Death by suicide is a complicated occurrence which often leaves loved ones saddened and confused. The on-paper version of Tyler Hilinski’s passing is no exception: tall, bright, likeable young man playing quarterback in the Pac10. He leaves behind a loving family and host of friends who will miss him dearly. So what went wrong?
Many recent headlines point to Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease found in people with a history of repetitive brain trauma.
According to the Instagram account concussiongameplan, Tyler “died by suicide caused by CTE.” In the current landscape of football, it is a compelling narrative, but it is categorically untrue. CTE, an abnormal spindle of tau protein that accumulates in the sulci of the brain’s cortex, does not cause suicide. That is not how it works. This sort of damage to the brain, depending on the region in which it occurs, can certainly complicate cognitive processing and lead to depression. But it does not, on its own, cause suicide.
This is an important distinction, and a necessary one. It is important because even in later stages of CTE (Tyler was in Stage 1), the damage does not have outright control over one’s behavior. It does not cause behavior at all, though it does affect it.
Major complications of CTE include degraded function of the prefrontal cortex, the brain’s lead conductor. Impulse control is primary symptom. Sufferers have also reported irritability and apathy. All of this is bad, terrifying in the worst cases. But it does not cause suicide, and the suggestion of such may be doing more harm than good (if good is what the headlines are after).
Consider the case of Todd Ewen, the retired hockey player who, after many years in the NHL, died by suicide. He was dealing with depressive symptoms, including impulse control, irritability, apathy, and the whirlwind of concerns associated with the newly omnipresent hysteria surrounding concussions.
Ewen had suffered many concussions over the course of his career and, considering his symptoms, assumed there was no coming back from his depressed state. Upon autopsy, it was confirmed that Ewen did not have CTE. He suffered from depression, and he needed help. The prevailing narrative of concussions causing an imminent downward spiral for former athletes took over and, instead of looking for help, he took his own life.
The modern sports landscape seems to be caught in what Harvard Professor Ellen Langer would call “entrapment by category.” Media has painted a picture of football as it relates to concussion, and concussion as it relates to CTE. All too often, concussions appear in headlines as having a direct link to suicide. This sort of rigidly compartmentalized thinking is lazy at best. It is harmful at worst, as in the case of Ewen, but more often and perhaps most importantly, it halts progress.
If we believe that CTE is what killed Hilinski, then we turn our backs on the collection of psychological components in play. We swing at only one component of his disease, unable to defeat it.
Mental illness needs to be talked about. The stigma needs to be removed, especially in athletics. Even now, our unwillingness to talk about mental health is propagating the issues of toxic masculinity woven into our social landscape.
We talk about the modern gladiator being taken out by brain damage because it is more comfortable than addressing the fact that the strong, 6’3” leader of the Washington State Cougars was a fragile, emotional, complicated, sad young man. Those are not qualities we like to talk about in locker rooms, or when we talk about locker rooms, for that matter.
Hilinski had CTE. It is possible that his condition exacerbated depressive symptoms and ultimately led to his death. It is equally possible, and I can say from first-hand experience, plausible, that he did not have a place in which or a person to whom he felt comfortable talking about his mental concerns. His friends and family will say they were always there for him, and I am sure they were. But playing college football and talking about your feelings, your perceived weakness, do not align.
Healthy individuals die by suicide every day. CTE was certainly a factor in the death of Hilinski, but it was not the only factor. To suggest so is an insult to the complexity of who he was.
NCAA, NFL, and all members of the football world, let’s pull the curtain back. Let’s talk about brain injury with as much accuracy as we can muster. Let’s talk about mental illness with all the courage that it takes to do so. Remove the stigmas, take care not to oversimplify, and let’s do our best to create a safe, healthy future for our athletes.