On the Morality of Watching Concussions: Or, My Personal Battle Over (American) Football

Last fall, Scott invited me to post here at Kulturblog on sports. After promptly forgetting and/or procrastinating for several months, I decided to finally write something. Unfortunately, I don’t think my first post here will be that popular a message with sports fans.

One hundred and twelve million people tuned in to the Super Bowl last week, and I admit I was one of them. (Well, at least the first half of the game; halftime came a little after 1AM here, so I went to bed instead of staying up to watch Madonna and the Giants come out as victors.) I admittedly enjoyed the game, though not as much as I enjoyed watching the BBC commentators try to explain American football to a British audience. (Especially when they attempted to explain the “safety” rule when Tom Brady was sacked in the end zone–that was comedy gold.) But I’ve felt guilty for the rest of the week over watching the game, and I still feel bad for tuning in. Why? Because I’ve been somewhat outspoken in my critique of football as a destructive sport that thrives on legions of fans watching top-notch athletes beat each others’ brains out to a point that many will likely die an early death, or at least suffer serious repercussions for much of the rest of their life. I have increasingly grown more strident in my belief that there is something seriously and morally wrong with American culture’s obsession with football, and yet I still gave in and watched the crowning moment of the sport in question. I have sincerely felt troubled with this hypocritical slip, and one of my cousins even called me out on it on facebook.

The last decade has witnessed a tremendous rise in frightening research results concerning the impact of American football (and sports in general) on the human body. More and more attention has been given to the dangers of concussions. The Center for Disease Control and Prevention has estimated that close to two million student athletes suffered a brain injury every year. Neurologists have demonstrated that those who suffer multiple concussions risk severe cases of memory loss, a decrease in performance at school, cognitive impairment, and frequent migraines. Even more troubling, research has shown that it doesn’t require a diagnosable concussion to cause serious problems; numerous minor hits that happen play after play after play (the nature of football) can have just as scary results as one or two major hits. To put it simply, the more conclusions that have come out, the darker the picture is. (See a great overview here.)

The most disturbing research concerning the NFL has been in diagnosing chronic traumatic encephalopathy (CTE). Possessing symptoms similar to Alzheimer’s, CTE is the result of the brain crashing into the skull too many times. While research is still young, early results have been spectacularly scary. Middle-aged NFL vets have been tested to be twenty times more likely to display symptoms. Twenty. Times. But official diagnosis can only be achieved through autopsies, so until more NFL vets donate their post-mortem brains to research, we can’t know the exact number for sure. (Fortunately, there have been growing numbers who have signed over their bodies for autopsies after they die, but that still requires waiting for them to, well, die. In one tragic case, an ex-NFL player who was plagued with early-onset dementia, amongst other medical issues, was so fed up with his symptoms and beset with depression that he gave in and shot himself in the heart so that his brain could still be examined.) The medical unit at Boston University that has been specializing in this research have only collected fifteen brains thus far–and guess what? Fourteen of them had CTE. This is serious stuff. (See this excellent summary of CTE, as well as other issues, and how it is likely just as prevalent at high school levels as at the professional level.)

It is tragically ironic that these statistics are becoming more well known at the very moment football has never been more popular. The National Football League likely made over ten billion dollars last year. That’s right, billion. It is the most profitable sport in America, and the competition isn’t really close. College football has been similarly successful, with numerous schools running after new collegiate conferences and tv contracts like high school girls chasing after a handsome jock. And that’s where the problem is: as long as we perpetuate a culture in which football is valorized, people will keep flocking to it, despite the medical risks. Instead, the NFL keeps introducing silly rules that try to decrease serious hits, when in reality they are impossible to follow and ridiculously difficult to regulate. (Do you really think it is fair to make James Harrison decide in a fraction of a second whether a quarterback is about to release the football, and then manage his 270lb body that is flying at full speed to hit a narrow “safe zone” on a moving target? Well, I don’t.) All of these rules are just lipstick on a pig, an attempt to rearrange chairs on the Titanic. If the sport is to be saved, and I’m not sure it can, it has to be modified in a way that will make it not very recognizable to what it used to be.

(And for the record, football is at least three times more dangerous than the next most dangerous sport: girls’ soccer.)

An excellent write-up this past week by Tyler Cowen and Kevin Grier examined the different possible ways that football will die as a sport. The quick way would be through legal action, as former athletes or parents of current players will sue leagues and schools for the damage that took place on the field. (The NFL has already faced three high-profile suits this year, and those were just the beginning.) It is not outlandish to imagine a state legislature in the next decade to pull all funding from school districts that maintain a football team. Then there are the economic issues: as the growing awareness of medical issues will cause insurance rates to skyrocket, thus making it impossible for schools to continue their football programs. And finally, and perhaps most importaning, parents will start realizing the risks that come with football, and will stop allowing their children to participate. Registration in youth football has already started to decrease, and I imagine that decrease will only continue. If the legal or economic issues don’t strike soon and offer football a quick death, it will only then suffer a slow decline as less and less youth enter the sport and it becomes, like boxing, a marginalized niche that will be predominantly filled by individuals from low-income families with poor schooling and little support.

But enough prognosticating of what parents, school districts, legislatures, and judges will do in the future. I’m more interested in the moral duties of us, the public consumers. For someone who, like me, finds serious problems with the current football culture, am I complicit in the debacle when I watch the Super Bowl? Are there moral issues concerning entertainment beyond being entertained? Because football players are using their own agency to participate in the sport, and are getting monetarily rewarded for their risks, does it justify our enjoying of their sacrifice? Am I justified in watching the Super Bowl, or in maintaining an irrational interest in the college football season? I often dismiss my concerns by explaining high school players are learning important life lessons, college players are getting free tuition, and NFL players receive a ridiculous salary…but these self-justifications always seem so, well, shallow.

I am haunted by how Malcolm Gladwell closed his brilliant and highly-recommended article on this issue. In response to a statement by Ira Casson, who heads an NFL committee investigating concussions, that it is ridiculous to think football will just stop, Gladwell wrote: “Casson is right. There is nothing else to be done, not so long as fans stand and cheer. We are in love with football players, with their courage and grit, and nothing else—neither considerations of science nor those of morality—can compete with the destructive power of that love.” He then included this poignant excerpt from a scholarly work on dogfighting:

When one views a staged dog fight between pit bulls for the first time, the most macabre aspect of the event is that the only sounds you hear from these dogs are those of crunching bones and cartilage. The dogs rip and tear at each other; their blood, urine and saliva splatter the sides of the pit and clothes of the handlers. . . . The emotions of the dogs are conspicuous, but not so striking, even to themselves, are the passions of the owners of the dogs. Whether they hug a winner or in the rare case, destroy a dying loser, whether they walk away from the carcass or lay crying over it, their fondness for these fighters is manifest.

It’s these words that make me think that we perhaps need more consideration on the morals of watching football. And it is these words that make me feel guilty for, once again, giving in and watching the Super Bowl.

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32 thoughts on “On the Morality of Watching Concussions: Or, My Personal Battle Over (American) Football

  1. This strikes me as ridiculously overblown and exaggerated. Millions have participated in football at all levels since the early part of the last century. Safety rules and equipment have only gotten better during that time and will continue to do so. The vast majority of players compete for years and live long and fulfilling lives after their playing days are over with no long term effects.

    To equate football with dogfighting is an irresponsible and disgusting joke. Even comparisons with boxing are inaccurate. In activities like boxing, injury or incpacitation of the opponent is the goal. In football of course, it is not at all the goal to injure or incapacitate any player, and any intent or attempt to do so is penalized. Are there some injuries and some safety concerns in football? Of course. But the answer to those risks is better equipment and more rules designed to protect the players. Football can be and usually is played without major injuries or overwhelming risks to players.

    Almost all sports, and many non-sport activities, carry some risk of injury. The idea that we can or should get rid of all these simply because of the risks associated with them is beyond silly. It’s not possible or desirable to eliminate risk of injury from sports or from life, and attempts to do so are misguided and doomed to failure.

  2. MCQUEEN: I encourage you to check out some of the links included in the post. In my opinion, this is not overblown at all. Tests have been done with even the most advanced equipment, and the results have been profoundly disturbing. They can keep trying to update the equipment and rules, but I strongly believe that only a radical transformation would have a chance at saving it. With youth football, the connections to early-onset symptoms of amnesia, frequent migraines for life, drop in energy and activity, and decrease in school performance are staggeringly high. With the NFL, the fact that fourteen out of fifteen autopsy tests so far have revealed the player to have CTE, a debilitating disease that should only be found in a minuscule percentage of people, is eye opening. If they find a connection of youth football to CTE, and some doctors hypothesize that players under the age of 18 may be especially prone to it, then the game is over. Period. They are constantly studying all other American sports, and nothing comes close to the results of football, so you can’t equate the risk of injury.

    Look, I’m not happy over these findings. I played football as a youth and in high school and loved it. But the more I have looked into it, and I have read nearly every study that has come out over the last few years (probably over a hundred from different research centers–the growing consensus is surprising), the more I conclude that a comparison to something like dogfighting is far from “an irresponsible and disgusting joke.”

    Football will be dead in two decades. Trust me. The question is how many of us, including me, will feel guilty for holding on to the entertainment value too long.

  3. Ben, it’s MCQ. Is it a problem for you to get my name right?

    From one of your links:

    “Over the last five years, she has autopsied the brains of fifteen former players who suffered from various mental conditions, including memory loss and depression. Fourteen of these players had CTE.”

    The autopsies were performed on former players who all had symptoms. That’s not a random sample, as you seem to imply. One would expect brains of symptomatic individuals to have problems, so you can’t hang your hat on this evidence.

    You say:

    “With youth football, the connections to early-onset symptoms of amnesia, frequent migraines for life, drop in energy and activity, and decrease in school performance are staggeringly high.”

    Where’s your backup for this statement? It’s pretty far out there, when we all know many, many players of youth and high school football who have lived long and happy lives, symptom free. My grandfather lived to 97 and was sharp as a tack to his final day, and they played with leather helmets in his day. I played and so have most of my friends and not one I’m aware of has any of the symptoms you describe.

    Sorry, I don’t trust you or your predictions. Football has lasted a long time. It has overcome a lot of problems in the past and will likely overcome this one. Concussions are a danger, but they can be reduced and football will continue to be played with relative safety and enjoyed by millions.

  4. MCQ: I don’t have time to respond in depth to your whole comment now, but I want to sincerely apologize for the name thing. I was writing on my iPad, and it did autocorrect. I am embarassed and ashamed that I didn’t catch it. Again, my apologies.

  5. Alright, I felt so bad about the name thing that I went to pull some references for you.

    Besides the studies mentioned in the Gladwell article, one of the most exhaustive studies on the effects on high school students was performed by Purdue University, which determined that small, undiagnosed hits have serious impact on a high school student’s cognitive abilities. (One article on this study is found here.) On tracing the potential damage of each of these medium to heavy hits, the New England Journal of Medicine published a study on tracing each impact on the brain. (Found here.) Also at issue is because most of these concussions go undiagnosed, many players fail to sit out the required amount of time, leading to more serious complications.

    One of the most informative writers on the issue has been Alan Schwarz of the NYT (you can do a search through his author page). He has closely followed the debates over high school, college, and professional sports, as well over the new equipment and their effectiveness.

    While many people are fortunate to live long, happy lives after playing football (I’m lucky to be among them), there have been a large number who have suffered the symptoms. We just choose to forget about them because we have no use for that narrative. Sure your grandfather lived to a ripe old age with no consequences, but that doesn’t justify the sport; my grandfather could say the same thing about smoking. The facts are that research is demonstrating the literal risks inherent in football, and they are much higher than any other American sports. They are scientifically documenting and analyzing actual effects on high school students, and the problems are only getting worse as players are getting bigger and faster.

    I’d love to see the changes put in place that will save the game. I have yet to see any inkling of what those could be, though.

  6. One potential solution is to decrease the amount of padding. The heavy padding allows much harder hits than football without padding. It would increase other types of injuries – especially career ending ones. However the number of concussions would almost certainly decrease. (This is an issue in boxing as well – the heavy gloves were supposed to help make boxing safer but arguably just enabled much, much heavier blows to the head)

  7. Ben, thanks for writing such an in-depth post. MCQ, thanks for offering a spirited rebuttal.

    I think this is a troubling issue that should be addressed, and is in fact, being addressed by the NFL, but I find it extremely doubtful that professional football will go away within a decade, or even be noticably marginalized.

    We can all agree on the fact the NFL has extremely deep pockets. This allows them to do everything in their power to protect players, hire boatloads of the country’s best lawyers to defend themselves, and put plenty of persuasive public relations spin out there. Say what you want about the NFL they are a savvy collection of business people and that is why they are easily the most successful sports leage in North America.

    Ironically, it’s those same deep pockets that may be motivating a lot of these lawsuits. Don’t get me wrong, I have sympathy for people who’ve been debilitated by concussions, but there are a great number of seemingly more violent and risky sports that aren’t facing such challenges, and the cynic in me says, it’s because there’s not the same money to be made by legal action. There’s not blood in the water.

    I am prone to guilt by nature (and perhaps, religious conditioning) but I don’t feel guilty when I watch professional football. I see millionaires who are well aware of the risks they are undertaking engaging in an inherently dangerous activity for billionaires who have taken nearly every reasonable step to protect the investments they’ve made in these athletes.

    If dramatic change happens to football I hope it occurs at the high school level, or lower, and works its way up. Those are the athletes that I think may be unaware of the risks they are taking.

  8. Brian: thanks for your reply. I completely agree that the NFL has the deep pockets and resources to fight this battle. I also don’t think it is likely that many colleges or high schools will drop the program in the next decade–though I think it is possible, and will become more likely the following decade.

    Where I think football will be hit the most is in the amount of youth and high schoolers who take part as many parents decide the risks are too high for their kids to get involved. Registration rates are already declining over the past few years, and I imagine it will continue to get worse. Within a number of years, I think there will be a serious difference in the talent pool, which will then accelerate the sport’s decline. If the courtrooms, schools, or legislatures don’t get involved in the next dozen years–which is possible–then football will die a slow death over the next two decades.

  9. I agree with that, Brian. I don’t see why anyone would feel guilt over watching the sport, especially at the professional level, where, not only are the players well-informed and well-protected, but they are also well-compensated, and can therefore be prepared for any health issues. I agree that, if there are unreasonable dangers (and I’m not convinced they are unreasonable) it’s at the younger levels whre we need to focus most of our concern.

    But here’s the thing: this post describes the danger as being from concussions. I know players who had concussions from playing football. It happened once or twice in my playing days. I can think of only one time it happened when I was coaching. I’m not talking just about kids getting knocked unconscious, but hits where a player feels dizzy afterward. As I say, those hits happened, but not frequently. Maybe one or two a year in youth and high school football. That’s not exactly a widespread problem.

    And again, I know no one in my playing or coaching experience who has had any lingering ill-effects from playing football. If the dangers and problems were as widespread and apparent as Ben claims, wouldn’t we (especially those of us close to the game) have seen more of it? Where are all the people who are supposedly experiencing these symptoms? Why don’t I know any of them?

    I just don’t believe this problem is as big as is being described here. And if it is not that big, then it is manageable: by doing everything we can to eliminate blows to the head, by increasing helmet safety technology, by increasing recognition of concussions and forcing players to sit out if they have one. There may be other things that can be done, but these are the obvious ones and they are already being done.

    Football is already losing ground at the youth and high school levels. This is happening primarily because of competition from other sports. Ironically, rugby (a sport arguably much less safe than football) is gaining momentum, while lacrosse, soccer, waterpolo and other alternatives also are gaining in popularity at the expense of football. If football dies at the youth level, it will most likely be from this increased competition, not primarily from safety issues.

  10. I think that’s where I approach the issue in my mind–in the comparison to other activities and the risks involved in them. Is playing football at a high school level more risky than say skiing or snowboarding or being an avid skateboarder? Is having your kid on the high school football team more or less dangerous statistically than giving him or her a driver’s license? It’d be fascinating to see such comparisons. Similarly, it’d be fascinating to compare the NFL’s safety records with that of other sports that are comparable in terms of history and scope. I know that they’ve never had a death on the field since the leagues merged. I know of one player getting paralyzed, which, of course, is one player too many, but how does the NFL compare to say NASCAR or the NHL.

    I do feel like the NFL is reacting swiftly to the concussion issue, which in itself suggests they are taking it extremely seriously.

  11. “I do feel like the NFL is reacting swiftly to the concussion issue, which in itself suggests they are taking it extremely seriously.”

    Yeah, they are dealing with it by pushing for an 18 game schedule :)

  12. I don’t watch football, but I wrestle with guilt when I watch freestyle motocross and MMA fighting. I don’t feel as badly about MMA as I do freestyle moto-x. MMA fighters may break a bone but they’re not likely to be killed in front of your eyes. In freestyle motocross these days, it’s a very real possibility, and I’m flinching every time I watch it. (I only watch it when my husband has it on.)

  13. And again, I know no one in my playing or coaching experience who has had any lingering ill-effects from playing football. If the dangers and problems were as widespread and apparent as Ben claims, wouldn’t we (especially those of us close to the game) have seen more of it? Where are all the people who are supposedly experiencing these symptoms? Why don’t I know any of them?

    A lot of the effects are subtle – increased depression, poor memory, minor behavioral issues. A lot of the effects don’t really start manifesting significantly until ones late 40′s.

  14. “Middle-aged NFL vets have been tested to be twenty times more likely to display symptoms. Twenty. Times.”

    What isn’t stated here, and I couldn’t find in the CTE link either, is: What is the baseline of these symptoms in the population? Is this something that is found in 1 out of 1,000 people generally or 1 out of 100,000?

  15. “A lot of the effects are subtle – increased depression, poor memory, minor behavioral issues. A lot of the effects don’t really start manifesting significantly until ones late 40′s.”

    If you ask me, increased poor memory, and minor behavioral issues are all simply symptoms of just being in your 40′s.

  16. Yeah, come on, I know a lot of people in their late 40s or older who played football in youth, HS, or college or all three. Heck, I’m now getting into my late 40s. So are all my football buddies. I know people with a lot of those issues, but many of them are women, who did not play football. Where did those issues come from for them? Must have been the full-contact hopscotch they played in gradeschool. When oh when will they ban that evil game?!

  17. And although I know Ben was joking with his comment re: an 18 game schedule, it’s worth pointing out that in the last agreement the NFL made with the Player’s Association they took the possibility of an 18 game schedule of the table for 10 years. In fact, it flew off the table so quick that one must wonder if owners really ever wanted it, or just wanted an easily disposable bargaining chip in their negotiations with the players.

  18. MCQ: so do you think they are falsifying their results of the number of serious concussions, and the results from those concussions? We can all have our anecdotal evidence, but that isn’t always reliable. When the Centers for Disease Control and Prevention estimate that between 1.8 and 3.6 million high school athletes suffered medium to severe brain trauma every year, are they way off base?

  19. I don’t know how they’re defining “medium to severe brain trauma.” Nor do I understand how they can “estimate” those results. Why such a big spread? Between 1.8 and 3.6 million? Really??? I don’t trust those estimates, especially with such fuzzy results. I question their methodology and I wonder why we can’t rely on actual reported concussions and actual reported symptoms. There are definitely some of those happening. Let’s focus on those and determine what symptoms they are causing and how serious and long-term the effects might be. I don’t think estimates of difficult to pin down diagnoses help anything. It just muddies the waters and it amounts to simple fearmongering.

  20. There are 16 million high school students in America, about half of them boys (link) So, the CDC thinks a quarter or a third of high school boys suffer brain trauma each year? Interesting.

    Ben P., how many people have been diagnosed with CTE?

  21. Mansfield: my apologies, I misspoke on the statistic. The number was adolescents, so that could mean more than just high schoolers (though not much). And it’s not just boys, though football does cause more than three times more traumas than the next highest sport.

    Are you asking how many athletes have been diagnosed with CTE, or the amount of people in general (for comparison purposes)? I’m on my ipad away from home right now, but I imagine you can get the statistics from the articles linked to on the wikipedia page for chronic traumatic encephalopathy.

  22. No, that doesn’t seem to be the case. In particular, the site for the Boston University Center for the Study of Traumatic Encephalopathy
    seems fairly statistic free and is focused on individual case studies, much like the multitude of articles linked at Wikipedia to articles on high-profile individual suffering.

  23. People do things they love that come with both potential and guaranteed costs. People love playing football. I’ve known a couple fellows who lived for it. As long as the risks aren’t being concealed from the players, I think people should do the thing they love. There is simply no way to quantify the cost of lost of health as against the cost of lost love.

  24. I think that’s true Thomas. However where I think the original post has a point is that the recruitment funnel for pro and college sports comes from high school athletics. The rules for minors really are quite different. I think the OP basically argues that football will die because it will dry up in many high schools.

    Now I disagree with this simply because I’ve lived in the south and seen their football culture. However I suspect over the decades football will become more depreciated in high school. I just think it unlikely it’ll happen as quickly as some do. There will be lawsuits but given the popularity of the sport and the fact people chose it freely the argument that Congress would make exceptions seems certain.

    So the problem is really with high school sports. That will affect many schools outside of the football belt though. So expect to see blow back the coming decade in Washington, Oregon and others. However I’d be shocked if even there we see anything decisive before 2022.

  25. Did you see this story in ESPN today?.

    Duerson, who was 50 when he died, knew there was something wrong somewhere. He told people, “There is something going on in my brain.” In his final moments, he wrote a note requesting that his brain be examined for football-related damage. And to make sure it would be available for medical study, he aimed the fatal bullet at his chest rather than his head.

    As Duerson must have suspected, the pathological postmortem study of his brain showed that he suffered from chronic traumatic encephalopathy (CTE), a form of damage to the tissues of the brain that results from concussions. The laboratory finding and the final years of Duerson’s life offer a clinical chronology of the depression, flawed judgment, mood swings and loss of impulse control that derive from damage to the brain.

    Duerson’s four children are now relying on the medical evidence and their father’s troubled last few years in a wrongful death lawsuit they have filed against the NFL. It’s only one of 659 similar lawsuits filed thus far against the NFL, but it’s the one to watch.

  26. I saw this article about a high school football injury and thought it might be relevant:

    http://news.yahoo.com/football-head-injury-results-4-054535759–spt.html

    The school district ended up paying $4,400,000. Ouch.

    I live in a small town where high school sports are essentially worshiped. I don’t think there’s any chance of high school football going away for at least several more decades. Which is unfortunate, really, because the focus should be on education and not sports. A lot of the kids who where high school athletes 10 years ago did construction until the economy tanked and now are unemployed or leave their families to work in North Dakota. I think many of them would’ve done well in college–and be in a better situation today–had their focus in high school been on academics instead of sports.

  27. It shouldn’t be either/or. Sports should be a supplement to academics, not an alternative. People used to do sports as a way of becoming well-rounded. Now, everyone tries to become as good as possible in one specialty and everyone is pigeonholed into one thing by the time they are 16. That’s one of the main problems with high school sports. If it wasn’t so crazy serious, if football was a hobby instead of an identity, then we would all be a lot better off.

    When I was coaching, I used to remind my kids all the time: this is supposed to be fun. Problem is, it was more often the parents who needed reminding.

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