Critically Examining Sports' Concussion Crises: Abstracts

“A Clear Conscience”: Advertising Football Equipment and Responsibility for Injuries

Kathleen E. Bachynski, New York University

This paper examines how manufacturers of protective sports equipment have shaped public understandings of youth football safety in the United States. An analysis of historical equipment advertisements, newspaper accounts, company research studies, and legal proceedings indicates that equipment advertisements and product liability cases were particularly influential, in sometimes contradictory ways.

Sporting goods advertisements throughout the twentieth century have shared elements common to many forms of American advertising, such as claims about how products can enhance personal style, identity, and fulfillment. But marketing of protective equipment also inherently, sometimes explicitly, signalled to consumers that sports activities carried a certain element of risk. Manufacturers of protective gear thus had to portray a nuanced portrait of the injury hazards associated with the sport: they needed to depict youth football as sufficiently risky to require the purchase of extensive equipment, but not so risky as to be inappropriate for children. In so doing, these ads promoted ideals associated with particular forms of twentieth century American masculinity. By not only protecting body parts but also boosting athlete’s confidence and limiting their fears of injury, advertisements contended that football gear would enable boys to “smash through” their opponents. Protective equipment facilitated such aggression while purportedly shielding players from its harmful physical consequences.

Equipment ads communicated that technology and engineering were effective in mitigating risks, and often specifically emphasized manufacturers’ alliances with coaches and doctors in working to protect children. Although no standards for football helmets or other equipment existed before the 1970s, such claims were widespread. Yet in defending themselves against product liability lawsuits, manufacturers emphasized the lack of relationship between helmets and the injuries of individual plaintiffs. Manufacturers further argued that individual coaches, parents and children should take responsibility for preventing football-related injuries because they had voluntarily chosen to assume the risks of the sport. They also threatened that lawsuits would doom football by rendering sports equipment manufacturing and insurance prohibitively costly. Ultimately, sporting goods manufacturers largely succeeded in framing the issue of football safety as a matter of individual responsibility, while presenting protective equipment as necessary and sufficient to address safety concerns.

“I Kinda’ Lost My Sense of Who I Was”: Athletes’ Experiences of Concussion and Rehabilitation

William Bridel, Danika Kelly, Matt Ventresca (Georgia Institute of Technology), & Kathryn Schneider, University of Calgary

As part of a randomized control trial investigating the potential benefits of lowlevel aerobic exercise in rehabilitation following sport-related concussion, we conducted 15 pre- and post-treatment semi-structured interviews with male- and female-identifying athletes and their parents/guardians. These pre- and post-treatment interviews were formatted to facilitate the collection of feedback on the clinical intervention itself, as well as to gain insights into athletes’ experiences of concussion and the rehabilitation process. We then subjected the interview transcripts to a thematic analysis informed by (the limited) socio-cultural literature on sport-related concussion that exists at present. Within this small body of research, there have been few studies exploring the lived experiences of athletes who have sustained and undergone treatment for concussive injuries. Athletes’ narratives and ideas were not monolithic; yet in this paper, we discuss common themes that emerged through our interviews, including the “emotional” experience of concussion, through which athletes described a loss of identity, a sense of abandonment, but also sources of support. Whereas neuropsychologists are typically concerned with how a brain injury is influencing a patient’s mental and emotional wellbeing, our analysis connects these experiences to broader social norms and values. We also present findings illustrating an (often taken-for-granted) reliance on medico-scientific knowledge in recovery and rehabilitation, exploring how the medicalization of concussion can downplay the importance of the emotional/lived experience of this type of injury. The paper concludes with some commentary on interdisciplinary collaborative work, based on our experiences working across methodologies and epistemologies within this particular concussion-focused project.

What Does the Precautionary Principle Demand of Us? Ethics, Population Health Policy, & Sports-Related TBI

Daniel Goldberg, University of Colorado Anschutz Medical Campus

The primary claim of this paper is that a robust understanding of the precautionary principle (“PP”) in population health carries significant ethical and policy implications regarding sports-related traumatic brain injury (“TBI”). Theoretical analysis of the PP has advanced in the last decade, and several recent monographs in particular offer thoughtful frameworks both for the ontology of the PP (“what is it?”) and for its ethical significance in public health policy. This paper fleshes out a robust model for the PP, and then applies that framework to the maelstrom of issues swirling around sports-related TBI (esp. as to vulnerable groups like children and youths). Despite the variety of perspectives on the PP, most commentators agree that it is particularly relevant in cases where it is difficult to specify the extent of the risk from a hazard to which large numbers of a vulnerable population is exposed. Sports-related TBI in children and youth is just such a case. The PP, therefore, can shed light on crucial questions connected to such TBI, including but not limited to:

  1. What standards of evidence are needed to justify interventions designed to ameliorate the risk (understood in terms of both prevalence/incidence and severity)?
  2. To what extent does the PP relax the standards of causality required to justify specific policy interventions?
  3. Which (kinds of) interventions are justified based on the imperfect evidence regarding the risks?

In context of sports-related TBI, application of a theoretically-robust framework for the PP demonstrates that demands for strict standards of causality as a prerequisite for public health action are unjustified and should be rejected. Such demands have immense ethical and policy implications, and have historically often been deployed by regulated industry in service of the manufacture of doubt. The paper argues that such demands have no place in policy discourse on sports-related TBI and should be repudiated. Instead, the paper offers several policy recommendations for addressing sports-related TBI in vulnerable populations that are firmly rooted in the PP and which therefore more appropriately manage the risks posed by such TBI – even where the full extent of the risks are simply unknown.

The Athlete’s Body and the Social Text of Suicide

Michelle Helstein and Sean Brayton, University of Lethbridge

This paper is interested in the sporting body as a site of resistance and refusal. Specifically, it examines how suicides of former professional gridiron football players (Dave Duerson, Ray Easterling and Junior Seau) and hockey “enforcers” (Derek Boogaard and Rick Rypien) offer a social commentary on physical labour in late capitalism. While widespread news reports have rightly raised concern over the possible connections between contact sports, brain injuries and depression, these discussions have tended not to foreground labour and in fact have actively depolitized the athlete body as a labouring body. As such, we argue that athlete suicides must be read collectively as a “social text”, symptomatic of specific working conditions and labour struggles often misread as external to sports. To excavate the political possibilities of athletes’ suicides we turn to sociological and anthropological studies of the body and to suicide as social protest (i.e., hunger strikes and self-immolation). Here the self-destruction of the athlete’s body can 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. As we argue, the recent spate of athlete suicides marks a “corporeal critique” that speaks to professional sport as an economic enterprise indebted to the use, abuse and “disposability” of athletic bodies as physical labour. Rather than framing and dismissing each suicide as an act which says something about the characteristics and experiences of an individual, as those now left behind to memorialize the act we have an obligation to acknowledge and extend the expression of the act as collective, political, and communicative.

Brain Politics: Gendered Difference and Traumatic Brain Injury in Sport

Kathryn Henne, University of Waterloo/Australian National University

Media coverage of high-profile lawsuits involving professional sport leagues in North America have attracted significant public attention, pointing to the embodied effects of traumatic brain injury (TBI). While these developments mark a shift in public consciousness, discourse often fails to acknowledge the vast majority of people affected by TBI are not necessarily male athletes in contact sports. This paper recognizes popularized depictions of TBI, but focuses primarily on how the knowledge and treatment of TBI has gendered contours. It adapts insights from Anne Fausto-Sterling’s influential book, Sexing the Body: Gender Politics and the Construction of Sexuality (2000), which examines how relationships between gender and sexuality inform the treatment—both societal and medical—of intersex persons and how we make sense of physical bodies more generally. In doing so, it seeks to make sense of how gendered politics inform the treatment TBI and, by extension, how we make sense of human brains. Drawing on interview and (inter)active observational data, it scrutinizes how advocates, clinicians, and researchers frame concerns related to (binary) sex difference in relation to understandings of TBI. Some of these issues include how women are under-represented in TBI clinical trials, how pre-clinical trials often exclude female subjects, how strength differentials between athletes in men’s and women’s sports may affect TBI occurrence rates, and whether TBI is reported by female athletes as often as their male counterparts. In tracing how notions of sex difference enter into discussions of TBI research and treatment, it considers how critical feminist approaches to biomedical knowledge (e.g., Richardson, 2012), feminist materialist readings of neuroscience (e.g., Pitts-Taylor 2016), and gendered examinations of physical injuries experienced by women (e.g., Theberge 2012, 2015) aid in illuminating how gender politics not only inform brain science (e.g., Jordan-Young 2010), but also interventions targeting TBI in sport. It then interrogates the limits of these feminist perspectives by asking how a wider politics of difference shapes emergent agendas around TBI. The paper concludes with a reflection on how TBI might offer a space for alternative framings and possibilities informed by feminist science studies (see Subramaniam 2009).

Cross Disciplinary Conversations, Questions, and Answers

Michelle LaPlaca & Matt Ventresca, Georgia Institute of Technology

This session entails a dialogue about connections between scholarly communities studying traumatic brain injuries (TBI) from scientific and socio-cultural perspectives. The discussion will highlight the specific goals and challenges underlying different disciplinary approaches, but will also focus on exploring pathways for collaboration and understanding across research areas. The conversation will cover a broad range of topics, including: ways to communicate ideas to both medical/scientific and social scientific/humanities audiences, the role of media in shaping public debates about TBI, and how external forces (media, politics, economics, etc.) influence how TBI research is conducted and taken up by multiple audiences. This session will also offer an opportunity for each speaker to reflect on how conducting TBI research has impacted their scholarly and personal relationships with sport cultures. The overarching aim of this session is to explore common ground across disciplinary paradigms and to encourage interdisciplinary knowledge sharing practices.

Rating Risk: Done and Undone Helmet Safety Science

Daniel Morrison, Vanderbilt University

Despite their effectiveness in preventing severe injuries as part of a football player’s protective equipment, research suggests that helmets are often only marginally effective in reducing concussion risk. For example, a recent “drop test” study (Lloyd and Conidi 2014) reported that helmets reduce concussion risk by 20%. One study (Bartsch et al. 2012) found that leather football helmets were comparable or better in head-impact situations and on TBI risk when compared to modern helmets. Helmet safety and efficacy in reducing the risk of concussion is important because this and other forms of TBI are a threat to the public health. about 1.7 million people in the U.S. sustain a TBI annually, resulting in over 200,000 hospitalizations and about 52,000 fatalities (Langlois, Rutland-Brown, and Thomas; Roozenbeek, Maas, and Menon 2013).

This paper investigates the social organization of knowledge regarding helmet safety. I investigate the metrics used to evaluate helmet safety and reveal the affordances and limitations of helmet safety rating systems such as Virginia Tech’s Summation of Tests for the Analysis of Risk (STAR), likely the most influential safety measure in use today (Gruley 2015). I argue that while no helmet can completely prevent concussion in contact sports such as football, current regulations and testing regimes such as STAR often fail to model the kinds of impacts that most frequently lead to concussion. Despite the fact that recent research indicates rotational acceleration to be the most likely mechanism for concussion (Sone et al. 2017), helmets are most often rated on their ability to withstand straight-ahead impacts. To make this case, I marshall evidence from the scientific literature on the relationship between helmets and concussion in the military, sport, and leisure activities. Having reviewed this evidence, I then turn to a critical, close reading of Virginia Tech’s efforts to measure helmet safety risks, and the deployment of these measures in the marketing of football helmets. I draw on the STS literature in agnotology (the study of ignorance) (Croissant 2014; Frickel 2014; Frickel and Kinchy 2015; Rappert and Bauchspeis 2014) to make sense of what is systematically missing in helmet safety science. I suggest that risk calculations such as helmet safety measurements should be understood as producing knowledge/ignorance (Tuana 2004), and further argue that such measures produce a double ignorance, first, through scientific, and second, through marketing strategies that, paradoxically, rely on rating systems such as STAR. I conclude by offering some recommendations for citizen action and future research.

Trauma and Recovery: Violence Against Women in a ‘Neurological Age’

Cathy van Ingen, Brock University

In her groundbreaking work, Trauma and Recovery: The aftermath of violence – from domestic abuse to political terror, Judith Herman (1997) argues that the central dialectic of trauma is the impulse to assert that horrible events have occurred while also denying them. To study gender-based violence is to encounter this dialectic. Feminists have long worked to bring violence against women into public awareness, to address the trauma of sexual and physical violence, and to counteract the silencing and denial that enable gender-based violence and gender inequality to continue. Increasingly, however, the focus of trauma work has shifted through a revolution in neuroscience research, which has helped anchor and advance the study of trauma through powerful neuroimaging techniques and biomedical advances on the biological effects of psychological trauma. The concern for feminists working in the trauma sector is that a biomedical approach to trauma and traumatic brain injury can obstruct the structural nature of gender-based violence, framing trauma as an individual experience rather than placing it in a broader political frame. This paper is centered on addressing the question: what happens to women’s voices, experiences, and activism in a ‘neurological age’? It questions the dialectic of trauma that risks privileging sophisticated brain imaging techniques over women’s experiences of trauma. At the heart of this inquiry is research and direct service work conducted over the past 11 years with women who have experienced sexual assault and violence and who participate in the Shape Your Life program, a free, non-contact, trauma-informed boxing program in Toronto, Canada.

What’s “Traumatic” about Traumatic Brain Injuries?

Matt Ventresca, Georgia Institute of Technology

The purpose of this paper is to interrogate taken-for-granted and often competing discourses of trauma within the context of traumatic brain injury (TBI). Medicalized definitions of TBI are typically constructed around notions of “brain trauma,” meaning physical damage to brain tissue that induces symptoms  from headaches and dizziness to nausea and confusion (Malcolm, 2017). Yet sport and neuropsychologists have also documented how an athlete’s experience of TBI and recovery can be characterized by depression, anxiety, and loss of identity (Carrol & Coetzer, 2011; Leddy et al, 2012). Drawing from the work of critical trauma studies scholars, this paper explores how the overlapping physical, psychological, and emotional dimensions of TBI can make the lived experience of these injuries “traumatic” in more ways than one (Casper & Wertheimer, 2016; Morrison & Casper, 2012, 2016). I conduct close readings of neuroscientific and neuropsychological studies concerning symptoms, treatment, and recovery from sport-related TBI. I examine how these studies connect the physiological and psycho-social dimensions of various stages of TBI, with a particular emphasis on the potentials and limitations of dominant biopsychosocial approaches to treatment and recovery. I investigate how neuroscientists and psychologists mobilize these approaches in the context of both acute concussive injuries and long-term forms of brain damage such as Chronic Traumatic Encephalopathy (CTE). My analysis seeks to broaden conventional definitions of brain trauma and disrupt the privileging of neurobiological damage as the primary object of medico-scientific concern. I argue that such re-imaginings of what’s “traumatic” about TBI can work to overcome the limitations of cause-and-effect biomedical models and re-emphasize how lived experiences of TBI cut across (and dismantle) mind/body divides pervading contemporary scientific thought.