Nobody in boxing talks about concussion.
Given the objective of the sport is quite literally to hit another person in the head until they can’t take it any more, you’d think it would be a topic visited with some frequency.
Mention concussion in a boxing gym and you are met with a squirming, uncomfortable silence. Sometimes there are nods, a murmured hrm, before your fellow conversationalist slides quietly away. If someone feels trapped, they may bust out a bit of bro-science: It’s just one of those things. It’s just a bit of conditioning. Don’t worry too much about it. Shake it off. Keep your chin down and your guard up, you’ll be fine.
When I first began boxing, I took this blasé approach in my stride. I assumed everyone in the gym had made their peace with the dangers inherent in the sport. After a while, getting thumped became a matter of pride. “Tell you what, you can certainly take a punch,” a coach said to me one day, and I wore it as a badge of honour. The harder I trained, the harder the hits would be. Occasionally I would make my way home, ears ringing, feeling like my head was stuffed with cotton wool. But I just did what everyone else did: I shook it off, assuming I’d feel better after a good sleep. Most of the time, I did – until the day I opened my eyes to a drilling pain in my skull and wave after crashing wave of nausea.
Concussion is in the news again this week with the postmortem finding of chronic traumatic encephalopathy (CTE), a neurodegenerative disease caused by repeated head injury, in the late Australian rules footballer Polly Farmer.
The condition is commonly understood as the consequence of a knock to the head, but the focus on the mechanics of what happens outside the skull can be misleading. Concussion results from the movement of the brain inside the skull. The transmission of force from blow or sudden jolt – it doesn’t need to be a direct hit – can cause the brain to move or twist, or crash against the wall of the skull. So while we associate concussion with semi-abstractions – consciousness or lack thereof, confusion, impaired thinking – the reality is as physical and visceral as any other injury. Neurophysiologist Alan Pearce described it to me as “the shearing and stretching of neurons”.
There are around 60 recognised symptoms of concussion. Some people show symptoms immediately. For others, they are delayed. My experience of concussion may be completely unlike yours, and the apparent force of the blow is no reliable indicator of the damage that may result. Critically, there’s no 100% reliable way to objectively diagnose it. Many of the symptoms rely on the injured person self-reporting. But how can they self-report symptoms of an injury they don’t recognise or understand?
I didn’t really appreciate the seriousness of the resounding silence on this issue until I started investigating the death of Sydney boxer Davey Browne Jr.
Browne was knocked out in the final minutes of a 12-round regional championship fight held at a western Sydney RSL. He wasn’t a big name, but he was known around the gyms in Sydney. He came from a boxing family. His brother had fought for a world title and Browne was a talented sportsman with potential to make it big.
His death was initially reported as a tragic accident – the consequence, it seemed, of an unlucky contender doing the unthinkable: taking his eyes off his opponent for a crucial but deadly split second.
What did not become clear until much later, and was eventually exposed in the two-week-long inquest into his death, was that Browne was badly concussed in the 11th round of his fight. He’d been knocked off his feet twice in that round, and as he headed back to his corner after the second blow, he appeared to stumble. He was late coming out for the final round, wobbling and falling back against the turnbuckle as he stood up, before being pulled into the ring by the referee. He was knocked out by his opponent, Filipino featherweight Carlo Magali, 30 seconds into the final round. That final blow caused a subdural hematoma that killed him three days later.
Amy Lavelle, Browne’s widow and mother of his two young children, later told me that the incident reminded her of an episode of Air Crash Investigations. A series of tiny mistakes, omissions and inconsistencies that seemed innocuous on their own, nevertheless added up to something catastrophic.
At the inquest, I found it difficult to control my rising anger as, almost to a man – and they were all men – the officials who were responsible for Davey’s safety that night told the coroner in evidence they did not know the symptoms of concussion and they did not think Davey was concussed. Even the ringside doctor, a still-practicing physician, who had noted on his report the “major head injury” Davey had received in round 11, said: “Is he unfit to fight? I thought he was fit enough to give it a go.”
When doctors first began diagnosing boxers with dementia pugilistica (punch-drunk syndrome, the forerunner of CTE) they saw it not just as a physical illness but a social one. Those men, “fighters of the slugging type” as one of the earliest specialists, Harrison S Martland, wrote in 1928, dragged their feet, slurred their words, lost their balance and their memory.
They also beat their wives, fell deep into gambling debt, abused alcohol and other drugs. In some cases they were institutionalised. In others, they died – in bar brawls, in accidents, or they took their own lives. Sometimes they took others with them. Often they were not looked after, not helped to understand or manage their symptoms.
Boxing is ground zero for head injury research, so it is ironic that concern about concussion should now be shaking up professional football leagues and other contact sports around the world, while combat sport continues to duck and weave away from it.
“It’s not just a boxing issue,” Pearce told me when I was researching Browne’s death. “It’s any sport in which there are repetitive hits to the head, which may or may not result in concussion.”
Pearce was the lead author of the study that found CTE in Farmer. Farmer had played 356 A-grade games over 19 years, and died last year at 84. He was diagnosed with Alzheimer’s disease at the age of 64, and was exhibiting personality changes, depression, anger and aggression issues around this time.
None of my training or sparring partners in the boxing gym ever told me which knocks were bad, or how to tell. My trainers never gave me advice on how long to rest or suggested I ought to see a doctor. And we certainly didn’t talk about the fact that every hit to the head causes damage – and that we may not be able to see that damage until years later. In the six years that I’ve been involved in the sport at an amateur level – across at least five gyms in two states and working with up to a dozen different trainers – the only time I ever had a conversation with a fellow boxer about concussion was when I brought it up.
But we should be talking about it. We should be talking about it in the gym, on the footy field and in the locker room, with our teammates, our coaches and, especially, with our peers. When people with a history in elite contact sport exhibit violent or extreme antisocial behaviour, we should be asking if sports-induced brain damage may be a factor. Brain injury can be manageable – if it’s diagnosed accurately and early. Destigmatising it is a critical part of a culture of care in sport – something that should be central to any sport, especially one that involves repeated hits to the head.
Because a sport that doesn’t talk about concussion – that doesn’t understand it, that doesn’t educate its participants about it, that doesn’t empower them to speak up, to report symptoms or concerns or support their teammates to do the same – is a sport that’s putting its players at massive risk.
Concussion is not just a physical injury, it’s a social one. The solution must be too.
• After the Count by Stephanie Convery is out 3 March through Penguin Random House