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Photo: Cavan Images/Getty Images

Shane Tamura never played professional football. He never played in college either. By all accounts, his career as a running back was limited to high school. But before he opened fire in a Manhattan office building on Monday, killing four people, the 27-year-old wrote a note saying he had the same telltale disease as the pros: chronic traumatic encephalopathy, or CTE.

Tamura apparently targeted the building because it contained the headquarters of the National Football League. In the note, he referenced a former NFL player who was diagnosed with the disease after committing suicide. Tamura also wrote that “the league knowingly concealed the dangers to our brains to maximize profits. They failed us.” Investigators say they are still working to piece together his motive.

The degenerative brain disease, believed to be caused by repeated impact to the brain over time, can only be definitively diagnosed post-mortem and any such diagnosis for Tamura would not be immediate. While the public has mostly understood the disease as one that impacts professional athletes who have spent much of their lives taking repeated blows to the head, researchers have for years gathered evidence that young athletes can also develop CTE. And like some professional athletes with the disease, their lives can end in a violent spiral.

Wyatt Bramwell, whose passion for football began in the third grade, took his own life in 2019 when he was 18 years old after leaving behind a video asking his parents to have his brain examined for CTE.

“He shot himself in the heart, not the head,” his mother, Christie Bramwell, said after it was confirmed, four years later, that Wyatt had CTE. He had played tackle football for about 10 years and had his heart set on a college football career, but the “voices and demons” in his head derailed those plans, he said in a video shortly before shooting himself in the chest. (On Monday, Tamura shot himself in the chest, also saying he wanted his brain studied after his own death.)

Bramwell’s brain, part of a 2023 study by researchers at Boston University, revealed some of the worst damage ever seen in someone so young, the Concussion Legacy Foundation said at the time. The study suggests there are many more young athletes like Bramwell suffering from the disease.

Chris Nowinski, the co-founder of the Boston University CTE Center, says the “only risk factor” for CTE is “years of play” in a collision sport like football.

“We published a study years ago showing that the average hit to a 9-year-old is just as hard as the average hit to a college football player,” he says. “We don’t have a good window into the damage we’re doing to children, but if you hit a kid in the head a few thousand times while the brain’s going through critical windows of development, you can expect to change the course of their brain development.”

Before becoming a neuroscientist, Nowinski played football at Harvard University and spent a couple years as a heel in the World Wrestling Entertainment before retiring due to chronic head injuries. Since then, he has become a leading researcher in sports-related head trauma.

While a running back like Tamura may have only played four years of competitive football, Nowinski says, youth players can still be exposed to frequent head impacts beyond just concussions. There’s also no correlation between the presence of CTE and the number of concussions an athlete suffers. “But that is primarily because we don’t diagnose most concussions and people don’t remember most concussions,” he says.

The risk of developing CTE is “directly related to the number of years of playing football,” says Dr. Ann McKee, the director of the Boston University CTE Center. For every 2.6 years of playing football at any level, according to McKee, the risk doubles. Since repeated hits to the head are seen as the norm in some contact sports, young athletes may not even be aware of the dangers, and the common perception that only concussions can cause CTE is false. “The concussions are the tip of the iceberg,” she says. “The real issue is the hits to the head that don’t cause symptoms, and that’s the majority of the hits.”

When there are no symptoms, she said, people aren’t aware of the risks of damage.

“We are not protecting them right now,” she said, adding that unless measures are taken to limit the number of hits to the head in youth contact sports, or to limit each athlete’s time in the game, “They are not protected.”

The drastic behavioral changes associated with CTE can often be mistaken for other mental health issues, since there’s no way for doctors to test for CTE and in most cases, they probably wouldn’t even suspect it. McKee laments that youth athletes who do complain about certain symptoms are often “dismissed” or have their concerns “invalidated.”

Meiko Locksley, one of 152 athletes diagnosed with CTE before even reaching the age of 30 as part of the Boston University CTE Center’s 2023 study, never made it past college football and began exhibiting signs of the disease in his 20s.

“I always thought, like, how do you go from a normal 21-year-old Division I football-playing person to, literally six months later, saying you hear people in the basement of an apartment where you lived on the eighth floor and you don’t have a basement?” Michael Locksley, his father and a University of Maryland football coach, said in a 2023 interview.

The study that led to Locksley’s diagnosis also presented a worrying discovery: More than 40 percent of 152 contact sport athletes who were younger than 30 at their time of death had CTE. Most of them had only played football in high school or college, and the youngest among them was only 17. Some of them had played other contact sports, like ice hockey, rugby, wrestling, or soccer.

Suicide was found to be the most common cause of death for those who were found to have CTE, a grim finding that raises the question of whether or not some form of recognition of their symptoms by doctors might help them avoid that fate.

While concussion protocols have been implemented in many high school football programs, requiring players to sit out if they are showing signs of a traumatic hit, there’s nothing to stop the many other strikes to the head accumulated during a game.

“If you’re a starter and it’s an important game, they’re going to try to get you back out there,” says Alan Castillejos, who was the quarterback at Permian High School in Texas — the one from Friday Night Lights — playing to 19,000-capacity home crowds just after the movie came out. He remembers a senior-year home game in which he was hit in the head while scoring a touchdown. He went to the sideline and told the trainer his vision was blurry and that he had a massive headache. “The trainer took a smelling salt, broke it, and jammed it up my nose,” says Castillejos. “He goes, ‘Sniff on that for about five minutes.’”

Even as the risks became more known, it’s hard to change the nature of a sport designed to hit the other guy as hard as possible. “I wanted people to see that I can knock somebody out,” says Castillejos, who is a physical therapist in Odessa. “I think football’s done a good job of taking some of that stuff out. But it doesn’t change the fact that what you are taught and told to do — and what you want to do — is just go blow somebody up.”

The NFL was accused of covering up what it knew about football leading to long-term brain injury until it was forced to admit to a link between the sport and CTE during a congressional hearing in 2016. In response to public pressure over head trauma in recent years, the league has made significant efforts to reduce big hits — including limiting tackling in practice and effectively retiring the kickoff, a high-collision, high-injury event.

“But those two changes have not been made at the high school football level,” says Nowinski. “The NFL players have a union that fights for them, and so therefore they’ve pushed for these changes.”

While the league has been the focus of the larger conversation around head-trauma, Nowinski says that CTE is a “disease of pediatric exposure.”“Beer league hockey players aren’t hitting each other in the head, adults playing soccer aren’t hitting the ball with their head 100 times a week,” he says. “This is something that only kids are willing to do. They don’t know better. We should be calling this, primarily, a pediatric acquired disease.”

Did the Office Shooter Have CTE? The Brain Disease Goes Beyond the NFL.

Did the Office Shooter Have CTE? The Brain Disease Goes Beyond the NFL.