League of Denial

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease caused by repeated head injuries. Bennet Omalu discovered the disease in 2002 during the autopsy of Hall of Fame center Mike Webster. Since that time, over 100 former NFL players have been found to have CTE. The disease is similar to Alzheimer’s disease and dementia pugilistica, which is commonly found in the brains of boxers, because it involves the buildup of tau protein in different regions of the brain.

League of Denial offers two specific definitions of a concussion, one from the NFL’s Mild Traumatic Brain Injury Committee and one from neuroscientist Kevin Guskiewicz. The MTBI committee’s definition is rather broad, calling it “any traumatically induced alteration of brain function” and listing the symptoms of blackouts, wooziness, amnesia, headaches, vertigo, memory loss, personality change, and lethargy (132). Guskiewicz’s definition is more precise:

A concussion is a blow to the head followed by a variety of symptoms that may include any of the following: headache, dizziness, loss of balance, blurred vision, “seeing stars,” feeling in a fog or slowed down, memory problems, poor concentration, nausea, or throwing up. Getting “knocked out” or being unconscious does NOT always occur with a concussion (115). 

Dementia is a broad category of brain diseases marked by long-term cognitive decreases, particularly with memory. Whereas diseases such as chronic traumatic encephalopathy and dementia pugilistica can only be determined post mortem, dementia is typically diagnosed in living patients. Virtually all of the deceased NFL players who were discovered to have CTE experienced one form or another of dementia before their deaths. 

Dementia pugilistica, also known as “punch-drunk syndrome,” is a neurodegenerative disease caused by repeated head injuries. Nearly identical to chronic traumatic encephalopathy, dementia pugilistica is recognized by the buildup of tau protein in the brain. The disease has been chronicled in boxers since 1928, but it was not until 1973 that it became accepted science due to postmortem examinations. When the first cases of CTE were discovered, the pathologists expected to find dementia pugilistica.

Forensic pathology focuses on determining the cause of death by the examination a corpse. Forensic pathologists are specially trained to perform autopsies and determine causes of death and the presence of disease. Bennet Omalu was the forensic pathologist on duty when the body of Mike Webster arrived at the Allegheny County Coroner’s Office. 

A mass tort is a civil action involving numerous plaintiffs against one defendant. Typically, these arise out of the defendant’s causing numerous injuries or harm through the same act. Initially, there were several lawsuits against the NFL for its participation in concealing the link between football and brain damage, but those were consolidated into one mass tort involving nearly 6,000 former players or their families. The NFL settled the case for $765 million plus legal fees of nearly another $200 million. 

Neuropathology is the study of disease of nervous system tissue. The two primary neuropathologists in League of Denial are Bennet Omalu and Ann McKee. Omalu made the discovery of chronic traumatic encephalopathy in Mike Webster and later discovered the disease in other former NFL players. McKee took up the mantle as the discoverer of the majority of CTE cases in her position with Boston University’s Center for the Study of Traumatic Encephalopathy. 

Developed by former Oklahoma Sooners head coach Bud Wilkinson, the Oklahoma drill is a football practice technique. The drill is sometimes called “the nutcracker” because of the helmet-to-helmet contact required. While it is purported to be a blocking and tackling drill, many critics have suggested that it exists as more of a motivational drill. The drill typically consists of one offensive player versus one defensive player with a ball carrier trailing the offensive to either slide by the blocked defender or be tackled. To open the book in Chapter 1, the authors use an anecdote involving the Oklahoma drill to introduce Webster, who excelled at the drill because of his superior strength and willingness to hit.