Cheryl Shepard heard arguing followed by gunshots before she entered the master bedroom of her son's home on December 1, 2012. There, she saw her 25-year-old son, former Kansas City Chiefs linebacker Jovan Belcher, bending over the body his girlfriend, 22-year-old Kasandra Perkins; he was kissing her forehead and saying he was sorry. Belcher had shot her nine times.
According to police reports from that day, Belcher then apologized to his mother, kissed his three-month-old daughter, and drove his Bentley to the parking lot of his team's practice facility. That's where he held a gun to his temple and said to his coach and manager, "I have hurt my girl already and I can't go back now." Moments later, he kneeled down and shot himself in the head.
News of Belcher's murder–suicide fueled growing concern about the long-term effects of concussions for professional athletes, and especially football players. A post-mortem autopsy revealed that Belcher had suffered from chronic traumatic encephalopathy (CTE), a progressive, degenerative disease often found in individuals with a history of repetitive brain injuries. The brain degeneration that results from CTE is associated with symptoms like impaired judgment, impulse control problems, aggression, depression, and progressive dementia, among others. Sadly, there is a long list of football players whose suicides have been linked to brain trauma and CTE.
But for players whose traumatic brain injuries (TBIs) have not progressed to the point of developing CTE, a history of repeated head injuries—even mild or subcussive ones—can still result in some similar symptoms, including increased aggressive and disinhibited behavior. While TBIs are not unique to professional athletes, the NFL has reportedly stated in court documents that almost one in three football players will likely develop long-term cognitive problems stemming from brain damage.
"The symptoms of a TBI can be anything from a little forgetfulness, a little inappropriateness, to [being unable to] speak correctly [or] walk—just the full spectrum of what the brain does," explained Dr. Brent E. Masel, the national medical director of the Brain Injury Association of America. To understand the issue of disinhibition and brain injuries, Masel says to think of the expression that someone "has no filter"; the symptom of inappropriateness—or disinhibition—is a common outcome of a disconnect in the brain's frontal lobes as a result of a TBI, according to Masel. "Your frontal lobes act as a check on your behavior," he says. The effects are not unlike what happens when you drink too much and become an obnoxious version of yourself who throws a glass at the bartender, makes an unwanted pass at an Uber driver, or jumps out a bar window; those with TBIs often face similar issues of poor judgement, impulsivity, and disinhibited verbal, emotional, or physical behavior.
While recent research is shedding light on the correlation between domestic violence and TBIs, it's possible to ask the same question about the relationship between sexually violent behavior and brain injuries. While it's nearly impossible to determine the exact number of alleged sexual assaults committed by current or former NFL players, Broadly's recent investigation into off-field behavior by NFL players found more than 15 active members of the NFL with sexual assault–related allegations against them, including: Ray McDonald, Ahmad Brooks, Ben Roethlisberger, C.J. Spillman, Frostee Rucker, Jordan Hicks, Perrish Cox, Josh McNary, and 2015's number one draft pick Jameis Winston. This list does not include former NFL players accused of rape or sexual assault.
Studies conducted on convicted sex offenders have found that between 5 and 35 percent have some form of neurological damage or disorder. However, rates of related brain injury in these studies may be underrepresented because offenders with disabilities are often removed from the criminal justice system altogether, and the studies often don't account for individuals with offense histories pre-injury, or when alcohol was involved.
Virtually none of the people in our research had pre-morbid histories of inappropriate sexual behavior, so it did seem to be a consequence of the brain injury.
Researchers in Australia looked at incidences of inappropriate sexual behavior in over 500 patients with severe TBIs across 11 rehabilitation service centers. Within their three-month study published in 2013, Prevalence, Clinical Features, and Correlates of Inappropriate Sexual Behavior After Traumatic Brain Injury: A Multicenter Study, they found that 8.9 percent of patients exhibited some form of sexually inappropriate behavior.
"Virtually none of the people in our research had pre-morbid histories of inappropriate sexual behavior, so it did seem to be a consequence of the brain injury," says Dr. Grahame Simpson, an associate professor at Griffith University in in Queensland, Australia, and lead researcher on the study.
In 43 of 45 cases in the study where inappropriate sexual behavior did occur, it was accompanied by other "challenging behaviors"—most commonly aggressive or inappropriate social behavior. "Our research shows that inappropriate sexual behavior generally occurs as part of a broader pattern of more general disinhibited or dyscontrolled behavior; this can then be exacerbated when alcohol is included in the mix," says Simpson. During those three months of study, reports of rape were rare. Instead, forms of sexual harassment, like inappropriate touching or talk, were more commonly reported.
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The study included both women and men, but overall researchers found that the impact of TBIs was largely on men, particularly those who sustained more severe head injuries and at a younger age. "We think that as males grow older, social behavioral routines become more deeply embedded in the brain, and there is also ongoing maturation of the pre-frontal cortex up to the early 30s," Simpson says. "Therefore, there is a greater resilience to damage to the brain [after that point], so older males are less likely to display such inappropriate behaviors."
The risk of sexually intrusive behavior following a brain injury is significant enough that many medical professionals who work with patients with severe brain trauma fear being harmed by their patients. In a survey of 133 rehabilitation professionals who work with patients with TBIs, 66.9 percent reported that they fear being hurt at work, and 60 percent said they feel they did not have adequate training to deal with sexually intrusive behaviors. As often happens with sexual harassment in most settings, this may be more indicative of how we handle—or don't handle—issues of non-consensual sexual behavior than of the rates of sexually intrusive behavior following TBIs. Regardless, researchers have still sought to outline approaches to rehabilitation for sexually intrusive behavior for people with TBIs, as it's known to be a concern for patients with TBIs and for the medical professionals who treat them.
When it comes to a possible correlation between reports of sexually violent behavior by NFL players and the history of severe brain injury among professional football players, Simpson believes TBIs may be one factor among many, but we don't currently have enough research to adequately weigh all the various risk factors at play.
Could a brain injury be a factor? It might. I'd say a factor as opposed to a cause.
Masel agrees, also pointing out the general culture of violence and aggressive behavior in football as another risk factor for sexually violent behavior. "I've always really thought—just as somebody who follows football—that kind of behavior is part of the way their life is," he says. "They live in a violent world. Obviously there are some great people in football, but some people respond violently because that's just sort of their training. Could a brain injury be a factor? It might. I'd say a factor as opposed to a cause."
While there may not be enough current research specific to football players and rates of sexual violence, there is a wealth of evidence and research on the risk factors of sexual violence that permeate the NFL. Sexually violent behavior followings TBIs often occurs in tandem with other aggressive behaviors, and NFL players are arrested more often for violent crimes than the general population. Additional risk factors include the production of hypermasculinity, a culture of entitlement, and patriarchal views towards women within that heterosocial culture.
When we look at the behavior of those with severe brain trauma, Masel believes we have to be aware that an individual cannot always be held responsible. "It's like a little baby who pees on himself. Well, they have no control over that—just physically they have no control," Masel says. "Very often with this disinhibited behavior, the patient has no control over that."
Nevertheless, there are many aspects of this issue that are within our control, including reducing other risk factors for sexually aberrant or violent behavior, ensuring that administrators and managers set strong standards of behavior, and providing appropriate neuropsychological assessment when there is concern.
While Jovan Belcher's murder of his girlfriend raised national attention for traumatic brain injury and risks of domestic violence, many rightfully pointed out that domestic violence is a complex and multifaceted issue—one that certainly cannot be reduced to a single cause. Brain injury is not to blame for a systemic, patriarchal culture of violence against women—one in which more than 30 percent of women murdered every year are killed by their intimate partners. But brain injury cannot be removed from that world either, and we should be considering it as an additional risk factor. National football players are at greater risk of being affected by brain damage, and severe brain injuries have been proven to heighten disinhibition and aggressive behavior. Considering the NFL's long history of violence, this should definitely remain a concern.
The NFL did not respond for comment on this story.