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March 24, 2014

Baseball Therapy

The Complicated Recoveries of Aroldis Chapman and Salvador Perez

by Russell A. Carleton

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Last Wednesday night, something truly awful occurred in a spring training game between the Royals and Reds. In the sixth inning, Reds closer Aroldis Chapman was getting in some work and faced off against Royals catcher Salvador Perez. In the regular season, that matchup would be compelling stuff, but this was just a fake game, so no one thought much of it. You’ve probably seen the replay of what happened next: Perez squared one up and hit a line drive that caught Chapman in the face. Chapman was taken off the field by stretcher and the game was called off.

Thankfully, Chapman received immediate medical care. Reports are that he was diagnosed as having sustained fractures in his face and a mild concussion. That’s most certainly not a good thing, but as several have pointed out, he could have ended up with much worse. In fact, there are reports that Chapman might be able to pitch in late April if his recovery goes well.

However, there’s more to heal here than just Chapman’s facial bones. The big question on everyone’s mind seems to be how Chapman will heal psychologically. His arm was not affected, and with proper medical care, I trust that his bones will heal. But will he have trouble functioning as a major-league pitcher when he comes back because he’s too traumatized by this event? What of the fact that he was diagnosed as having a concussion? And what of Salvador Perez who, as was clear in the replay, was horrified by what happened? What about everyone else associated with the game who no doubt saw the replay?

If the reader might indulge me while I put on my other hat … I hold a Ph.D. in clinical psychology, and while I have never met either Chapman or Perez, I can at least speak intelligently as to what the data out there suggest we might expect after an event like this. So I propose to look at the matter from the perspective of Chapman, Perez, and baseball more generally.

The Neuroanatomy of a Pitcher
Initial reports in the aftermath of the line drive were encouraging: Chapman had never lost consciousness, and he was moving his arms and legs and communicating with the trainers (both Reds and Royals trainers ran out to help) and teammates.

There were plenty of people who were worried that Chapman’s spinal column may have been affected, which the news of his movement ruled out. But that information was also important in assessing the severity of his concussion. A concussion occurs when the brain bumps up against the skull and sustains bruising. There’s a layer of cerebral-spinal fluid surrounding the brain that is there specifically to provide a buffer so that even if the head sustains a traumatic bump, the force is somewhat absorbed by the liquid. Of course, that works for some bumps, but not others. This was a hard ball traveling at a high rate of speed. There’s not a lot of defense for that.

If someone has sustained a head trauma and a potential concussion, there are three main factors to look for. Did he lose consciousness? Did the trauma induce a seizure? Is there any evidence of amnesia? In Chapman’s case, he reportedly did not lose consciousness. There was no report on whether he experienced seizures, although the fact that he was in enough control of his functions to be talking after being hit suggests that at the very least he didn’t suffer prolonged seizures. Given that his diagnosis was one of a “mild” concussion, it’s likely that he did not. Reds catcher Brayan Pena, one of Chapman’s closest friends, reported that he visited Chapman at the hospital and that the two shared some inside jokes about Cuba (both men are from there), leading Pena to report that Chapman’s memory seemed okay.

It’s tempting to think that the diagnosis of “mild” concussion means that Chapman will be up and about in no time and slinging fastballs by May. The truth is that concussions aren’t that simple. I assume that Chapman had a CT scan of his brain, looking to see whether there was any bleeding or swelling. That information hasn’t been released. The problem with bleeding and swelling in the brain is that the head is a closed system, which makes it unlike most of the rest of the body. There aren’t a lot of places for the blood to go, nor for the swelling brain to expand. The location of the bleed (if there was one) is also important. Different parts of the brain control different bodily functions, and sometimes symptoms don’t immediately show up.

It’s possible that Chapman will be back on the mound after the facial fractures heal, but do understand that any time you’re dealing with the word “concussion,” there’s uncertainty. In fact, the CDC recommends a lot of rest and a slow recovery. A lot of physical activity can overstimulate the brain, and the brain already has enough to deal with as it tries to heal. Of course, baseball—like a lot of sports—has disregarded this guidance in the past. From 2000 to 2012, the most common number of games missed due to concussion was none (27 percent of cases). (The situation has improved of late.)

But even past that, many commentators have wondered whether Chapman will be mentally the same after being hit. Will he have that extra bit of fear in the back of his mind? We know that among people who are exposed to horrible, major stressors (being involved in combat, being sexually assaulted), between 10 and 30 percent (estimates vary widely) develop post-traumatic stress disorder (PTSD). PTSD is a chronic condition, one that I would never wish on anyone, but it’s not the only thing to worry about. A 2000 study found that people who had been through an accidental event were also at risk of developing other anxiety and mood disorders. This is not a matter of these people being weak or flawed. This is simple human biology. The natural human response to a traumatic event is anxiety and avoidance. If you’d like to know all the gory neurological details, I’ll be happy to fill you in. I’ve said this before in this space, but if you see someone who is recovering from PTSD or anxiety (or any mental health concern) consider that they are living their life, even though their own biology is working against them. That takes strength.

The good news is that not everyone develops anxiety after an event like this, and if they do, people do recover. In general, treatment involves gradual exposure to the initial trauma, where it is appropriate. For example, Chapman might start out by simply describing the event in his own words and seeing how he feels afterward. If he feels nervous, there are coping strategies that he might use to help himself feel more at ease. If that works, he can move toward standing on a mound. But the reality of it is that Chapman probably (but not certainly) will have that thought in the back of his head when he comes back.

What’s sad is that if he pitches poorly, the performance will be blamed on his “thinking too much about what happened” and “not getting over it,” because apparently he’s weak if he doesn’t get over something that could have left him disabled in the space of a couple of weeks. If Chapman is nervous when he steps back on the mound, it’s possible that he will find comfort in repeating a motion that he knows well: throwing a ball 102 mph. There’s great comfort in repetitive motion, and even more comfort when the umpire yells “strike three” after you repeat it a couple of times. Maybe the anxiety does mess him up, but I guarantee that no matter what happens, it will be explained with an embarrassingly over-simplified narrative that ignores how complicated recovery really is.

The reality of Chapman’s recovery is that things are far from settled. He will need some time to heal physically and mentally. He may or may not develop symptoms following from his concussion. He may or may not develop anxiety about pitching. It’s a lot easier to place a recovery time on the physical aspects of his wounds.

The Runaway Line Drive
After news of Chapman’s injury came out, there was a sincere outpouring of support for Chapman from around baseball. Thankfully, there were also those offering kind thoughts toward Royals catcher Salvador Perez, who hit the line drive. It’s important to note that Aroldis Chapman isn’t the only person who might have been traumatized by what happened. There can be secondary trauma, in which a person is not directly involved in a traumatic event but is either involved in or a witness to an event. And it was pretty clear that Perez was shaken up after the play. After the ball was hit, he ran to the mound, obviously distraught about what had happened. He paid a visit to Chapman in the hospital as well. Let’s give him credit. He acted honorably.

Intellectually, everyone—even Salvador Perez himself—knows that he wasn’t trying to hurt Chapman. It’s understood that pitching carries a certain occupational risk of that sort of event happening. This was a freak accident, so why was Perez so upset? One reason is that there’s an inborn bias that all humans have to avoid doing harm to others. There’s a well-known example in which a person is presented with a (hypothetical) situation in which there is a runaway train that will surely kill five people. However, the person is told that by pressing a switch, they can divert the train onto another track where it will kill one person. Would you press the switch? Obviously, the logical answer is that you should. One death is preferable to five (even though neither is a good option.) People hesitate to throw the switch, because it means that an action that they take results in the death of someone who otherwise would have lived.

That fear that one might have been the cause of harm, even if it was unintentional, is hard to shake, even if logic says one is completely blameless. I’m guessing that Perez might have had some guilt around that, combined with the secondary trauma of witnessing what was likely a horrible scene on the field. My hope is that he has already had a chance to debrief with someone trained in trauma crisis intervention. Working through the survivorship guilt is a matter of being able to go from the emotional reaction to the logical one. Most people get there, but it’s not an automatic process.

He was a skater boy…
I first started doodling sabermetric things on paper in October of 2006. I was at a conference in (appropriately enough) Lawrence, Kansas. Rock chalk, Jayhawk. At that same conference, I also wound up talking to someone who had done research on helmet use in skate parks. In her work, she had gone out and asked a bunch of skaters why they (mostly) didn’t wear helmets. There were the usual reasons that “It didn’t feel good” or that “It gets in my way.” But when she asked follow-up questions, the real reasons came out.

One was that a helmet was something that a beginner wore on his first day at the skate park. The cultural meaning of a helmet within that setting was “I don’t know what I’m doing.” The other was, “Well, a helmet is only useful when you fall and I’m too good to fall.” She heard this from people who clearly knew (and who clearly didn’t know) what they were doing. The kicker was that when she asked them about what protections a helmet could provide and what could happen if they did have a bad fall, they all knew. Yet it was rare to see a helmet on anyone’s head. How is it that a group of people can recognize a danger, know of an antidote that was easy to get, say that they believed it was effective… and then not use it? Right: 16-year-old boys.

What’s fascinating is that I could have sworn that I heard the same presentation happen in the aftermath of the Chapman incident. Major League Baseball has approved padded hats for voluntary use by pitchers, and yet no one has put one on in a game. They don’t feel right. They mess up my pitches. I can totally understand why someone else would want to wear this. It’ll never happen to me, though.

There are, of course, people who are hoping that in the wake of the Chapman injury that more of these hats will appear on the heads of pitchers. These folks might try to use Chapman as a warning of what might happen. It probably won’t work, and for reasons similar to those the skaters gave. The cap probably does feel weird. It probably would take some getting used to (but so does a new workout regimen or trying a new grip for a pitch). And besides that, an event like the one that happened last week is rare, and the padded hat wouldn’t have protected Chapman where the ball hit him.

It’s not just about showing players the horrors of what could happen. They already know that. The research says that fear tactics are about the worst way to implement a public health program. You have to address the cultural issue that goes along with the behavior that you’re trying to encourage. Why go out on the mound with a visible symbol that you are afraid? Why be the first to rock the boat? So, for those hoping that Chapman’s woes will inspire others to take a look at the protective hat, it’s not going to be that easy. You have to intervene at that cultural level, and changing a culture takes a lot longer than showing someone a frightening YouTube clip.

Russell A. Carleton is an author of Baseball Prospectus. 
Click here to see Russell's other articles. You can contact Russell by clicking here

5 comments have been left for this article. (Click to hide comments)

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Kyle Matte

It's obviously on a much, much smaller scale and far less traumatic, but I hit three pitchers with line drives in my softball league last season. The fear of injuring another person was so engrained in my head that every time I stepped to the plate I was purposefully opening my front shoulder super early in an attempt to pull the ball down the left field line as opposed to crushing it up the middle or to left-center.

And these were body shot line drives that caused only bruising and "walk it off" injuries. I can't even fathom how it would feel to hit someone in the head and see them stretchered off.

Mar 24, 2014 07:22 AM
rating: 5
 
buddons42

I was that guy in my softball league last summer that got hit in the face and stretchered off. Luckily no concussion but broken jaw in 4 places and 2 fractured sinuses. Ouch. I was back on the mound about 2 months later. I started using a helmet with a full steel face mask and I'll fully admit even with the armor on I still had THAT thought in the back of my head every pitch for the rest of the season. We'll see if it gets any better this year, if not it might be time to give up pitching for good.

Mar 24, 2014 08:21 AM
rating: 6
 
Richie

Seems to me like pitchers are much more likely to suffer harm getting hit in the face rather than on the head. Is that factually so? If so, then we are talking mask rather than helmet.

Mar 24, 2014 09:26 AM
rating: 2
 
Michael Bodell
(89)

I think pitchers should be brought up wearing helmet/masks like a catcher/goalie. Pitchers don't really need tons of head movement or visibility, and if they learned from a young age it wouldn't feel weird.

Mar 25, 2014 00:59 AM
rating: 0
 
R.A.Wagman

If anything, pitcher head movement can throw off command.
But I think you are correct - they need to begin growing up that way.

Mar 25, 2014 04:34 AM
rating: 0
 
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