Tuesday, January 10, 2012

Using the Right Words for Impact

(I originally posted this on the critical thinking website Does This Make Sense , an excellent collection of writers, hosted/edited by the wonderful Nikki Stern.  I repost it here as a backup.)

Certain sports are now being forced into a deep conversation about concussive head injuries, with attendant changes in the terms of the discussion.  To begin, the linking of the words head and injury is itself a change.  Traditionally sport makes a distinction between the terms hurt and injured.   When an athlete is hurt  they are in pain but safely able to play, maybe at a reduced capacity, whereas an injured athlete is damaged to the point of being unfit for play or at risk for even graver damage unless they stop playing.  Until recently in the culture of sport, to have a concussion, at least in all but the most severe cases, was to be hurt, not injured.  Effective lobbying and awareness campaigns by medical advocacy and other groups are largely responsible for changing this culture to where concussion is now being counted as an injury to the brain.  The change was helped along by the fact that the victims of these concussions represent a substantial economic asset to their respective professional enterprises as well as themselves.

Also significant is the growing body of preliminary but ominous evidence for long term physical and psychological damage in retired professionals in violent sports.  Granted, dementia pugilistica, the medical term for punch drunk, which is the neurpsychological deficits seen in aging professional boxers that result from a career spent being punched in the head, has been part of the lexicon for a long time, but it is restricted, at least conceptually, to a particular sport.   Now an increasing number of aging football and hockey players are reporting a similar diffuse spectrum of cognitive and affective mental health problems over their lifespan, to a degree that has become impossible to ignore.  Concern has risen to the point that respective NFL and NHL players associations have started including it in their collective bargaining positions regarding player retirement benefits.

The most dire evidence has come from the involvement of of neuroscientists who have brought new more sensitive tools to the study of the brain and behavior.  Histological analysis, which reveals details at the level of brain cells and their component large molecule protiens, is finding a characteristic neural degeneration in brains of those with history of repeat head trauma.  They have introduced a new term into the lexicon: Chronic Traumatc Encephalopathy or CTE.   The term was born after a set of post mortem case studies of the brains of a handful of NFL players who died at very young ages, all but one by suicide of one form or another, and who's post football life was characterized by a host of severe neuropsychiatric symptoms and/or bizarre behavior.  All their brains showed dramatic evidence of neuronal damage at the fine structural levels now revealed by the neurological assays.  (A perfusion of work and writing on the subject is available.  I refer the reader to  Malcom Gladwell's 2009 essay, Offensive Play: How different are dogfighting and football?,  Christopher Nowinski's 2006 book Head Games: Football's Concussion Crisis, Ken Dryden's current article on Grantland.com Concussions in the NHL: Waiting for Science, and The Center for the Study of Traumatic Encephalopathy website, for further reference.)

The NFL and NHL, to their credit, have taken this new evidence and the new way of talking about concussion to heart.  While there is some question in my mind whether their measures are sufficient, concussed players are now being afforded more protection and time to heal.  Yet, by publicly responding to the problem, the NFL and NHL have also exposed what a Pandora's Box it is, and just how normal it is for their players to have concussions.  Cases like NHL star Sidney Crosby who spent 11 months waiting to recover from post-concussion syndrome, only to be re-injured by an incidental blow to the head after less than a month back, serve to underscore the point.  The magnitude of the problem only seems to grow the closer one looks at it.  This  is true of the continuing post-mortem brain research as well, which, if anything, grows more grim.  More brains of athletes from sports involving violent collision will have to be studied to get a definitive answer to how many develop CTE, but the preliminary data point frighteningly in the direction of a high rather than low number.

Which brings me to my closing modest suggestion, that we stop using the term contact sport or violent sport as our general term for these contests and use the term impact sport.  Impact sports would be defined as those that employ impacting blows, especially of unrestricted force, and particularly where increased force of impact confers competitive advantage.  Thus football would be an impact sport but wrestling would not, although both would be violent contact sports.  Hockey would be an impact sport, water polo would not, although both are contact sports.  Boxing would be the prime example of competitive advantage with greater impact, since if you hit someone hard enough to give them a concussion, you win the game.  The point of the term impact sport would be to prevent these distinctions from confusing the conversation, while also avoiding focus on specific sports.  Since there are many impact sports it makes no sense to have one conversation about football, one about hockey, etc.  The term would also exclude those sports that are merely dangerous, where an accidental impact is a significant risk without being a formal element of play.  Soccer players collide at high speed, downhill skiers and cyclists crash, divers hit their heads on springboards, yet these would not constitute impact sports.  Also, excluded from the definition are sports where players are required by rule to avoid impact, such as charging in basketball.  What I am suggesting is that we acknowledge that impact is part of some sports in ways it is not part of others, and that unrestricted impact is the single most important factor in the concussion debate. Not contact, not danger, not risk, not even violence.

In conversation the most valuable result is not just the exchange of ideas, but the negotiation of better ways to talk about an issue.  When the language does not conform to what is the case, the resulting discussion can't make reasonable headway.  Using injured instead of hurt for sports concussion has represented progress in this sphere, and has already helped a great deal.  Having a proper term for the kind of sport we're really talking about can only help further.

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