Head Games: The Moral Calculus of Football and CTE

In light of the latest findings on CTE in the brains of former NFL players, it’s time to reconsider how we think about football

The University Of Massachusetts Medical Center sits high on a hill on the Worcester side of Lake Quinsigamond, not far from the high school at which my father was the assistant principal, and even closer to the state park where he first taught me to swim. He’d grown up swimming at a pond near where he lived and, during World War II, the Navy taught him even more strongly, how to swim for his life. (To this day, I remember some of what he taught me. If your ship is sunk, and you’re underwater, before you surface, wave your hand in the water right above your head, disbursing whatever’s up there, so you don’t come up in the middle of a patch of burning oil.) He was a great swimmer, until he couldn’t remember how to do it anymore. Later, he forgot how to play golf, feed himself, speak, and, ultimately, be the person he was in the world. He had Alzheimer’s Disease. Ultimately, all four of his siblings did, too.

At the UMass Medical Center, there is a white filing cabinet with long metal drawers. In one of those drawers are the slides containing what is left of my father’s brain. Under a microscope, you can see the “plaques and tangles” that are characteristic of the disease that killed him. They are black, deadly things, as though someone had put out cigarettes in my father’s hippocampus. Later, I wrote a book about the whole thing—my father, our family, and the disease that hangs over us like grapes in a poisoned arbor. There are two things I learned from my experience and through my research. One is that I do not want to get Alzheimer’s Disease, or anything like it. The second is only a fool or a madman would volunteer to get Alzheimer’s Disease, or anything like it.

In an article in last week’s Journal of the American Medical Association, the team at the Boston University’s School of Medicine which has been doggedly researching the effect that playing American football has on the human brain produced its extensive study under the authorship of Dr. Ann McKee, who has been ringing the fire bell on this issue since 2009. The team studied 111 brains donated by former NFL players. Of these, 110 showed damage characteristic of chronic traumatic encephalopathy (CTE), which seems to work on the brain the same way that Alzheimer’s does. (Accumulation of a protein called tau is seen in brains affected by both diseases.) The person with CTE is not the same person he was without it. An individual disappears into the disease. Someone else emerges—angry, frightened, impulsive, lost in a deep and infernal fog.

There were 202 brains studied by the team at BU and CTE showed up in 87% of them. The argument, for all practical purposes, seems to be over.

‘I Feel Lost. I Feel Like a Child’: The Complicated Decline of Nick Buoniconti

Since the results were published, John Urschel of the Baltimore Ravens announced his retirement. He is 26 years old. Urschel is an interesting case because he also is a certified mathematics genius who has published nine working papers and is presently working toward his Ph.D at MIT in some space-alien field of mathematics that I believe would break my brain if I tried to understand it. I’ve never met Urschel, but he happens to be engaged to one of my best friends in the business, so, when he announced his retirement, I was surprised how happy I was for the both of them. The paradigm of how we follow football is changing right under the NFL’s feet.

Writing in The Players Tribune last year, Urschel eloquently explained how he could still play the game and put his mind at such a terrible risk.

I play because I love the game. I love hitting people. There’s a rush you get when you go out on the field, lay everything on the line and physically dominate the player across from you. This is a feeling I’m (for lack of a better word) addicted to, and I’m hard-pressed to find anywhere else. My teammates, friends and family can attest to this: When I go too long without physical contact I’m not a pleasant person to be around. This is why, every offseason, I train in kickboxing and wrestling in addition to my lifting, running and position-specific drill work. I've fallen in love with the sport of football and the physical contact associated with it. Simply put, right now, not playing football isn't an option for me.

That’s what the old paradigm of how we follow football used to sound—the joy of having people who loved the work of hitting people, the ecstatic celebration of vicarious violence. Too bad about all those knees and shoulders and elbows, but, hey, the price they pay, right? Going to a luncheon with Hall of Famers at any Super Bowl always looked like those black-and-white films of reunions at Gettysburg. It was uncomfortable, but tolerable, and you could always convince yourself that these guys “gave 100%” to keep you entertained. There was a moral calculus that at least came out somewhere close to even. That’s not the case any more.

The more you play American football, the more damage you do to your mind. No position is safe; there even were a punter and a placekicker in the study. If you watch football, if you enjoy American football, then what we know now has got to change your personal moral calculus.

Counting the Days While My Mind Slips Away

In December of 1953, the American tobacco industry was in deep trouble. Research into the deleterious health effects of cigarette smoking was beginning to pile up ominously all over the country. So the industry did what American industries do—it hired Hill and Knowlton, a power in the advertising industry even then, to spin itself out of trouble. H&K earned every nickel it made from this particular client. Its strategy included buying its own scientists to cast doubt on the mounting evidence. As medical historian Allan Brandt put it in his magisterial study, The Cigarette Century, “[This] strategy for ending the ‘hysteria’ was to insist that there were ‘two sides’ … This strategy would ultimately become the cornerstone of a large range of efforts to distort scientific process in the second half of the 20th century.”

“Hysteria” has been a weaponized word, useful when large industries don’t want to face up to the damage they may be doing. We saw it used with cigarettes. We’ve seen it used in regards to the public health crisis currently facing football at every level.

If there is going to be chronic denialism on this issue, it may not come from the NFL, although some of it surely will. It’s going to come from the people in the game, the fans of the game, and many members of football’s kept national press, who are unwilling or unable to change their moral calculus and who become aggravated when somebody suggests that they should. For example, in 2015, Jim Harbaugh, the coach at the University of Michigan, suggested that American football was “… the last bastion of hope in America for toughness in men, in males.” (So much, one supposes, for the SEALs.) Coach Bruce Arians of the Arizona Cardinals expressed concern that America’s mothers were refusing to let their sons play football because of the head injury issue. (Mama, don’t let your babies grow up to be safeties.) Danny Kanell, then of ESPN, called attention via Twitter to the peril he perceived from the folks he called “concussion alarmists.” (Kanell also managed to work “the liberal media” into his tweet, thereby winning that week’s game of wingnut rhetorical bingo.) In support of Kanell, Jason Whitlock of Fox Sports bellowed his contempt for what he called “the media-driven concussion hysteria.” Hill and Knowlton would have been proud of that one.

To be fair, Whitlock later in the same piece admits that football is “barbaric,” which is better than other Football Under Attack pieces I’ve read. Let us be clear: I am not suggesting that we ban the game. That kind of thing never works in America and, generally, the attempts to do it end very badly for society at large. But I do find myself wondering if the shift in the moral calculus is profound enough to shake the purchase that American football has on the culture in so many different places—from high schools in Texas to the gambling floors in Las Vegas. And I think of John Urschel again, and I’m happy he was strong enough to give up something he loves in order to pursue something else that he loves. And I think of my father, who could swim for hours, when he was still who he was born to be.

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