by Michael D. Anestis, Ph.D.
The other day, a friend of mine shared a link to an ESPN story written by former NFL linebacker George Koonce in which he courageously shared his story of struggling to adjust to post-NFL life. This is a topic that I've thought about from time to time in the past and which was already on my mind in the wake of Junior Seau's recent death by suicide and I wanted to take the opportunity today to write a bit about it and to hear your thoughts on the issue.
Before getting into the specifics of this particular situation, let me quickly refresh your memory on the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS; Joiner, 2005). I've written about this a ton on PBB, as I was trained by Dr.Joiner and the theory is a core feature of my own research (click here for our initial article on this), but it's worth setting the stage for this by quickly outlining the key components. The theory points out that there is an important difference between the desire to die by suicide and the ability to die by suicide - that the vast majority of those who want to die by suicide can't and the vast majority of those who could do not want to do so.
The desire is said to be comprised of two variables: thwarted belongingness and perceived burdensomeness. Thwarted belongingness is a sense on the part of an individual that he or she lacks meaningful connections to others - either that others do not care about them or that although others care they do not fully understand them, thereby leaving a sense of distance. Perceived burdensomeness is a sense on the part of an individual that he or she makes no meaningful contributions to the world - that their death would be worth more than their continued life. When both of these variables are present, and particularly when an individual feels hopeless about these two issues, the desire for suicide becomes much more likely (see Van Orden et al., 2010 for a summary of the data supporting the IPTS).
The ability for suicide is a bit more of an unusual idea. At its core, the idea behind this variable is that we are not inherently capable of killing ourselves. The will to live is woven into our genes and the drive to survive makes inflicting lethal self-harm remarkably difficult. This, in large part, explains why there are somewhere between 8.5 and 25 non-fatal suicide attempts for every death by suicide and an enormous number of individuals who desire death by suicide but never attempt. Taking it a step further, Joiner's point here is that suicidal behavior is both terrifying and physically painful/uncomfortable and that, in order to engage in serious or lethal suicidal behavior, an individual must develop the ability to tolerate great amounts of physical pain and to overcome the fear of death/bodily harm. What research has shown is that this habituation process occurs through repeated exposure to painful and/or provocative events (PPEs). PPEs can be a lot of things. They could be repeated episodes of non-suicidal self-injury, witnessing death/physical injuries in others, or even experiencing flashbacks of injuries you've had in the past (e.g., Anestis et al., in press; Joiner et al., 2009). Keep these points in mind as you read this and consider how they might be relevant to NFL players transitioning into post-NFL life.
One of the main issues discussed by Koonce is one that I have been talking about with colleagues quite a bit and a point I've seen discussed in various media outlets as well: adjusting to life after the NFL is an extreme struggle for some players. When I think about that transition, I tend to see a parallel with the situation experienced by soldiers reintegrating into civilian life post-deployment. Now don't get me wrong here - this is not another misguided comparison of football to war. Not at all. The overlap I see isn't one in which they are all "soldiers." Rather, much like military personnel deployed in OIF/OEF, NFL players spend a portion of their life sharing an experience that differs greatly from that of most Americans. It is an insulated culture in which they have a clear membership and purpose and are celebrated for that reason. As Koonce says in his article, football becomes their identity and, in that sense, they share a bond with other players that would be difficult for any of us not involved in that experience to fully grasp. They train relentlessly to perform their duties and then, one day, they're done. Suddenly, for a lot of them purpose and group membership are a lot less clear. Certainly many of them have families that love them dearly, but those family members likely did not share the NFL experience and, in that sense, the former players may still feel somewhat distant. Think back to my description of thwarted belongingness and perceived burdensomeness...see any relevance here?
Now, that particular aspect of the NFL experience isn't altogether different from a lot of professions. A lot of people are a bit adrift when they transition out of an experience around which they've built much of their identity. In fact, men over the age of 65 have the highest rate of death by suicide of anyone - signalling that retirement may, in fact, serve as a risk factor for some. The thing is, NFL players retire MUCH younger than most of us do. In a lot of ways, this sounds (and in many cases, is) wonderful, but that no doubt depends upon the individual. In some ways, it might simply push a risk factor typically applied to older adults (or to young soldiers suddenly thrust back into the life of a civilian) to a younger age bracket.
Another issue that sets former NFL players apart from others (and strengthens the parallel to military service), however, is in the likely impact of their chosen career on the acquired capability for suicide. Playing football involves years of physically demanding and painful experiences. Players put their bodies at risk every time they step on the field, every time they make a catch across the middle, lower their shoulders to make a hit, or step in front of a blitzing linebacker to protect the quarterback. The very nature of their job requires them to absorb immense amounts of physical punishment and to develop the ability to not only tolerate the pain, but overcome the fear of experiencing physical harm. Here again, a parallel to military service is strong. We've published data showing that US Air Force personnel who recently completed basic training reported higher levels of the acquired capability than did civilian clinical and non-clinical samples. Certain jobs require you to experience pain differently and to recalibrate your response to risk. That adjustment is pivotal for the survival of those in those jobs while they are involved in the job itself and, in and of itself, the adjustment is not problematic. The question, however, is what happens if those folks develop suicidal desire. It may be easier for former NFL players to act on suicidal desire, particularly with respect to lethal means, than it is for individuals whose lives have not involved so much pain and provocation.
My point here is not to say that military service or professional football are bad. Quite the opposite, actually. My point, rather, is to say that, given the inherent risks associated with playing football, steps need to be taken in order help former players enhance their sense of purpose and belongingness after their playing days are over. This could involve a multitude of options, but involving former players in the league somehow (through NFL charities, some sort of former NFL players golf tour, etc...) could serve to ease that transition a bit and keep vulnerable individuals from getting stuck in a cycle that ultimately results in the desire for death.
I would give almost anything to actually collect data on NFL players and alums to measure these ideas, but that is likely impossible, so it is important to keep in mind here that my thoughts on these issues are just thoughts and not empirically-based opinions. Thinking about things in this way, however, seems more useful to me (and certainly more solution-oriented) than simply looking at former players and shaking your head at them because you think having lived a life of celebrity and wealth should make it easy to overcome life transitions that are inherently difficult.
I would be interested in hearing your thoughts on this. Certainly I have not mentioned CTE here at all and that's a relevant issue to consider (and not one that is in any way inconsistent with these ideas). What else do you think plays a role here? What should be done?
Dr. Mike Anestis is an incoming assistant professor in the Department of Psychology at the University of Southern Mississippi
Sources cited in this post:
Anestis, M.D., Tull, M.T., Bagge, C.L., & Gratz, K.L. (in press). The moderating role of distress toelrance in the relationship between posttraumatic stress disorder symptom clusters and suicidal behavior among trauma-exposed substance users in residential treatment. Archives of Suicide Research.
Joiner, T.E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
Joiner, T.E., Van Orden, K.A., Witte, T.K., Selby, E.A. Ribeiro, J., Lewis, R., & Rudd, M.D. (2009). Main predictions of the interpersonal-psychological theory of suicidal behavior: Empirical tests in two samples of young adults. Journal of Abnormal Psychology, 118, 634-646.
Van Orden, K.A., Witte, T.K., Cukrowicz, K.C., Braithwaite, S.R., Selby, E.A., & Joiner, T.E. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575-600.