When Derek Boogaard died, the hockey world had almost forgotten about him. He’d been off the ice for six months, reportedly suffering from chronic post-concussion symptoms, not practicing with the team, often not even in New York. Like many players on the long-term IR, his activities were of little interest to the fans or the media. Like many aging enforcers, his absence was acceptable and unremarkable. Maybe he would come back, maybe he wouldn’t, but either way, nobody was exactly holding their breath. Every time the Venerable Sidney goes off the roster, the hockey world immediately launches into a tense Crosby-Watch, but there was no such thing as Boogaard-Watch.

Ironically, Derek was more dead to the hockey world while he was still living than he has been since. After his overdose, and especially after the three-part New York Times exposé on the trajectory that brought him there, his hungry ghost has haunted the NHL. He died a bad death, and in some way- indirectly, maybe, through neglect and denial and various other sins of omission- he died at our collective hands. The responsibility the hockey world never took for his life has become a responsibility we cannot escape for his death. We think about it still.

Now, nearly a year later, the NYT has come out with a follow-up piece tracing Len Boogaard’s attempts to puzzle out the train of causation that led his son to that fatal combination of alcohol and Percocet. While the first NYT series posited CTE as the proximate cause of Derek’s trouble, Len’s research tells a somewhat different and equally troubling story. Piecing together four years of medical records, cell phone logs, and financial documents, what emerges is the outline of a massive addiction problem. Dozens of doctors, hundreds of prescriptions, thousands of pills, year after year, from 2008-2011. Boogaard was a huge man, true, but looking at the list of medications and the frequency with which they were prescribed, he also must have built up a huge tolerance. It’s a list that looks like it would kill a normal person ten times over. It’s insane.

It makes me wonder if, in focusing so much of our outrage and guilt over his death on CTE, we are missing an even more important issue. As this Slate article points out, the popular conversation about CTE has outpaced the science. Journalists and sports fans routinely assume a direct link between CTE and psychological and emotional problems that has not entirely been proven. While the signs of the disease have been found in post-mortem in the brains football players who did suffer and died badly, like Junior Seau, they’ve also been found in the brains of ex-players who were by all accounts mentally healthy. It is possible that, in pinning all our fears on concussions, we are overlooking the other factors in athletes’ lives that predispose them to addiction and mental illness.

Professional sports are a world of pain. We seldom consider this, although we are well aware of the frequency and severity of injuries. But though we see people getting hurt all the time, we don’t see very much suffering. Players are always presented to us placidly lying down for stitches, joking with media about their knee rehab program, smiling through broken teeth. They don’t look like they’ve been hurt. They don’t look like people who’ve suffered something. They seem fine. So we wince and laugh and praise their toughness, and go on with our lives figuring that they’re somehow just a more badass class of person than ourselves.

We thought Derek Boogaard was the ultimate badass. His reputation was built on a facade of incredible strength and implacable toughness. The Boogeyman. People loved to see him absorb pain and inflict it in equal measure, confident that he would always come out in the post-game interviews smiling and amiable, reassuring us that nobody really got hurt.

But the medical records make it amply clear that he was in constant pain.

We thought Derek Boogaard was tough, and maybe in the beginning he was. But by the end, his toughness was a chemical cocktail of painkillers, antidepressants, and sleeping pills. How often does this happen? How much of what we call stoicism in hockey is really just numbness? How many men in this game, every day, are only able to keep doing this job because of their own personal narcotic blends? The relationship between CTE and addiction is still being studied. The relationship between taking many hundreds of Vicodin and addiction, however, is pretty well established. We don’t need any additional scientific research to understand that people who get hurt a lot and get prescribed a lot of intensive-strength pain medication are likely to form some very bad habits. We already know that.

And yet, despite the fact that hockey obviously puts players at high risk for addiction, despite the fact that hundreds of players throughout the history of game have died or declined due to problems with drugs both legal and otherwise, the NHL’s treatment programs remain a mystery. We are assure that they exist, of course, that resources are available and everything is being done and it’s all under control, but no specifics are ever offered. No interviews are ever given, no courses of rehabilitation ever outlined. As much as we complain that the NHL’s supplementary discipline and officiating offices operate shrouded in secrecy, these are models of transparency compared to the NHL’s drug abuse treatment programs.

Len Boogaard’s findings do not show much evidence of coherent policies to either prevent addictions or treat them. Derek’s problem was conspicuous, and yet seemed to have no trouble finding team doctors willing to continue prescribing him pills, often without an examination or even a notation in his file. His treatments do not appear to have been overseen by any one physician. Rather he was able to cobble together an assortment of both team and non-team doctors who were willing to prescribe overlapping courses of Vicodin and Percocet amounting to over a hundred pills per month. These he supplemented with additional drugs from street dealers, as well as prescriptions for sleeping pills. His use in 2008 was so extreme that the Wild forced him into treatment and, to their credit, tried to subsequently enforce a regimen of strictly non-narcotic painkillers through the 2009-2010 season. However, he continued to suffer from chronic pain and was still taking regular cycles of pills and injections. Although technically ‘clean’ of the drugs he’d been in treatment for, his body was still regularly full of supplementary chemicals. The man was still struggling.

And then, after all of this, the Rangers signed him to a four-year, $6.5 million contract. A month into it, one of their team doctors prescribed him Vicodin again.

Let this sink in for a minute. The New York Rangers, who knew through Doug Risebrough that Derek Boogaard had developed a serious painkiller problem with the Wild and that he had already been through rehab once, hired him to be their long-term enforcer. Think about that logic: Hey, let’s take a guy who’s already got a bunch of chronic injuries and has already struggled with a narcotic addiction of epic proportions and pay him a disproportionately huge salary to deliberately re-injure his already chronically broken hands and face for four years. The New York Times piece notes “the difficulty of treating a player subjected to continual pain without the use of powerful pain pills.” It was so difficult for the Rangers, apparently, that they didn’t even try. They put him back on the same stuff he’d gone on rehab to get off of.

On subjects like this, the sort that provoke moral outrage, people tend to throw around words like ‘sickening’ and ‘disgusting’ pretty lightly, but in this case, I don’t think there’s any other way to think about it: the Ranger’s decision to sign Boogaard and use him in that role, knowing what they knew, is fucking sickening. It is absolutely morally bankrupt. To take a man who has already just barely scraped through a painkiller addiction and put him in the path of so much more goddamn pain, pain of the sort that may well be impossible to treat without resorting to the same drugs he can’t safely touch, is beyond irresponsible. To then prescribe him those very drugs again is abusive and exploitative. It’s almost sadistic.

To me, and you may disagree but let me make the case, the worst thing about hockey is not that it damages people. It’s that it makes use of damaged people. Players’ desire to keep playing no matter what the cost to themselves, teams’ desire to squeeze whatever value they can out of a contract no matter what the cost to the player, and fans’ perverse perception that there is nothing worse in the universe than a promising career that ends early; these three factors conspire to keep guys in the game who should not be there anymore. There are some things- and among these I would include chronic concussion symptoms, serious addictions, and signs of severe mental illness- that should not be played through. There are some things that should end a hockey career.

This is a very dangerous game. It destroys people. In fact, it has a long, horrible history of destroying people, of taking talented boys and using them until there’s nothing left to use, leaving behind damaged men made old before their time, with chronic pain and psychological baggage and no marketable skills. In the olden days, for many men the end of a pro hockey career meant the beginning of a life of menial labor and alcoholism. As I’ve discussed before, the All-Star Game was actually invented as a solution to this problem, to create pensions for ex-players and their families, to raise money so that men who’d been ruined by hockey could survive.

Nowadays, we have little sympathy for the idea that players can still be ruined by hockey. We think of the retired as spoiled millionaires who probably spend the rest of their lives blissfully playing video games and boating drunkenly. But if the Boogaard case makes anything clear, it’s that the money does not necessarily mean much in the face of serious post-hockey damage. All his millions did for him is buy him drugs and isolation. All they did was fund his death.

Hockey is a sport that needs aftercare. The NHL needs treatment programs for addiction and mental illness that are not focused on getting men back into the game but on getting them out of it. It needs mechanisms for identifying the guys who are suffering seriously and getting them off the ice, into rehab, and eventually into post-hockey careers. For the bright and the talented, there are always job offers, for the superstars there is always the option of a comfy, shiftless retirement, but pro hockey is full of men who never played enough years or a big enough role to accumulate millions, who sacrificed much of their education and personal development in pursuit of the dream. Fans are apt to justify not caring about them by pointing out that there’s no reason why the professional transition from sports to non-sports should be especially traumatic, but as the Slate article points out, we have ample evidence that it is anyway. Whether or not you believe it’s a valid problem, it remains a real one.

The NHL/NHLPA substance abuse treatment program needs to be more and it needs to be more public. Not with names, of course; privacy is essential to such programs, although I bet a successful treatment-and-transition initiative would generate more than a few guys who’d love to tell their stories. But even anonymously, there needs to be some public awareness of what the program is and how it’s helping. We, as fans, need to know that the game we love and the League we pay are taking some responsibility for the damage they do. We need to take some of the stigma off of players who have such illnesses and make use of such programs. Hiding it behind a wall of complete secrecy only contributes to the impression that addiction is shameful and the League doesn’t give a fuck about players who suffer from it.

In our alarm over CTE and brain trauma, we focus entirely on causes, but what if we’re wrong about the causes? What if the problem isn’t really concussions at all? What if concussions, in the end, only account for a small fraction of hockey-related psychological problems? What if we reduce concussions and pat ourselves on the back for doing something while dozens of players are still suffering the exact same problems Boogaard had due to chronic pain, closeted mental illness, and dysfunctional treatments for both? We believe that the League must reduce head hits, and it must, but even with a dramatic decline in concussions, hockey will still cause pain and it will still cause addiction. There is no simple equation: eliminate fighting, give out enough punitive suspensions and no one will ever suffer like Boogaard again. There will always be physical damage in hockey. There will always be psychological damage in hockey. The measure of the League isn’t whether it has the godlike power to prevent pain from happening, it’s how it treats those who’ve gotten the worst of it.

By that measure, it failed Derek Boogaard miserably, and for all we know, it is continuing to fail other players right now. Until it learns how to take care of its own, this League deserves to be haunted.

Comments (33)

  1. *Slow clap*

    Amen.

  2. Where do I even start? I’ll start here: I feel deep shame over the fact that so many physicians prescribe so many dangerous drugs with such impunity. It’s embarrassing, it’s sad, and it’s deadly. Having said that, I’m sure there are plenty of NHL doctors who do the right thing. Of course we never hear about them because they’re not the ones prescribing ridiculous amounts of inappropriate medication and directly contributing to the death of a player.

    Let’s take this statement: “What if concussions, in the end, only account for a small fraction of hockey-related psychological problems?” and take hockey out of it completely. Yes, the evidence suggests that concussions contribute to depression, and depression predisposes to substance abuse. But in this large group of people there will be those who struggle with depression and substance abuse never having suffered a single injury. You’re right, Ellen. Concussions and CTE are not the final answer. Overhauling the system to better manage pain, mental illness and substance abuse isn’t either, but it’s a badly needed step.

    I’ve spent lots of time trying to figure out how to make NHL medical staff impartial and focused on the patient’s well-being rather than on quickly getting them back in action to satisfy the desires of the player, the team, management and yes, the fans. I don’t have an answer. I’ll keep thinking.

    • One question for Jo, as I’m not a doctor, but can doctors share medical records, prescription history of a patient without the patient’s consent? The reason I’m asking is some have implied that these team doctors should have been talking to one another about the prescriptions they have been giving to Boogaard and thus should have known. I am under the impression that they can’t, due to patient-doctor confidentiality, but perhaps in a NHL environment it’s different.

      • There are definitely laws governing privacy (HIPAA in the US), but one would hope that in an organization like the NHL players would sign waivers regarding the sharing of medical records between different physicians involved in their care. It’s pretty standard in “real life”. There are also controlled substance registries in many states (sorry, don’t know exactly how many) where any doctor can look up any patient to see what they’ve been prescribed. Every doctor also has an individual state and federal prescribing license that ties them to prescriptions they write. See how broken this whole thing is?

  3. Two quick points: Boogaard was specifically signed, to a bloated contract and fanfare, because Gaborik decided to go after Carcillo, who actually had a bemused expression while he pounded away. It created a belief that Gaborik needed someone like Gretzky’s McSorely, and a general ‘toughening up’ if you will. There was only so much Avery the team could handle.

    Next, every professional athlete including Boogaard makes an “Achilles Choice.” He was never forced to lace ‘em up and drop ‘em, but he was given $1Million+ reasons to make a certain choice.

    Finally, there is an inherent conflict of interest in “team doctors.” Is their job to help the team or care for the patient, which are often mutually exclusive. Throw in that the players themselves often inisist on deterimental treatment in order to play on (and prevent that promising rookie from taking their roster spot) and that the medical professional is more loathe than lawyers to police their own, and you have doctors prescribing more painkillers to a known addict who already has enough to tranquilize a village because their employer and the ‘patient’ want it that way, regardless of the medical situation.

    OK, three points, I didn’t expect a Spanish Inquisition,

    • 1. There are plenty of guys in the league who were in better mental condition to handle the role that Gaborik “needed” filled. And let’s be honest here. Who runs the Rangers? Glen Sather or Marian Gaborik? It better be the General Manager.

      2. You think a guy who was in rehab and addicted to countless pain medications and had been told from a very young age that his only ticket to the NHL was to fight and be a good really had any kind of choice? Money aside, the guy had no concept of any other way to play the game.

      3. I think the team is often much more responsible for this than any doctors. See Lindros, Eric for more details on what happens when a team decides to ignore doctors and push a player past his limits.

      • Unfortunately for us Rangers fans, it’s Sather who apaprently holds on to the belief that an enforcer creates room for the scorer, if Carcillo knew he’d face Boogaard on his next shift he wouldn’t have whacked Gabby who wouldn’t have felt the need to drop ‘em while the rest of his team sort of looked confused. Somehow, the Sedins and the Red Wings didn’t get the memo.

        Your 2 is almost a perfect reflection on Achilles Choice viz Boogaard.

        Lindross is an excellent example. His Rangers contract (another Slats piece d’resistance) placed an emphasis on games played, and he played to the contract. When that was removed, BOOM, two more concussions and out he went.

    • I take issue with the argument that substance abuse and mental illness are a choice, financially motivated or otherwise. He chose to be an enforcer. I’d guess he didn’t bank on the fact that the job came with intolerable (poorly medically managed) pain. They don’t tell you that in peewee hockey.

      I do agree that there’s an inherent conflict of interest in “team doctors”. Absolutely.

  4. Thank you Ellen for another amazing article. I read the NYT piece after you tweeted about it this morning and was stunned by how easily he was able to obtain the drugs from the people who really should have been protecting him. I hope this will light a fire under the NHL to make some changes in how teams deal with pain kilers and the substance abuse policy itself. But I also doubt we will ever hear about it.

  5. This is a great article. I’ve actually been thinking lately about the way in which NHL teams use, and often don’t use physicians. Teams seem to have a roster of ‘Team Doctors’ but most of the face to face primary care is provided by the training staff, who while are excellent at what they do, are not physicians. Often so called Team Doctors will just follow the advice of training staff and are just hand over the prescriptions they’re told to. And I’ve even heard of ‘Team Doctors’ being fans who happen to be physicians with all kinds of specialities, and who take on the role in return for season tickets. They don’t seem to be Sports Medicine specialists.

    I’m not sure what the solution is, but shouldn’t it at least be conceivable that each team should have an actual MD on their staff, who act as their players primary physician, and then at least the mess of being passed from one ‘Team Doctor’ to the next without a proper system of communication. This doctor would be equally under pressure to follow the wishes of the team, but I’m not sure there’s a way to solve that without having them all paid by the NHL or NHLPA.

  6. Whoa whoa whoa WHOA!!!!!

    Moral Outrage? What?!?!? Sorry, Ellen, but your argument is based on specious reasoning, a fallacy of Causal Reductionism.

    Derek Boogard was an unrestricted free agent offering his services as an enforcer. The Rangers felt they needed a tough guy, especially since Avery was on the decline, Donald Brashear failed to do anything useful, and Gaborik had the shit beat out of him by Carcillo. Sather, looking to fill a need, offered a contract to Boogard, the latter accepting of his own free will. Both sides agreed to a deal that would mutually benefit both parties.

    Glen Sather and the Rangers employ on retainer, at great cost, lots of doctors, trainers, etc. They work, one would presume, in the best interests of the franchise. Why then would they sign, at great fanfare and expense, someone whom they ABSOLUTELY knew (as you presume) was damaged goods? What benefit does such an act possibly bring to them? Boogard’s death was/is sad, yes, and totally preventable – yet this is something we know NOW, in hindsight, a knowledge gained only via post-mortem methods. To presume that the Rangers knew all along that he hadn’t kicked his pill habit and suffered from brain trauma, and still signed him anyway to a very expensive 4-year deal (for an enforcer) out of some form of hockey sadism, is silly at best, libelous at worst.

    C’mon, hon, I know you hate the Rangers, but you’re smarter than this.

    • It’s in the NY Times piece. It mentions in several places that the Rangers had been informed of Boogaard’s addiction history and that Risebrough, who had drafted Boogaard in MIN and subsequently moved to NYR had been in contact with him while he was in rehab. I’m not presuming anything, I’m merely considering the New York Times to be a reputable source. If you think they don’t have grounds for what they reported, take it up with them.

    • They also signed Eric Lindros whose abuse at the hands of the Philadelphia Flyers was extremely public and well documented.

      • No, they TRADED for Lindros, who was given a clean bill of health, at the time, by several doctors. His contract even had a games played provision.

        *In 2001, in a dark, alcove office, somewhere in the catacombs of MSG, below even the subways, LIRR, and NJ transit, sits The MARQUIS DE SLATS, gently stroking a white kitten*

        “I GOT IT!!! I will trade for Eric Londros in the hopes that he’ll sustain yet another concussion – I’ll even have an old employee from the Neil Smith regime, Jason Doig, do it! BWAAHAHAHAHAHAHAHAHAHA”

        *cut to BLACK*

    • Andy Petrovitch: “C’mon, hon, I know you hate the Rangers, but you’re smarter than this.”

      And this is what I found most annoying about the reaction to CBC’s announcement of “While the Men Watch.” You f*ckers showed up in DROVES in comment threads all over the web to prove you’d gone through sensitivity training when that issue was hot. You typed about how the show was WRONG. You tweeted that it was SEXIST. You blogged about how it smeared women by not acknowledging our general hockey interest, knowledge, and involvement.

      But when a women writes a hockey article and someone disagrees with her, slamming her for her gender in the comments, where are all of you? If Ms. Etchingham were gay or black and someone smeared for it, you’d respond. But it’s just that she’s female… Dead silence. Nothing.

      Look, there will always be some fool that throws in a reference to the writer’s “otherness” when s/he has an issue with the writer’s work. The question is whether it’s tolerated by everyone else. I’ve been a hockey fan for a long time. I’ve long been aware that it’s just fine with the rest of you when a female commentator takes it on the chin–or wherever or however she has to take it–for making a point someone dislikes while being female. If you’re a woman and a hockey fan, it’s an unavoidable part the experience. So is the knowledge that the rest of you don’t notice and/or care.

      So, the next time something like “While the Men Watch” happens, please don’t take up the cause. Please just sit there, ignore the insult, and be complicit. It would be a lot more honest.

  7. Addendum:

    -Even if Sather knew (as the NYT article suggests) that Boogard was still addicted, why would he sign him if he (the latter) was going through relapse? I know Slats historically has had a soft spot for troubled players (Mactavish, Redden, etc.) but signing an active addict is something that even a loon like him wouldn’t do. Did Risebrough convince Slats that Boogard was “just fine?” If so, then the fault’s on Risebrough, not the evil, sadistic Marquis de Slats.

    -From the NYT article: “The records paint an incomplete picture. They do not show what Boogaard told doctors or the degree to which he may have misled them. They do not indicate what the doctors knew, if anything, about Boogaard’s pursuit of drugs bought illicitly on his own. They do not reflect whether the doctors knew what other doctors were diagnosing or prescribing.”

    • Or, maybe it’s possible that drug addiction is totally rampant in the NHL (among other sports) and that it’s treated with relatively casual disregard.

  8. I don’t necessarily want to equate the average Joe w/ what professional atheletes go through in terms of pain, but for the sake of discussion i’m going to anyways. Regular people, every day, go through very similar circumstances. They lose their job. They lose their home. They lose their family. They get hurt. Whatever the case may be, they have reason to feel pain and to suffer. And just like in Boogaard’s case, doctor’s prescribe numerous prescriptions to deal with the symptoms of the anguish. People can’t sleep. Pills. Feeling unhappy? More pills. Having trouble eating? Pills. Can’t eat enough. Pills again.

    This total disregard for what is right, and what is the correct way to deal with pain and anguish is a society and cultural-wide issue. Hockey players have to remain tough and effective to play. But it’s really not that much different the further down the ladder you go.

  9. “In our alarm over CTE and brain trauma, we focus entirely on causes, but what if we’re wrong about the causes? What if the problem isn’t really concussions at all? What if concussions, in the end, only account for a small fraction of hockey-related psychological problems? What if we reduce concussions and pat ourselves on the back for doing something while dozens of players are still suffering the exact same problems Boogaard had due to chronic pain, closeted mental illness, and dysfunctional treatments for both?”

    Ellen, this is a complete red herring. The link between degenerative brain conditions, and repeated blows to the head is one of the strongest, and well evidenced relationships in sports science. Literally decades of research into conditions caused as a result of boxing injuries have shown this. Now, one can quite rightly argue a lack of similarity between hockey (and various other sports) and boxing. However, hockey and other contact sports do provide an environment where multiple concussive and sub-concussive impacts can occur frequently. Sub-concussive impacts are of particular concern, as we are only beginning to learn that their additive effects can be as bad as an impact with clear physical and mental symptoms.

    I am sure that many people, like the many who have previously written articles about this, will state that the science is not proven. Some may even suggest that science is never ‘proven’, and they would be correct. As a Neuroscientist myself, I do applaud such sentiment, but it is not the be all and end all of any discussion. In fact, I think it is being used by people who wish to simply dismiss the link out of hand, without listening to experts in the field, or looking closely at all the evidence. If we have a degenerative brain condition where there is a clear, well-evidenced and plausible mechanism of action (i.e. repeated concussive and sub-concussive impacts to the head) and what appears to be a correlation between sufferers and contact sports, that should be good enough to provoke some kind of alarm. Medical science is not a field where one waits for irrevocable proof before taking action, because that leaves people dead.

    Personally, I do think the link with NHL-level fighting might be overstated in some corners (because of its relative rarity) . However, I think what is understated is the effect of general hockey play (i.e. sub-concussive impacts). Additionally, watching the NYTimes’ (?) piece on Boogaard, it struck me just how much fighting there is in lower leagues. In my mind, there can be little doubt that the severity and frequency of the impacts felt by the brain of an enforcer leads to some kind of degeneration. Dismissing reasonable scientific enquiry as ‘hocus-pocus theorising’ (quote from the slate article you link to) is frankly idiotic. The discussion about the link between concussion (and sub-concussion!) and CTE has indeed outpaced the science, both in the vitriol decrying the ‘lack of proof’ and the absurd expectation that 100% certainty is needed before we can act.

    • For the record, I’m in favor of making changes to reform the standard of hitting in the NHL and, insha’allah, reduce hits to the head. However, my concern is that hockey will always be a sport with relatively high concussion risk, and as you say, sub-concussion risk. Heads are going to get hit, whether by mistimed/misaligned hits that get penalized, legal hits that produce unfortunate contact with the ice/boards, or raw accidents like the one that got Giroux. Since I don’t want to see the elimination of contact altogether, I believe that improved identification and treatment of those at risk for CTE is equally as important as preventative measures, if not more so.

  10. Otherwise good article. Haha.

  11. Aren’t doctors supposed to “do no harm”?

  12. Wow. That just sent my mind spinning, great article.

  13. FWIW, the NY State Legislature is considering a “medication tracking” bill, which would allow “the State” to track prescriptions, and to purportedly prevent something like what happened to Boogaard.

    Is this what we want? Do we want the Attorney General (or anyone else, for that matter) to know if we are following our doctor’s advice and are taking Prozac, oxycodine or something for that nasty herpes flare-up? Do I want my doctor, when he (or she) should be thinking about whatever ails me, thinking instead about having to explain the treatment to some government lawyer some time in the future?

    There will ALWAYS be people who, through addiction, mental illness or whatever, work the system to get their dope. I guess to a certain point I agree with Ellen that if the NHL and NHLPA accept someone into their haloed ranks, then the NHL and NHLPA has accepted a certain responsibility to ensure their treatment of said individual doesn’t lead to a multi-part expose in the New York Times. For those of yu following the ‘bounty’ scandal in the NFL, all the players talk about how “the crest”, the NFL brand on everything, means more than the team or individual players, that bringing shame to “the crest” will get them suspended longer than any cheap-shot hit in a game. But that goes both ways.

    • No, I don’t want the state to track medications for everybody, I want NHL medical staff to do it for their own patients, which is hardly unreasonable. Like it or not, lots of people seeing your medical information is the price of being a pro athlete, and if NHL teams employ doctors who are in the business of prescribing highly addictive painkillers in large quantities, than the NHL/the teams should expect those doctors to track and coordinate those prescriptions in a systematic fashion. It’s both responsible medicine and good business, and the right thing to do as well.

  14. So, then. What do we do now?

    And I mean that “we” literally and all-encompassingly. We, as hockey fans, as hockey media, as players, as coaches, as owners, but most PARTICULARLY as fans. What do we do? What can we do?

    It is on our behalf as fans that the game is staged the way it is, as a spectacle on ice, a struggle with gladitorial, combative overtones. It is we, as fans, who derive the most direct benefit of anyone not actually playing from what happens on the ice.

    We tie ourselves so firmly, so strongly to the actions of these players during their careers; we follow them if they play for OUR team, they become OUR guy, and we hate them when they hurt US. We use the first-person plural when talking about these teams, these collections of men precisely BECAUSE we identify so closely. And yet, when they’re done playing, we forget. Not immediately, not in a flash of “Who was that?” but memories fade, are superseded by other memories. The Disintegration of the Persistence of Memory is no less real for being the title of a Dali painting. These players and what they’ve done for the team, for the US of our imaginations fades away with time, taking our love and adulation with it.

    Our society is filled to overflowing with people broken by our corporate culture, our society’s burgeoning need for more, better, mine mine mine. Our relentness need for economic growth; our never-ceasing acquisitive, mercantilistic culture; our society that admits no difference and allows no flaws; all these things leave broken, damaged people in their wake. EVERYWHERE. They’re on the street corners, in the unemployment lines, in military hospitals, in your neighborhood, in your home. They’re probably even reading this right along with you now.

    “Hockey culture” prides itself on being better, different. The tale of Derek Boogaard, the tale of Rick Rypien, the tale of Wade Belak; all these tell us something we don’t want to hear. Hockey breaks people. Just as much, if not more than, the rest of our society. And we, as fans, have something to do with that. Some will say, it’s owners chasing the dollar. Some will say, the players know their choice. Some will say, coaches push too hard. Some will say. Some will say.

    Know this. Those dollars? Those are OUR dollars. That choice? Is the choice WE put before them. Those coaches? Are the ones WE admire for being hard-nosed, tough. The ones we clamored to put there. We helped build this, we need to help re-build it.

    So, then. What do we do now? No, really. What ARE we supposed to do? Because I’d like to get started.

  15. Boogaard’s brain showed tangles consistent with CTE, not medication use/abuse. CTE pathology is uniquely seen in repetitive head blows. So why would we think opioid use caused this?

    • Did you read the Slate article? The nature and degree of the relationship between the tangles in the brain and the symptoms of dementia is not fully understood. Those tangles have been found in the brains of athletes who showed no symptoms of emotional or psychological distress. In other words, having CTE may not necessarily be a mental death sentence. My concern is that when we attribute Boogaard’s problems exclusively to CTE, we miss other things in his life- such as the chronic pain and subsequent addiction to painkillers- that are more obvious, proximate causes of his suffering and death.

      His brain trauma and his drug addiction may well have been related, but CTE can only be diagnosed post-mortem, while the drug problem could be identified and treated while he was still alive.

      • Of course we attribute Boogaard’s mental problems to his brain, and the pathology found in his brain! This article dismisses the salient fact that the brain causes our consciousness and our mental life. And lesions in the brain are intimately related to cognitive and emotional problems. We find examples from all over: Alzheimer’s disease, all the other dementias, and head trauma itself, which causes exactly the type disinhibitions, sleep disturbances, and cognitive changes displayed by this sad case.

        Why was he is pain and why was he emotionally deregulated in the first place? How did he go from well wrapped young man to addicted and mentally ill? The best answer seems to be CTE. Now, the more obvious proximate causes are also the most superficial and even trivial. They themselves have causes, they did not spontaneously generate like frogs out of mud.

        As a neurologist, I have diagnosed atypical static encephalopaties in the setting of multiple head blows as being possible CTE. The condition is untreatable, but the symptoms that arise can be partially managed. Of course, it was exactly this management and over management that caused Boogaard’s death.

        This matters in a few ways: for one, the NFL, among others, is trying to whitewash CTE. And while CTE cannot be treated, it can be prevented – by banning football and by limiting head blows in the other helmeted sports. That’s what I recommended here: http://seedmagazine.com/content/article/disposable_heroes/

        • If you’ve published the results of your research somewhere, can you send me the links? I’d love to read it, as what you’re saying seems to conflict with what Slate reported on the issue.

          But no matter what your profession, you have to concede that people often develop drug addictions for reasons other than CTE. In other words, logically: people who have CTE may develop drug problems, but not all people who have drug problems suffer from CTE. Replace ‘addiction’ with ‘depression’ and the logic is the same. Again, focus on treatment for addiction and depression benefits far more players who are suffering than focusing only on those who’ve had head trauma.

          If you want to concern yourself exclusively with CTE, that’s your prerogative, but I think the sport as a whole should concern itself with all kinds of mental health issues, from all kinds of causes.

  16. Great article Ellen, once again.

    I’ve added a post to my blog about Derek Boogaard and what we can learn from his story – http://itsnotpartofthegame.blogspot.ca/2012/06/what-we-can-learn-from-boogaard-story.html. Beyond Boogaard’s personal issues and struggles, the hockey system he went through can teach us a lot about what is wrong with Junior Hockey, the NHL and how the sport uses it’s playes.

    • Published results: you can try this review first: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337491/?tool=pmcentrez but this review is limited in scope. To really understand why CTE is so obviously the culprit here you need to know about the brain. We know that ALL neurodegenerative diseases are due to protein misfolding. We know the pathologic changes in CTE is a proteinopathy, a tauopathy names after the protein, which misfolds to create tangles. And we know that proteinopathies kill neurons. If those neurons create new memories, then the picture is clinical Alzheimer’s. If those neurons amplify movement, then the picture is Parkinson’s. If those neurons set social and emotional ranges, the picture is FTD (or perhaps CTE). So that’s the proper backdrop when having a conversation about CTE, knowing a lot about other neurodegenerative diseases.
      The flawed Slate paper that seems to be your only source of knowledge just says exactly what you do: that there are other causes, other factors, other considerations that account for the suicides of these players. Neither you nor the Slate writer seem to realize just how rich the history of neuropathology is and how terrible and how unusual it is to see a proteinopathy at the age of 28! That’s 28 years old. You’ve never seen a brain, have you. Seeing a single tangle in a 28 year old would be amazing – the talk of the pathology lounge. Seeing a brain that’s full of them is as bizarre as it is abhorrent – as bizarre and abhorrent as my failure to impress upon you how pathologic it is. Here, look at pathology:
      http://www.nytimes.com/interactive/2011/12/04/sports/hockey/boogaard-video.html#chapter/3/c27
      My profession brings me into contact with the depressed, the addicts. Mental illness of all kinds. Each is caused by a corresponding brain pathology, we just can’t see or scan it. We’re not talking about them, and the weakness of your position is betrayed as you bring them up. We’re talking about people like Boogaard, and many (many!) NFL players. We’re talking about Boogaard’s brain, after nearly a lifetime of head blows, was full of tangles at the age of 28.
      So yes, given this data, and the data from all the cases collected so far, you’re exactly right: we should concern ourselves exclusively with CTE. You say that like it’s a bad thing! It isn’t. It is the proper approach given what we know so far. The most compelling story goes puts concussions and head blows upstream, axonal changes and tau changes and neuronal loss midstream, which empties into a swamp of clinical symptoms.
      Now who knows about upstream causes other than head blows. Is a concussion on steroids worse, more likely to result in a tangle? Is a head blow on pain meds? We don’t really know. What we know is that we have a slew of subjects who had multiple concussions, later some had behavioral disorders, and many were found to have tauopathies on pathology. Given all this, it seems to me that we don’t concern ourselves enough with CTE. We don’t talk to middle and high school players and their parents about it, we don’t talk about banning football in association with academic institutions, we don’t question our coarse entertainment or the suffering it brings to the players.

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