Anna Cassell; Nobody Ever Mentioned That...
Northwestern soccer player Anna Cassell
Over the course of the last decade, the dramatic effects of concussions have become increasingly known to the general public. Headaches, light sensitivity, and blurred vision are physical symptoms which are all too real, and can have a debilitating effect on the person suffering from the trauma. Often overlooked, however, are much more hidden and sometimes long term, emotional effects.
Anna Cassell was a Freshman goalkeeper at Northwestern University when she suffered her first concussion after taking a knee to the head scrambling for a loose ball.
“I finished out the game and thought I was fine. It was a Sunday night and I was trying do some school work and spend time with my mom and I just felt really off”, she recalls. “I had a headache, and I just didn’t feel like myself. I had never experienced a concussion before so I didn’t really know what that meant.
After going through the concussion protocol, Anna returned to practice about a week later. Her ability to practice successfully, however, may have been masking the more severe, emotional toll the concussion was taking.
“I was really struggling to adjust to college and having a hard time finding my niche. After the concussion I really just declined from an emotional perspective. I fell into what in hindsight was absolute depression,” she said. “I had a tough time getting out of bed in the morning, and I spent most evenings on the phone back home with my parents, crying. I was really emotionally unstable and very unhappy. That head injury really sent me off on a downward spiral.”
“That went on for about two or two and half months, and then finally in January when I was able to right myself and get re-centered, it was probably my brain and brain chemistry returning to its normal homeostasis, that allowed me to start feeling normal again. It’s just fascinating because it was what I would consider a pretty mild concussion, but given the right circumstances it really had a terrible negative effect on my quality of life because of the emotional effects.”
The next incident occurred at the beginning of Cassell’s sophomore season. During a pre-season road trip, and she was kicked in the head during the course of an otherwise very strong game for Anna.
She recalls, “I was playing really well, I felt really good, then I got kicked in the head and began feeling a little off. There was a nagging voice in my head saying ‘maybe this is a concussion’ but I sort of talked myself out of it and said ‘no, I’m fine, I’m playing well, my team needs me, I need this, I’m competing for the starting spot and I need to continue to have this really positive experience’, so I just shook it off and finished the game.”
Like so many other high level athletes, Cassell’s drive and competitiveness leads to a natural inclination to fight through adversity, and often injury. The needs of the team and an individual’s desire to fulfill her role within the team, can be a powerful force in a players dishonesty with themselves and others.
Cassell said, “After the game I had a headache, put an ice pack on my head, and i didn’t bring it up to the trainer. Someone asked me if I was OK and if I had another concussion, and I said ‘No, I don’t think so’.... And they said ‘good, because we need you’.... And that to me was validating what I was thinking that I was a vital piece of the team.”
She continued, “That was on Friday, and I felt kind of headachy the rest of the day and then all day on Saturday. Sunday we had another game, in warmups I felt a little off, but again I convinced myself that I was OK. we started playing the game, I was playing fine, but as the game went on I kept feeling worse and worse. I sort of realized, ‘OK, I think I have a concussion’. I decided I’d pull myself out at halftime and tell the trainer.”
Unfortunately, the circumstances of the game didn’t allow Anna’s plan to unfold. With five minutes left in the half, she was elbowed in the head, and any uncertainty about the severity of what she was previously feeling went out the window. Anna immediately knew that she was done for the day and had a pretty severe concussion.
All of the traditional effects, such as phonophobia, light sensitivity, and severe headache were all present. However, the emotional trauma taking a toll on Anna was now becoming visible to outsiders as well.
“At one moment on the sideline I felt fine, and the next minute I was sobbing and balling my eyes out and I was just back and forth, back and forth, and really could not get control of my emotions and I also felt super guilty because I’d known that I’d probably had a concussion and I kept playing. I was going to pull myself out and I didn’t, and now I was in a much much worse spot than I had been before,” recalls Cassell.
The emotional effects continued well beyond the game and the 5-hour bus ride back to Chicago.
Anna said, “We got back to campus and the scariest thing that happened with this one was that the emotional volatility persisted. I have vivid memories of one night having a panic attack in my dorm for really no reason. It was the middle of the night and I was out in the hallway hyperventilating and I can’t get control of my emotions. That pressing anxiety was super scary and I had these anger flashes that I had never had before. I’m typically a pretty optimistic happy person and I just remember sitting in my car one night crying, screaming, and pounding on the steering wheel because I was so frustrated, and that was totally uncharacteristic of me, so just seeing that shift in myself was super scary, because you just lose control of yourself.”
Cassell accounted for these incidents by assuming that the cause was frustration over not being able to play the sport she loved. At the time, she was fully unaware that instances of head trauma can have such an impact on a person’s emotional state.
“Through all of this nobody ever told me ‘hey, post-concussion you can really have some significant depression, anxiety, anger. That’s a normal progression of this injury.’ Nobody ever mentioned that, and that’s one of the biggest issues I had with all of the treatment I received. People were looking out for me and making sure I was recovering from an intellectual perspective, but emotional counseling would have been extremely valuable to justify that ‘this is not just you, this is probably the head injury.’ Instead I was thinking something was wrong with me, and that I didn’t have the coping skills that I previously thought that I had,” recalls Cassell.
Eventually, throughout the course of her sophomore season, Anna’s recovery progressed to the point where she had a successful year on the field and in the classroom during fall semester. During winter season, however, Anna was struck in the face with the ball. For a goalkeeper on the shorter side, this is not an uncommon occurrence. However, this instance led to an immediate recognition that something was off, and Cassell immediately took herself out of the game.
“The problem with this one was that the impact was not that significant, it had lower impact than my previous injuries, and so I thought ‘I’ll be over this in a little bit’, but I didn’t get over it for a very long time. I missed 10 days of school waiting for my symptoms to go away, and they just didn’t get better. Finally I had to sit down and say ‘OK, I’m a pre-med student, I want to go to medical school, I’m missing two weeks of class, what am I going to do?’ I came to the conclusion that soccer was going to be a long way away and that I needed to focus on getting back in the classroom. I got back in class and sort of muddled my way through that semester with persistent symptoms,” said Anna.
At this point, small concerns about her ability to fully regain health started to creep into Anna’s head. She said,
“I continued to struggle with symptoms for 4 or so months after the injury and at that point I’m wondering ‘How am I ever going to get back to playing Division I college soccer’?”
That summer, Anna sat down with the training staff and coaches to discuss her future, and they decided that a medical redshirt for her Junior year was the best plan to allow her time to fully recover. Unfortunately, even the best laid plans don’t always materialize. As she trained with the team during the course of that fall season, her symptoms continued to return as she attempted to replicate game-like scenarios.
“At this point it had been 6 or 7 months and I started to realize that I’m not ever going to get back to where I need to be and I also have these non-athletic aspirations, including going to medical school and a career that involves having a highly functioning brain. Nobody ever told me specifically that I needed to retire from soccer, but I spent a long time thinking about it, seeing neuropsychologists and talking to my athletic trainer about it. Interestingly, I had no conversations with my coaches about it until I had actually made the decision that I wasn’t going to play soccer anymore,” Cassell recalls.
She feels very fortunate that she was also able to stay on scholarship, and recognizes that other athletes without guaranteed scholarships may push the envelope beyond what should be considered safe.
“These scholarships are incredibly valuable and if I had had to bring that into the equation, who’s to say that I wouldn’t have tried to keep playing just to retain my scholarship,” she said.
“When I stopped playing soccer it was devastating. I felt like my entire identity had been taken away from me..."
While her brain was now able to mend, no longer playing soccer still took an emotional toll. Anna recalls, “When I stopped playing soccer it was devastating. I felt like my entire identity had been taken away from me. My whole life I had been a soccer player and I had professional aspirations. To go from loving a sport so so much, to not being able to be around it because it was too painful was really hard. I probably spent six months mourning that loss”. She continued, “I was very fortunate to have a very supportive group of friends who were not athletes and a very supportive family who helped me through that. Losing soccer was really hard, and coupling that with still suffering the effects of the last concussion made it a really difficult experience”
In hindsight, Anna is still happy with her soccer playing experience. She’s often asked if, knowing what she knows now, she would do things differently in terms of playing soccer, or playing at the level she did.
“I would 100% play soccer at the level that I did, again. It taught me tremendous life lessons. It built some incredible friendships. It really shaped the person I am today, but I also have no regrets in terms of stopping soccer when I did. I was able to stop playing before I developed an injury that would have lasting effects on me. I feel like two or three years ago, I returned 100% to my baseline. Who knows what would have happened had I kept playing, so I think I stopped at the absolute right time for myself. I’m really glad that I did that, when I did,” said Anna.
Today, while no longer suffering from the effects of her soccer related concussions, Anna does play the occasional pick-up soccer game (never as the goalie). However, she has largely transitioned to more outdoor lifestyle sports, and particularly those which Utah’s topography encourages.
“I ski, I mountain bike, I trail run, and I actually recently got into ultimate frisbee and I’m now playing that competitively. Thankfully I don’t feel at all affected by my concussions.”
As a current medical student, one might expect Anna to follow a neuroscience path given her history, however, she notes that her experiences have actually had a different impact on her medical career, one that directly relates to the doctor/patient relationship.
Anna said, “The thing that I really struggled with when I was making the decision to not play anymore was that the doctors couldn’t say ‘you should do this or you shouldn’t do this’. Now that I’m actually in medicine I realize that that happens a lot. It’s very rare that we actually say ‘this is 100% what you should do’. There’s a lot of shared decision making, and I actually think that’s a good thing in the long run. But as a patient it can sometimes be really hard. You just want somebody to tell you what you should do, and so I think I have a lot more empathy and understanding now for patients when we’re saying ‘Well, these are your options’ and they ask ‘Well, doctor, what should I do?’. I understand what it’s like to be in that position, because I’ve been a patient and I’ve struggled, so it’s given me more empathy for what it’s like to go through a situation like that.”
Her experiences with head trauma did, however, directly impact her Senior Thesis as an Anthropology major at Northwestern. Anna interviewed 20 other women who had to retire from soccer due to concussions. Two common themes emerged during this process, both of which were directly relatable to Cassell’s own history.
First, was that nearly all of the players were deceptive in acknowledging that there was a problem.
“People would either intentionally, or unintentionally hide their concussions because they didn’t want to let their team down, didn’t want to let themselves down”, says Anna.
The second theme was the emotional effects which Anna continues to be eager to bring to the forefront. She recalls, “The other thing was how emotionally impacted they were by the concussion, and that they didn’t understand what was going on. That really resonated with me in that I’m not alone in this experience and this is something that a lot of other people are having to go through.”
As a parting thought, Anna wants the people in player’s lives to be aware of the more hidden emotional symptoms. She said, “The emotional effects of concussions need to be more normalized and people need to be on the lookout because it’s not surprising to me how someone can have a concussion and do something impulsive, like hurting themselves, or hurting someone else. I think when your brain chemistry is messed with it’s really really scary.”