Hard Knock Life: Negotiating Concussion and Dementia in Sport is project by Greg Hollin, a sociologist based at The University of Leeds in the UK. The project commenced in September 2018 and is funded via a Wellcome Trust Research Fellowship in Humanities and Social Science.
‘Chronic Traumatic Encephalopathy’ (CTE) is a form of dementia associated with concussive and sub-concussive injuries most frequently sustained during sporting activity. Drawing upon Medical Sociology and Science and Technology Studies (STS), and through extensive ethnographic investigation, this project is amongst the first to examine this emerging diagnostic entity from such a perspective. Hard Knock Life will examine, first, how CTE is rendered intelligible through sporting activities and the subjects who take part in particular practices. Second, the project will consider how sporting communities understand CTE and negotiate conflicting narratives of sport as an enjoyable and desirable part of a healthy lifestyle and a potential cause of long-term neurological harm
The project will offer significant insight into how CTE comes to be known through particular social settings while also offering novel understandings of how sporting communities navigate complex medical categories and implications for their practices. The following questions will guide the research project:
1) How is CTE shaping conduct within sporting sites?
2) How do these sporting sites, in turn, shape the (neuro)sciences and their understandings of CTE and dementia?
3) How should we understand the diagnostic expansion which has seen shift from ‘punch drunk syndrome’ articulated as a risk for elite athletes in collision sports to a broader public health narrative?
Why is the idea important?
There is a growing concern about a ‘silent epidemic’ (Carroll & Rosner 2012) of dementias associated with concussive and sub-concussive blows to the head (Maher et al. 2014). Epidemiological studies have suggested there are between 1.6 – 3.8 million sports related concussions in the United States each year (Langlois et al. 2006: 376) and similarly significant numbers have been reported in the United Kingdom and elsewhere (Bleakley et al. 2011). These concerns over concussion have materialized, in significant part, through the naming of a neurodegenerative disease associated with head injury. Named Chronic Traumatic Encephalopathy (CTE), this diagnostic entity is increasingly deemed an urgent public health issue (Bachynski & Goldberg 2014).
In the first decade of the twenty-first century, discussions of concussion-related dementia oriented around a number of high profile cases, with American footballer Mike Webster and professional wrestler Chris Benoit two prominent examples. Webster died in 2002 at the age of 50 after suffering with significant mental health problems while Benoit died by suicide in 2007, aged 40, after killing his wife and son (Fainaru-Wada & Fainaru 2013: 249). The post-mortem examination of these individuals’ brains played a significant part in the naming of CTE as a novel neurodegenerative disease associated with sport. Furthermore, these cases received significant attention; Webster formed the basis of both the film Concussion (Landesman 2015) and the book League of Denial (Fainaru-Wada & Fainaru 2013) which claimed a cover-up on the part of the National Football League (NFL).
High-profile cases such as those of Webster and Benoit continue to receive significant media coverage and shape articulations of CTE. However, discussions of CTE are proliferating across a number of settings and the risk is no longer restricted to individuals competing in elite or high-impact sports. Population based-studies have suggested CTE is a health risk for amateurs playing comparatively low-impact sports such as soccer (Maher et al. 2014) and worries over the physiology of children has led to a to a focus upon youth sports such as American football in the US (Bachynski & Goldberg 2014) and rugby in the UK (Kirkwood et al. 2015). As a result of these fears there have been recent, high profile, calls to ban contact rugby in schools (Sport Collision Injury Collective 2016) and instigate rule changes within soccer (Wilson 2016).
This project will consider how practitioners understand themselves, their brains, and their conduct while simultaneously examining how CTE is co-produced within sporting arenas. By considering this co-production of sporting subjects and diagnostic entities, the project will yield novel empirical and theoretical findings relating to the social shaping of this crucial, emerging diagnosis.
Methodology to be used
The project will primarily be based around in-depth ethnographic fieldwork undertaken in the north of England. This ethnographic work will be supplemented by interviews with key stakeholders concerned with the management of CTE within sporting contexts. In particular, academic researchers examining CTE, representatives of sporting bodies, and charitable organisations who attempt to measure and intervene in debates surrounding CTE will be interviewed.
The ethnography will examine professional and policy terrains and will incorporate document analysis, interviews, and observations (of practice sessions, team meetings, and matches) in order to examine how CTE is entangled with narratives of age, risk, masculinity, class, technology, and the brain. This ethnography will be oriented around three contrasting sporting sites which have been picked in order to bring into relief various facets of CTE.
First, the project will examine CTE in the context of American football. American football is the sport with which CTE is most intimately entangled and the disease is argued to offer an existential threat to the game (Cornwell 2016). The sport, and the NFL in particular, has responded through attempts to mitigate risk through a focus upon rule change, technological innovation and, allegedly, deliberate obfuscation (Fainaru-Wada & Fainaru 2013). This strand of the project will examine amateur American football against this backdrop.
The second ethnographic field site will examine age-group rugby. There is considerable discussion in the UK of the risks associated with playing rugby. Much of this discussion concerns ‘return to play’ protocols in professional rugby but there have been recent high profile calls to ban contact rugby in schools (Sport Collision Injury Collective 2016). This portion of the project will consider concussion in the context of a mass participation sport played by children where responsibility is distributed differently to the other sites which primarily revolve around adults.
Third, concussion and CTE will be examined in the context of professional wrestling.
Professional wrestling has a particularly strong tradition in the north of England (Litherland 2014). Furthermore, professional wrestling makes an interesting boundary case, for it is unclear if practitioners are athletes, actors, or both. Both the absence of an overarching governing body and the fact that wrestling mimics sport (without strictly being a sport) ensures that professional wrestling is not beholden to the same legal requirements as the other cases under examination. This liminal status is a matter of ongoing legal controversy in the United States (Sellers 2016) and the similar positioning of professional wrestling as ‘sporting entertainment’ in the UK ensures that, despite structural differences, similar concerns apply (Litherland 2014). This section of the project will examine concussion in the context of wrestling’s ‘spectacle of excess’ (Barthes 2009).
In all cases, observation of practice sessions, team meetings and matches will take place. Formal and informal interviews with key stakeholders (players, coaches, medics, parents, and supporters) will also be undertaken.
Bachynski, K.E. & Goldberg, D.S., 2014. Youth sports and public health: Framing risks of mild traumatic brain injury in American football and ice hockey. Journal of Law, Medicine & Ethics, 42(3), pp.323–333.
Barthes, R., 2009. Mythologies, London: Vintage Books.
Bleakley, C., Tully, M. & O’Connor, S., 2011. Epidemiology of adolescent rugby injuries: A systematic review. Journal of Athletic Training, 46(5), pp.555–565.
Carroll, L. & Rosner, D., 2012. The Concussion Crisis: Anatomy of a Silent Epidemic, New York: Simon & Schuster.
Cornwell, R., 2016. Concussion in the NFL: The dying game. The Independent. Available at: http://www.independent.co.uk/sport/us-sport/national-football-league/concussion-in-the-nfl-the-dying-game-a6804216.html.
Fainaru-Wada, M. & Fainaru, S., 2013. League of Denial: The NFL, Concussions, and the Battle for the Truth, New York: Three Rivers Press.
Kirkwood, G. et al., 2015. Concussion in youth rugby union and rugby league: A systematic review. British Journal of Sports Medicine, 49(8), pp.506–510.
Landesman, P., 2015. Concussion, United Kingdom, Australia, & United States of America: Columbia Pictures.
Langlois, J.A., Rutland-Brown, W. & Wald, M.M., 2006. The Epidemiology and impact of traumatic brain injury: A brief overview. J Head Trauma Rehabil, 21(5), pp.375–378.
Litherland, B., 2014. The Field and the Stage: Pugilism, Combat Performance and Professional Wrestling in England, 1700 – 1980. University of Sussex.
Maher, M.E. et al., 2014. Concussions and heading in soccer: A review of the evidence of incidence, mechanisms, biomarkers and neurocognitive outcomes. Brain Injury, 28(3), pp.271–285.
Sellers, S.M., 2016. Pro wrestlers’ concussion case poses new legal twists. Bloomberg Law. Available at: https://www.bna.com/pro-wrestlers-concussion-n73014445126/ [Accessed November 28, 2017].
Sport Collision Injury Collective, 2016. Open Letter: Preventing injuries in children playing school rugby, Available at: http://www.sportcic.com/resources/Open Letter SportCIC March1st 2016.pdf.
Wilson, J., 2016. PFA urges FA to consider ban on heading for children under 10. The Telegraph. Available at: http://www.telegraph.co.uk/football/2016/12/29/pfa-urges-fa-consider-ban-heading-children-10/.