With the release of “Head Games,” a new documentary by the maker of “Hoop Dreams” that carries the tagline, “How much of you are you willing to lose for a game?,” we thought it an appropriate moment to ask some experts to weigh in on the relationship between sport, physical play, and brain trauma. Recent medical reports have raised concern about the safety of a number of sports—including hockey, boxing, and mixed martial arts—and have indicated that the potential for permanent damage begins with youth sport. American football, in particular, has been subject to scrutiny as a result of the deaths of several retired NFL players, including football legend Junior Seau, in seemingly very specific suicides: they shot themselves in the chest, in some cases with the explicit goal of preserving their brains for study. The NFL is also facing a lawsuit brought by over 2,000 players who believe the league has deliberately hidden known risks to profit from the game’s hard-hitting style. Even Malcolm Gladwell has gotten in on the action, comparing the ethical implications of football players destroying their minds to the brutality of dogfighting in a well-read New Yorker article. In this scary era, a new survey suggests parents are reconsidering whether to allow their children to play contact sports, especially football.

What, if anything, has surprised you about the reactions to the growing amount of information on the dangers of high-contact sports?

Jay Coakley: That people can dismiss, ignore, or discredit systematically collected evidence about harm possibly being done to the brains of players in certain sports, especially young players.

Nicole LaVoi: That some individuals still do not take concussions seriously, including leagues and parents who continue to allow young (mostly) boys to play contact football at very early ages.

Eric Anderson: Frankly, I’m surprised it has taken this long. Most of us, intuitively, know that it’s a poor idea to pick your computer up and bang it against the wall; even when dropping an iPhone one lets out an “Ohhhhh!” for safety of the phone. Yet using the head as a weapon has maintained hegemonic acceptability as part of many forms of competitive, organized team sports. With rumors for decades (true or not) about the cerebral disadvantages of being a jock, how these types of sports have remained popular is a fascinating subject.

The answer, in short, is that physical damage to the body and brain have been acceptable in the pursuit of ultimate manliness: a distancing of oneself from homosexuality and effeminacy. It is only now that matters are beginning to move on the [need to] protect your brain from chronic traumatic encephalopathy. [T]his has as much to do with a flood of new scientific evidence as it does parents and youth themselves desiring to distance themselves from old-school masculinities.

Dominic Malcolm: Being based in the UK and being mainly interested in UK sports, I’m at an arm’s length from North American developments. But one of the most surprising things for me is the speed with which a concussion has gone from a medical condition about which there was a great deal of uncertainty to something about which people now speak with a great deal of surety. The 2004 Consensus Statement on Concussion in Sport noted that there was no appropriate experimental model for sports concussive injury, no agreement on how to grade concussion injuries, and no scientific evidence that successive concussive injuries resulted in permanent damage. The 2008 Consensus Statement continued to recognize the evolving nature of scientific knowledge about concussion. Though not a surprise, it is certainly a concern that huge leaps are now being made on the basis of what can only be limited knowledge. So, as alluded to in the preamble to this roundtable, considerable credence is being given to the idea that concussion leads to depression which leads to suicide. People tend to unproblematically translate concerns about one sport to all sports, and from elite, professional sport to recreational sport.

One of the popular arguments for dismissing the findings is that the athletes have chosen to play the game despite knowing the risks involved. What might a more sociological perspective suggest?

LaVoi: Children and youth love to play sports, and when a system is in place that allows participation, they will play. The structure (i.e., league, rules, and policies) should protect individuals, especially children and youth. At higher levels, such as professional sport, where adults can weigh the risk with the benefits of participation (i.e., lucrative contracts), the individual agency argument carries more weight. But in the case of most professional leagues until VERY recently, the information players needed to make an informed decision was withheld or suppressed from players in the name of making money and exploiting the bodies of (mostly) men. I think a more interesting question is: What does it mean as a society that we are willing to allow individuals to risk their health and well-being in order to be entertained?

Anderson: Players don’t chose to play the game beginning as adults—sport is thrust upon youth from the time of near-mobility. Here it is formalized and made compulsory  (such as in physical education classes). Today’s professional football players began the sport when they were too young to weigh the consequences. They instead entered a system because adults praise that decision. Yet the system is designed to select for the best, and thus those who are successful narrow their master identities and their self-perceptions of who they are around the sport. So, Tim, who is 15 and excelling at football, receives praise from his peers, parents, extended family, school, and even sometimes the media, for his efforts. This encourages him to further focus on football, shutting out other perspectives, abilities, and social groups. The point is, professional athletes were socialized into this highly risky activity; they have predicated their identity and often their sense of masculinity upon it. This is not “free” choice.Professional athletes were socialized into highly risky activity; they have predicated their identity and often their sense of masculinity upon it.

Malcolm: Sociologically, a Marxist might say, regardless of how much money these individuals actually receive, what we are dealing with here is the exploited proletariat. I would be wary of going too far down this route of portraying all these athletes as cultural dupes, unaware of their “real” interests, however. When I have spoken to athletes about concussion—and indeed other injurious behavior—they seem to be keenly aware of the potential risks entailed. However, they take these risks because the rewards are good—not just (or even) financially, but in terms of identity and belonging and social status. Sociologically we should recognize that people will always construct their identity and accrue social status by taking risks and being different. Punitive regulation is no more the way forward than is excusing behavior because “it’s the way we’ve always done things.”

What can we learn about the larger relationship between sport and violence from NFL, athlete, and fan resistance to suggestions about changing the game to increase safety?

Coakley: There are very deep vested interests—emotional, financial, and status related—in the way the game is currently played and the violence involved in normal play. The $9 billion annual revenue taken in by the NFL is only the tip of the iceberg. The interests go all the way down to the sport stores that sell footballs to be placed in the hospital cribs of baby boys in various towns in Texas and Ohio. And after spending tens of thousands of dollars on season tickets and supporting college teams, people will experience extreme cognitive dissonance when confronted with this topic, and their first inclination will be to question and dismiss the head trauma data. Masculinity issues play heavily in this as well.

LaVoi: The answer to this question goes back to [asking]: What does it mean as a society that we are willing to allow individuals to risk their health and well-being in order to be entertained? What does it mean that professional leagues exploit the bodies of athletes for profit without concern to protection in the long haul?

Anderson: The largest obstacle in the path of progressive change on this matter seems to emerge out of the defense of tradition and history. “You can’t change the game, it’s traditional.” But games change their structure all the time! Whenever the corporate dollar is at stake, the game is changed. Thus, basketball (for example) introduced a three-point line and a shot clock. Even baseball introduced penalties for time consumption. Today’s youth do not long for the day when football was played without pads and helmets; instead, they look upon the history of the sport and ask: “How could they have been so stupid?” Tomorrow’s youth will view the clash and bang of head trauma in the same light. History is only as convincing as one is old.

Malcolm: In understanding the defense of the status quo, we need to think about the importance of memory and nostalgia, both in terms of structuring human perceptions in general and perceptions of sport in particular. Record books, halls of fame, etc. continually romanticize sport’s past and proposals. Anchoring oneself to the past gives a sense of security in a rapidly changing world. People have done it for centuries. Sport provides an excellent vehicle.We need to think about the importance and nostalgia, which give a sense of security in a rapidly changing world. Sport provides an excellent vehicle.

What I think we can learn (or at least remind ourselves) about the link between sport and violence is that the contemporary popularity of sport is fundamentally related to the opportunities sports provide for emotional experiences (in contrast with our daily lives). Combat sports such as boxing, football, and rugby exist on the boundary of socially acceptable and unacceptable violence. Sports are demonstrably less violent than they were, say, 100 years ago, but so is society at large and so is our sense of what is acceptable. There were concerns about how violent sports were 100 years ago, we see a different form of it today, and I would think that we will be talking about similar things in another 100 years.

Do you think contact sports can be changed to be made safe? If so, where would the impetus for change need to come from and at what levels would it need to be implemented?

Coakley: There is a need to limit the extent to which the brain moves inside the skull. At present, no technology can claim to do this. Until players have a full explanation of this fact and its relevance to their sport and their actions during practices and games, they are not making fully informed choices to play. This raises the question of exploitation and liability, especially when the players are under age 18. Until further data become available, flag football with regulations limiting the possibility of head trauma may be the way to go with all young people under 18 years old.

LaVoi: Yes, in part, sport can be made to be safer, but there is always going to be risk involved in every sport, and some sports involve contact more than others. There are examples of policies that have made sports safer. Pop Warner Football raised the age for full contact; USA Hockey eliminated checking among younger age groups and focused the youngest ages more appropriately on skill development; the Little League implemented a pitch count to protect young elbows from overuse injuries; and professional leagues have increased fines and game suspensions for egregious contact that increases likelihood of serious injury. So yes, sport can be made safer with rules and policies that are enacted and enforced strictly and without delay. However, what needs to happen before real change that improves the likelihood of health and well-being for all athletes is the culture of violence that surrounds contact sports such as hockey and football. The link between masculinity, “What it means to be a man,” toughness, aggression, and violence in sports (and fans who want to see and be entertained with such displays of masculinity) needs to be broken down. Unfortunately, this might be the hardest aspect to change, because the culture of masculinity is at the heart of power performance sports.

Anderson: Change is already occurring. For example, after a discussion I had about this issue with the CEO of i9 youth sports, in which over one million kids play, he banned heading the ball in soccer (tackling in football was already banned). So part of this will come from those concerned with our youths’ health. Another part concerns those liable against lawsuits. The NFL currently has thousands of lawsuits pending, and as parents begin to sue universities and high schools, administrators will be forced to conduct a cost-analysis. In my estimation, and this is purely a guess, I see that the writing is on the wall: the days of using one’s head as a weapon will dissipate within the next decade or two.

Malcolm: Yes, sports have generally become less violent. There are two caveats to this however. First, don’t assume that all changes will “improve” the situation, because human understanding of both the social world and the medical body is really quite limited. Consequently, we can easily get things wrong, and my fear is that this is a real danger in relation to concussion because, frankly, we know relatively little at the moment. For instance, you could argue that the introduction of padding and helmets, designed to make American football “safer,” has actually had the opposite effect—it is the sport about which there is the most concern. Rugby union officials believe that the introduction of padding actually increased injuries in the sport, because it makes players feel so well protected they can use their body to inflict greater violence (called “risk-compensation theory”). Rugby union will never introduce helmets because of this fear. Similarly, there is some research that suggests the introduction of more padded gloves in boxing may have decreased cuts and bruising, but increased brain damage.Rugby union officials believe the introduction of padding actually increased injuries; it makes players feel so well protected they can use their body to inflict greater violence.

Second, there are limits as to what is possible. If you make a sport too safe, people won’t be interested. I would argue that Mixed Martial Arts developed precisely because participants found that more established combat sports were becoming overly regulated and therefore emotionally stale and boring. If you regulate all the contact out of American football, participants may simply move to something else—like rugby—or recreate new sports forms.

I’ve spent my fair share of Sundays (and Monday nights) in front of the television set, so I need to ask, what should fans like me do? And, knowing the high risks that players at all levels are placed under, am I bad person if I continue to tune in?

Coakley: I no longer watch American football or hockey and will not do so until rules are changed to make the incidence of head trauma much less frequent or until data indicate that head trauma does not harm the brain in any serious way. To take pleasure in watching events in which young people are seriously injured on a regular basis is a naïve, possibly a barbaric form of self-absorption. But I am willing to listen to how people justify their consumption of these activities despite the injuries. If the justifications make sense in humane and ethical terms, so be it. But I’ve not yet heard such a justification that I can buy.

LaVoi: This is a complicated question. I do think fans are part of the problem, because fans expect and want big violent hits and ESPN’s “play of the day” where men level each other. Violence is what gets glorified and covered, therefore fans expect these displays. The media glorification of violence is also part of the problem. It is similar to the idea that sex sells women’s sport (which it doesn’t!), but violence sells men’s sport. Many fans uncritically accept this is “just the way it is,” and rarely think about whether violent displays are what is best for the health and well-being of the athletes. Most fans don’t ask themselves why this type of athleticism is entertaining. If fans are really concerned, they don’t have to tune in. If parents are concerned, they don’t have to allow their sons and daughters to play these sports. I do think as the science emerges around concussion, and the data are compelling, it will result in a change of policy, how the games are played, decisions made in families, and perhaps help shift the culture of masculinity that pervades power performance sports. However, I do think if fans ask critical questions, they may start to question tuning in—or, at the very least, have a different perspective on the games and athletes they consume.

Anderson: This is the same level of involvement as within all issues concerning proximity of responsibility. It’s really about diffusion of responsibility—it’s the same manner that corporations operate. “It’s not my fault for buying those shoes made from slave labor, watching that TV show, or eating meat: the problem is too large, and my involvement won’t make a difference.” The reality is, education on most of these matters has proven that one’s involvement likely doesn’t make a real impact. We still eat too much meat, we still buy clothes made from child labor, and we still watch and patronize football. I have very little faith that people will stop, voluntarily, watching NFL matches. I note that even among my colleagues, critical scholars of sport, every year we meet to discuss our research, we (not me) also patronize the local (always men’s) professional sports team. If critical sport scholars are not going to boycott paying for sport, I doubt your average NFL fan will, either. Thus, the locus of responsibility for change needs to lie with either legal action or legislative [action]. After all, professional sport is a workplace, and it should therefore be monitored by the same legal processes for health and safety as any other workplace.

Malcolm: While there is no such thing as a completely free choice, I think it would be wrong to completely discount the views of participants. NFL players may consider themselves exploited, but they continue to perform and therefore want fans to tune in. It seems paradoxical to consider someone a “bad person” for doing what the person they are trying to help wants them to do.

Rather, action should come at the systemic level. We need more funding for relevant research encompassing various sports and various levels of sport. We need medicine and social science to combine to assess the objective physiological changes and the subjective individual experiences [of players]. But we also need to foster the social conditions within sports so that athletes can get the best possible help. Most significantly, medical staff need autonomy…. They need to be rewarded for health-related outcomes, rather than their team’s sporting performance. They need to be employed on the basis of their medical expertise and not on the basis of who they know, their enthusiasm for the sport, or how willing they are to compromise their opinions and go along with more powerful owners and coaches.

Playing regulations can also be brought in to support players. For instance, in [the] rugby union in England, they have just introduced a “concussion bin,” which enables players with suspected concussions to receive much longer periods of treatment. But whatever regulations are introduced, they need to come from consultation and consider the way that players are likely to respond. For instance, rugby union had a very strict rule that stated that any concussed player had to stop playing and training for 3 weeks. This could be called “progressive,” as the clear aim was to protect players. But the result was that players feared being side-lined, so they hid their concussions from medical staff. The result: no medical supervision whatsoever, and, thus, far greater danger to players.