwork and brings communities and families together. “I don’t dislike football,” he insists. “I love football.” At the same time, he has come to view it as a dehumanizing spectacle that debases both the people who play it and the people who watch it.
“Dehumanizing sounds so extreme, but when you’re fighting for a football at the bottom of the pile, it is kind of dehumanizing,” he said during a series of conversations over the spring and summer. “It’s like a spectacle of violence, for entertainment, and you’re the actors in it. You’re complicit in that: You put on the uniform. And it’s a trivial thing at its core. It’s make-believe, really. That’s the truth about it.”
How one person can reconcile such opposing views of football — as both cherished American tradition and trivial activity so violent that it strips away our humanity — is hard to see. Borland, 24, is still working it out. He wants to be respectful to friends who are still playing and former teammates and coaches, but he knows that, in many ways, he is the embodiment of the growing conflict over football, a role that he is improvising, sometimes painfully, as he goes along.
More than anything, Borland says he doesn’t want to tell anyone what to do. This is the central conflict of his post-football life. He rejected the sport, a shocking public act that still reverberates, in tremors, from the NFL to its vast pipeline of youth leagues. Yet he’s wary of becoming a symbol for all the people who want to end — or save — football.
We trailed Borland for five months as he embarked on a journey that drove him deeper into the NFL’s concussion crisis and forced him to confront the sport in ways he avoided while playing. One day in June, he returned to Archbishop Alter High School in Kettering, Ohio, to visit with his old coach, Ed Domsitz. “We’re in a period now where, for the next 10 or 15 years, many of us, we need to figure out a way to save this game,” said Domsitz, a southwest Ohio legend who has coached for 40 years.
Jovial and gray-haired, Domsitz was standing on the Alter practice field, a lake of synthetic green turf. He tried to recruit Borland to his cause.
“Why don’t you come back and coach the linebackers?” Domsitz asked. “We need to teach these kids the safe way to tackle.”
“Some of my best tackles were the most dangerous!” Borland responded, laughing.
“You’re exactly the kind of people we need,” the coach insisted.
Borland lowered his head, embarrassed. “I can’t do that,” he said, almost inaudibly. “Maybe I could be the kicking coach.”
Later, away from Domsitz, Borland explained: “I wouldn’t want to be charged with the task of making violence safer. I think that’s a really difficult thing to do.”
In the months following his retirement, Borland has offered himself up as a human guinea pig to the many researchers who want to scan and study his post-NFL brain. He has met with the former vice chief of staff of the U.S. Army and with mental health experts at the Carter Center in Atlanta. He has literally shrunk, dropping 30 pounds from his 248-pound playing weight while training for the San Francisco Marathon, which he ran in late July.
As the Niners reported to training camp in July, Borland was examining the Book of Kells, a 1,200-year-old manuscript, at the Trinity College Library in Dublin, the start of a six-week European vacation.
In many ways, Borland is like any bright, ambitious recent college graduate who is trying to figure out the rest of his life. In other ways, he’s the most dangerous man in football.
On that day back in April, Borland stared hard at his iPhone, pondering what to do about the NFL’s summons to a post-retirement drug test. The league says it reserves the right to test players — even after they’ve retired — to ensure that they don’t dodge a test, then return. But given the stakes, and the NFL’s dubious history on concussions, it occurred to Borland that maybe, just maybe, he was being set up.
“I don’t want to be a conspiracy theorist,” he says. “I just wanted to be sure.” Borland agreed to submit a urine sample to the NFL’s representative, who drove in from Green Bay and administered the test in the Wisconsin trainer’s room. Then he hired a private firm for $150 to test him independently. Both tests came back negative, according to Borland.
“I don’t really trust the NFL,” he says.
TOWARD THE END of his rookie season, Borland read League of Denial, our 2013 book chronicling the NFL’s efforts to bury the concussion problem. After his last game, he contacted us through former St. Louis Cardinals linebacker David Meggyesy, who also walked away from the NFL, in 1969. Meggyesy wrote a best-selling memoir, Out of Their League, in which he described football as “one of the most dehumanizing experiences a person can face.” Borland, a history major at Wisconsin, had met Meggyesy during his senior year, after hearing him give a guest lecture titled “Sports, Labor and Social Justice in the 21st Century.”
It’s tempting to draw parallels between Borland and Meggyesy, both of whom reject the NFL’s easy narrative of cartoon violence and heroic sacrifice. Late in his pro career, Meggyesy was benched for his political activism. At Wisconsin, in 2011, Borland was punished with extra conditioning for skipping class to protest Republican Gov. (and current presidential candidate) Scott Walker, who was trying to limit collective bargaining for public employees. Borland marched with three cousins, one a teacher, and carried a sign that read: recall walker.
But there are significant differences between the two men. . .
Later in the article:
Robert Stern [is] a neurology professor at Boston University, the leading institution for the study of chronic traumatic encephalopathy, or CTE. Over the past decade, the disease has been found in the brains of 87 out of the 91 dead NFL players who were examined. In late February, a BU-hosted “consensus conference” concluded that CTE is a distinct neurodegenerative disease found only in patients who experienced brain trauma. The NFL rejected its link to football for years.
Borland, somewhat derisively, calls “the overwhelming tide of marketing about how great and awesome football is.” Borland scoffs at the oft-repeated clichés about football’s unique ability to impart wisdom. “It’s too bad Gandhi never played football,” he said one afternoon. “Maybe he would have picked up some valuable lessons.”
I found this article, “A Common Language: Ron Capps served in Rwanda, Darfur, Kosovo, Eastern Congo, Afghanistan, and Iraq. When he got back, writing was the only thing that could truly bring him home again.” in Believer, by Kristina Shevory, to be extremely interesting (and very powerful). I was struck by this paragraph:
“Healing happens only in community, and it’s mainly a community of veterans, a circle of people you get to trust and understand your experience,” said Dr. Shay. “You can’t define what it means to be understood, but it sure as hell matters. The heavy lifting is done by and for the veterans. Time itself doesn’t heal.”
I was struck by the thought that one is healed by communication and a community. This struck with extra force because I just watched the (excellent) interview I blogged in this post, which talks about how efforts to go it alone do not work.
Shay is the author of two excellent books that I’ve read: Achilles in Vietnam: Combat Trauma and the Undoing of Character and Odysseus in America: Combat Trauma and the Trials of Homecoming. Both are well worth reading. (Links are to inexpensive secondhand copies; new copies are, of course, readily available from on-line vendors such as Amazon.) These were early entries in a growing field: book written to deal with the reality of the terrible psychological, moral, and spiritual damage that war does to those involved. Some examples:
Soul Repair: Recovering from Moral Injury after War
Warrior’s Return: Restoring the Soul After War
Killing from the Inside Out: Moral Injury and Just War
Afterwar: Healing the Moral Wounds of Our Soldiers
There are many others. I have not read these, but the Amazon reviews are 5-star or close to it (greater than 4-star).
The growing number of such books is some indication of the toll America’s non-stop wars have had on those who fought it, but course the damage and deaths from such wars goes far beyond the damage to the US: for example, look at Iraq today.
Why has the US constantly waged war in recent decades? Perhaps because those who make the decision to go to war do not fight in it and (of late) have never fought in any war and thus lack any read understanding of the costs of war. Similarly, the pundits and news analysts who comment on US decisions to wage war also lack war experience for the most part. When you think about how the Iraq war inaugurated by the Bush Administration, based on deliberate falsehoods, and about how the cost and consequences of that war continue to reverberate, it should make you question the wisdom of war.
UPDATE: From another article (also well worth reading) this chart hints at the suffering our wars cause our own troops.
Or, to put it positively, why mundane routines are pleasurable. From a book review by Elizabeth Kolbert in the New Yorker:
. . . Consider the following scenario. One afternoon, you’re sitting in your office with wads of cotton stuck up your nose. (For the present purposes, it’s not important to know why.) Someone in your office has just baked a batch of chocolate-chip cookies. The aroma fills the air, but, since your nose is plugged, you don’t notice and continue working. Suddenly you sneeze, and the cotton gets dislodged. Now the smell hits, and you rush over to gobble up one cookie, then another.
According to Steinberg, adults spend their lives with wads of cotton in their metaphorical noses. Adolescents, by contrast, are designed to sniff out treats at a hundred paces. During childhood, the nucleus accumbens, which is sometimes called the “pleasure center,” grows. It reaches its maximum extent in the teen-age brain; then it starts to shrink. This enlargement of the pleasure center occurs in concert with other sensation-enhancing changes. As kids enter puberty, their brains sprout more dopamine receptors. Dopamine, a neurotransmitter, plays many roles in the human nervous system, the sexiest of which is signalling enjoyment.
“Nothing—whether it’s being with your friends, having sex, licking an ice-cream cone, zipping along in a convertible on a warm summer evening, hearing your favorite music—will ever feel as good as it did when you were a teenager,” Steinberg observes. And this, in turn, explains why adolescents do so many stupid things. It’s not that they are any worse than their elders at assessing danger. It’s just that the potential rewards seem—and, from a neurological standpoint, genuinely are—way, way greater. “The notion that adolescents take risks because they don’t know any better is ludicrous,” Steinberg writes.
Teen-agers are, as a rule, extremely healthy—healthier than younger children. But their death rate is much higher. The mortality rate for Americans between fifteen and nineteen years old is nearly twice what it is for those between the ages of one and four, and it’s more than three times as high as for those ages five to fourteen. The leading cause of death among adolescents today is accidents; this is known as the “accident hump.”
Steinberg explains the situation as the product of an evolutionary mismatch. . .
Evolution again: adolescents are exploratory and experimental-minded, with benefits to the group as a whole: finding new sources of food (plant, animal, or region), thinking up new ways to hunt, and undoubtedly a fair number dying from consuming toxic food—but the group thus learns and advances. Doesn’t this remind you of the viral swarm entity a few blog posts ago?
Steinberg explains why the risky behavior is done to get attention, and why attention is so important—i.e., such a reward.
It’s worth the 8 minutes:
A very interesting column by Brian Merchant in Motherboard examines the trends in how corporations manage employees and finds that most are moving rapidly in the direction of the Amazon model. Well worth reading. [edit: broken link fixed – LG] You can certainly see the reasons that the culture is pushed, and you can see who benefits and who suffers adverse effects.
From the article:
“I wasn’t surprised about anything in the report, except maybe the desperation that allows workers to accept such conditions,” Douglas Rushkoff, a professor of media theory at CUNY, and the author of Present Shock, told me in an email.“But what Amazon is doing is entirely consistent with the way most companies are using digital technology. It’s a way of extracting value from humans and converting it into share price.”
Of course, working conditions like these are what gave rise to unions to begin with. In addition, government is the other force protecting employees (the public) from excessive demands. For example, the 40-hour work week, the safety requirements enforced by OSHA, and so on. But in recent decades the government has discontinued this role for a variety of reasons, including targeted budget cutbacks by Congress.
It will be interesting to see how it plays out. The numbers are on one side, power is on the other.
UPDATE: Interesting further context for the anecdote told by Jeff Bezos.
Earlier I linked to “The Coddling of the American Mind,” by Greg Lukianoff and Jonathan Haidt in the Atlantic. It describes the infantilizing of higher education with the goals of (1) avoiding intellectual challenge and (2) increasing student emotional comfort. The authors’ recommendation of cognitive behavioral therapy is quite interesting: identifying cognitive mistakes and attacking them head on. CBT has been proven to work: numerous studies validate its effects. The entire article is worth reading. It has this appendix:
Common Cognitive Disorders
A partial list from Robert L. Leahy, Stephen J. F. Holland, and Lata K. McGinn’s Treatment Plans and Interventions for Depression and Anxiety Disorders (2012).
1. Mind reading. You assume that you know what people think without having sufficient evidence of their thoughts. “He thinks I’m a loser.”
2. Fortune-telling. You predict the future negatively: things will get worse, or there is danger ahead. “I’ll fail that exam,” or “I won’t get the job.”
3. Catastrophizing.You believe that what has happened or will happen will be so awful and unbearable that you won’t be able to stand it. “It would be terrible if I failed.”
4. Labeling. You assign global negative traits to yourself and others. “I’m undesirable,” or “He’s a rotten person.”
5. Discounting positives. You claim that the positive things you or others do are trivial. “That’s what wives are supposed to do—so it doesn’t count when she’s nice to me,” or “Those successes were easy, so they don’t matter.”
6. Negative filtering. You focus almost exclusively on the negatives and seldom notice the positives. “Look at all of the people who don’t like me.”
7. Overgeneralizing. You perceive a global pattern of negatives on the basis of a single incident. “This generally happens to me. I seem to fail at a lot of things.”
8. Dichotomous thinking. You view events or people in all-or-nothing terms. “I get rejected by everyone,” or “It was a complete waste of time.”
9. Blaming. You focus on the other person as the source of your negative feelings, and you refuse to take responsibility for changing yourself. “She’s to blame for the way I feel now,” or “My parents caused all my problems.”
10. What if? You keep asking a series of questions about “what if” something happens, and you fail to be satisfied with any of the answers. “Yeah, but what if I get anxious?,” or “What if I can’t catch my breath?”
11. Emotional reasoning. You let your feelings guide your interpretation of reality. “I feel depressed; therefore, my marriage is not working out.”
12. Inability to disconfirm. You reject any evidence or arguments that might contradict your negative thoughts. For example, when you have the thought I’m unlovable, you reject as irrelevant any evidence that people like you. Consequently, your thought cannot be refuted. “That’s not the real issue. There are deeper problems. There are other factors.”
Really, at this point a new name would be better—isolated personality disorder, or the like. Michael Byrne explains at Motherboard:
What schizophrenia is not: A state of being multiple contradictory things at once.
Feel free to chase the etymology of “schizo” all the way to its Greek origins as a prefix meaning roughly “split” or “divided.” And feel free to argue that said roots justify a billion hacky music writers calling songs and albums and bands “schizo” when what they really mean is “different things together.” (Which they will continue to do because they will continue to not have anything better to say than “this song or album or artist has ‘different things together.'”) Send me your dictionary links and examples of historical usages of the non-psychiatric definition of schizo and schism. What about schizocarp and schizogenesis? Surely psychiatry can’t take away my ancient Greek-derived deprecated slang?
No—no it can’t. But understand that by calling the new Kanye West track a“schizophrenic monster” or that Kate Nash album “thrillingly schizophrenic” or some Eminem verse “full schizo Slim Shady mode” you do nothing but hurt and obfuscate. Your misuse of “schizo” and “schizoid” and schizophrenic has only the effect of perpetuating misinformation and stigmatization. And for what?
A shitty metaphor.
A survey conducted in 2007 found that about a third of total uses of “schizophrenic” in the US press involved the metaphorical two-things-at-once slang definition rather a reference to what schizophrenia actually is (or what it is to be schizophrenic). In the German press, that share jumped to nearly 60 percent. And among music reviews, my own unscientific research suggests that the percentage of metaphorical misuse is pretty much 100 percent.
The “schiz” in schizophrenia indeed derives from schism, but not in the classic modern interpretation of cleaving between two oppositional concepts. The schism of schizophrenia is detachment—schizophrenia is very broadly characterized by an inability to correctly interpret sensory input and, in some part, to make sense of the real-world. This has a lot of seemingly disparate manifestations—delusions, hallucinations, extreme social detachment and self-isolation—but it’s basically like being forced to live in the world one step removed. This is the schism.
Patrick House, a neuroscientist at Stanford University, got this exactly right a couple of years ago in a piece for Slate called “Schizophrenic Is the New Retarded.” “The metaphorical use of schizophrenic suggests a rapid and unexpected switch from one extreme state to another, something like an embattled other self breaking through and taking over,” he wrote. “But schizophrenia is not some unexpected polarity, nor is it a disease of fugue-like dissonance or a Jekyll-and-Hyde struggle for control.”
If the whole Jekyll-and-Hyde psychiatric fiction corresponds to anything, it’d be multiple-personality disorder or dissociative identity disorder, a diagnosis thatremains (justifiably) controversial. Schizophrenia is really nothing like that—in the canonical sense, it’s a disease of disordered thinking, a partial inability to separate the signals of the everyday lived world from its noise. If anything, it’s more like being trapped in personality solitary confinement than it is sharing different personalities. A profound and profoundly disabling unrelatability.
Of course, schizophrenia is hardly alone in this problem. See also: Oh I’m just so OCD about my Gmail inbox or I’m just so bipolar! I like junk food and vegetables. Or whatever. These are like the classic tools of cheap hyperbole. . .