While boxing has been around for many years, there are many inherent dangers within the sport. Boxing is uniquely one of the only sports where injuries are intentionally caused to its participants (Bledsoe, Li, & Levy, 2005). One of the injuries in which boxers are most at risk is head trauma, more specifically, brain injuries (McCrory, 2002). McCrory (2002) reports that one of the worst types of brain injury is known as chronic traumatic encephalopathy (CTE), or more commonly referred to as “punch drunk” syndrome. Injury to the brain can affect different individuals in different ways, depending on the damage done (Stoddard & Zimmerman, 2011; U.S. Department of Health and Human Services, 2013). The impact of brain injuries and a case study looking at key events in the life of Mike Tyson will be examined to illustrate the visible symptoms of chronic trauma to the head. There is controversy regarding whether or not boxing should be ended. Based on the knowledge of the effects of TBI one can certainly say that something needs to change for the well-being of these athletes (Bledsoe, Li, & Levy, 2005; McCrory, 2002).
Keywords: boxing, traumatic brain injury, head trauma, violence, aggression
Traumatic Brain Injuries: A Brief Examination of the Injury-Violence Correlation
While boxing has been around for many years, there are still many inherent dangers within the sport. Boxing is uniquely one of the only sports where injuries are intentionally caused to its participants (Bledsoe, Li, & Levy, 2005). One of the injuries in which boxers are most at risk is head trauma, more specifically, brain injuries (McCrory, 2002). McCrory (2002) reports that one of the worst types of brain injury is known as chronic traumatic encephalopathy (CTE), or more commonly referred to as “punch drunk” syndrome. Injury to the brain can affect different individuals in different ways, depending on the damage done (Stoddard & Zimmerman, 2011; U.S. Department of Health and Human Services, 2013). The impact of brain injuries and a case study looking at key events in the life of Mike Tyson will be examined to illustrate the visible symptoms of chronic trauma to the head.
Traumatic Brain Injury (TBI)
Definition and Statistics
Traumatic brain injuries (TBI) occur when sudden trauma, like a jolt or a blow to the head, disrupts the brain’s function (Stoddard & Zimmerman, 2011). A TBI can result from either a closed head injury or a penetrating head injury (U.S. Department of Health and Human Services, 2013). TBIs can be focal or diffuse, causing injury to one part of the brain or various parts of the brain, respectively. TBIs range in severity from mild to severe; however, almost 75% of them are of the mild variety (Stoddard & Zimmerman, 2011). Around 3% of all TBIs are caused by sports-related activities, such as what occurs in boxing.
Impact and Symptoms
Patients with traumatic brain injuries can experience mild, moderate or severe symptoms depending on how much damage was done (U.S. Department of Health and Human Services, 2013). An injury may be noticed either immediately or up to numerous weeks after the incident. Symptoms may vary as well. Some symptoms of TBI include dizziness, lightheadedness, blurred vision, confusion, ringing in the ears, headache, fatigue, lethargy, bad taste in the mouth, a change in sleeping patterns, changes in mood or behavior, and problems with memory, concentration, thinking or attention. TBIs “…can cause functional short- or long-term changes in cognition (eg, memory, reasoning), language (eg, communication, expression, understanding), and emotion (eg, depression, anxiety, personality changes, social inappropriateness)” (Stoddard & Zimmerman, 2011, pp. 1075). Speech may often be slow or slurred, while emotional and behavior problems may be varied (U.S. Department of Health and Human Services, 2013). Some examples of the emotional and behavioral problems often observed include depression, anxiety, irritability, paranoia, anger, violence, impulsivity, noncompliance, social inappropriateness, egocentrism, aggression, and substance use/addiction. These can be quite serious changes in behavior. Some individuals with TBI have such serious changes in behavior and personality that they are diagnosed with borderline personality disorder. Many of the symptoms displayed by victims of TBI are identical to symptoms experienced by people suffering from borderline personality disorder. As serious as TBIs are, there is an even more serious form of brain injury known as chronic traumatic encephalopathy (CTE) that boxers are prone to developing.
Chronic Traumatic Encephalopathy (CTE)
CTE, according to McCrory (2002), “…represents the cumulative long term neurological consequences of repetitive concussive and sub concussive blows to the head” (pp. 2). CTE is seen more often in professional boxers than it is in amateur boxers. In fact, research suggests that boxers who obtain more blows, more bouts, and who have more knock-outs are more likely to have an “increased incidence of positive CT findings and a higher risk of long-term neurologic disability” such as CTE (Bledsoe, Li, & Levy, 2005). CTE has progressive symptoms, especially involving cognitive and neurological issues, such as issues with speech and gait, memory impairment, behavior and/or personality changes (e.g., irritability, impulse control issues, paranoia, and affective issues), as well as psychiatric issues (McCrory, 2002; Handratta, Hsu, Vento, Yang, & Tanev, 2010). CTE is often associated with a decline in both physical and mental abilities, including issues with dementia and Parkinson-like symptoms (Bazarian, Cernak, Noble-Haeusslein, Potolicchio, & Temkin, 2009). The last stage of CTE is called dementia pugilistica, or DP. Bazarian et al. (2009) describe DP as, “Clinical symptoms often occur 10 to 20 years after retirement from the sport. Neuropsychological tests reveal deterioration in memory, information-processing speed, finger-tapping speed, attention and concentration, sequencing abilities, judgment, abstraction, reasoning, planning, and organization” (pp. 443). These symptoms can significantly impair a person’s life, especially a boxer who has been active all of his life. One of the questions often asked about brain injuries of any kind is how it impacts one’s likelihood of becoming aggressive or violent. There are many studies that suggest that violence and aggression are indeed a potential risk in individuals who have experienced TBIs or who have developed CTE (Kerr, Oram, Tinson, & Shum, 2011; Langevin, Ben-Aron, Wortzman, Dickey, & Handy, 1987; Stoddard & Zimmerman, 2011; U.S. Department of Health and Human Services, 2013).
The Injury-Violence Correlation
Research appears to suggest that there is a strong correlation between brain injuries and aggressive behaviors and violence (Kerr, Oram, Tinson, & Shum, 2011). Individuals with impulsive aggression were more antisocial, impulsive, and irritable than controls. Additionally, those individuals with traumatic brain injuries who were predisposed to aggression and violence were found to be impulsive and aggressive. According to Stoddard and Zimmerman (2011), research with prisoners who had TBIs suggests that these brain injuries are strongly correlated with committing violent acts. Stoddard and Zimmerman (2011) also report that youth who suffer from TBIs were more likely to be impulsive, have a psychiatric diagnosis, and report early criminal behavior and substance abuse. In a study by Langevin, Ben-Aron, Wortzman, Dickey, and Handy (1987), violent offenders were more likely to have a drinking problem than controls and they also reported feeling depressed, out of control, and hostile more often than controls. Langevin et al. (1987) also reported that brain pathology was also noteworthy in the violent offenders they studied. One study reported 2 factors that predicted aggression in people with acquired brain injuries (Kerr, Oram, Tinson, & Shum, 2011). The first factor was a low level of education (less than 10 years) and the second factor was a history of acting aggressively. Another study based on parental self-reports suggests that significantly more delinquent youths who suffered from TBIs had a lasting change in academic performance, emotional and behavior control, and interactions with family and friends (Hux, Bond, Skinner, Belau, & Sanger, 1998). The delinquent youths reported significantly more long-term effects from their TBIs than did the non-delinquent youths. Stoddard and Zimmerman (2011) also report that head trauma to the prefrontal cortex may cause delays in maturation of the prefrontal cortex, and reduced functioning of this area has been associated with violence and aggressive behavior. Altogether, research does indeed suggest that there is some sort of association with brain injuries and violent and aggressive behavior.
Phineas Gage, Head Trauma, and Aggression
The case of Phineas Gage may be noted as one of the most well-known and highly discussed cases in psychology textbooks in relation to brain injuries and a change in personality and behavior. While Gage was working on the railroad in 1848, an explosion caused a tamping iron to go through Gage’s head. After the accident, Gage’s behavior changed and he became “moody, irritable, profane, impatient, and obstinate” (Sue, Sue, & Sue, 2005). There was quite a bit of damage to Gage’s brain tissue in this accident, as the iron was three feet long and one inch in diameter. This suggests that there was certainly an association between the head trauma and the irritability and moodiness that Gage began to experience. The Phineas Gage case suggests that there is indeed a historical association between head injuries and aggressive behaviors or personality changes, just as other research also seems to suggest.
Case Example: Mike Tyson
As this paper originally intended to discuss head injuries due to boxing, Mike Tyson will be examined. There are many instances that could have caused Tyson injury to his head and brain (“Boxing – Mike Tyson’s Psychological Exam,” 1998; Kervin, 2012). Tyson began fighting as a child in the streets and reported being knocked unconscious on multiple occasions as a child (“Boxing – Mike Tyson’s Psychological Exam,” 1998). As a boxer for many years with 50 wins and 6 losses, Tyson has been punched in the head, head-butted, and knocked out 3 times (“Boxing – Mike Tyson’s Psychological Exam,” 1998; “Mike Tyson,” n.d.). Tyson often reports many symptoms of brain injuries such as depression, substance abuse, mumbled speech, irritability, anger, impulse control issues, struggles with memory, and he also exhibits the features of borderline personality disorder (“Boxing – Mike Tyson’s Psychological Exam,” 1998). Tyson was arrested for the rape of a beauty queen named Desiree Washington in 1992 (Kervin, 2012). Then, in 1997, Tyson bit off part of Evander Holyfield’s ear in a boxing match, and was then disqualified and lost his boxing license (Kervin, 2012; “Mike Tyson,” n.d.). Tyson appears to exhibit many signs of brain injury. He has shown evidence of violence and aggression (e.g., the rape conviction and the Holyfield match). However, Tyson was neurologically evaluated when applying for a new boxing license and no abnormalities were found in the EEG (“Boxing – Mike Tyson’s Psychological Exam,” 1998). It is, however, possible that Tyson does have damage and it may be more noticeable now that technology has improved. The events of Tyson’s life, as well as Tyson’s behavior, suggest that there is likely some sort of damage from the multiple losses of consciousness as a child and all of the injuries he received while boxing. The symptoms he exhibits fit perfectly with those exhibited by those with traumatic brain injuries. However, if Tyson does indeed have brain injuries, they are likely mild since he has exhibited fewer symptoms in recent years (iChannelMedia, 2012; Kervin, 2012). Tyson may, however, need to remain aware of the symptoms of chronic traumatic encephalopathy (CTE) because it may develop years after a boxer’s career is over, and it is even more dangerous than traumatic brain injuries in general (Bazarian, Cernak, Noble-Haeusslein, Potolicchio, & Temkin, 2009; McCrory, 2002).
Brain injuries are a very real and dangerous possibility for boxers (McCrory, 2002). Symptoms of brain injuries may vary, but often include depression, anxiety, irritability, paranoia, anger, violence, impulsivity, noncompliance, social inappropriateness, egocentrism, aggression, and substance use/addiction (U.S. Department of Health and Human Services, 2013). Often these individuals may even be diagnosed with borderline personality disorder because of its similarities with these symptoms. As the symptoms suggest, violence and aggression may be seen in individuals with brain injuries, and research supports this link between brain injuries and violent and aggressive behavior (Hux, Bond, Skinner, Belau, & Sanger, 1998; Kerr, Oram, Tinson, & Shum, 2011; Langevin, Ben-Aron, Wortzman, Dickey, & Handy, 1987; Stoddard & Zimmerman, 2011). This type of behavior is evident in the life of Mike Tyson, a boxer who has had many injuries to his head (iChannelMedia, 2012; Kervin, 2012). Tyson exhibits these symptoms, but there is no evidence at this time that he actually has any traumatic brain injuries (“Boxing – Mike Tyson’s Psychological Exam,” 1998). Regardless, TBIs are a real risk for all boxers and anyone who receives an injury to their heads. This may cause a drastic change in one’s behavior, leading to violence and aggression. It is debated whether or not boxing should be changed or ended based upon research done on brain injury (Bledsoe, Li, & Levy, 2005; McCrory, 2002). With the seriousness of these injuries in mind, one must consider that something must change in order to help boxers like Tyson and other athletes from developing injuries that could be better prevented.
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