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Traumatic Brain Injury

Abusing Men’s Bodies (and Minds) for Our Viewing Pleasure

Football, like cigarettes, should come with a clear, big-letter warning.

US Navel Academy, Released to Public
Source: US Navel Academy, Released to Public

Football—watching it, not playing it--is clearly America’s pastime. Every year in recent decades the Super Bowl is the most-watched TV event of the year, and all or nearly all the 20 most-watched TV events are also football games. We are a nation that loves violence, or at least that loves to watch it. I’ve argued elsewhere (e.g. here) that watching or engaging in pretend violence is not harmful, but football is real violence, not pretend.

Football causes long-term brain damage in large numbers of players.

Football regularly causes serious brain damage, referred to as chronic traumatic encephalopathy (CTE), which leads to a set of symptoms that may appear years or even decades after retiring from the game. The symptoms can include severe depression, irrational violence, dementia, and premature death, sometimes by suicide. Such damage derives not just from major crashes to the head but also from repeated smaller hits, which seem innocuous in their immediate observable effects (Nowinski et al., 2022). These can be hits well below the level that result in noticeable concussions.

All this has been known to the sports world for at least 90 years. As far back as 1932 a report (identified by Stephen Casper, reported by Chen, 2023) at the annual N.C.A.A. conference acknowledged everything noted in the previous paragraph. What is new, at least relatively new, is detailed understanding of the anatomical brain changes that result from repeated hits to the head, which apparently underlie the behavioral consequences (Nowinski et al., 2022). This understanding has brought new publicity to the harmful effects of football and at least some renewed public awareness (though not enough).

How frequent is CTE?

Over the past 10 years researchers have identified the telltale brain changes of CTE in hundreds of football players who donated their brains for autopsy at their death after suffering CTE behavioral symptoms (Nowinski et al, 2022). Research suggests that, overall, professional football players have at least a 15% chance of eventually exhibiting the symptoms of CTE and that the likelihood of CTE increases with every year of involvement in the sport.

There is reason to believe, however, that for current players, the risk is even greater than it was for those whose brains have been examined. The players are now bigger, stronger, and faster than they were in the past, so the head hits are harder, and the players devote more time crashing into one another in training, resulting presumably, in increased likelihood of CTE.

Although the risk of CTE increases as years at football increase, there appears to be no completely safe “dose” (Nowinski et al, 2022). Research has even revealed CTE in some who only played youth or high school football, and some neurologists suspect that young brains may be even more susceptible to the damage than more mature brains. Yet, even now tens of thousands of children as young as five years old play adult-run tackle football (Chen, 2020).

The case with football and CTE is similar to that, decades ago, with smoking and cancer. The billionaire franchise owners, and the universities enriching their coffers from it, put their heads in the sand or go through motions of “making the game safer” (analogous to putting filters on cigarettes), while doing whatever they can to obscure the science that proves the dangers and to resist any pressure to abolish or seriously change the game. Those who enjoy the product from the safety of their living room couches likewise put their heads in the sand, preferring not to see or believe the data.

What can and should we do about this abuse of boys and men, who seek the glory blind to the gory?

I won’t watch football. If nobody watched it, it would go away. But that’s not going to happen anytime soon. People are going to keep watching football for years to come. But here’s a proposal that may have at least some chance of acceptance (suggested by Stephen Casper, as reported by Chen, 2023).

Suppose a new law, or surgeon general proclamation, required that a prominent sign be placed in every locker room in the country, with big letters, saying: WARNING: FOOTBALL HAS BEEN SHOWN TO CAUSE BRAIN DAMAGE LEADING TO SUCH SYMPTOMS AS SEVERE DEPRESSION, IRRATIONAL VIOLENCE, DEMENTIA, AND SUICIDE. It would be like the warnings on cigarette packs and cigarette ads.

We might also require that the warning be shown before and several times during every televised football game and require that anyone signing up to play the game sign a statement acknowledging that they have read and understand the warning. At least then we would know that those who choose to play football, and those who choose to support it by watching, would know what they are getting into.

What about children too young to understand and weigh the warning? They should be running around playing in their own joyful ways, as children are designed by nature to play, never lined up by coaches to crash into one another on command. That change would happen quickly if parents had to sign the warning.

I conclude, as I did in an earlier post on this topic, with excerpts from the late George Carlin’s classic comparison of football with baseball (which used to be our national pastime):

“Baseball begins in the spring, the season of new life. Football begins in the fall, when everything is dying.”

“Baseball is played on a diamond, in a park. The baseball park! Football is played on a gridiron, in a stadium.”

“In football you wear a helmet. In baseball you wear a cap.”

“Football is concerned with downs—what down is it? Baseball is concerned with ups—who’s up?”

“In football you receive a penalty. In baseball you make an error.”

“In football the specialist comes in to kick. In baseball the specialist comes in to relieve somebody.”

“In football the object is for the quarterback, also known as the field general, to be on target with his aerial assault, riddling the defense by hitting his receivers with deadly accuracy in spite of the blitz, even if he has to use shotgun. With short bullet passes and long bombs, he marches his troops into enemy territory, balancing this aerial assault with a sustained ground attack that punches holes in the forward wall of the enemy's defensive line. …. In baseball the object is to go home! And to be safe!—I hope I'll be safe at home!”

To see the whole thing, with Carlin’s great way of presenting it, click here.


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Chen, I. (Feb. 1, 2020). Exactly how dangerous is football? The New Yorker.

Chen, I. (Feb. 11, 2023) The forgotten history of head injuries in sports. The New Yorker.

Nowinski, C., et al. (2022). Applying the Bradford Hill criteria for causation to repetitive head impacts and chronic traumatic encephalopathy. Frontiers in Neurology 13 Article 938163.

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