When the Hits Don’t Heal: Athletes, CTE, & Suicide Risk with Dr. John Gaal

What repetitive head trauma, pain, and identity loss teach us about depression, opioids, and suicide risk in athletes

Overview

We tell athletes to “shake it off,” “tough it out,” and “get back in the game.”
But what happens when the injury is inside the brain, quiet, cumulative, and deadly?

In this episode of Hope Illuminated, Dr. John Gaal shares the devastating story of losing his 24-year-old son to suicide and the painful discovery afterward that his son’s brain showed hallmark signs of Chronic Traumatic Encephalopathy (CTE).

That grief became a catalyst for John’s work at the intersection of repetitive head trauma, depression, pain, opioids, identity loss, and suicide risk, especially among athletes.

This conversation brings together heart and science to ask a question our culture often avoids:

How many deaths are we calling “mental health problems” when they may also involve brain injuries we never diagnosed?

In our conversation, we discuss…

What is CTE, and how is it related to concussions?

CTE (Chronic Traumatic Encephalopathy) is a progressive neurodegenerative disease associated with repetitive head impacts, not just a single concussion.

Can CTE increase depression or suicide risk?

Research suggests repetitive head trauma is associated with mood changes, impulsivity, depression, and cognitive impairment — all of which may elevate suicide risk, though causation remains an active area of study.

What are the early warning signs after repeated concussions?

Common red flags include personality changes, irritability, depression, sleep problems, memory issues, impulsivity, substance use, and social withdrawal.

Why are athletes at higher risk for suicide after injury?

Athletes often experience identity loss, pressure to perform, stigma around help-seeking, and sudden changes in role and purpose after injury.

How do pain and opioids complicate brain injury recovery?

Chronic pain after injury can lead to opioid exposure, which may worsen depression, impair judgment, and increase suicide risk.

Key Themes Highlighted in This Episode

1. CTE in Plain Language

  • CTE is linked to repetitive head impacts, not just “big hits.”

  • Abnormal tau protein accumulates in brain regions responsible for:

    • Mood regulation

    • Impulse control

    • Memory and learning

  • Damage often affects the frontal lobes, medial temporal lobes, and hippocampus

2. The Gap Between Science and Lived Experience

  • Most people recover from concussions within weeks

  • A subset develops persistent symptoms or long-term complications

  • Families often live in the tension between scientific uncertainty and lived reality

3. Athlete Identity and Psychological Risk

  • Injury threatens identity: “Who am I if I can’t play?”

  • Culture of toughness discourages disclosure

  • College and elite athletes face unique suicide risk factors

4. Pain, Opioids, and Suicide Risk

  • Pain → depression → substance use → suicide risk

  • Especially relevant in sports and construction

  • Mental health, addiction, and suicide exist on a shared continuum

About Dr. John Gaal

Dr. John S. Gaal is a labor leader, researcher, and nationally recognized advocate for worker wellness, mental health, and suicide prevention.

A former union apprentice with over 40 years in workforce development, Dr. Gaal holds degrees in construction management, architecture, and international business, and a doctorate in organizational leadership. He has completed postdoctoral work at Harvard University and the University of Florida and is a Fulbright Scholar in Labor and Industrial Relations.

Dr. Gaal’s work is deeply shaped by lived experience, including the loss of his son to suicide, and focuses on understanding how brain injury, pain, opioids, identity, and mental health intersect, particularly in high-risk industries.

References & Research

Eggleston, B., Wenske, C., Sweat, C., Nolan, D., Sajjadi, N. B., Mazur, A., & Hartwell, M. (2024).
Trends of public interest in chronic traumatic encephalopathy (CTE) from 2004 to 2022.
Journal of Osteopathic Medicine, 125(4), 173–178.
https://doi.org/10.1515/jom-2024-0015

Anton-Lotruglio, E. M., & McManama O’Brien, K. H. (2025).
College student-athlete suicide: A systematic review.
Archives of Suicide Research, Advance online publication.
https://doi.org/10.1080/13811118.2025.2509653

Banks, L., Howell, N., & Spittler, J. (2025).
Post-concussion syndrome: Persistent post-concussive symptoms (PPCS).
In Concussion management for primary care (pp. 135–155). Springer.

Khan, S., & Talley, L. (2025).
Beyond the hit: The hidden costs of repetitive head trauma.
Neuroscience Insights, 20.
https://doi.org/10.1177/26331055251316315

National Institutes of Health.
Effects of repeated head trauma in young athletes.
https://www.nih.gov/news-events/nih-research-matters/effects-repeated-head-trauma-young-athletes

Listen to the Episode

Gain insight into how brain injury, pain, and identity loss intersect, and what families, coaches, and leaders need to know.

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