Kramer’s suicide attempt puts focus on depression

Erik Kramer’s ex-wife told NBC last month the former quarterback fired a gun at himself after suffering from depression caused by playing in the NFL.

With increasing concern about brain trauma leading to depression in violent contact sports, Marshawn Kramer’s assertions resonated.

But, doctors warn, mental health is complicated, and misconceptions make treating players’ depression more difficult — with potentially tragic results.

Increased awareness of the risks of concussion and repeated violent contact leads too many athletes and their loved ones to believe they reached a dead end, and suicide provides an escape and a way to summon help for others, according to doctors.

In fact, doctors say, most depression suffered by athletes is treatable and fairly well understood.

“Those things are what we need to be worried about in a professional athlete, more than the head trauma,” said Dr. Jeffrey Kutcher, an expert on concussion research, professor of neurology at the University of Michigan and director of the Michigan Neurosport Program.

“And I don’t say that because I don’t think head trauma is a risk. But I say that because the same thing happens in non-contact athletes and athletes who do not experience problems with concussion. They experience similar problems with depression.”

An article published in June in Neurology, a peer-reviewed journal of the American Academy of Neurology, provides evidence for the theory that athletes’ mood disorders are likely attributable to head trauma in only a minority of cases.

Athletes often struggle with emotions when they retire.

Too few respond to early signs of depression, doctors and former players say, and too many players cling to notions of strength, self-image and discipline developed as highly successful athletes, rather than seek treatment.

After the roar of the crowd subsides, feelings of power and invulnerability persist.

In that setting, the suggestion and considerable publicity that depression is caused by brain trauma and even CTE – chronic traumatic encephalopathy, a progressive degenerative disease currently diagnosed only after death — can lead depressed people to believe their circumstances are beyond hope, doctors and former players say.

“Pulling back the sheets on this issue is certainly something that’s important to me, as a former player, as someone who suffers from depression and as a clinician,” said Dwight Hollier, director of transition and clinical services for the NFL and a former Dolphins linebacker.

“I think it’s extremely important to keep knocking down the wall of stigma for help-seeking behavior. And as we talk about these men in particular, we are talking about athletes and how much of a challenge it is to get through a definition of manhood that’s been unfairly defined.”

Suicides increase

The current concern is a troubling increase in suicides by NFL players, which occurred with no evidence of an increase in brain trauma.

A study reported in the American Journal of Cardiology in 2009 documented nine suicides by NFL players from the late 1960s to the early 1990s. In a similar segment of the total population, 21 suicides would be expected.

“Now, in recent years, just tracking the media, you come up with something like 14 to 16 or so suicides among players, and Mr. Kramer is an attempted suicide,” Kutcher said. “The point is, our rate of suicides by NFL players has gone through the roof the last four years.

“Something else is going on.”

Kutcher and others believe that rather than increased brain trauma, it may well be “suicide contagion.”

It is well-recognized in medicine that when a specific population of people is told they have an elevated risk of suicide for a believable reason, suicides increase, whether the reason is true or not.

It is part of the reason the Centers for Disease Control and Prevention advises against promoting overly simplistic reasons for suicide, sensationalizing the life of the victim or over-publicizing it.

“I have no doubt that the way that we’ve talked about suicide, and the people who have been screaming the loudest from the mountaintops about the impact of brain trauma have had an effect,” Kutcher said.

“And I think it’s greater than the effect that we would have seen from just playing football.”

Brains ‘very resilient’

Eric Hipple, a former Lions quarterback, said some of the recent highly publicized suicides of former NFL players were avoidable.

“With the ability to reshape and remodel itself, given a positive foundation and therapy, the brain has a chance to, psychologically anyway, overcome many things, and to be very resilient,” said Hipple, outreach coordinator for the University of Michigan Depression Center, which has done pioneering work with the NFL Players’ Association.

“That being said, if we paint the picture of a person who had concussions and is going to have CTE as a death sentence, then it sets a really bad outlook for recovery. Because, if that is the case, then why am I doing anything about recovering, if it is set in stone?”

Hipple lost a son to suicide in 2000. He nearly lost his friend and former teammate, Kramer, last month.

Kramer’s career included long odds, struggle and, ultimately, success. His life contains tragedy.

As a player, Kramer was considered so tough his nickname was “Brass.” An offensive lineman leaving the field once suggested part of Kramer’s anatomy was made from it.

Emerging from a vast crop of high school quarterbacks in California, Kramer landed at North Carolina State. Undrafted, he played in the Canadian Football League.

When NFL players went on strike, he crossed the picket line. Eventually, he seized the Lions starting job and is their only quarterback in 58 years, since Tobin Rote in 1957, to win a postseason game.

He later went to Chicago, where he holds the Bears season records for passing yards and attempts.

In 2011, his son Geffen was found dead of an overdose.

A second son is attending high school.

“His personality? He was a great guy and a caring person,” Hipple said.

“But he was also one of those who would rise to challenges, and he overcame about everything that should have kept him out of football, by working hard, by studying, by training, training, training, training, and by taking that extra mile farther than most people would.”

Fighting ‘the transition’

As for all players, the performance eventually stops.

Something common to football players, far more common, doctors assert, than brain trauma induced by concussion, is “the transition.”

Suddenly not playing is a blow, mentally, emotionally and psychologically.

“They lose their identity, they lose their income, their relationships change with those that are around them,” Hipple said. “They lose their relationships with everyone in the locker room: their teammates, the trainers who are taking care of them, and the doctors that are supposed to help.

“All that happens in a single swoop, and it’s almost always unpredictable.”

Hipple described the meeting when a coach cuts a player as “a traumatic moment.”

“It should be treated as such,” he said.

The NFL and the NFLPA have some programs in place.

Help available

The difficulty is former players and their families recognizing the issues and defying the stigma of getting help.

The league has an employee assistance program that provides eight counseling sessions for each specific diagnosis, for current and former players and their families; a 24-hour confidential crisis line that directs players and families to immediately available services in their area; and access to a team of former players who provide general advice as “transition coaches,” but who also receive mental health training.

The greater effectiveness of peer-to-peer counseling is demonstrated by the military, Hollier said.

“With the stigma so deep, having these conversations, talking about mental health, talking about outreach having transition coaches available, having resources available that they can actually tap in and utilize is so important in any approach to mental health,” he said.

Research at UM

The players union joined forces eight years ago with the University of Michigan Depression Center to survey athletes, and it continues to provide for more research through the research, care and public policy clinic and the Eisenhower Center, a residential rehabilitation facility that focuses on traumatic brain injury, and Harvard University.

The NFLPA also has a social worker on staff, as does its foundation.

“But we’re not a hospital, so we try to make sure any player who contacts us is provided with immediate information about services in their area, whether they can travel to the University of Michigan or not,” said Andre Collins, a former Lions linebacker and Penn State All-American who is director of retired players for the NFLPA.

The first step in the protocol for the union is an immediate evaluation, Collins said.

But the player must be willing.

And Collins said the union believes that while brain trauma and CTE are critical issues, significant factors leading to depression likely exist without them.

“That’s clearly our position,” he said.

gregg.krupa@detroitnews.com

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