At the climactic moment of Concussion, a docudrama out Christmas Day about the young coroner in Pittsburgh who took on the NFL, the FBI turns up. Will Smith stars as Bennet Omalu, whose discovery of what seemed to be a lethal form of illness in the brains of former football players has already turned into a long and painful fight. Doctors on the NFL payroll have done a hatchet job on his reputation, even trying to make his papers disappear from scientific journals. Strangers have targeted him with death threats, and a late-night caller has yelled at him for trying to “vaginize” the nation’s most popular sport.
Then Omalu shows up at work and finds the feds going through the files of his boss and mentor, the forensic pathologist Cyril Wecht. The charges against Wecht sound trumped up—84 counts of corruption, most for ticky-tack transgressions like sending private faxes from the office—but Omalu knows what’s really going on. He’s an immigrant, a black man, a whistleblower, and suddenly an existential threat to a $12-billion industry. “You are attacking him to get to me!” he cries at the agents.
It’s the movie’s most dramatic scene and one that, taken at face value, has some terrifying implications. According to Concussion, Omalu’s work on chronic traumatic encephalopathy, or CTE, posed such a danger to established interests that it produced a cover-up of historic proportions—one that reached not just the boardrooms of the NFL but all the way into the U.S. Department of Justice. The movie tells us that the feds were in cahoots with sportocrats, as if then-commissioner Paul Tagliabue called in favors from the President to make Omalu go away.
That’s not even half true, of course. Here are the boring real-world facts: The FBI did raid Wecht’s office, but that happened three months before Omalu published any of his research on brain injuries in football. The government did indict Omalu’s boss, but for reasons that had nothing whatsoever to do with the NFL or CTE, nor with the Nigerian-born pathologist whom Wecht had taken under his wing. And while the movie version of Omalu swears he’ll never testify against his mentor and then is banished from his office to a different job in the Central Valley of California, the real-life Omalu did show up in court as a witness for the prosecution and even made a bid for Wecht’s job. (He didn’t get it and eventually decamped from Pittsburgh of his own accord.)
I know that railing against the inaccuracies of a Hollywood film “based on real events” is like yelling at the sky for being blue. But the exaggeration of the plot against Omalu in Concussion feeds into a pervasive myth at the center of the national discussion over football and head injuries. It turns an ugly episode in corporate denialism—the NFL’s attempt to duck the dawning science of head trauma—into a lurid fantasy of persecution. In that way, the film echoes the media panic over football: We’ve been so eager to attack the league’s pattern of deceit that we’ve fallen victim to our own error-ridden narrative.
“The movie is emotionally and spiritually accurate all the way through,” Concussion’s writer-director Peter Landesman told the New York Times on Wednesday, in response to griping from another source—the son of former defensive back and suicide victim Dave Duerson, who appeared as a villain in the film.* But Landesman’s loosey-goosey docudrama standards are exactly the problem. When Omalu’s character says, at one point in the film, that “God did not intend for us to play football” and later warns that as long as we do, “men will continue to die,” he’s appealing not to fact-based objective truth but to an alternate reality—an emotional, spiritual one—that has come to dominate the enlightened person’s understanding of the NFL.
Are we actually watching players kill themselves before our eyes? No, not on average: A 2012 study of several thousand NFL retirees, conducted by researchers at the National Institute for Occupational Safety and Health, found that the former football players lived significantly longer than race- and age-matched controls. They were much less likely to die from cancer, heart disease, diabetes, accidental falls, or homicides than anybody else. That doesn’t mean that taking hits improved their health, of course; surely the opposite is true. But still this study gave the lie to a fundamental intuition about football and one that’s touted almost everywhere. There’s zero evidence that playing professional football shortens lives on average. Those are the facts. Take ’em or leave ’em.
This is the best study that we have on NFL players and mortality, yet its findings never seem to enter public consciousness. The simple truth, that former players aren’t dying—that in lots of ways they’re much healthier than you or me—smacks against the screen-ready version of history, in which a team of underdog physicians, led by heroes like Bennet Omalu, risked their livelihoods to expose a hidden slaughter.
“Look, at this point we know how dangerous football is,” said correspondent Jonathan Mahler in recent video for the Times. “Anyone who continues to believe that professional football players aren’t potentially shortening their lifespan by playing this game is living on another planet.” Even former football players have bought into the caricature of football as a deadly sport. At a recent screening of Concussion, former linebacker Keith McCants burst into sobs. “If we knew that we were killing people,” he said after the movie, “I would have never put on the jersey.”
Here’s a more sedate and honest formulation: Omalu really did discover an unusual pathology in the brains of former NFL players, and the NFL’s corrupt administration really did attempt to discredit his research and then for half a decade ignored this important line of inquiry (only caving under congressional scrutiny). But these facts have been spun out, in this film and elsewhere, into a melodrama wherein Omalu’s deadly brain pathology drives football players crazy and destroys their minds. Eventually it leads to suicide.
Perhaps. The fact that football players live longer lives, on average, doesn’t mean they aren’t also subject to an epidemic of suicide. After all, only a fraction of chronic smokers end up dying from lung cancer, but they’re still 23 times more likely than nonsmokers to get the disease. But is football really causing suicide? Again, there’s zero evidence to support the claim. According to the NIOSH study from 2012, ex-players are much less likely to kill themselves than men of the same race and age.
That hasn’t stopped the media machine, which seems inclined to tie every former athlete’s suicide to game-related damage to his brain. Omalu himself has been among the strongest proponents of this idea. And in Concussion, his character makes the link explicit: In explaining the death of another former Pittsburgh Steeler, Terry Long, Omalu says, “Football gave him CTE, and CTE told his brain to drink a gallon of antifreeze.” The film also tells the stories of several other players who killed themselves in recent years: Andre Waters, who shot himself in the head in 2006; Dave Duerson, who shot himself in the chest five years after that; and Junior Seau, who did the same as Duerson in 2012. And it also strongly (and misleadingly) implies that two other players’ deaths were quasi-suicides: that of Justin Strzelczyk, who perished in a car accident as he sped away from the police in 2004; and that of Mike Webster, the patient zero for football-related CTE, who died of a heart attack in 2002.
It’s Webster’s death that serves to launch the plot of Concussion, with some embellishment. In real life, the Pittsburgh Steelers’ Hall of Fame center ended up homeless, drug-addicted, confused, and so beset by chronic back pain that he could hardly sleep. At one point he grew so desperate for some rest that he bought a stun gun so he could zap his leg to knock himself unconscious. But according to the film, those self-administered shocks may have been the cause of death. Concussion shows Webster on the autopsy table right after getting zapped—a suicide by Taser.
Maybe that’s the emotional truth, as Landesman would have it: Webster may not have really killed himself, but the head-trauma–induced downward spiral of his life surely amounted to a suicide in slow motion. The real-world facts are much more complicated, however. Webster was depressed, divorced, a former steroid user, hooked on painkillers and Ritalin. And according to League of Denial, the best and most complete account of football’s concussion crisis, Webster’s risk factors for collapse were legion. A victim of ghastly child abuse with two alcoholic parents, he had mental illness running through both sides of his family. His uncle killed himself. His mother had a nervous breakdown. All four of his siblings were bipolar; one attempted suicide several times; another ended up in prison.
The same sad backstories could be told of the other football suicides shown in the film. Long had tried to kill himself before he drank the antifreeze, going back to when he was still an active player. He was also a steroid user, separated from his wife, and in the lead-up to his death he both filed for bankruptcy and came under indictment on federal charges of mail fraud and arson. Waters suffered from chronic pain in every part of his body and had been involved in a four-year battle for custody of his daughter. He was terribly depressed. Duerson had also split from his wife and lost most of his money in a horrendous business deal; not long before his suicide, he was passed over for a job. Strzelczyk was a heavy drinker and a drug user who heard voices in his head. Seau was an alcoholic, a compulsive gambler, and divorced; he’d also tried to kill himself before.
One might reasonably conclude that all these men were at a tragic, elevated risk of suicide and mental illness, brain damage notwithstanding. Or one might conclude the opposite—that these men would have been just fine if CTE hadn’t pushed them to these depths; one might speculate that the marital problems and drug addictions and other personal tragedies were a function of phosphorylated tau proteins in their brains. According to the story of Concussion, and the one promoted by Omalu and his peers, that’s exactly what occurred. If CTE doesn’t lead to suicide directly, then it causes lots of things that themselves can lead to suicide: drug abuse and gambling; violent mood swings and depression; dementia and psychosis.
Is there any truth, though, to that idea—objective as opposed to spiritual? In the fall of 2008, researchers at the University of Michigan ran a survey of about 1,000 former players from the NFL, and asked them questions about their physical and mental health. About 3 or 4 percent described themselves as being in the middle of a major depression—the same as in the normal population. When asked if they’d ever been diagnosed with depression, about 16 percent of the players said they had—again about the same as other people. (Among younger retirees, the rates of depression were slightly higher than expected.)
So former NFL athletes aren’t really more depressed than anyone else. What about violent mood swings? The researchers in Michigan asked the ex-players if they’d ever experienced “attacks of anger when all of a sudden [they] lost control” and became violent. About 30 percent said they had. The baseline rate for U.S. men is much higher—more than 50 percent.
More distressing was what the survey said about cognitive impairment. The researchers asked the former players if they’d ever been diagnosed with “dementia, Alzheimer’s disease or other memory-related diseases,” and about 1 in 20 said they had. That’s a prevalence six times greater than you’d find in the reference population. The NIOSH study corroborates this disturbing fact: Ex-NFL athletes turned out to be significantly more likely than their peers to die from neurodegenerative diseases.
A 4.6-percent rate of memory-related disease in the Michigan study is disastrously high. But let’s keep this number in perspective. Other injuries to former players—those that lead to chronic pain and arthritis—are about 10 times more common and could well be even more disabling. Many of us assume that it’s worse to have memory loss than it is to suffer chronic pain, but there really isn’t much evidence in support of that conclusion. In any case, however one might try to frame the numbers, it’s clear enough that cognitive impairments represent an urgent problem for retired players. But that’s not the same as saying that the game is turning players into vacant-eyed, suicidal psychopaths. It’s not the same as saying that God did not intend us to play football.
Concussion apes the great majority of press coverage of concussions in suggesting that players’ higher rates of cognitive impairment help explain ex-player deaths. It’s always the same account: The man who killed himself grew increasingly distracted and forgetful after his retirement; his cognitive impairments came in tandem with a sudden emotional decline. As Omalu might say: Football gave him CTE, and CTE turned his brain to mush. But these are just-so stories, concocted after the fact to fit the standard media narrative of head trauma.
Here’s another just-so story. It’s well-established that depression on its own produces cognitive impairment: Meta-analyses of the research literature suggest that people in the midst of a major depressive episode will flounder on tests of recall and recognition; they’re often unable to concentrate and have other deficits of the sort ascribed to Duerson, Seau, and the others. So perhaps these men grew depressed in the years after their retirement, as some people do. Maybe they also had bad luck—business deals gone awry, relationships that failed—and their depression metastasized into other mental problems. Maybe chronic pain from playing football left them hooked on opiates. Maybe they were prone to mental illness. Maybe they didn’t know how to go about getting help. And maybe all of these factors came together and pushed them to their deaths.
But there’s no room for wishy-washy doubts or alternative hypotheses in the docudrama version of the truth. For some of these men, a trip to a psychiatrist may well have been a lifesaver. But we forget that vital fact, and instead we blame an occult, incurable disease.
In truth, no one knows exactly how the brain pathology that Omalu first observed in Mike Webster’s brain relates to anyone’s experience in life. We don’t even know how many people might have the disease. According to Ann McKee, a neuropathologist at Boston University, more than 90 percent of the players’ brains that she’s examined show signs of the disease. (McKee would have made a fabulous character in Concussion, by the way, but alas her presence might have made Omalu seem less important. She and her colleagues were snipped out of the narrative, Bechdel test be damned.) “I think the incidence and prevalence have to be a lot higher than people realize,” she told Frontline, before suggesting that it’s anywhere from a minimum of 10 percent of all professional football players to a significant majority of them.
Think about what all this means. We know that football players are much less likely than other people to kill themselves, and that on average they live longer lives. We know they suffer from depression at about the normal rate. We know that they’re less prone than average men to violent mood swings. We know they’re disproportionately the victims of memory disorders but that the rate is still low in absolute terms, at less than 5 percent. And we believe that CTE affects up to 90 percent of all the men who ever played professional football.
If you look at all those facts together, you might conclude that 1) CTE is indeed a widespread epidemic among former contact-athletes but 2) its clinical effects are pretty modest, since most men who have it are not depressed or otherwise impaired. It could well be that this brain disease doesn’t have much bearing on the lived experience of its sufferers. Maybe someone could have all the signs of tau-protein pathology that Omalu found in Mike Webster’s brain and feel totally fine. In fact, we know from other studies that some degree of tau-protein build-up is a normal part of aging and that the presence of neurofibrillary tangles does not reliably predict cognitive impairment.
None of this is to say that CTE is fake or nonexistent. I’m only trying to point out that the science of the illness is still in an embryonic stage. We have no idea how many people really have it and what, exactly, “it” is. More importantly, we have only a blurry understanding of how CTE manifests in life. And until we get some answers to those questions—important work is now underway—we’re stuck with a spotty, shifting knowledge of the problem.
In the meantime, the bogus story of Concussion, the one so often parroted in the press, admits none of this uncertainty. It baits us into nutty, unsubstantiated claims. (Here’s one: Maybe Lou Gehrig didn’t really have Lou Gehrig’s disease but CTE instead.) It causes panic among athletes and their families, at every level of the sport. The fear of CTE infects the minds of men even in their final moments—think of Duerson and Seau, taking bullets in the chest, perhaps convinced they had no hope of escaping their disease. And, ultimately, it leaves the rest of us less informed than we were before.
*Correction, Dec. 21, 2015: This article originally misidentified Dave Duerson as a former linebacker. He played defensive back.