With the release of a film telling his story, Bennet Omalu describes the process of discovery that led to clashes with the league – and how his own encounters with depression helped enhance his understanding

The film begins much like the real story, with number 52: Iron Mike Webster.

The day he was inducted into the NFL hall of fame, Webster, a Pittsburgh Steelers legend and stalwart center of one the greatest dynasties in league history, was at the beginning of a very public unravelling. It was late July 1997 in Canton, Ohio, and Webster’s acceptance speech rambled and dragged, running beyond his allotted time by a good 13 minutes. It wasn’t without its lucid moments, though. “You know it’s painful to play football, obviously,” Webster said. “Two a day drills in the heat of the summer and banging heads. It’s not a natural thing.”

Five years later, at age 50, Webster was dead, of an apparent heart attack. The man scheduled to perform his autopsy might have known less about Iron Mike than anyone in the city of Pittsburgh. Bennet Omalu, a Nigerian-born forensic pathologist, only knew what he’d seen on television earlier that morning, that this favorite son of the steel city was disgraced – sleeping in his truck, estranged from his wife, busted for forging prescriptions.

As he moved through the examination, weighing, measuring, and testing, eventually Omalu arrived at Webster’s brain. When he opened the skull, Omalu was surprised to find that by all outward appearances, it was completely normal. On a whim he ordered an assistant to “fix the brain”.

Over the ensuing decade, that decision would bring Omalu face to face with the billion-dollar National Football League and its army of lawyers, doctors and public relations experts. The conclusion he would come to, that the human brain cannot withstand an unlimited number of traumatic impacts, presented a profoundly inconvenient truth for America’s game.

Omalu’s research suggested that eventually the collisions, large and small, which characterize a contact sport like football take their toll. Speaking to the Guardian in New York, Omalu said: “There is no equipment that can prevent this kind of injury.”

Now that his findings are mainstream, in the form of the just-released movie Concussion starring Will Smith, the future of the game is more in doubt than ever.

One of the first things Omalu noticed about Webster’s body was the hardened calluses on his forehead, a shelf of scar tissue, right about where the – in those days – thin, stiff padding of his helmet would be thrust into Webster’s face on every snap. There was no shortage of damage to discover. Ever the embodiment of lunchpail Pittsburgh tough, Webster, in his last year, had begun repairing his body in blue-collar fashion: spit and glue. Literally. Webster had taken to reattaching his teeth with super glue, and using it to plug his wounds. He was using duct tape to make walking on his cracked, disfigured feet bearable.

Facebook Twitter Pinterest Alec Baldwin and Will Smith in Concussion. Photograph: Everett/Rex/Shutterstock

And Iron Mike’s psychiatric deterioration was at least on pace with what was happening to his body. Webster was scarfing down Ritalin like candy; it was the only thing that could steady his mind enough to perform daily tasks. He was afraid to fall asleep, and yet took to shooting himself with a stun gun just to pass out.

Omalu, too, knew what it was like to be psychiatrically unwell. In college, which he began at age 16 at the University of Nigeria Enugu, Omalu began to experience profound bouts of depression. In Jeanne Marie Laskas’s book Concussion, Omalu describes feeling unable to move, unmotivated to do anything. “Something was wrong inside me, very, very wrong,” he said.

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Omalu told the Guardian that this experience with psychiatric illness, at a time in Nigeria when the very idea was generally regarded as disgraceful, played a major role in how he approached Webster that September day in 2002. “When I met Mike Webster in death, that morning I had heard about his life. I empathized with him. I saw myself in Mike. What it is to be psychologically ill and have people not understand,” Omalu said.

“It was one of the factors that converged to help me unravel this disease,” Omalu added. “There was this camaraderie between me and Mike, so I said to him: ‘Let’s figure this out together, there’s something wrong.’”

Omalu didn’t know what he was looking for when he asked that Webster’s brain be fixed, the chemical process that solidifies the organ enough to be sliced and examined. But Omalu was certain that “people don’t go crazy for no reason”, Laskas wrote in Game Brain, the 2009 GQ article which spawned both the book and the movie Concussion.

After Omalu had the slides made, spending tens of thousands of dollars of his own money, he finally made a key discovery: pathological buildup of a protein called tau. While tau belongs in a healthy brain, too much and the proteins tangle up and strangle off healthy cells. In the film, Smith’s character describes it as like pouring concrete down plumbing pipes. These tau tangles had been seen before, in boxers, part of a condition known as dementia pugilistica, or punch-drunk syndrome. This was the first time, however, that it had been seen in the brain of an NFL player.

Facebook Twitter Pinterest Bennet Omalu: ‘Your brain resets itself.’ Photograph: Joshua Bright/The Guardian

“After a certain number of blows to your head, nobody knows exactly what number, your brain resets itself and begins to initiate abnormal biochemical cascades that result in the buildup of abnormal proteins like tau. So by the time tau is accumulating, the injury is already done,” Omalu said.

Omalu was a newly certified neuropathologist in 2002, one qualification on a laundry list of credentials that today includes his MD, master’s degrees in public health and business, and five medical board certifications.

As a novice and a no-name, if a gifted one, Omalu looked for more established brain experts to co-sign on his discovery. With Steven DeKosky, a big-name neurologist at the University of Pittsburgh, and Julian Bailes, a neurosurgeon and former Steelers team doctor in tow, Omalu took the idea of chronic traumatic encephalopathy, or CTE, to publication. Omalu would go on to find the pathology in the brain slides of other ex-players, including former Steelers Justin Strzelczyk and Terry Long, as well as former Philadelphia Eagles safety Andre Waters.

The NFL scoffed at the CTE paper. It asked for a retraction. When the league didn’t get that, it decided to ignore Omalu instead. In 2006, when the league hosted a “concussion summit” in Chicago, Omalu wasn’t invited. Bailes, played by Alec Baldwin in the movie, presented the research – Omalu’s research – to the league. Even today, with his relationship to CTE now enshrined in Hollywood lore, Omalu said the NFL wants nothing to do with him. “The NFL has not found any goodwill in reaching out to me,” Omalu said.

The NFL is not alone. Omalu wound up on the outside looking in several times over in the CTE debate, like when his onetime partner Chris Nowinski went off to found the Concussion Legacy Foundation in Boston, or when the National Institute of Health (NIH) began doing CTE research. “The NIH assembled a panel of doctors to determine the criteria for CTE; they never even reached out to me. Any official who was responsible for that needs to be fired,” Omalu said.

Facebook Twitter Pinterest A trailer for Concussion.

By 2014, the NIH had identified 59 cases of CTE in 62 ex-players’ brains they had studied. NFL donations totalling $12m had been directed to the studies.

The league has known at least something about concussions since the early 1990s, when two star offensive players, running back Merril Hoge and wide receiver Al Toon, both retired before age 30 due to concussion concerns. In Hoge’s case, after suffering two concussion in a five-week span, his heart actually stopped and he needed to be resuscitated. Hoge spent two days in the ICU, and the next two years recovering from severe cognitive symptoms. In 1994, the same year Hodge retired, the league launched its “mild traumatic brain injury” committee, which, unsurprisingly, published a great deal of research suggesting concussions and brain trauma were a trifling concern for NFL players.

In Hoge and Toon’s cases, the issue was seen as a matter of timing, and a matter of severity. The problem was that both had been concussed too often, with too little time to recover, and now their brains were susceptible to more damage. This is the kind of concussion understanding the league’s new concussion protocols, introduced in 2013, are designed to address. Spot players who may be concussed, run them through a battery of tests to find out how badly, make sure they don’t come back too soon.

What the new rules don’t cover – what they can’t, by definition, according to Omalu – is the very nature of the game. The brain impacts that happen simply because one is engaged in the repeated impacts of blocking, tackling and being hit. Asked about the league’s new emphasis on “taking the head out of the game”, Omalu laughs his trademark high-pitched chuckle. “Can you take the head out of a high-impact contact sport? No!”

Omalu, and most other concussion experts, now agree that CTE is not triggered by undiagnosed concussions per se, but simply in the course of the normal “sub-concussive” hits which define the game.

Facebook Twitter Pinterest Bennet Omalu and actor Will Smith pose together at the cast photo call for the film Concussion. Photograph: Evan Agostini/Invision/AP

No rule changes and no protective gear can alter that fact, according to Omalu, and he pins most of his hope for saving the sport on a “pharmacological intervention” – such as a pill one could take to prevent the buildup of tau.

Until that day comes, CTE will loom large over football at all levels, including youth. Omalu has opined that children should be kept from the game until age 18.

“Any activity which results in repeated blows to the head has the risk of causing brain damage. Once you know the risk involved in something, what’s the first thing you do? Protect the children from it,” Omalu said.

Whatever the solution, Omalu believes it can only emerge in the light of the truth. “No matter who you are, no matter the color of your skin, there’s only one truth,” Omalu said.

Omalu’s full last name, Onyemalukwube, translates to “if you know, come forth and speak”, a fact screenwriters adapting his story for the big screen could hardly have improved upon. Asked if it’s a name he’s lived up to, Omalu laughs and smiles: “I have! I have!”