Unlocking the Cage author Mark Tullius: “I worry that my occasional slow speech and constant terrible memory might be indicators of a troubled future.”
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Chris Palmquist
September 7, 2015 · 9 min read
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Mark Tullius is an Ivy League graduate, author, former MMA fighter, and force behind Unlocking the Cage, a years-long text and video inquiry into why we fight.
He joined the Cleveland Clinic Lou Ruvo Center for Brain Health’s Professional Fighters Brain Health Study. The Study examines the brain function of active and retired boxers and mixed martial arts fighters, focusing on early identification of neurocognitive decline and prediction of long-term neurological consequences.
My wife finishes her breakfast and questions why I’m just now filling out the forms. I ask her to give me a few minutes while I figure out how many rounds I’ve fought, how many concussions I’ve accumulated, and decide how to answer the questions on whether or not I’m displaying any symptoms of permanent impaired brain function.
Finally, I look up from the papers and tell Jen that I’d been putting off the forms because I didn’t want to think about them. As much as I don’t want to, I admit I’m nervous about the appointment. I worry that my occasional slow speech and constant terrible memory might be indicators of a troubled future.
Jen assures me that I’ll be fine, and I return to the papers, relieved that the next question, which asks whether I fall asleep in unusual situations, is easy to answer. I’ve never done anything like fall asleep in the middle of a conversation. I feel more confident that all the tests will come back showing I’m fine, one of the lucky ones who won’t develop brain damage from repeated head trauma.
I arrive early and walk around to the front of the building, even though the heat is almost intolerable. The building’s design is uniquely beautiful, a metallic masterpiece designed by Frank Gehry, but its chaotic curves fill me with a sense of dread, an image of a twisted brain. The courtyard and surroundings are relaxing and peaceful though, and I’m greeted by a friendly volunteer who guides me to the check in.
I’m 43, the youngest person in the lobby by at least ten years. The medical center is dedicated to finding more effective treatments for brain diseases and the fighter study is just just a small part of it. I don’t fit in here, I think to myself, at least not yet. I can’t help but look around, wondering what types of brain degeneration the different individuals might be suffering. One of my relatives is in the beginning stages of a fight with Alzheimer’s, and a friend’s wife of 62 years is about to lose her long, drawn-out battle. It’s not something I would wish on anyone.
Looking down at my paperwork, I realize that seeing my losing MMA and boxing records doesn’t bother me like it used to. It dawns on me, however, that a losing record is probably a solid indicator that I took way more punishment than I dished out. The time I had double vision and a headache for two weeks comes to mind. I question why I’d been so careless when it came to concussions in football and fighting.
An assistant escorts me back and briefs me on the cognitive testing. I feel prepared because I’ve played a lot of brain games through Lumosity since I began worrying about my brain two years ago. I score above average on some tests, but my reaction time’s only average. The speech part is next. I stumble through a couple of these tests, but the assistant assures me I’m doing fine.
The physical test is all about balance, so I’m fairly confident, especially since I’ve been doing a lot of yoga. I feel solid standing with my feet together, hands on hips, eyes closed, but I just can’t do it with my right leg raised. I try again and again but can’t hold the pose for more than a second. The assistant doesn’t say whether or not that could mean anything, so I jot down a note to ask the doctor.
After a painless blood draw, I meet with Dr. Charles Bernick, the Associate Medical Director of the Clinic and principal researcher of the Professional Fighters Brain Health study which currently includes about 400 current and 50 retired fighters. I mention that I’ve interviewed about the same number of MMA athletes from around the country and I always look for noticeable signs of damage, especially with guys that have had long careers or taken a lot of abuse due to their fighting style. Overall, I’ve detected very few indications of brain damage, even amongst those with 40 plus fights under their belt, but I admit that my brief and uneducated analysis is very limited since I didn’t know the fighters prior to their careers and their self-assessments probably aren’t very accurate. I believe many fighters might not notice subtle changes in behavior or ability and, if they do, they may attribute it simply to aging.
Dr. Bernick nods, and I’m reassured to hear he has a fairly similar impression of MMA fighters. He tells me the repeated head trauma can lead to progressive neurological deficits, but it doesn’t occur among all athletes. It’s too early to guess what percentage of MMA fighters might be affected, especially since the sport is so new and symptoms of permanent brain damage might not present for five years or more after the last trauma.
There’s no denying brain trauma is affecting some MMA athletes though. We see the early retirements and talks of concern, fighters giving up their dreams because they value their brain health. It doesn’t seem to happen often, but how many fighters are actually aware of a neurological decline, and would they even admit it or let it stop their career? That also doesn’t take into account the number of lower-level professional and amateur fighters who don’t make the news. Overall, I’m still fairly confident the risk isn’t high for MMA fighters, and I’m convinced both boxing and football are much more likely to lead to problems.
Having played both high school and college football, and having gotten my ass kicked all over the boxing ring and MMA cage, I can’t help but wonder what my odds are. What did my tests indicate? What does my awful balance reveal?
Dr. Bernick goes over my history, and asks me to fill him in on the details. I talk about the three times I lost consciousness in football, and the three much more serious concussions in fighting. I tell of the slurred speech and difficulty arranging words that I experienced while boxing but fortunately normalized when I went back to MMA. There’s the final concussion where I saw a punch coming; the next thing I knew it was fifteen minutes later and I was in the locker room, talking to my coach who was about to take me to the hospital. I explain that I didn’t take another blow to the head for the next nine years, but then got sucked back into the sport and sparring. I admit to being dumb enough to have my brain knocked around by Fabricio Werdum, Renato ‘Babalu’ Sobral, and dozens of fighters around the country. It was then, I tell him, that I did my research on brain damage, switched over to Brazilian Jiu Jitsu, and hadn’t been struck in the head for over a year.
We went over my current status and I explained that I wasn’t experiencing any mood shifts or noticeable problems. My biggest issue was the memory loss, something I became aware of after college but was never too concerned about. Instead of worrying it was an indicator of a decline, I liked to think all those forgotten memories were discarded because my brain needed the room to store something more important or, more likely, from a quarter century of marijuana use.
Dr. Bernick took note of everything and continued the neurological examination by checking my reflexes, gait, and balance, and had me follow his fingers with my eyes. He discussed the goals of the project and how they hoped to answer many of the questions I had.
The study’s emphasis is on early identification of neurocognitive decline and prediction of long-term neurological consequences. They hope to discover why with similar levels of trauma, some fighters are more at risk for the decline in brain health. With the MRI I was about to undergo, and the other tests I’d just finished, the researchers hoped to detect even the earliest and most subtle signs of brain injury. By repeating these tests four years in a row, they hope to find biomarkers or clinical indicators that can predict cognitive decline, and better understand the impact of each risk factor.
With so many fighters involved in the study, and the massive amount of data, it is promising that the research team will discover the answers to these questions. The only problem is that, as to be expected with any volunteer longitudinal study, there will be a number of participants who don’t complete the testing. The continued recording of data is where most answers will come from. It is crucial that participants complete the four years of testing. Even if a fighter retires and no longer experiences head trauma, the comprehensive test results are invaluable.
I’m committed to the testing and I hope to encourage other participants of the study to finish all of their evaluations. Maybe even more fighters will volunteer for the study. The results will not only help fighters and our sport, but anyone else with head injuries, whether civilian or military. It may even help to find treatments for diseases such as Alzheimer’s and Parkinson’s. I sincerely appreciate each of the fighters who have already participated, as well as the tremendous support from the UFC, Bellator, and Top Rank for their funding.
I am not a crusader for brain health who thinks MMA is going to mean the doom of everyone who participates. In fact, I’d say the reward of competing in martial arts outweighs the risk. That said, I’ve spent the last three years finding out what type of people fighters are, and I consider lots of these men and women my friends. I’ve met so many incredible and inspiring individuals and it is difficult knowing that some of them will have brain health issues. I understand most current fighters like to block this out and think it won’t happen, but let’s face it, getting punched, kicked, slammed, elbowed, and kneed in the head isn’t going to have a positive effect on your brain. My fellow fighters, whether or not you participate in the study, I ask that you be more aware of your brain health. Ask friends and loved ones to let you know if they see any changes in your mood, speech, movements, etc. Most importantly, train smart and surround yourself with informed coaches and managers who’ll look after you. I also suggest that you be proactive and do whatever you can to postpone any decline.
