Two thought-provoking accounts of the concussion crisis in sport

Tobias Stark
Dept. of Sport Sciences, Linnaeus University, Sweden

In one of his most illustrious stand-up routines, the renowned comedian Jerry Seinfeld pokes fun at mankind’s application of the safety helmet:

There are many things that you can point to that humans are not smart. But my personal favorite would have to be, that we had to invent the helmet. What was happening, apparently, is that we were involved in a lot of activities that were cracking our heads. We chose not to avoid these activities but instead came up with some sort of device to help us to continue to enjoy our head-cracking lifestyle. The helmet. Even that didn’t work, because enough people weren’t wearing them, so we had to come up with the helmet law, which is even stupider because the idea behind the helmet law is to preserve a brain who’s judgement is so poor, that it doesn’t even try to prevent the cracking of the head it’s in!^[1]

Seinfeld’s cunning piece inevitably comes to mind while I am reading two recent and exceedingly thought-provoking Routledge publications, namely Dominic Malcolm’s The Concussion Crisis in Sport and Sociocultural Examinations of Sports Concussions, edited by Matt Ventresca and Mary G. McDonald. The two books paint a bleak picture of the concussion problem in sport. As a matter of fact, their basic premise is that contemporary sport is in a state of emergence because of the serious concussion crisis at hand. Tellingly, Malcolm states:

Concussion has become one of the most significant issues in contemporary sport. The life-changing impact of head injury and the possible threat that chronic traumatic encephalopathy poses to children and young athletes in particular is calling into question the long-term future of some of our most well-established sports. But what are the real issues behind the headlines and the public outcry, and what can and should be done to save sport from itself?^[2]

Subsequently, the aim of The Concussion Crisis in Sport is to “explore the various dimensions of [sport-related concussions] as an issue and to identify the distinct features of certain contemporary societies that have led these concerns to come to the fore”.^[3] In order to do this, Malcolm has adopted a multidisciplinary theoretical and methodological approach, applying a wide range of evidence and various analytical perspectives.

The Concussion Crisis in Sport is divided into nine chapters. Chapter 1 is an introduction, where Malcolm outlines the analytical foundation of the volume. The second chapter discusses concussion as a social issue. Malcolm argues for the need to perceive the emergence of social issues with regards to power relations, “as the actions of socially influential people either promote or prevent such issues becoming part of a broader public agenda”.^[4] The next two chapters seek to validate the claim that sport has a concussion crisis by shedding light on the processes that has sparked the current situation. In Chapter 4, Malcolm takes a closer look at the biomedical evidence for concussions and related conditions, pondering what – and how much – that is actually known. He concludes that although, lately, the body of evidence has grown significantly, there is still a dearth of consistent data and, thus, a perturbing uncertainty.

Chapter 5 contemplates various ethical considerations in relation to the regulation of head injuries in sport, while the sixth chapter maps the scientific documentation regarding the lived experience of concussions. In chapter 7, Malcolm begins his synthesis of divergent bodies of knowledge, converging biomechanical evidence with ethical considerations and the so-called “realities of human behavior”.^[5] This discussion sets the stage for chapter 8, where the social roots of concern for sport related concussions is dissected, as the understanding of traumatic brain injuries is developed in relation to a number of wider social processes, examining, among else, the interplay between medicine, health, risk, aging, commercialization, nationalism, celebrity, and violence in contemporary societies. Lastly, in chapter 9, Malcolm turns his attention to the question of what the future holds for sport’s concussion crisis and the potential for its resolution, arguing for the need of a combination of biotechnical solutions and game-related resolutions, as well as more profound cultural change in sport in general.

Sociocultural Examinations of Sports Concussions is an anthology, edited by Matt Ventresca and Mary G. McDonald. The works collected in the volume is the result of a three-day workshop hosted by the Georgia Institute of Technology in March 2018. In the introduction (chapter 1), Ventresca and McDonald concludes:

Scholars have identified that ‘the problem’ of concussion is almost exclusively conceptualized through a biomedical or neuroscientific lens, where the extent of the injury is defined according to impairments across biological systems. [Still] contrasting comments […] vividly illustrates how the materiality of sports concussions is intertwined with cultural norms and ideologies.^[6]

Hence, Sociocultural Examinations of Sports Concussions “seeks to critically engage such entanglements of the biological and the cultural”.^[7] Consequently, the ten chapters that make up the book move beyond the analysis of concussions as a mere biomedical and/or neuroscientific issue to explore the social, economic, political, and historical forces shaping the cultural impact of brain injuries.

The volume is thematically organized in two separate sections. The initial section (“History, Health, Ethics”) consists of four papers, all of which deal with the medical, the political, the epistemological and the moral stakes at play in debates about traumatic brain injuries in sports. In the first (Chapter 2), Dominic Malcolm investigates the medicalization of concussions and its possible link to Chronic Traumatic Encephalopathy (CTE). On the one hand, such medicalization has helped to instill a sense of beneficence and a broader public awareness about sports-related brain injuries. On the other hand, Malcolm argues, such a biomedical focus tends to (re)standardize particular sets of practices and ways of knowing, which in turn limit alternatives while frequently surprising individual differences and autonomy.

The following three chapters examines gridiron football, amid recent concerns about the consequences of repeated, forceful collisions that help to constitute the sport. Yet, the papers show that particular stakeholders – such as leagues, advertisers, players, parents, and the media – “frequently downplay or deny the embodied effects of concussions in an effort so maintain the sport’s masculine status and associated lucrative markets”.^[8] Kathleen Bachynski offers an historical breakdown that outlines concurrent legal, medical, and ethical trends related to the game. In “Football Helmet Safety and the Veil of Standards”, Daniel R. Morrison reveals how football helmet-rating bodies produce misleading information about helmet safety, whereas Daniel Goldberg (chapter 5) maintains that:

Ultimately, the decision on whether and when it is appropriate for youths and adolescents to participate in sports – or activities in general – that pose significant risks of [traumatic brain injuries] is a complex moral, social, and political inquiry. Reasonable people of good conscience can and do disagree on the acceptability of exposing children to risks the premise measures of which are largely unknown. But robust processes of deliberative democracy […] and public reason needed to resolve the problem should not include the types of arguments using preservation of the status quo on the basis of insufficient proof of causation. Such arguments are specious, contravene the epistemic and ethical warrant of the [precautionary principle], and have contributed to immense and inequitably distributed population health harms for over a century. Such arguments should be rejected wherever they appear, and preferably absented from public and policy discourse entirely.^[9]

The second section (“The Politics of Trauma, Experience, and Research”) scrutinizes the various experiences of sports related brain injuries and highlights the limitations of the current research paradigm. For example, authors William Bridel, Matt Ventresca, Danika Kelly, Kevin Viliunas, and Kahryn Schneider contend that first-person narratives, produced by athletes suffering from concussions, must constitute a greater portion of research going forward. Cathy van Ingen, on her part, argues for a feminist approach to further the understanding of the subject matter, in moving beyond the medio-scientific concerns by also privileging the voices of women as an entry point to shed light on “the patriarchal forces and actors which perpetuate trauma”.^[10]

In the paper “The Athlete’s Body and the Social Text of Suicide”, Sean Brayton and Michelle T. Helstein examines how the suicides of former professional football players and so-called ice hockey enforcers offer a social commentary on physical labor in contemporary capitalistic society:

Drawing on sociological and anthropological studies of suicide as protest, [they] explain how self-destruction of the athlete’s body can and should be understood less as an individual psychological aberration than as a political act, one that reflects and reacts against a specific set of socioeconomic conditions.^[11]

In the two ensuing chapters, Kathryn Henne then highlights how hegemonic conceptions of sex and gender not just inform brain science, but also produce inadequate ways to address the symptoms and consequences of sport-related brain injuries. And finally, in the last chapter, Matt Ventresca examines the scientific framing of the concussions by dissecting the postulations that support the biopsychosocial model of traumatic brain injuries, not least the dominating “cause and effect” orientation of the concurrent scholastic paradigm. As an alternative, Ventresca, much as Malcolm in The Concussion Crisis in Sport, calls for new critical interdisciplinary insights, better equipped to bridge the biological, psychological, and social aspects of brain injuries.

Truth be told, I am ambiguous as to whether The Concussion Crisis in Sport and Sociocultural Examinations of Sports Concussions can be said to have confirmed or refuted Jerry Seinfeld’s notion of mankind’s application of the safety helmet as evidence of us humans being unsmart. However, I am firmly convinced that both books are vital – maybe even life-saving – contributions to the rapidly growing academic literature on sport and health issues, thus furthering the understanding of one of contemporary sports’ most pressing issues: the alarming concussion crisis. In fact, I would recommend all sport researchers regardless of discipline and specialization to read them, as they are not just concerned with a serious sport and health problem, but are also breaking new scientific ground in bridging biomedical and neuroscientific assessments with theoretical and empirical know-how rooted in the humanities and the social sciences.

Copyright © Tobias Stark 2021

Footnotes

[1] Seinfeld, “The Pitch”, season 4, episode 3. Quoted from https://www.sportbikes.net/threads/seinfeld-on-helmets.437403/. See also: https://youtu.be/xgOUgrOHuFc.

[2] Malcolm, 2020, p. i.

[3] Malcolm, 2020, p. 4–5.

[4] Malcolm, 2020, p. 8.

[5] Malcolm, 2020, p. 5.

[6] Ventresca & McDonald (eds.), 2020, p. 4.

[7] Ventresca & McDonald (eds.), 2020, p. 4.

[8] Ventresca & McDonald (eds.), 2020, p. 12.

[9] Ventresca & McDonald (eds.), p. 90.

[10] Ventresca & McDonald (eds.), 2020, p. 14.

[11] Ventresca & McDonald (eds.), 2020, p. 132.