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Concussion and boxing

concussion
Action Images/Andrew Couldridge
Terry Dooley examines what has for too long been an elephant in the room: the link between taking punches, concussions and failing mental health

JERMAIN TAYLOR was always a bit different. The country music loving 2000 Olympic bronze medallist was polite, quiet, stable, and he had athleticism coupled with the type of natural talent that does not pop up too often. By 2005 he had the world, and Bernard Hopkins’s middleweight titles, in his hands. The Taylor of 2019 is a totally different proposition.

Felony after felony piled up over time: police were called out in 2011 when he smashed his mother’s car window, he shot his cousin, Tyrone DaWayne Hinton, in 2014 while preparing to challenge Sam Soliman for the IBF’s middleweight title, and he fired his gun at a Martin Luther Day parade and threatened a family. Then he went to rehab, where he punched fellow patient Jason Isaac Condon, fracturing his skull.

The former fighter plead guilty to nine felony charges in relation to his cousin. He admitted that he was broke despite some attracting huge paydays in the past. Indeed, he was picked up in November last year for failure to pay $5,300 in child support. The 41-year-old also violated the terms of his parole and his ability to stand trial was called into question due to diminished “cognitive abilities”.

Debate raged over whether Taylor should have been allowed to fight after he was knocked out by Kelly Pavlik (rsf 7), Carl Froch (rsf 12), and Arthur Abraham (KO 12) between 2007 and 2009. It is clear that there was a personality change in Taylor after those defeats, the type you sometimes see when someone has endured severe head trauma. An MRI in 2009 confirmed that his short-term memory had been impacted by a minor subdural hematoma, a brain bleed that can lead to death. At one point he was told he would never fight again.

Eventually, he was cleared by the Nevada State Athletic Commission after tests at a Mayo Clinic did not flag up any future injury risks. The commission had recently overturned a 1972 ruling that had placed a blanket ban over fighters who had a history of brain injuries. They went for a case-by-case option instead, opening the door for Taylor to apply for his licence.

concussion
At one point Taylor was told he should not fight again Action Images/REUTERS/Las Vegas Sun/Steve Marcus

His 2011 comeback was divisive, especially when footage emerged of him acting erratically and displaying slurred speech. There were misgivings over him before he went in against Soliman in 2014 and picked up the IBF title for a second time. Taylor was once again winning in the ring, but struggling badly with life.

Taylor put it best in a moment of lucidity after a victory over Juan Carlos Candelo in December 2013, his fourth comeback win. “Man, what else am I supposed to do?” he told the press. “I have nothing else to do. I’ve been doing this job since I was 12. This is my life. When I took those years off, I sat back and thought about it: ‘What am I supposed to do?’”

How can someone who has dedicated themselves to a sport since the age of 12 not only walk away but make and retain enough money to live the rest of their life in relative comfort? If Taylor is struggling to pay child support now then what will life be like for him in his 50s?

The question of when a fighter retires and who decides if it should be forced on them is a hard one. It is easy to advocate calling time on a career from the sidelines. It is something that has raised its head recently following a series of worrying social media posts, since deleted along with his accounts, from British heavyweight David Allen.

Granted, Allen is not as extreme a case as Taylor yet concerned fans asked where we draw the line. If every boxer who posted extreme messages on social media was forced to retire there would hardly be anyone left yet Allen, like Taylor, has had some hard fights and defeats. He took some extreme punishment in his last loss, a 10th-round retirement defeat to David Price in July that left him hospitalised.

Prior to his disappearance from social media Allen was scheduled to appear on Matchroom’s October 19 card in Newcastle. The 27-year-old has proven himself willing to shore up bills, bringing in some wider fan interest and shifting a few extra tickets. That is why he will always be in work as long as he is licenced.

To his credit, Allen took the issue into his own hands by releasing a statement in which he declared that he has decided to take a well-earned timeout. In many ways it is as brave a move as the decision to step into the ring in the first place. It is a choice that we can implore a boxer to make yet is one that they have to take ownership of. If they want to fight then they will find a way to fight, straying outside the well-regulated auspices of the BBBoC if required.

This is all increasingly prevalent given that The Sun recently sensationalised the issue of concussion, — taken from the Latin concussio, ‘a shaking’ — by stitching up Anthony Joshua’s trainer Robert McCracken over his use of the word in relation to Joshua’s loss to Andy Ruiz Jnr. In that bout, Joshua struggled through a haze following two knockdowns in round three. Insinuating that McCracken somehow played Russian roulette with his fighter ignores a key factor in boxing: if you stopped fights purely due to suspicions of possible concussion we would lose a lot of glorious moments.

If Joshua had emerged victorious post-fight, talk would have focused only on his in-ring comeback. Think of the McCracken-trainer Carl Froch, who was floored heavily in round one of his 2013 fight against George Groves, took more heavy blows in the early going, and then earned a controversial stoppage in the ninth to retain his WBA and IBF super-middleweight titles.

George Groves
Froch did have to rise from a heavy knockdown to beat Groves

If you remove fighters from these types of fights as a preventative measure you insult their decision to partake in the sport in the first place. You prevent them from rising to glory, as boxing thrives in unlikely comebacks and reversals. Still, the question of whether we should send fighters out for more once they have been heavily floored is one that haunts people within the sport.

It is not just the boxer who pays the price when it all starts to turn in on itself, as Maryse Hatch found when her husband, former amateur boxer Curtis, began to behave erratically and violently years after retiring before eventually taking his own life in 2011. The story was brought to wider attention by Lyra McKee, who also reported the results of tests on the brain of former middleweight champion Paul Pender by Ann McKee in her article The Fight of your Life (mosaicscience.com).

Pender had suffered with depression and mood swings later in life that led him to a VA hospital, where the initial diagnosis was Alzheimer’s. When he died McKee looked at his brain and concluded that: “I was doing the autopsies and I fully expected to see Alzheimer’s. But he had anything but. He had a brain that…for a person who studies brains and makes that their life mission, I’d never seen anything like it. The tau [protein] pattern [a substance that damages brain cells] in this particular brain was extraordinary.”

As far back as 1928, forensic Pathologist Harrison Martland coined the phrase “Punch Drunk” in his famous article (Martland H.S., ‘Punch Drunk’, Journal of the American Medical Association). Writing in 1937 J.A. Millspaugh came up with the more medial sounding “dementia pugilistica” (Millspaugh JA, ‘Dementia pugilistica’, U S Navy Medical Bulletin 35). Eventually, Macdonald Critchley came up with the term Chronic Traumatic Encephalopathy (Critchley, M. ‘Punch  drunk  syndrome:  the  chronic  encephalopathy of boxers’, Neurochirurgie Hommage à  Clovis  Vincent, 1949), a damaging degenerative neuro disease caused by repeated head injuries.

In 2009, the same year that Taylor was knocked out twice, Robert L. Heilbronner et al published ‘Neuropsychological Consequences of Boxing and Recommendations to Improve Safety: A National Academy of Neuropsychology Education Paper’ (Archives of Clinical Neuropsychology).

Although Heilbronner and co pointed out that, statistically, boxing is safer than some other sports, and not all participants sustain long-term injury, a study had found that the existence of multiple sub-concussive head blows, blows that don’t cause concussion yet are still damaging, appear to be ‘the primary cause of neurologic injury in boxers, especially for a subset of professional boxers with extensive fight histories’ (Jordan B. D., et al ‘CT of 338 active professional boxers’, Radiology, 1992).

Because of the very nature of boxing, Second Impact Syndrome (SIS), adding a second brain injury before the earlier one has been diagnosed and treated, is also a huge risk to the well-being of fighters. Heilbronner also had some positive words as the fact that people fight less often coupled with greater medical provisions has gone a long way to reducing boxing-related neurological problems, although the American Association of Neurological Surgeons estimates that 90 per cent of boxers suffer some form of brain injury.

Work has continued this year on the link between head trauma, depression and performance levels. The conclusion is that boxers suffer from a “particularly high number” of RHIs (Repetitive Head Impacts), the sub-concussive impacts mentioned earlier, and that the wider bearing on mental performance, health and long-term well-being is becoming more evident (Bern Lee et al ‘The Relations Among Depression, Cognition, and Brain Volume in Professional Boxers: A Preliminary Examination Using Brief Clinical Measures’, Journal of Head Trauma Rehabilitation, 2019).

Furthermore, reaction times in some physical and mental tasks can be dulled by depression and anxiety (Yavuz and Oktem, ‘The Relationship Between Depression, Anxiety and Visual Reaction Times in Athletes’ Biology of Sport, 2012).  If we believe the science it becomes a vicious circle: head trauma can cause depression, which in turn can result in reduced performance levels and that can lead to greater exposure to further head trauma.

In a 2017 study punchily titled ‘Concussion’ (The American Journal of Medicine), William J. Mullay MD pointed out that the issue had long been acknowledged in medical circles while reiterating that it is a wider sporting problem that leads to alteration in neurological functioning and “post-concussion syndrome”, the headaches, imbalance and “fogginess” that some complain about after tough fights — contests that may not lead to an hospital visit or check-ups.

Mullay estimated that in the USA alone there are 3.8 million cases of concussion in sports per year — that is a lot of damaged brain cells. He advocates immediate removal from the field of play, but what if that is not always possible, as is the case in boxing?

‘It is clear that there is a direct link between boxing, concussion, depression, and other physical and mental health issues’

Heightened awareness of the risk involved is probably why so many fans implored Allen to take a time out yet if he had been cleared to fight in Newcastle and gone ahead with it the decision to do so it would have rested on his shoulders. Free choice is the rub. History proves that if a fighter wants to be licensed they will find somewhere that will issue one and carry on regardless.

Taking a step back is a hard decision for a boxer to make, and, friends and family aside, it is one they face alone due to a lack of any real kind of aftercare.

People like Michael Gomez, for example, are cast out like lepers. If we see them, see their post-boxing struggles, we have to confront some uncomfortable truths. It is almost as if we fear that if we come into contact with them we will catch something. If you rub up against the truth it rubs off on you. 

With the best will in the world one cannot see anything other than a sad ending for Taylor. Allen, though, is young enough and personable enough to forge a life outside boxing, if that is the path he wishes to take. Ultimately, the decision rests with the fighters, and we know what they will decide to do if the fire still burns.

For this writer, it is as clear as day that there is a direct link between boxing, concussion, depression, and other physical and mental health issues. The science is reaching a point where to say otherwise would be like advocating the crazy belief that the world is flat. Deep within ourselves, most of us know it to be true: we have seen it, heard it, read about it and, in the case of Muhammad Ali and others, celebrated the insanely damaging bravery that we know has its effects. Increased medical provisions, greater awareness, and all the other things currently in place cannot allow us to fudge the issue or, worse, sensationalise it. It is time to open our eyes.

1 Comment

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  • This is one of the best articles I’ve ever read in Boxing News.
    In the face of this medical evidence it would seem wise that the boxing authorities act before being forced to at some point in the future.
    More involvement of the medical community seems essential with brain scans after every fight so that fighters have the latest information before deciding to continue their careers. Maybe a small percentage off all fighters’ purses could finance such a system in various countries.
    As the full effects on the brain from head trauma doesn’t usually present until many years later this isn’t the full answer but probably the best boxing can do without ripping the soul out of the sport.

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