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Posted: Wednesday May 5, 2010 1:55PM; Updated: Wednesday May 5, 2010 2:18PM
David Epstein
David Epstein>VIEWPOINT

Head injuries may offer insight into Roethlisberger's recent behavior

Story Highlights

Stories of Ben Roethlisberger violating social rules are rampant in Pittsburgh

Roethlisberger's conduct is similar to that of someone with frontal lobe damage

It also sounds a lot like that of a man in his 20s with a $102 million contract

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Ben Roethlisberger has suffered at least four concussions during his career.
David Bergman/SI

Dr. Jordan Grafman has never examined nor met Ben Roethlisberger, and yet listening to him talk about the people he studies, it's as if he's describing the troubled Steelers quarterback.

Grafman is a neuropsychologist at the National Institute of Neurological Disorders and Stroke, and for decades he has studied the effects of brain trauma on Vietnam veterans as well as civilians. "My specialty is frontal lobes," he says, referring to the part of the brain involved in regulating a person's judgment, inhibition and social behavior. "A person with damage might not read the intentions of a woman at a bar very well, for example," Grafman says. "They might succumb to more primitive urges instead of saying, 'I shouldn't do this because it affects my career.'"

It is exactly Roethlisberger's apparent lack of inhibition, foresight about career repercussions and poor social judgment -- and perhaps his inability to judge the intentions of women -- that currently have him suspended from the NFL following two separate accusations of sexual assault, one in Georgia and one in Nevada. Roethlisberger spent the weekend undergoing an evaluation, mandated by NFL commissioner Roger Goodell, to see whether past brain trauma -- a 2006 motorcycle accident and a batch of concussions suffered on the football field -- has anything to do with his behavior.

I spent last week in Pittsburgh reporting this week's SI cover story on Roethlisberger, and found that his social indiscretions appear to be wide-ranging and chronic. Interestingly, the anecdotes I heard about Roethlisberger's conduct in Pittsburgh sound a lot like Grafman's description of an individual with frontal lobe damage.

According to Grafman, two particular behaviors are endemic to people with moderate or severe frontal lobe injury, or to people with more mild but repetitive injury: 1) violating social rules by saying inappropriate things, and 2) saying appropriate or typical things in an inappropriate context.

"If you're married and you're flirting with another woman in an elevator with your wife next to you," Grafman says, "that's the kind of clearly inappropriate behavior." Roethlisberger is not married, but one man told me that Roethlisberger had asked out his wife while the man was present.

"Say somebody comes into the room dressed like an idiot," Grafman says. "You might say something about it, but you'd whisper to your friend, not to the person. If you say it to the person themselves, that's a violation of social rules."

Another person told me that Roethlisberger said aloud to a friend, "I didn't know you like fat chicks," referring to a woman standing near the friend. According to the account relayed to me, Roethlisberger proclaimed this loudly enough that it was clear that he had no regard for whether the woman heard or not.

Granted, as Grafman notes, "we all say inappropriate things sometimes," but "it's the frequency with which it happens, and the unawareness. When you have a frontal lobe injury in particular, you often become unaware of your inappropriate behaviors. The observations usually come from wives or children." A typical situation in my reporting last week was something like this: I would hear that Roethlisberger had, for example, said inappropriate things to waitresses at a restaurant or walked out on a bill, so I would call the establishment. "I don't know if he walked out on a tab here," would be a typical response from whoever picked up the phone, "but he was really rude to my friend after he invited her over to his table." Tales of indecorous acts abounded.

It seems that Roethlisberger has attained a sort of legendary boor status in Pittsburgh. But my experience has been that hometown fans are generally reticent to speak ill of their star's off-field behavior unless it gets really bad or really prevalent. The sheer magnitude of incidents in this case is overwhelming, again bringing to mind Grafman's statement that "it's the frequency with which it happens" that might indicate a frontal lobe injury.

The frontal lobe is not finished forming until the middle or even late 20s. Grafman notes that teenage boys generally stumble through relationships with girls, trying to figure out what to say and how to interpret when a girl's physical gestures are inviting contact. "Socially finessing those circumstances takes time and experience and further maturation of the frontal lobe brain tissue," he says. "If you're in the middle or even late period of that development, maybe 14 to 28 [years old]," Grafman says, "and you have a brain injury, it's going to make it that much more difficult to resolve social behaviors so that you're acting appropriately as an adult."

In addition to inappropriate social conduct, Grafman says people with frontal lobe damage may not be able to resist certain behavior even though it is clearly not in their long-term interest. In short, people with frontal lobe damage are more likely to flunk the famous "marshmallow test," in which kids are given a second marshmallow if they have the discipline and foresight to hold out from eating the first for a specific period of time.

As this week's SI story reports, Roethlisberger seems to have failed some of his personal versions of the marshmallow test, not only by engaging in impulsive behavior, but by returning to helmetless motorcycle riding within months of the accident that nearly killed him.

Granted, Roethlisberger's conduct might also sound a lot like a description of a man in his 20s with a $102 million contract who is a deity in the town where he lives and plays. Michelle Rouda, 24, used to work in the VIP section at the Pittsburgh bar Margarita Mamas and remembers years ago the first time she saw Roethlisberger: "He ordered a bottle of Patron," she recalls, "and I looked up at him and he was chugging it standing on a table and there were all these girls reaching up to him and he was dumping tequila on people." It doesn't take a cubist's imagination to see how something short of brain damage might alter the rules of social engagement just a tad for someone in Roethlisberger's position.

The question now is whether the doctors evaluating Roethlisberger can possibly tease apart the quarterback's original personality (as altered by stardom) from any potential effects of frontal lobe damage. "Is this from a motorcycle accident, or is this his true personality? I don't think anybody's going to know for sure," says Stuart Silverman, a Pittsburgh neurologist who has worked with professional athletes, but not with Roethlisberger. "You'd have to find out what his grade school teachers thought of him," he added half-jokingly.

According to reporting done by SI writer-reporter Andrew Lawrence in Findlay, Ohio, where Roethlisberger attended high school, the quarterback was generally liked and respected and not associated with tales of misbehavior. So is the change due to money and stardom, or brain damage? "I'm not sure who's going to figure that out," Silverman says. "These are multifactorial things. There are multiple possible components, and in someone like [Roethlisberger], I'm sure it's multifactorial."

NFL teams use the ImPACT test, which gauges things like memory and focus, to see whether a player is still suffering from a concussion -- Roethlisberger has had at least four of them. A healthy player takes a baseline test, and then repeats the test after a concussion until he once again reaches his baseline score. But that kind of cognitive testing isn't going to indicate frontal lobe damage. "That really comes from the observations of others," says Grafman.

If doctors conclude that Roethlisberger's behavior is the result of brain injury, the treatment, Grafman says, is to manage his environment and keep him out of precarious social situations, a difficult task at which his bodyguards/woman-wranglers fared exceedingly poorly. In time, a person with frontal lobe injury can be trained to control his or her social behavior.

If doctors do decide that Roethlisberger's misconduct was spurred by brain trauma, the deeper question for the NFL will be determining whether to fault the motorcycle accident or the battering that he has taken on the field -- 242 sacks and at least four concussions. If doctors suggest that Roethilisberger's social development is stunted, and that hits he has taken on the field are, at least in part, responsible, imagine the instances of football players' inappropriate behavior that might be viewed in a new light.

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