Did Alexander the Great suffer from CTE?

The following are some thoughts on this article, which, in short, suggests that the personality changes over the course of Alexander the Great’s reign could have been caused by Chronic Traumatic Encephalopathy (CTE) perhaps caused by his shorter than average height. In other words, to quote Jake Nabel, Alexander the Great “often got bonked on the head.”

The thrust of the article is as follows: Alexander the Great was short and was therefore closer to his opponents and was struck in the head by at least glancing blows in the sources with some regularity. As has been a topic of concern in the arena of football, repeated head trauma can lead to CTE, which manifests with symptoms such as altered personality, uncommon susceptibility to alcohol, blackouts, extreme emotional swings, paranoia, and violence. All of these symptoms are attributed to Alexander and CTE provides an explanation that accounts for the greatest number of symptoms, ergo Alexander had CTE.

Some of the points made in the article are provocative and worth consideration. The focus on CTE could be poo-pooed as a flash-in-the-pan contemporary concern brought on by modern athletics, but ought to be taken into account in how we think about ancient warfare. Our medical data from antiquity is, effectively, non-existent, but human physiology hasn’t changed that much.

That said, I am skeptical of the larger argument.

First, I think that Alexander’s shortness, while a generally accepted fact, is a bit of a red-herring, not only because he was frequently fighting from horseback, but also because I wonder whether the difference in height would have made a significant difference over, say, his recklessness. Then, is it necessary to single out Alexander from the other Macedonians whose bodily harm receive less attention?

Second, the author implies that Alexander’s men also became more violent as Alexander’s head trauma grew worse. The implication is that they were following Alexander’s orders, but I am mistrustful of such a direct causal relationship, particularly because the author (following the model of the ancient sources) chooses to focus directly on Alexander’s erratic behavior. This is not a problem unique to this article, but is endemic in the thinking about Alexander the Great’s campaigns.

Third, the author too readily accepts the ancient sources at face-value, something which has been called into question, particularly on the issue of wounds (see particularly: Riginos, JHS, 1994). I happen to believe that Alexander the Great was wounded fairly regularly and sometimes severely, but hinging an argument on the specifics of the wounds is problematic, to say the least. This approach sees the symptoms and then goes looking for the wounds to support the thesis, without questioning whether those wounds might not have actually existed.

Fourth, and building from the issues of sources, all of which were composed or written hundreds of years after Alexander died, the article in question seemed to me to downplay any political, social, or literary explanation for the changes in Alexander’s behavior. On the one hand, this is the rhetoric of a journal article, but, on the other, it ignores how a Roman philosophical context shaped the accounts of Alexander murdering Cleitus just as much as it ignores the strains placed on the court by Alexander’s appointing Persian nobility to important positions, thereby challenging the supremacy of the Macedonian elite.

The author concludes by invoking the unsolved mystery that is Alexander’s death and suggesting that Alexander’s greatness should be read in terms of disability because of how long he functioned with a deteriorating brain. (I assume this differs from the alcoholism thesis because the latter is self-inflicted.) Such post-facto, blind diagnoses are deeply problematic, good for a headline, but light on substance.

Like many theories about the ancient world, the idea that Alexander suffered from CTE or a comparable type of trauma cannot be discounted because there is not enough evidence one way or another. The author is certainly correct that a surface-value reading of the evidence does supply evidence for CTE, and I like this explanation better than an anachronistic attribution of “alcoholism.” And yet, it is also necessary to pull back to see where this fits within the larger context rather than looking to isolate CTE as a universal explanation for the changes in Alexander’s behavior.

Local Advertising and Concussions

Despite the national sports media members who loudly protest that they played through concussions and were just fine, concussions are serious. Of course players are going to try to go back into the game if given a choice, competitors are driven to compete and do not like being forced to watch, particularly once they reach a level where past performance validates their ability. That is why the coaches, the officials, and the support staff need to step in and protect the players from themselves. And, as Stephania Bell used to remind the hosts of ESPN’s fantasy focus podcast, it is a misnomer that there are “mild” concussions. Concussions are brain injuries that range in symptoms, but that are all serious and get worse with repeat occurrence.

Michigan football has a number of problems right now and while the fans are angry for any number of reasons, it was the procedure (or lack thereof) for a concussed quarterback, Shane Morris, who was allowed to go back into the football game when visibly in need of his teammates to stand upright after a vicious hit, that landed Michigan football on national TV morning shows. It was an NFL concussion lawsuit that saw a judge reject a 870 million dollar settlement because she believed the the settlement would not be able to cover all the damages (she approved it when they removed the cap on payouts). A new book, Boy on Ice, details the life of Derek Boogaard, an enforcer in the NHL, who suffered multiple concussions and then died of a drug overdose at 28; Boogaard’s family donated his brainstem to science because he underwent a personality shift in the last years of his life. Major league baseball has had issues with players hit in the head, colliding with walls and players, or getting kneed in the head while sliding into a base, which has derailed the career of a number of excellent players.

The list goes on, the point is just to illustrate that concussions are not an isolated issue and are hardly limited to contact sports. This is the context in which I am actually outraged at the radio ad run by one of the local car dealerships.

Fletcher Honda in Columbia, Mo, currently has on air a commercial imitating a football game. A player gets taken out in a vicious hit and the coach comes out to ask if he knows where he is. In a dim and woozy voice the player asks for a combo meal. The coach asks a second question and the player says he wants a super-sized combo meal. Then the coach asks if he knows where to get the best deal for his trade-in vehicle, to which the player more confidently replies that the answer is Fletcher Honda. Because the player gets the third question right, the coach proclaims he is good to go.

My problems here are that the ad is completely tone-deaf and that if I heard someone legitimately answer the first two questions I would diagnose him with a concussion over the radio, without needing any training or further confirmation. But then they imply that he is going to go right back into the game. Because he knows a bit of trivia that may or may not be true about a car dealership here. At least if anyone questions them about their message, they can say that their spokesman had a brain injury when he asserted it.

I am not in advertising and I am aware that local dealership ads are not easy and that this is their attempt at provide a humorous, catchy spot. And I have given some thought to how they might revamp this same concept in a way that relieves my concern, but I don’t see one. Making light of concussions is beyond tacky and I cringe whenever I hear it come on.