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Cole Madison's Example Should be the NFL Standard for Mental Health

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Cole Madison's Example Should be the NFL Standard for Mental Health

Mental health in the NFL has been a topic of discussion for the last several years.  During this time, there have been countless untimely deaths, suicides, and mental health issues related to CTE.  CTE or Chronic Traumatic Encephalopathy is a degenerative disease of the brain that manifests itself in players who have suffered repeated brain trauma over the course of their careers.  This degenerative disease is the reason why countless football players suffer from life-altering changes to their mental health both during and after their playing careers.  

The NFL has certainly come a long way from the days when players and commentators openly criticized Heinz Ward for sitting out of a crucial game for fear of a concussion.  Although steps have been taken to limit trauma to the head, the reality is that football is a brutal sport and the effects of traumatic brain injuries can be felt after just one incident.  

Curtin University Associate professor of Physiotherapy and Exercise Science, Daniel F. Gucciardi poses the question of whether mental toughness and mental health are seen as contradictory in an "elite sport" such as the NFL.  

Gucciardi answers the question of whether mental toughness and mental health are seen as contradictory by citing various mental health professionals who highlight the idea that "elite sports" make for mentally stressful work environments because of the pressure to succeed, which evokes hypermedia exposure and intense criticism when a player is unable to perform, even if it is due to injury.  This is why until recently, players would face the stigma of being labeled as soft or weak if they took themselves out of a game to prevent further injuring themselves.  

Gucciardi, in his article "Are Mental Toughness and Mental Health Contradictory Concepts in Elite Sport?" says that "elite sport" is an "environment where the perceived consequences of appearing weak outweigh the incentives of seeking help.  Thus, the answer to this target question was yes; mental toughness and mental health are contradictory concepts in elite sport".  

The case of Packers offensive guard Cole Madison stepping away from football to attend to his mental health is one that shows that the conversation of players actively seeking help without fear of being perceived as weak is beginning to resonate within NFL circles.  However, the circumstances behind the tragic suicide of his former quarterback, teammate, and best friend Tyler Hilinski, shows that the NFL, and football in general, have major issues with trying to protect their players from traumatic brain injuries.

The reality is that it is going to be a difficult task to prevent players from suffering traumatic brain injuries in a sport that has some level of helmet to helmet contact on almost every play.  Everyone who was connected to Tyler Hilinski, including his family members, could only recall a very small amount of impactful hits to his head, yet the medical examiner still determined that he had stage 1 CTE (Greg Bishop, Sports Illustrated, "A college Quarterback's Suicide. A Family's Search for Answers"). It is apparent, through the tragic death of Tyler Hilinski that CTE is a very prevalent presence in football players, even players without a history of traumatic brain injuries.

Cole Madison finds himself trying to reconcile both the dark specters surrounding his best friends death as well as the root cause for him (Tyler Hilinski) taking his own life which is related to the symptoms of CTE.  Madison left the Packers during the time in between rookie camp/orientations and the start of training camp when it was determined that Hilinski was suffering from stage 1 CTE upon his death.  Madison is a first-hand witness to the effects of CTE and has come face to face with the reality that his brain could be affected by the same disease by continuing to expose himself to the risk of traumatic brain injuries.  

Tyler Hilinski's father, Mark, highlighted the stigma related to reaching out for help within football circles by saying that "he believes that his son would have had a better chance if the stigmas were less prevalent and better understood".  

Former NFL quarterback Drew Bledsoe, whose son was a teammate of Tyler's at Washington State, cemented Mark Hilinski's message by saying that "As men, we have to learn to talk about how we are feeling...reaching out for help when we need it is not a sign of weakness.  Trusting your friends and asking for help is the ultimate sign of strength" ("A College Quarterback's Suicide. A Family's Search for Answers").  

Cole Madison's decision to step away from football and address his mental health needs, as well as weighing the risks of playing football in the NFL should be applauded and considered as "the ultimate sign of strength".  In doing so, Cole Madison is honoring his friend and fulfilling the mission of Tyler's family's foundation, Hilinski's Hope, by taking care of himself and his mental and emotional health, so that he can be a present and positive force in the lives of his family and friends. 


David Michalski is a staff writer for Cheesehead TV. He can be found on Twitter @kilbas27dave 

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Fan friendly comments only: off Comments (28) This filter will hide comments which have ratio of 5 to 1 down-vote to up-vote.

TheVOR's picture

So I've said many times, I believe the next CBA will include disclaimer and no liability against the NFL player clauses.

This is like smoking cigarettes, if you continue doing so, after everything we know today about smoking, its your choice?

The affects on that brain are no longer hidden in dark places. The risks are known! Anyone playing football at any level needs to understand the risks you're taking, from parents, right down to players!

Also with Cole, it would obviously be nice to know you're thinking about not playing professional ball prior to an NFL draft that includes your name. I get it was an after the fact deal, but, you either want to play, or you don't. It's really not that big of a decision. You assume the risks and liability, understanding that a small % of players have issues, or you retire.

mamasboy's picture

Countless untimely deaths and suicides due to cte? Countless? Could I see the stats supporting that? I've never read any comparisons of the average Joe suicides, and suicides by football players. It might be interesting to find out if there's any difference at all.

Rak47's picture

Idk about average Joe suicide numbers but I do know in 2017 there were just over 300 police officers who died that year nationwide, 46 from on duty gunfire. That year Nationwide 240 officer deaths were suicides. We have more officers killing themselves than there are thugs on the streets doing them in.

Lare's picture

"Also with Cole, it would obviously be nice to know you're thinking about not playing professional ball prior to an NFL draft that includes your name. I get it was an after the fact deal, but, you either want to play, or you don't."

I agree 100%. I respect Madison's right to make a decision on what's best for his health going forward, But I do not respect him for signing a contract, accepting his signing bonus, reporting for a few practices, then deciding he doesn't want to play anymore but keeps his signing bonus.

Like my Grandpa used to say "If you want to be treated like a man you need to act like a man."

Skip greenBayless's picture

You have a lot of nerve Lare attacking a guy in his worst of time and asking for him to repay back money. Wow!!


KnockTheSnotOutOfYou's picture


Lare was spot on Dash!

I understand there are issues with Madison none of us know of and probably cannot relate to. However, at some point he needs to make decision. There are many difficult challenges he will face in life and this was one of them. It is pretty easy either you are going to play or you aren't. Do not keep the Packers hanging particularly after treating you so well.

Personally, I believe Madison is coming back to the Pack. Whether coming back in best shape of his life and with a vengeance, or coming back out of football shape and uncertain of his commitment is the question.

Football is a violent sport but not even close to what the every day blue collar guy is exposed to on a daily basis. As a young man I worked as a merchant marine and got hurt several times. Without doubt I was exposed to a fatal injury dozens of times daily. In college and grad school I worked either building or servicing silos and slurry stores. No safety harnesses hanging 100 feet in air on a rope and board, no gas masks upon entering manure pits. Other times the chain on augers at bottom of silo would come off and we would need to dig a hole thru tons of feed and crawl in underneath hundreds of tons of corn and work on chain hoping the cavity would not collapse. My brother got gassed and in coma for week. Brother in law killed on duty as MI State Police Officer. Family members shot in WW2.

What these football players are exposed to with the risk vs rewards is ridiculous compared to the average Joe out there. Oh yes, my salary doing the above jobs were in the $4 to $6 range.

Suck it up!

LeotisHarris's picture

Jesus, Knock, all of the times you put your life at risk for minimum wage doesn't make you a man. If you're going to risk your life in situations you know to be dangerous "hope" is a really poor strategy. I grew up in rural Wisconsin, and personally know families devastated by the exact situations you described. There's a reason county outreach offices offer farm safety updates and seminars. You're just plain lucky you weren't a Darwin Award winner.

Bearmeat's picture

I'm fine with that, as long as the revenue % given to players goes WAY up and the contracts become fully guaranteed upon signing.

Lare's picture

CTE is the end result but there are many other questions that need to be answered. When did the impacts occur that caused the damage? Was it in junior high school, high school, college? Was it from football or some other sports? And why do some players get CTE but hundreds of others don't? What about the frequency of occurrence in other sports (boxing, MMA, etc.) where many more impacts to the head occur?

The bottom line is that athletes in every sport need to assess the long term risks to their participation and make decisions they feel are in their own best interests.

Ferrari Driver's picture

I think soldiers must have an agreement against what they suffer. Hard for someone like me who has never been in that situation to fully understand the stress they must have to endure. At least in football we used to have pretty good equipment, but these pro athletes play at such speed with great size it's turned into another game than what we knew as kids.

sonomaca's picture

CTE could end contact football (and hockey) if it’s found that many or most players suffer from the condition to one degree or another.

Jonathan Spader's picture

They need to broaden the scope of CTE study. I know quite a of construction workers that have suffered head trauma. There is still a ton we don't know about the human brain.

Since '61's picture

As of 2018, 111 former NFL players who were autopsied after they deceased 109 were found to have CTE. That is a very high percentage, 99%. It is enough to be statistically accurate to state that nearly every player suffers from CTE.
Thanks, Since '61

Thegreatreynoldo's picture

Yes, that is concerning, but it is terrible science. The players and/or their families who donated their loved ones for an autopsy probably suspected some brain trauma. It is a selection bias.

There are thousands, hundreds of thousands of people who played high school, college and/or pro football who never allowed an autopsy because no changes inconsistent with normal aging or normal behavior ever manifested. If one adds in every other form of sport right down to surfing, skiing, rugby and soccer, there are hundreds of millions who participated in some form of activity with an associated risk factor.

The statistic you cited is not statistically *accurate* significant and is clearly insufficient to conclude that nearly every player suffers from CTE. I believe I read that study, and I read several others. One thing I learned is that a decent percentage of people who never participated in activities thought to have a higher risk of causing CTE do have CTE. There is a self-selection bias in those since permission is needed to autopsy someone.

That being said, I didn't let my son play football. He did play club Lacrosse, but he was an adult when he started that.

Since '61's picture

TGR - just as an FYI, a few paragraphs from the study.

"For the study, the researchers began with the donated brains of 202 football players. Pathologists, knowing nothing of a patient’s history or symptoms, examined each brain for evidence of CTE. At the same time, clinicians—blinded to each brain’s pathology—used medical records and interviews with family members to collect detailed information about each patient’s medical history and symptoms. The group met for regular consensus meetings, where the pathologists and the clinicians presented their findings. They limited the study to football players, providing a somewhat homogeneous sample.
Of the 202 brains studied, the group diagnosed 177 with CTE, including 110 of 111 from the NFL players (99 percent); 7 of 8 from the Canadian Football League (88 percent); 9 of 14 semi-professional players (64 percent); 48 of 53 college players (91 percent), and 3 of 14 high school players (21 percent). (The group also studied the brains of two pre-high-school players, neither of whom was diagnosed with CTE.) The brains of former high school players showed only mild pathology, while the majority of college, semi-professional, and professional players showed severe pathology."

You are correct in that the brains donated had all played football and exhibited behavior indicative of CTE. As you know, the problem, at least for now, is that there is not a definitive test for CTE while the person is alive. Although they are working to develop accurate testing.

Like you my son did not play football growing up. He is a doctor now and he has access to the studies and medical journals and keeps me updated on this topic and the respective research. To me the significant problem is how CTE affects behavior. In some cases people turn violent, in others they gradually lose their ability to function, others lose memory, others become depressed some to the point of suicide, etc. There are a wide range range of symptoms.

I wonder if CTE is one cause for players committing domestic violence and other crimes. The research also indicates that CTE may cause PTSD which has become very prevalent among our veterans returning from overseas. There appears to be some correlation between the behavior of at least some returning vets and former football players.

We are in the early stages of researching this issue and more information needs to be gathered but hopefully a reliable diagnosis and treatment can be developed to relieve people from this disease in the reasonably near future.

At the least, the NFL which has the resources should be doing more to help their former players and to protect the current and future players with better equipment. This will likely be one of the major issues contested during the next CBA negotiations. The players will want funds set aside to help them while the owners may want them to agree to a hold harmless clause. I have believed for a few years that the next CBA will result in a lengthy shut down for the league. There are several serious and contentious issues that both sides will want to resolve. Time will tell.

In the meantime I wish the best for Cole Madison and I support any and all players who decide to step away from the game and protect themselves. Thanks, Since '61

Ferrari Driver's picture

Great post; I thoroughly enjoyed the read. Thumbs up!

Since '61's picture

I appreciate your comments Ferrari. Thanks, Since ‘61

PatrickGB's picture

Both in sports and in the military, young men and women are told about risks. Yet, it’s in the nature of young people that they don’t yet have the full sense of what that may mean to them personally. Both physical and mental trauma may often await them. If they did fully realize that risk, they might reconsider their employment. It’s the rest of us who reap the benefit of their sacrifice. God bless them.

bigspiker's picture

If parents think playing soccer where the ball can be headed with no protection and the ball can travel 40 mph (with pros up to 80 mph) is a better option they are kidding themselves.
Hockey? Don’t get the scientists started. Basketball falls can land a head on the floor. Bike riding? Car crashes? Wrestling? Baseball to the head? Skateboarding gave me my worst concussion. There are so many ways to get traumatized. But is there really any study that says waiting for a protocol to say no signs is helpful long term? I wonder

KnockTheSnotOutOfYou's picture

There is risk getting up in the morning and driving to work.

Each player needs to evaluate the risk and decide whether they want to continue playing. Stop after first concussion, or third? At some point a player needs to accept responsibility for their health. There certainly would be a number where I'd say it is time to retire. Aikman had a lot of concussions and quit.

Ryan B Dub's picture

Hope this kid does what is right for him. Never easy losing a loved one. Especially when they are young.

Old School's picture

We are all in charge of our own happiness. Some find it on the football field, and that's their choice. Some, like Madison, will find it elsewhere.

I think the problem is the helmet. We need better helmets. Yes, you can do stuff with rules changes but we still have to get a better helmet.

scullyitsme's picture

I saw a documentary once that claimed 95% of coal miners who work in the mines an average of 10 years end up with black lung disease and shorten their life close to 20 years. They are still desperate for their mining jobs to come back and love their employers. I wouldn’t do it, I wouldn’t let my daughter do it, I don’t understand why others do it. Point is, now they have the science, they know what to expect and they get paid handsomely for it. I’d guess they all think they’ll be in the percentage that sneaks by and doesn’t get it. We are an odd species that’s bad at math. Think I’ll by a lottery ticket and I love me some packers.

Thegreatreynoldo's picture

Or they are willing to work at a family-supporting job so their children can have better lives. They aren't dumb hicks who don't know the odds: many are making a knowing sacrifice.

scullyitsme's picture

Its also not unlike smoking or chewing. I chewed for a lot of years thinking I’d be the one that it didn’t effect my teeth or gums, but as I got older and took a few math classes I realized that probably wasn’t the case. When my daughter was born I quit because I thought to my self, “if I die from throat cancer and leave her without a dad in this word because I was so stupid, I’d feel pretty shitty”. On the other hand, if my liver goes from drinking too many leinenkugals, that’s just the way it is. We all make choices. I wish for the packers sake he’d just make his.

Ferrari Driver's picture

Some excellent posts on this link which are well thought out and views expressed. Thanks for the interesting reads. Quite a few thumbs up!

Skip greenBayless's picture

Thank you.


LeotisHarris's picture

"Heinz Ward." LOL

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