According to actuaries employed by the National Football League (NFL), long-term cognitive issues will emerge in the lives of nearly 28% of professional footballs players. This statistic only became available following the relentless work of Dr. Bennet Omalu, who discovered and named the cognitive impairment known as chronic traumatic encephalopathy (CTE) in 2005. The film Concussion follows Dr. Bennet Omalu, portrayed by prominent actor Will Smith, on his journey of identifying CTE – from the autopsy of Mike Webster that started it all to the U.S. Senate hearings in which the NFL had to answer to the scientific connection between CTE and American football. In particular, viewers see these events unfold through the lens of truth – how far do we go to find the truth, especially regarding our health? To tell it? To uphold it in the doctor-patient relationship? Omalu strives for the truth amidst clashing individual (his extensive education), interactional (his dissenting coworkers and fellow Pittsburghers), institutional (the stonewalling NFL), and population-level (hegemonic, patriarchal football culture) forces that shape the construction of this devastating disease.
The first time that viewers are introduced to Dr. Omalu is when he is testifying in a legal case as an expert witness. His extensive academic resume is at the forefront of his testimony – a medical degree from the University of Nigeria, medical residency at Columbia University in New York, master’s degrees in Public Health and Epidemiology, board certification in Forensic Pathology with a focus on Neuropathology, and more. As a result of his education, Omalu received a job in the Allegheny County Coroner’s Office after immigrating to the United States from Nigeria. The next time Omalu appears on screen is when he is at work and performing an autopsy on Rachel Green. Before making the first incision, he pulls up next to Rachel, smiles, and speaks in a comforting tone: “Okay, Rachel, I need your help. We are in this together. Please help me find out what happened to you.” Although subtle, this connection that Omalu builds with his deceased patient serves as an example of his life’s mission: to use the knowledge and opportunity that he is awarded by being a doctor in the United States to act as his patients’ spokesman. According to Talcott Parsons, the physician has four key responsibilities within the doctor-patient relationship: to cure the patient, to manage uncertainty, to manage access to confidential information, and to act ethically. While Omalu cannot meet the first of these charges (he is a medical examiner and thus cannot ‘cure’ his patients), he does work towards the other three quite thoroughly. In fact, his coworkers ridicule him for his dedication to finding the cause of death (“You’re not her shrink, Bennet!”) and to preserving the body to his best ability during autopsy (he uses his own set of simple tools that limit additional injury to the body). Furthermore, he does not seek grandeur or prestige from his position; rather, he accepts each and every case as they come, regardless of who is on his table.
That is how Dr. Omalu meets Mike Webster, a Hall of Fame football player from the Pittsburgh Steelers who played center, a position particularly vulnerable to injury. In his retirement, Webster is shown having symptoms of dementia and depression, being restless and easily agitated, and using electroshock tools on himself. His mental and physical condition left him alienated from his friends, family, and doctors, who were at a loss for the cause of his decline. Ultimately, he dies at 50 years old as a result of a heart attack, and his body is brought to the Allegheny County Coroner’s Office, where Omalu happens to be on call. When he arrives to work that day, Omalu is met by the grief of the Pittsburgh people and the outrage of one of his coworkers (“I can’t believe it’s you…leave him be.”) – they want their hero to rest in peace, no questions asked. Omalu resists his colleague’s forceful demeanor; he has a job to do, and he plans on completing it to the best of his ability and doing what he can to find out the truth behind both Weber’s life and death. According to the doctor, “cardiac arrest may be how he died but not why…People do not go mad for no reason.” When Omalu is told that the additional tests that he wants to run won’t be paid for by the county, he takes the money out of his own pocket. From the microscope slides he commissions, he finds that Webster had severely damaged neurological structures and protein buildups resembling those of Alzheimer’s patients. After getting into contact with Steven DeKosky, a neurologist from the University of Pittsburgh, and Julian Bailes, the former team doctor of the Pittsburgh Steelers, Omalu and his boss, Cyril Wecht, publish a case study stating that Webster obtained brain damage from playing football, terming the impairment chronic traumatic encephalopathy (CTE). This publication was not without its opposition, though. Indeed, Omalu received many phone calls from individuals threatening him to stop his research and his prying into the business of the NFL and its players. While such comments left Omalu shook (he had trouble sleeping at times), he did not waver from his efforts to explore the truth. This commitment to educating the public about CTE was further validated when more retired NFL players (Justin Strzelczyk, Terry Long, and Andre Waters) are believed to have died after showing symptoms of CTE.
Unfortunately, while Omalu is able to work against the interactional social determinants that threaten his life’s work, he falters when met with the institution behind the disease: the National Football League. For a long portion of the film, the NFL remains silent and reticent to comment on Omalu’s work, lest they validate him by acknowledging him. Years after Omalu’s initial publication, however, the NFL agrees not only to hold a Concussion Summit on player safety but also to allow Omalu to present his findings. Omalu becomes excited at the prospect of sharing the truth he has discovered to the only organization with the ability to fix the issue at hand. Yet, that excitement is shattered when the NFL both bars Omalu from the Summit and denounces him and his work within a couple of hours, claiming that any trauma found by Omalu was the result of non-football-related injuries. As a result, the NFL becomes a social force directly acting against the widespread education of CTE and its prevention. In the weeks that follow, additional pressure on Omalu to rescind his publication and its findings builds. For example, Wecht, the county coroner and Omalu’s superior, is prosecuted on seemingly-baseless charges of corruption as a result of meddling with the NFL’s pristine reputation; the charges are only dropped once Omalu is forced to agree to leave Pittsburgh. Prior to his relocation to the San Joaquin County Coroner’s Office in California, Omalu makes a final plea for truth and honesty from the NFL, its officials, and doctors.
Clearly, the power of the NFL is not to be underestimated let alone challenged. Indeed, American football forms a unique hegemonic culture of its own, which touches both young and old equally. Football provides jobs to its players, coaching staff, and administrative employees; scholarships to kids wanting to go to college who maybe cannot afford to do so; and a form of entertainment that has consumed an entire day of the week. As such, the NFL serves as a socioeconomic powerhouse with significant political and social clout, evidenced by Wecht’s prosecution and the reverence people have for their favorite football players like Webster. Yet, as a result of Omalu’s consistent probing, the renowned institution is forced to listen when another football player, Dave Duerson, concedes the validity of Omalu’s work in his suicide note. A conference is subsequently held by the NFL Players’ Association on the topics of concussions, CTE, and player safety, and Omalu is invited to speak. He concedes that he would not be there if one autopsy — that of Mike Webster — had not turned his life upside down. By having the chance to develop a relationship with Webster, he notes that he was given the “gift of knowing” and the ethical burden and responsibility to share the truth he discovered with the population that is at risk by engaging in this endemic pastime. Following the conference, the NFL commissioner is brought to the floor of the U.S. Congress and testifies that there is a link between CTE and football – finally, the truth is acknowledged. The film even notes the comments of Representative Linda Sanchez, who compares the NFL-CTE link to that between smoking and lung cancer (which we have extensively covered in class) in which tobacco companies denied the connection for years before they were forced to admit they were wrong.
The social construction of a disease is dependent on several factors, such as why the medical community identified the condition at that time, how the condition is spoken about, what experiencing the condition entails, and conflicting perspectives on the validity of the disease itself. As evidenced in Concussion, CTE was identified by Dr. Omalu in a time in which several former NFL players were experiencing and dying from a haphazard set of symptoms, as seen in Mike Webster. The condition itself is of a neurological basis, stemming from multiple head injuries – a common hallmark of playing football. Because of its association with football, a dominant patriarchal symbol in the United States, CTE was met with heavy criticism from the general public and the NFL itself, which questioned not only the disease’s validity but also the validity of the diagnosing doctor, Omalu. Moreover, the conversation surrounding the disease played into larger themes such as the stigma surrounding men and illness. While men are more likely to partake in risk-taking behaviors (e.g. sports like football and playing while injured), they are also less likely to seek help in the form of medical care (O’Brien, 2005). In the context of CTE, football players, a largely male population, are reluctant to seek help for their treatment because of the concepts of masculinity that they have learned from football culture and American society, as per the constructionist perspective of gender (Courtenay, 2000). Thus, Concussion serves to not only describe the plight of a young doctor attempting to provide veracity about a critical medical condition but also bring to light how society and gender norms struggle against constructions that threaten their existence.