Keith O’Neil: A Football and Public Health Hero
Keith O’Neil is a former Super Bowl champion and the founder of the Forever Foundation, an organization whose mission is to educate the public about bipolar disorder and to de-stigmatize the illness. In September he spoke at the Brain and Behavior Research Foundation (formerly NARSAD) meeting in Washington, DC.
O’Neil’s life story holds many important lessons— not only about the difficulties of bipolar illness, but also about the hope of recovery. He described being six years old and experiencing high levels of anxiety and fear, and an inability to get to sleep. His mind raced and he was so irritable that he was nicknamed “The Bear.”
The anxiety and the racing thoughts continued, and O’Neil became increasingly depressed. When he was 10 or 12 years old, he began to experience suicidal thoughts and searched his parents’ medicine cabinet for pills he could use to commit suicide. Anxiety and depression became more prominent even though he was an “A” student, one of the most popular kids at school, and an extraordinary athlete, and had a loving family and many friends. He began to use alcohol excessively, had conduct problems, was impulsive and was always in trouble.
O’Neil excelled in football in high school, started college at Northern Arizona University, and quickly became an All-American linebacker at Penn State. He was a first-round draft pick for the New York Giants. His teammates would nap between workouts for coach Bill Parcells, but instead, O’Neil would sit and cry over his inability to sleep. When he was later picked up by the Dallas Cowboys as a free agent, he was unable to sleep for five nights.
O’Neil moved on to the Indianapolis Colts. He did not sleep for four nights before his first game, and told coach Tony Dungy that he needed help, as he did not think he could play the next day. Dungy took him seriously and had him meet with the general manager, the team doctor, and the trainer. O’Neil felt extraordinarily relieved to be able to talk about his anxiety for the first time and took some clonazepam (Klonopin) for sleep and anxiety. Although he missed his first game, he became increasingly successful and the captain of the team that three years later would go on to win the Super Bowl.
O’Neil returned to the Giants for five seasons. While in New York, his wife miscarried, triggering O’Neil’s first major manic episode. He felt super human, spent excessive amounts of money (bought a Rolex watch and three diamond earrings), did not need sleep, and was generally out of control. In 2010, O’Neil was diagnosed with bipolar disorder by Steven Dubovsky, one of the pioneers in the development of calcium channel blockers for the treatment of bipolar disorder.
After his manic episode, O’Neil swung into a severe 18 month–long depression, which he described as “the depths of hell.” He gradually improved and started on a regimen that included medications, exercise, and relying on his family for comfort and support. He then moved to Phoenix, Arizona to start his foundation—the Forever Foundation.
The foundation provides information about the illness and promotes de-stigmatization. O’Neil visits high schools to teach students about bipolar illness and the importance of talking about anxiety and depression and getting help.
In the question and answer period following his talk, O’Neil discussed his own treatment. His early experiences with antidepressants were somewhat positive for his depression and anxiety, but may have been influential in his first manic episode. He said he is now well, and described his current medication regimen, which includes lithium, the mood stabilizing anticonvulsant oxcarbazepine (called Trileptal, which is structurally similar to carbamazepine or Tegretol), and the atypical antipsychotic aripiprazole (Abilify), which works extraordinarily well for him and which he called his savior. O’Neil occasionally uses Ambien (zolpidem) or Seroquel (quetiapine) for sleep.
O’Neil talked about the importance of confronting his own illness and adopting a positive attitude about getting treatment and doing everything he could to get well. He had a family history of mood disorders including depression in his paternal grandfather and bipolar disorder in an uncle.
O’Neil remembered that in his days as a professional football player, even though he was a standout player, he was so anxious that he would get confused about the playbook and have to rehearse it over and over in order to remember. He felt that he dealt with his racing mind and his anxiety in part by funneling it into “controlled recklessness” as a football player.
Keith O’Neil received a standing ovation from the gathering of scientists and approximately 150 supporters of the Brain and Behavior Research Foundation .
It is noteworthy that after Keith’s presentation, many of the scientific presenters speaking about the latest advances in the understanding and treatment of anxiety disorders in children, depression, and bipolar disorder directly referred to his life story and the important messages embedded in it.
One example is the high family burden of illness. In the United States, first episodes of bipolar disorder begin in childhood (before age 13) a quarter of the time and in adolescence (before age 19) two-thirds of the time. More patients in the US compared to Europe have a family history that includes not only bipolar disorder but also many other psychiatric illnesses such as depression and substance abuse comorbidity. Grandparents of US versus European patients also have more mood and other disorders. The total family history burden of disorders in parents and grandparents is directly related to an earlier age of onset in patients with bipolar disorder.
Another example is O’Neil’s early experience of the illness and his personal traits. High levels of anxiety and insomnia are often early precursors to bipolar disorder. Individuals with bipolar disorder are often extremely smart, “A” students in school, and creative. The illness in adolescents and children is often not recognized or diagnosed for 10 to 15 years or more.
Another example is his symptoms. Suicidal ideation is common, and suicide attempts occur in about 40% of individuals with bipolar disorder. Use of alcohol and other substances of abuse is very common. Getting help for these addictions is important to getting well and staying well. Racings thoughts in an otherwise classical depression is often associated with either non-response to antidepressants or an increased risk of switching into mania on them. Severe unrelenting depression often follows a manic episode. Depression and anxiety can impair learning and memory.
O’Neil’s treatment also has similarities with many patients’. Recognizing the need for medications is a key to recovery. Requiring multiple drugs in combination in order to achieve and maintain remission is typical in the treatment of bipolar disorder. Eliciting and receiving support by family, friends, and others is an important component in fighting the illness. A positive approach to the illness, i.e. doing everything one can to ameliorate symptoms, is another key to getting well and staying well.
Being a role model, i.e. achieving great success in one’s profession even with the extraordinary adversities of bipolar illness is a great personal accomplishment and important public health message. Active work to de-stigmatize the illness, and helping young people to recognize psychiatric illness, talk about it, and get help can be life saving.
Being attentive to risk factors, such as family members’ histories of mood disorders, may heighten awareness of illness in childhood and shorten the time to first treatment.
