When Karen Zegel's son killed himself nearly two years ago, she was left not only with an irreparable hole in her heart but countless gut-wrenching questions.
What could have driven an intelligent, kind, loving man like Patrick Risha to hang himself with his dog's leash at the age of 32?[[387699041, C]]
The Dartmouth graduate had a young son whom he adored and a family that loved him. But Patrick had long been struggling and fighting demons no one understood _ especially him. He could not have known that chronic traumatic encephalopathy (CTE) had destroyed his once healthy brain.
In her recent testimony to a U.S. House subcommittee investigating policies to prevent youth brain injuries, Karen Zegel told lawmakers how she witnessed her son's slow descent.[[388851452, C]]
"I have seen close-up the transformation of a beautiful, bright, energetic, loving young man into a reclusive, paranoid, depressed and angry person,'' she told the committee. The blame, she firmly believes, lies in a life lived on the football field.
A native of the Monongahela Valley, where his father, Pat Risha, was Clairton High School's legendary football coach, Patrick relentlessly strove to excel at the game he knew and loved.[[388149592, C]]
``Football was their world,'' Doug Zegel, Karen's husband and Patrick's stepfather, said during an interview at the couple's Doylestown home.
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Growing up in a devout football family, in a town where football is akin to religion, there was never any question Patrick, although not a big kid, would play the game.
And he did _ a lot.[[389274461, C]]
Barely out of kindergarten, he was the Clairton team's mascot. Then, like millions of children across the country, Patrick stepped into his first football uniform in elementary school and launched a career that would see him on the field through college.
With each game, he was pounded. If he wasn't being slammed into the unyielding ground, he was crushing his opponent into it.
"He was so tough, so determined,'' Doug said. "He used his head as a battering ram,'' added Karen.
While in college, Patrick continued to fight mightily on the gridiron. Following his graduation in 2006, his mother said she noticed signs her son "couldn't get it together.''[[389288102, C]]
"He became reclusive, argumentative, moody and depressed,'' Karen said, her voice softening.
Once a bright, capable man, Patrick couldn't balance his checkbook.
"Ten years out of playing football and suddenly, he was not well-adjusted,'' his mother said.
The first time Karen heard of CTE was after Patrick's autopsy, when his brain was examined at the University of Pittsburgh and Boston University.[[388954862, C]]
The degenerative disease, caused by repeated blows to the head and other activities that cause the brain to bounce around in the skull, has been found in the brains of many former football players.
Years of football's jarring, repetitive hits left her son's brain broken, destroyed by CTE, Karen said.
"When I got that news,'' Karen said, "and I consider myself an educated mom ... I said, wait, if this happened to me, if I failed so terribly, what about other parents.''
Grieving and still baffled by the discovery, she and her husband began a mission to learn all they could about the disease, including, most importantly, how to stop it.
"CTE is 100 percent preventable,'' Karen said. "If we don't do anything, we're all complicit in the problem.''
Last year, 1.23 million children ages 6-12 played tackle football, up slightly from 1.216 million in 2014, according to data from the Sports & Fitness Industry Association, which commissions annual surveys of sports participation in the U.S.
Patrick's family hopes The Patrick Risha CTE Awareness Foundation and website StopCTE.org will inform parents, educators, coaches, health care professionals and others about the danger tackle football and other contact sports pose for children's brains.
"We hope our efforts will help enable parents to make informed choices and prevent the sure sadness that comes from watching a bright mind literally become unwired,'' the foundation said on its website.
In a 2015 Mayo Clinic study, researchers found CTE in males who had participated in youth amateur contact sports.
"The 32 percent of CTE we found in our brain bank is surprisingly high for the frequency of neurodegenerative pathology within the general population,'' said the study's lead author, Kevin Bieniek, of the Mayo Graduate School's Neurobiology of Disease program.
The study was the first to look for CTE in nonprofessional athletes. Bieniek said the frequency with which CTE was found was "surprising.''
Scientists examined 1,721 cases in the clinic's brain bank. They found 32 percent of the 66 males who had played contact sports as youth and young adults had CTE. By comparison, none of the 198 brains of those who had not participated in contact sports, including 66 women, had CTE pathology.
"The purpose of our study is not to discourage children and adults from participating in sports because we believe the mental and physical benefits are great,'' Bieniek said.
However, he said, "it is vital that people use caution when it comes to protecting the head.'' Greater CTE awareness, said Bieniek, will lead to greater emphasis on making contact sports safer, better protective equipment and fewer head-to-head contacts.
As awareness around concussions and CTE has grown, Pop Warner, a national youth sports organization widely recognized as a leader in children's football programs, has adopted new policies.
Starting this season, Pop Warner is eliminating kickoffs for its three youngest divisions that include children ages 5 to 10. Now, the ball will be placed on the 35-yard line to start each half and after each touchdown, spokesman Brian Heffron said in an email.
"Following the season, Pop Warner will review the results of the move as it considers implementation in older divisions,'' said Heffron.
The organization also has reduced contact time to 25 percent during practice across all divisions, he said. In 2012, Pop Warner banned full-speed, head-on blocking and tackling drills where players lined up 3 yards apart.
Greater education for coaches has been an important part of the NFL's efforts to reduce concussions and other injuries in youth programs. Heads Up Football, a series of courses for coaches funded and promoted by the NFL, has been credited with helping reduce injuries by 76 percent and concussions by 30 percent.
However, a recent review by The New York Times found no such reductions.
"The research and interviews with people involved with it indicate, rather, that Heads Up Football showed no demonstrable effect on concussions during the study, and significantly less effect on injuries over all, than U.S.A. Football and the league have claimed,'' the Times article said.
Both U.S.A. Football and the NFL acknowledged the study's inaccuracies and pledged to correct them.
"We kind of knew for a long time that Heads Up Football was a farce,'' said Karen. "They dusted off a program from the 1960s and re-engineered it. It gives parents a false sense of security.''
Whether you hit with your head or your shoulders, she said, "it's all the same stuff ... your brain is still moving forward. It doesn't matter what fancy helmet you buy. There's no safe way to play tackle football.''
If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 or visit the American Foundation for Suicide Prevention here.