DID ONE HIT LEAD TO A 13-YEAR-OLD'S SUICIDE?
Three years ago, James Ransom suffered a concussion playing tackle football. Just over one year later, he took his own life.
MIRIN FADER SEPTEMBER 12, 2018
More than a thousand people came to James Ransom's funeral. His parents, Greg and Courtney, and his sisters, Julia and Lillie, were in attendance, each one imbued with a sorrow that crashed like waves. James' buddies were there; some wore bright yellow sneakers and ties—an homage to James' love of SpongeBob SquarePants. His elementary and middle school teachers, his football teammates and coaches, his neighbors and other members of the community all came. Row by row, they packed the Church of Jesus Christ of Latter Day Saints in Mission Viejo, California, full of grief, full of love.
"He never knew how many lives he touched," Lillie says. "He never knew how many people loved him, how many people needed him."
Giant poster boards bearing James' face were sprinkled throughout the church. Greg made them. He had been too devastated to put them together at first, but Courtney nudged him to do it. He found joy in the process, however—combing through the albums, picking the photos he liked best, seeing his son's doughy cheeks. His son in his football uniform, swallowed by giant shoulder pads, proudly clutching a football. His son dressed up as Harry Potter for Halloween. His son and wife rolling their top lips over, making funny faces.
A pianist began to play, and Lillie took the podium to sing "For Good" from Wicked. She was scared, staring at the casket in front of her, but she loved to sing and James was her No. 1 supporter. He used to come to her plays and whisper to their mom: "Lillie's got the best voice in here! They shouldn't let anybody sing but her!"
Lillie took a deep breath and let the rhythm take her:
Like a comet pulled from orbit
As it passes a sun
Like a stream that meets a boulder
Halfway through the wood
Who can say
If I've been changed for the better?
Because I knew you
I have been changed
More than a thousand people came to James Ransom's funeral. Those who knew James are still searching for answers as to the nature of his death.Photo courtesy of the Ransom family
There was not a dry eye in the church. A woman in the first row buried her head into the neck of the man next to her as tears streamed down her cheek. Greg and Courtney cried. They had seen their son go from a kid with a playful personality who loved what many young kids love—football, family, friends—to a kid who struggled with mental illness and ultimately took his life. The change was swift and drastic—it happened in just over a year's time. Those who knew James are still searching for answers.
The Ransoms live on a street full of kids. About 40 of them. The trees are green, and the lawns are immaculately trimmed. There are American flags and basketball hoops. Wide pavement to play in the hot sun. The cream-colored two-story houses start to look the same. A nearby cafe, Lola's, serves muffins that ooze fresh blueberries on first bite.
Ladera Ranch, about 10 miles east of Laguna Beach, is full of families with kids who play sports, and those families watch those kids play sports and become close with other families with kids who play sports. Both Greg and Courtney grew up around football—the former in Richland, Washington, and the latter Glendale, a suburb of Los Angeles. Greg played tackle football, beginning in the ninth grade. Courtney enjoyed watching youth football as a young girl. Her father played quarterback in high school and her high school boyfriend was a punter.
James loved football. He began playing tackle at age nine. (Kids are allowed to play tackle as young as five in Santa Margarita Pop Warner.) He was a natural lineman—big and strong and skilled. He started on offense and defense and liked blocking and being depended on. When he was 12, James joined the Stallions, and in a year's time he became known as one of the toughest kids on his team. Players went one-on-one in practice, and whoever knocked the other kid off stayed. He hit hard and he got hit hard, too.
"My son would often go head to head, repeatedly," Greg says. "Who knows how many times they were hitting each other like that?"
When he was 12, James joined the Stallions, and in a year's time he became known as one of the toughest kids on his team. "My son would often go head to head, repeatedly," his father, Greg, says.Photo courtesy of the Ransom family
September 12, 2015, was a normal Saturday by most measures. A weekend day on the gridiron at West Covina High School. The Stallions were playing the West Covina Bulldogs. Courtney was not at the game. Greg, the Stallions' team manager, was on the sideline monitoring substitutions.
He didn't see it when it happened. He only heard what happened from James after the game. The game had gotten chippy, and during one play an opposing player hit James on the side of his head. James later said the player was dirty—intentionally so. Parents in attendance couldn't say for sure. Either way, James shook it off and continued to play. He was not taken off the field—maybe because nothing seemed out of the ordinary. According to Pop Warner, America’s largest and oldest youth football organization, Santa Margarita officials “have no memory or record of an injury so they are unable to describe it.”
James didn't say anything about the hit to anyone during the game. His reasons for doing so the Ransoms can now only speculate. He may not have had the awareness, as a 12-year-old, in his moment of distress, to think that he might have had a concussion. He may not have even understood what a concussion was.
Even if he did register that he had a concussion, he had learned from his coaches that playing through pain was part of the game. "Toughness" was something his coaches preached. According to Greg, there was a "culture of yelling" that James' coaches adhered to—even if players cried. (Jason Wegis, the Stallions' head coach, did not return requests for comment. Stan Bennett, the line coach, declined to comment.) The culture was familiar to Greg from his playing days; he and his friends feared their coach, who was allegedly known to throw helmets at players.
After the game, on the way home, Greg noticed blood on James’ ear. The lobe was smashed and the skin had an abrasion. Later that night, James told Greg he had his "bell rung." He also told his father it wasn't the first time something like this had happened. "Oh, I've gotten my bell rung before," James said.
"What?" Greg asked. "What do you mean?"
"I've had my bell rung before," James replied, nonchalantly, as if it were as common as running a route or completing a pass. "I've been hit so hard I've seen stars before."
James practiced on Monday, but on Tuesday he began to feel nausea and dizziness during drills. His parents took him to a pediatrician, who diagnosed James with a concussion, clinically known as a traumatic brain injury (TBI). He was told to sit out for a week. A few days later, on Saturday, James and Greg went to see the Stallions play from the sidelines. Afterward, they watched the BYU-UCLA football game on television. But when James went to a concussion specialist the following week, he had no recollection of watching the Stallions or UCLA games.
Another specialist later on found James to have lost a substantial amount of his short-term visual geometric memory. During one test, he was shown rectangles and squares, which were then taken away. A few seconds later, he was asked to draw what he just saw. He couldn't remember the shapes.
There were other changes, like balance and vision. He couldn't stand on one foot without falling over. He had severe nausea within five to 10 minutes of attempting schoolwork, as his eyes struggled to track objects. His right eye and left eye struggled to work together; he was diagnosed with a third-nerve palsy and convergence issues. He was found to have lost a quarter of his visual spectrum and was given corrective glasses.
Within two to three weeks of his brain injury, James began exhibiting signs of intense obsessive-compulsive disorder. He was consumed with ensuring the battery on his phone was always 100 percent charged, with making sure the software on his tablet was always updated. He made sure doors were always locked. Courtney says James liked structure and had always been a perfectionist—he cried because he scored a 98 on a test at age eight—but after his brain injury, his behavior was different. "He was doing things he had never done before," Courtney says. "It was disturbing."
James wasn't just smart; he was curious. "He thought very deeply about things," says Paul Conover, the bishop at the family’s church. James knew two coding languages and was learning a third. He was interested in math and history, especially the Constitution. He took to philosophy. "He was brilliant," Meredith Ritner, an English instructor who taught James in the eighth grade, recalls.
Though James was accustomed to "A" grades, he struggled to complete schoolwork after the injury. His teachers allowed him to not turn in work while he was recovering—James had a doctor's note—but when "zeros" showed up on James' academic profile on School Loop, Ladera Ranch Middle School's online portal, he got frustrated. (The zeros were temporary.)
"He felt as though he were a failure," says Tom Bogiatzis, school counselor at Ladera Ranch Middle School. "He'd say, 'I'm not going to be successful. I'm not going to be good at anything.'"
James felt like he was falling behind and that his life was over. He became irritable, angry and aggressive, grabbing his father's neck on more than one occasion. He'd randomly chatter his teeth or throw himself on the ground and make strange noises. Sometimes his eyes rolled back uncontrollably. None of this was behavior he'd exhibited prior to his brain injury.
Before the concussion, he had been gentle. He was affectionate and had a sweet disposition. He rescued animals, like Rosie the beagle. One time, he found and returned a neighbor's lost dog. "He was the kind of brother that would give you a big bear hug," says Julia, 17.
But afterward, James grew meaner, shrewder. "This wasn't the gentle kid that I knew," Courtney says. He yearned for isolation, despite the fact that, previously, he had never really liked being alone. He told Lillie, with whom he used to spend hours playing Minecraft, to leave him alone.
The Ransoms were terrified. They couldn't understand what was happening to their child. Let alone understand how to help him. "As a parent, dealing with this, you have no idea what's going on," Greg says. They went from appointment to appointment, seeing neurologists, pediatricians, concussion specialists, psychologists, ophthalmologists, vision therapists, physical therapists, desperate for answers, for relief. But James was still suffering.
James (bottom middle) was affectionate and had a sweet disposition. But after his concussion his parents, Greg (top right) and Courtney (top middle), couldn't understand what was happening to him.Photo courtesy of the Ransom family
Once, he and Courtney were standing on the pavement outside their house, about to get in Courtney's car, when James just began to walk the other direction. "James. Where are you going?" she called after him. "James!" He didn't answer. His mother's words flew right past him. He kept walking down the sidewalk, his body looking like a silhouette under the Southern California sun.
Dr. Bennet Omalu published the first evidence of CTE, or Chronic Traumatic Encephalopathy, the degenerative brain disease found in people with a history of repetitive brain trauma, in football, in 2005. By the time of James' injury in 2015, the term "CTE" was only just starting to matriculate into the public lexicon. (The movie Concussion, detailing Dr. Omalu's story, was released that year.) Like many parents at the time, Greg and Courtney knew little about CTE. "We didn't even think of it," Greg says. "We didn't think of it at all."
The disease seemed to them like something that was diagnosed in older men, men who had played in the NFL. Former San Diego Chargers linebacker Junior Seau had been diagnosed with CTE in 2013, less than a year after he took his life.
A landmark study by Dr. Ann McKee, a neuropathologist, published by the American Medical Association in July 2017, found that the incidence of CTE was markedly higher in football players than the general population. Of 202 football players, 177 had CTE. (Of the 111 NFL players included in the study, 110 had CTE.) Since, the disease has been found in cases of football players as young as 17 and 14. Recently, Tyler Hilinski, the former quarterback at Washington State who died by suicide in January, was posthumously found to have had CTE.
The Ransoms never thought about CTE in relation to their eighth-grade son. There was no way to know whether James had it, because the disease can only be diagnosed after death through brain tissue analysis. But he had been diagnosed with a concussion—a traumatic brain injury—and his behavior was growing more worrisome by the day.
One afternoon in October 2015, about a month after James' brain injury, Courtney walked into his room. She saw him lying on his white comforter, head pressed against his white pillow, arms folded across his stomach, eyes staring at the ceiling. The family cat, Meg, lay at his feet.
"It's OK, Buddy. You are going to be OK," she said. "We are going to be able to work this out."
"I don't think so," he said, turning to her, looking her in the eye. Courtney felt a chill. She says she knew in that moment, in the way mothers know things, that her son wanted to take his life.
In late December, Courtney caught him trying to take his life. It wasn't the first time he had done so, however, he would later admit; he had tried on another occasion, unbeknownst to the family. More erratic behavior ensued. In early January, he bolted out of the house, running past six houses and up a hill at the end of the block. Lillie chased after him. When she caught him, he told her they should run away.
The next day, Greg and Courtney took James to nearby UC Irvine's emergency room, and he was admitted to its neuropsychiatric unit. He stayed there, sometimes with one-on-one supervision, for the duration of the month. When James was discharged, Greg and Courtney still worried. Each day they thought, Today, we have to keep him alive. We just have to keep him alive. Sometimes Courtney would fall asleep on the stairs, staying near his room to make sure she didn't lose sight of him.
They drove James to more appointments, more specialists. Determined, devastated, hopeful, afraid. All the time. At any moment they feared their son could try to take his life again, right then, wherever they were. They continued to try to find a treatment. They were willing to give anything—their eyes, their arms, their legs—if that meant it would keep him alive. "I was trying to get through to him," Greg says. "I was trying to tell him: 'We love you. You don't have to do this.'"
What, exactly, was going on inside James' head? Concussions are known to produce emotional distress. Common symptoms include anger, denial, depression, shock, guilt, paranoia and impaired judgment. A 2014 study found that adolescents who suffered concussions and other traumatic brain injuries are "significantly more likely" to try to kill themselves. In 2016, researchers found that concussions—among other brain injuries—significantly increased the long-term risk of suicide among adults. In 2017, a medical study from Boston University found that those who played youth tackle football before the age of 12 were twice as likely to develop mood and behavioral problems and three times more likely to develop depression in middle age.
The brain doesn't mature until the mid-20s in terms of its physiology and basic biology, as major changes continue to occur through puberty and late adolescence to early adulthood. Blows to the head during that time (and beyond) can alter physical, cognitive and emotional development, according to Dr. Erin D. Bigler, Professor Emeritus of Psychology and Neuroscience at BYU. He has studied concussions for over 40 years.
"You're putting the brain at risk every moment that you're on the field and in practice," Bigler says, "and that is ultimately damaging the brain." The amygdala and hippocampus, both parts of the temporal lobe, are critical for emotional processing and memory. Bigler says those two areas are extremely vulnerable to the effects of concussions.
What those effects are, and how they manifest, is different for each kid, given each kid's genetic background and medical history. James' changes included vision, balance, impulse control and suicidal ideation, but another kid might experience other changes, like depression or anxiety. Some may not even know they are experiencing changes at all—not until later in life. Or ever. Still, those changes may be happening.
But what about the smaller hits that James said he had also taken—the times in which he got his "bell rung" but there was no concussion diagnosis? How much do those undiagnosed—sometimes smaller—hits impact brain function?
"The problem is, is that we don't have real, good, quantitative, physiological evidence about what's happening (in the brain) with a 'bell rung,'" says Dr. James Hicks, a professor at UC Irvine who co-authored a pioneering study about concussions in water polo. "Those are the kind of hits you might take a lot of and not really think about them."
Whether it was a small hit, big hit, a culmination of hits or some other factor that resulted in James' mood swings is not easily discernible. All his parents knew was that the boy they raised—the one who used to hold his mother's hand, who used to scream "I LOOOOOVEEE YOUUUU" to Lillie in the hallway between classes—was suffering.
A few months after he was released from the neuropsychiatric ward, James seemed to be doing better. He was managing his OCD using techniques he had acquired. He liked his psychiatrist. He was enjoying his personal training sessions, which he had three times a week, feeling active again. He traveled to Washington with his dad. He still had moments of extreme impulsivity, anxiety and erratic behavior but seemed optimistic about the future.
In August, James returned to Ladera Ranch Middle School to start eighth grade. He did well academically. His third-eye palsy seemed to be healing, though his balance was still off. He had a lot of friends. He was 13 and sprouted a foot taller. Girls liked him. Ritner identified him as a potential Student of the Year award winner. "Everything's going to be fine," Lillie thought. "He's going to get through this."
James (left) was smart and curious. "He was brilliant," Meredith Ritner, an English instructor who taught James in the eighth grade, recalls.
But Greg and Courtney were still fearful. They could not let their guard down, not with life and death always in the back of their minds.
The family traveled to Hawaii for Thanksgiving vacation in November. Sometimes James was happy; he laughed, tried to learn how to surf. Other times, he exhibited worrisome behavior. Once, he walked out of the hotel to the balcony and stood there for a while, looking down, a few floors below, in a contemplative state. Courtney, distressed by her son's actions, couldn't help but wonder if he was thinking of jumping.
A few days after returning home, James was back at school, standing with a bunch of students at lunch. A boy in a special-needs class approached him and reached for his chest. But before the boy could make contact, James swatted him away and hit him. The two tussled before teachers stepped in. James was sent to the principal's office, so upset with himself because he was not a fighter. He had never been sent to the principal's office before.
He tried to dust it off, channel his energy. He went to taekwondo with his neighbor and good friend William the next night, as he had begun to engage in light physical activity. James was in good spirits, having received the paper he needed to test for his next belt, yellow. He and William laughed in the car, as they always did, on the way home while playing Bop It. James talked about wanting to surf again.
A few hours later, James was talking with his mother about the incident at school the day before. She told him the kid who approached him was probably jealous of him and that James should act with kindness toward him. James agreed: "He probably is jealous of me." Courtney asked him why. James said: "Because I am smart, funny and people like me."
Later that night, James came downstairs to talk to his mom again, asking about her work, her upcoming projects. He went upstairs to go to bed but then came down again pretty quickly. He said he needed a glass of water. Courtney reminded him to take his medication and his melatonin, so he could get his sleeping schedule back on track. He nodded his head, finishing his glass.
"Goodnight," she said. "I love you."
"I love you, too."
James went upstairs and never came back down.
When you walk into the Ransoms' house, past the green door with a wreath of lavender and green hydrangeas, a tiny angel in the middle, the first things you notice are photos of James. On the walls. On top of a cabinet. Downstairs. Upstairs. With his sisters. With his parents. With his friends. Smiling in all of them.
"I see him everywhere. I want him everywhere," says Courtney.
It's been nearly two years since James took his life on November 30, 2016. The pain does not lessen as each day passes. "He was just a little boy," Greg says. A tear drops down his cheek. "And now he's gone."
Sometimes, Greg and Courtney replay every moment in their heads, from the hit to everything that came after. They've talked to the parents of James' teammates about what happened on the field. They've spoken with the Stallions' coaches. They've combed through James' account of what happened, wondering what might have been.
It is unclear if any athletic trainers or board-certified physicians were present on that fateful day. "What we are told is that Santa Margarita has at least two CPR / First Aid certified coaches," Brian Heffron, a spokesperson for Pop Warner, wrote in an email. "No one has a memory of the specifics of that game."
Youth sports organizations are not required under state law to report games in which an athletic trainer or board-certified physician is present, so it is unknown how many are typically present at youth games. Two months before James' death, the California legislature passed AB 2007, which required mandatory concussion protocols be followed—including, among other things, the removal of players suspected to have a concussion and that coaches or administrators complete head injury training. (It went into effect January 2017.) And just days before James took his life, Pop Warner launched a "concussion education campaign" and implemented safety measures—such as reducing contact in practice to 25 percent and requiring any player who suffers a suspected head injury to receive medical clearance from a concussion specialist before returning to play. (It is unclear what 25 percent constitutes, or what "suspected" means, or how the protocol is enforced.)
The Ransoms have not brought legal action against the Stallions, Santa Margarita Pop Warner, Pop Warner or the player who hit James. (Pop Warner is currently being sued in a class-action lawsuit for failing to institute safety protocols. The lawsuit is not related to James' death.)
Greg and Courtney have not seen footage, nor have they been able to retrieve it. Pop Warner said "no" when asked, in a written request, if it had video footage to make available. In a statement, Pop Warner wrote: "The loss of a child is heartbreaking and it's hard to imagine the pain the Ransom family has experienced. Our hearts go out to them.
"While football is a very physical sport we have worked hard to make the game safer for young people by instituting major rule changes, including limiting contact in practice, better training for coaches and education for parents and players. Pop Warner's concussion rule, which has been in place since 2010, requires any participant removed from play due to a head injury or suspected concussion to be evaluated and cleared in writing by a currently licensed medical professional trained in the evaluation and management of concussions before they return to play. During games, the home team must provide medical coverage. In the absence of a physician or ambulance on site, the team is required to supply an individual who is EMT qualified or certified in Red Cross Community First Aid and Safety."
The Ransoms have hungered to understand the science behind their son's apparent behavioral changes. But they have not had James' brain studied since his death, so they do not know whether James had CTE. At the time of his death, they didn't think about having his brain studied. It wasn't on their radar. Whether the Ransoms could, years later, still find out if James had CTE is unclear. "It depends on a lot of factors," Chris Nowinski, Ph.D., the co-founder and CEO of the Concussion Legacy Foundation, explained in an email. "People have been exhumed months after burial for a successful diagnosis."
The knowledge, the Ransoms insist, wouldn't serve any purpose for them.
"Nothing is going to bring James back," Courtney says.
Instead, the Ransoms have taken steps to educate themselves. Courtney pored through articles on the internet, reading blogs of families whose teens died from taking their own life. "After he died, I could not stop searching for answers," she says. Greg learned more about CTE, which led him to consider the effects of other brain trauma that hadn't resulted in CTE.
From Courtney's internet research, a pattern emerged: In many of the cases in which a teen took his or her life, there was a concussion. Many of the accounts seemed to be about young people who were just like James—people who were well-liked, performed well academically, lived "normal" lives that then took a drastic turn that resulted in death. Courtney then talked to other parents about their teenage sons who weren't, as Courtney says, "right," after some sort of concussion in football. She started to wonder if all of these things were connected.
Researchers in recent years have found that concussions can lead to mental illness and exacerbate symptoms or episodes of mental illness. Sometimes, it only takes a single head injury for mental illness to occur. Among teens, untreated concussions can lead to mental disorders. Not all teens who have suffered concussions develop mental illnesses. Some studies have shown that, for many athletes, mental effects resolve themselves over the long term. But a situation like James' is not out of the realm of possibility.
Though James' behavior changed following the traumatic brain injury suffered on September 12, 2015, the Ransoms will never know for sure what led to James' mental illness, but they want to help other families by telling his story. They have created the James Henry Ransom Foundation to raise money for other teens and adolescents and families struggling with mental illness.
Greg says he understands why people love the game of football and sees how their identities are wrapped up in it. He gets how this game has saved other people's and other families' lives—how it has provided a way out of poverty for some or offered a social connection for others, and how deeply meaningful that can be.
"It's not about being anti-football. We loved football. My son loved football," Greg says.
It's just that, "Football wasn't worth it," he adds.
Ultimately, James' story can help make parents more aware of the risks, Greg says. "If people knew what was happening to their kids, if they saw the bruises that accumulated on their legs, they'd be disturbed by it," Greg says. "But you don't see what's accumulating inside of a skull. You don't see it. … It's an injury people can't see so they pretend it doesn't exist.
"Nobody thinks their son can die playing this game, which they can," Greg adds. "Even if my son hadn't died, we went through hell for a year. Just the awfulness of my son having to go through that. … He didn't have to die for this to be awful."
Mirin Fader is a Writer-At-Large for B/R Mag. She's written for the Orange County Register, espnW.com, SI.com and SLAM Magazine. Her work has been honored by the U.S. Basketball Writers Association. Follow her on Twitter: @MirinFader.
Editor's note: This piece mistakenly identified Dr. Omalu as having published the first evidence of CTE, though it first emerged in print in 1949 via British neurologist Macdonald Critchley. The article has since been amended to clarify Omalu's work as being specific to football. We regret the error.
DID ONE HIT LEAD TO A 13-YEAR-OLD'S SUICIDE?