Ryan Freel

Ryan Paul Freel (March 8, 1976 – December 22, 2012) was an American professional baseball player. A utility player, Freel played second base, third base, and all three outfield positions in Major League Baseball for the Toronto Blue Jays, Cincinnati Reds, Baltimore Orioles, Chicago Cubs and Kansas City Royals between 2001 and 2009.

On May 28, 2007, Freel was injured in a game against the Pittsburgh Pirates when chasing a deep drive to right-center field. Freel and a right fielder collided, resulting in Freel's head and neck hitting Hopper and finally the warning track. He was transported by ambulance to Good Samaritan Hospital, where he was reported to be coherent with feeling in his extremities. Freel began working out on June 15, about 2 weeks after the collision. He was briefly sent to the AAA Louisville Bats for rehabilitation. Freel began getting random headaches and pains in his head, which delayed his return for another 2 weeks. On July 3, 2007, 1 month and 5 days after the accident, Freel returned to play for the Cincinnati Reds.

In 2009 with the Baltimore Orioles, he was hit in the head by a pickoff throw while on second base. He was put on the disabled list after the injury, and officially retired a year later.

On December 22, 2012, Ryan Freel died by suicide. After his death, Freel's family donated his brain tissue to Boston University for research into chronic traumatic encephalopathy (CTE), a degenerative neurological condition associated with multiple concussions which at present can only be conclusively diagnosed postmortem. In December 2013, a postmortem examination by the Center for the Study of Traumatic Encephalopathy showed that he was suffering from Stage II CTE, making him the first MLB player to have been diagnosed with the disease. Ryan was also diagnosed with various mental illnesses such as bipolar disorder, adult ADHD, depression, impulse control disorder and anxiety. Additional mental illnesses are consistent with many athletes who also suffer from CTE once their playing careers are finished.

Ryan Paul Freel 

March 8, 1976 – December 22, 2012

Day 27 - Brain Injury and Suicide Risk

Tiaina Baul "Junior" Seau Jr.
January 19, 1969 - May 2, 2012

NFL linebacker.
10-time All-Pro. 
12-time Pro Bowl selection.
Named to the NFL 1990s All-Decade Team. 
Elected to the Pro Football Hall of Fame.
In 2012 Seau died by suicide. 
He was diagnosed with CTE posthumously.  
Junior Seau was 43 years old when he died.

The link between brain injuries and suicide is undeniable. Studies have shown that both major and minor traumatic brain injuries (TBI) increase suicide risk. Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease often associated with athletes, is the result of having suffered multiple head traumas.

The list of those with CTE who had no prior history of mental illness, and then began exhibiting symptoms and/or died by suicide, is extensive. Here is a partial list of Former NFL players with confirmed CTE:

• Jovan Belcher^[4]
• Forrest Blue^[5]
• Bill Bryant^[6]
• Lew Carpenter^[7]
• Dwight Clark^[8]
• Daniel Colchico^[6]
• Lou Creekmur^[9]
• Art DeCarlo^[6]
• Shane Dronett^[10]
• Dave Duerson^[11][12]
• Pete Duranko^[6]
• Ray Easterling^[12][13][14]
• Frank Gifford^[12][15]
• Cookie Gilchrist^[12][16]
• John Grimsley^[17]
• Chris Henry^[12][18]
• Aaron Hernandez^[19]
• Jim Hudson^[6]
• Gerry Huth^[6]
• Tom Keating^[6]
• Terry Long^[1]
• Rob Lytle^[20]
• John Mackey^[12][21]
• Ollie Matson^[12][22]
• Tom McHale^[12][23]
• Earl Morrall^[24]
• Paul Oliver^[6]
• Joe O'Malley^[6]
• Mike Pyle^[6]
• Adrian Robinson^[25]
• Scott Ross ^[26]
• Tyler Sash^[12][27]
• Junior Seau^[12][28]
• Bubba Smith^[12][29]
• Robert Sowell^[6]
• Ken Stabler^[12][30]

The list above is woefully incomplete. At present, CTE can only be diagnosed post mortem. Some families are not comfortable donating the brains of their loved ones for autopsies related to CTE research. Also, understanding how to identify CTE is relatively new. Recognizing and diagnosing the condition has only been possible since 2002. Prior to that, the degenerative brain disease was not yet understood.

CTE was initially identified by the pathologist Bennet Omalu, MD, who performed the autopsy on former NFL player Michael Webster.Webster was 50 years old when he died. Webster had slowly developed increasingly significant symptoms of mental illness during his career in the NFL and following his retirement. After extensive research, Dr. Omalu was the first to discover abnormal proteins in his brain, referred to as neurofibrillary tangles. Today, brain imaging scans show the  permanent impact that concussion related CTE has on a brain:

For those living with the disease, the symptoms are devastating.

(Image above from the Patrick Risha Stop CTE Awareness Foundation)

Given this, understanding and addressing the risk of dying by suicide when a person has suffered a head injury is critical to overall suicide prevention. We must do more research on how to identify brain injury, as often a person who has incurred an injury initially has no (or very minor) outward symptoms.

It is absolutely imperative that people understand that the physiological response to (even minor) head injuries can have a profound impact on long term behavioral symptoms. The two are inextricably linked. Recent studies have shown that having suffered just one concussion leaves a person with a suicide risk that is three times that of those who have not had a head injury at any time during their life.

The urgency of needing more research speaks for itself. Postmortem is not an acceptable time to diagnose a fatal disease.

As a survivor of suicide loss, I also need to say this. The discovery of CTE makes a very important statement about the impact of stigma on suicide. Consider that until CTE was diagnosable, the public perception of of those who suffered from the related symptoms of mental illness and/or died by suicide, was accusatory and ugly. Like all who have struggled with these issues or lost their life in this way - those with CTE were often considered weak of character. Many athletes who died by suicide were deemed selfish and unappreciative of their success.

The pervasive belief that individuals suffering from symptoms of mental illness and who die by suicide are at 'fault' for their death is often wholly inaccurate.

The vast majority of the public still believe that a person who dies by suicide was making a 'choice' that they had entire control over. This is a belief that leads to agonizing questions asked by those left behind. This stigma is believed by the majority of the public, including those who have lost someone to suicide and those who are directly suffering from mental illness. Considering the fact that even one concussion raises suicide risk, why aren't we making diagnosis, awareness, and treatment of CTE and related conditions more of a priority?

Why aren't we comforting those who have lost someone to suicide by telling them that there are often definitive physiological reasons behind years of erratic behavior and suicidality?

Survivors of suicide loss torment themselves with guilt and rage related to questions around why the person they lost did not love them enough to stay alive, or why their own love wasn't enough to keep someone alive.

Again, it is critical that we do more research and that we develop better tools for diagnosis, treatment, and management of all factors that contribute to suicide risk, CTE and head injuries included.

Ernest Hemingway

Ernest Miller Hemingway was an American novelist, short story writer, and journalist. His writing had a strong influence on 20th-century fiction. Hemingway won the Nobel Prize in Literature in 1954. He published seven novels, six short story collections, and two non-fiction works. Additional works, including three novels, four short story collections, and three non-fiction works, were published posthumously. Many of his works are considered classics of American literature.

Hemingway went on safari to Africa, where he was almost killed in two successive plane crashes that left him in pain or ill health for much of his remaining life. Hemingway was known to be an alcoholic. Recently it has been speculated that he may have suffered from CTE as a result of injuries sustained in his plane crashes. Ernest Hemingway died by suicide on July 2, 1961. He was sixty one years old when he died.

Ernest Miller Hemingway

July 21, 1899 – July 2, 1961

Dave Duerson

David Russell "Dave" Duerson was an American football safety in the National Football League (NFL) who played for the Chicago Bears (1983–1989), New York Giants (1990), and Phoenix Cardinals (1991–1993). He was selected to play in four consecutive Pro Bowls for NFL seasons 1985 through 1988.

On February 17, 2011, Duerson lost his life to suicide. Following his request, his brain was sent to the Boston University School of Medicine for research on chronic traumatic encephalopathy (CTE). Neurologists at Boston University confirmed that Duerson had CTE as a result of the concussions he suffered during his playing career. Dave Duerson was fifty years old when he died.

Dave Duerson 

November 28, 1960 – February 17, 2011