Defamiliarizing Concussions: Sports Fandom,Injury,and Potential Attitudinal Shifts

Abstract

In this article, we examine whether modes of representation that disrupt and defamiliarize the naturalized understandings fans share about the legitimacy and necessity of spectacular violence and sacrifice in sport can have the potential to reframe fan attitudes and investments. We explore the social cognitive and attitudinal shift towards traumatic brain injury (TBI) and injury more broadly in American football of first year students with a stated investment in the spectacle of high-performance sports after viewing Josh Begley’s 2018 short film Concussion Protocol. By comparing the responses of students at the beginning of the semester to their responses immediately after viewing the film, this project reveals how placing fans of sport in a face-to-face relationship with athletic laborers can challenge preexisting assumptions about normalized violence in sport, ultimately effectuating a potentially new and more humane attitude to athletic spectatorship.

Introduction

The suggestion that repeated and severe head impact (HI) in US football is associated with traumatic brain injury (TBI) and cognitive degeneration is now a well-established empirical fact (see Bachynski, 2019; Casper, 2018; Harrison, 2014; Mez et al., 2019). Indeed, as Stephen Casper (2018) has noted in his review of the history of concussion, “for almost a century, single or repetitive HI have been known to result in degenerative processes. By the 1950s, subconcussive blows, second-impact syndrome, tangle pathology, and concerns about cumulative effects of concussion contributed observations that are now key to current understanding of concussion,” (p. 808). Yet, recently, concern for TBI and related brain injury in football has escalated due to increasing awareness of chronic traumatic encephalopathy (CTE), a degenerative brain condition producing symptoms such as depression, apathy, aggression, dementia, and suicidal ideation and actions (Bachynski, 2019). Path-breaking studies by researchers out of Boston University’s CTE Center have documented the incidence of CTE in the brains of deceased former football players, including the finding in one recent study that ninety-nine percent of former NFL players’ brains in a sample of 111 and ninety-one percent of former college football players’ brains in a sample of 53 had evidence of CTE (Mez et al., 2017). Further, McKee et al. (2023) have more recently found that “over 97% of CTE cases published have been reported in individuals with known exposure to repetitive head impacts, including concussions and nonsoncussive impacts, most often experienced through participation in contact sports” (p. 371) like football. Even in young contact sport athletes (younger than 30 years old), brain donors exposed to repetitive head impacts were highly symptomatic of CTE and 41.4% of 152 deceased contact sports participants were diagnosed with the disease post-mortem (McKee et al., 2023). Findings from the DIAGNOSE CTE (Arciniega et al., 2024) research project demonstrate that former college football players showed significant volume reductions in the hippocampus, amygdala and superior frontal gyrus compared to non-football players. This study found that these morphometric abnormalities “resemble the anatomic distribution of pathological findings from post-mortem CTE studies” (Arciniega et al., 2024, p. 1). Similarly, in a large sample, Mez et al. (2019) found that the odds of developing CTE double with every 2.6 years of football played. Earlier findings of this nature have penetrated popular culture through their depiction in high profile films such as the documentary League of Denial (2013) and the verisimilar narrative film Concussion (2015), and corresponding coverage in the mainstream media.

Despite the warnings and what may be a slightly declining participant pool (3% in the last year), eleven-player boys high school football participation remains robust at over one million participants – 22.2% of all high school boys’ sports participants in the US (Cook, 2019; National Federation of State High School Associations, 2019). Meanwhile, if we think in terms of television viewership as a metric of popularity, NFL viewership numbers early in the 2019 season were on the rise (despite the overall decline of TV viewership in general, it might be added)—up to an average of 16 million viewers across broadcasts, up five percent from 2018 at the same time, eight percent from 2017, and down only one percent from 2016 (Pallotta, 2019). While the audience of NFL regular season games dropped in 2020 by around 7%, this has been widely attributed to the Covid-19 pandemic and dovetailed similar decreases in most professional sports leagues, perhaps representing an anomaly rather than the norm (Adgate, 2020).

It is clear, then, that while the association of football with TBI and CTE has affected some viewers of, and participants in, US football, the impact has been relatively minor and has yet to widely negatively impact viewership or participation. This raises important questions about the relationship between harm, violence, spectacle and spectatorship in US popular culture. Research is thus needed to understand these connections and how they work to shape broader understanding of the relationship between repeated head injury (RHI) in football and degenerative brain injuries like CTE. At the micro level, it is indeed useful to examine the ways in which small groups navigate these relationships in educational spaces like classrooms in order to understand the ways in which people become familiarized with frames regarding head trauma in football. In what follows, we will trace some of the existent literature on football, violence, and representation in order to tease out these relationships and to address key questions related to how folks may be conditioned to participate despite knowing and accepting risk and associated harm. Through an engagement with theories on how aesthetic representation can provoke an estranging experience for the spectator, we focus on a case study of one aesthetic representation of head trauma in football by analyzing the film Concussion Protocol by Josh Begley as exemplar of such a mode of disruption. This paper also examines student responses to Begley’s film in order to unpack the potential efficacy of defamiliarizing film as intervention against the normalization of TBI and violence in popular sport.

Traditional Representations of Football

Scholars of US football have long noted that professional football has been viewed as a form of pleasurable violence for spectators. Trujillo (1995) explains that this violence should be understood through the prism of hegemonic masculinity, showing how violence is fetishized as a source of pleasure: “Television transforms [the bodies of football players] into objects of fascination and the aggressive and violent acts they perform into graceful gestures that can be appreciated aesthetically, even erotically,” (p. 419). Similarly, Oates (2007) has documented the way the public image of pro football has consistently been presented as and valued for being violent and aggressive. Echoing the above, Anderson and Kian (2012) acknowledge how the traditional narratives in coverage of professional football uphold “the image of the emotionally and physically impenetrable football player,” (p. 155). Their study of an incident in which a star player pulled himself from a significant NFL game after a conversation with a teammate found that the encounter was deemed relatively unnewsworthy – scant coverage was provided despite the team ultimately making the Super Bowl and receiving excess coverage overall. In other words, moments of disruption to the hegemonic narrative of legitimate and necessary violence received comparatively little representation. This is nothing new, for as Butterworth (2014a) documents, starting in the 1960–70s NFL Films began the deliberate project of framing football as a form of heroic violence. Elsewhere, he has added that “football is upheld in the USA as the standard bearer of masculinity in sport. Observers expect the game to be violent and, at times, to result in significant injuries. Spectacular collisions and big hits generate excitement among fans and provide tests of courage for players,” (Butterworth, 2014b, p. 874).

Even more recently, Karimipour and Hull (2017) have found in a large-scale study of ESPN articles from 2013–2014 that the company minimized the significance of concussions as a form of harm—a new iteration of the long-standing fetish for violence in coverage of the NFL. Of particular use, Furness (2016, p. 51) demonstrates that representations of football are pervaded with an “informed soldier trope” that frames athletes as knowingly consenting to violence and sacrifice. This is the dominant context (Abdel-Shehid & Kalman-Lamb, 2011; Hall, 1997) for the representation of the game and it is little wonder that viewership and participation numbers remain robust. Despite being promulgated as the hegemonic order by mainstream sports media in partnership with the NFL, there have emerged some counter-cultural movements seeking to expose the realities of athletic labor. In the pages that follow, we will trace out one of these interventions.

Indeed, there have been some shifts in representation. Like Anderson and Kian (2012), a study by McGannon et al. (2013) found a softening in media towards masculinity. In their discussion of the representation of NHL star Sidney Crosby after a concussion, the authors found a generally sympathetic tone in the coverage. These findings are suggestive of what we would characterize as a gradual shift – a small scale transition away from the reproduction of traditional hypermasculine norms – rather than a profound intervention against the normalization of harm and injury. In the context of football, this is particularly salient as football is likely the epitome of what Messner (2002) calls the “masculinist cultural center” of sport (p. 92). Further, Cassilo and Sanderson (2018) examined the 2015 retirement and denunciation of harms associated with football by former NFL player Chris Borland and also found consistently sympathetic coverage in the media. This is particularly noteworthy given that the popularity of the league has not significantly declined. Evidently, the increase in sympathetic mainstream media coverage of injury does not correlate with a fundamental change, challenge, or radicalization of general fan perceptions. It is precisely this question – of how media coverage influences cultural change – that we seek to explore in the present intervention. Finally, Oriard’s (1993) groundbreaking work explores the early history of American football and how it evolved into a cultural spectacle through its representation in the media, arguing that the media helped shape football’s image as a uniquely and fundamentally American sport – as a metaphor for American life. This important work explicitly highlights how media influences cultural change related to football and public understandings of the game as a cultural and commercial institution.

Some scholars have recently engaged with social media as a potential site of intervention against the dominant logic of masculinity, toughness, and legitimate violence. However, their findings suggest a striking lack of efficacy in this sphere. Hull and Schmittel (2015) contend that Twitter was not effectively utilized by concussion advocates as an intervention against violence in football when they examined the quantity and quality of interventions during one Super Bowl. Similarly, a study of TBI discussion on Twitter by Workewych et al. (2017) found a dichotomy between useful educational interventions and misinformation, suggesting that many people aware of and engaging with the notion of concussions and sport remain unaware of its severity, and indeed, are reproducing the fiction that “mild” concussions are in fact possible. Illuminating the importance of new media in constructing or reinforcing dominant ideology surrounding athletic violence, this body of work highlights the importance of scholarly interventions that aim to make sense of how trauma, violence, and harm, are represented in sport but also how they are understood throughout the public sphere.

This is not to say that meaningful popular representational forays against the systematic violence and harm of elite football have not been attempted. In 2013, PBS released the influential documentary film League of Denial. Furness (2016) argues that League of Denial challenged the informed soldier trope through the testimony of players who did not actually know what they were signing up for. Likewise, Oates (2017) finds that League of Denial juxtaposes rock ‘em, sock ‘em clips with the repercussions of that violence to disrupt traditional habits of viewership. Furness (2016) further points to the depiction of Mike Webster’s declining body as an intervention against hegemonic masculinity (e.g., Connell, 1995; English, 2017) and the informed soldier trope. Indeed, through analysis of images of spectacularized and mythologized violence, the film offers a systematic explanation of exactly how media spectacle normalizes violence. Furness argues that “Kirk’s stylistic choices in the documentary seem specifically aimed at re-presenting that same sporting violence—those same clashing bodies—not as dramatic stanzas in a heroic saga, but as a series of monodies in a grotesque tragedy,” (2016, p. 55). Yet, Oates (2017) has also noted that interventions such as League of Denial and the later feature film Concussion are marked by corporate imbrications that compromise their efficacy. For instance, in the case of Concussion, Sony Features deleted parts of the film to appease the NFL. In the case of League of Denial, ESPN pulled out of the project at the last minute, undermining both its distribution and content (Oates, 2017, p. 136). One of the most notable recent contributions is in the work of Grano (2020), who maintains that brain banking practices – in other words, practices that make NFL players visible as racialized biosocial subjects of brain trauma through techniques such as preventative testing, data collection, surveillance, and medical testing – offers supports for risk management and prevention strategies that may center the athletic worker encapsulated in a racial hierarchical game rather than football itself.

Concussion Protocol and Defamiliarization

Josh Begley’s (cite year) slightly over five-minute long short film Concussion Protocol offers a direct assault on the pleasure fans extract from the violence of football. Directed by Begley and distributed worldwide by Field of Vision and First Look Media, the film was released just before the 2018 Super Bowl and is a visual record of every concussion reported during the 2017-18 NFL season. As of July 2021, the film had amassed over 117,000 views on YouTube, and received some news media attention (notably outside of the NFL partnership suite of ESPN, CBS, NBC, FOX), with The Intercept’s King (2018) calling it “The Film the NFL doesn’t want you to see.” King (2018) continues to suggest that “the NFL has done a masterful job at mainstreaming violence of the game, so that fans and spectators don’t feel too bad about what’s actually happening out there…and no document has ever quite displayed the horror of it all like Concussion Protocol.” While the short film did not garner much mainstream media attention, it does present an explicit and humanizing account of the harrowing life of athletic workers put in the middle of an inherently violent – yet massively popular – professional sport.

As a direct rebuttal to the misrepresentation of football violence presented by the prepackaged NFL product, Begley strips these devastating moments of the cheerleader framing of sports/media complex (Jhally, 1984) television coverage and then defamiliarizes them through reverse motion – a technique that centers the violence of concussions and eliminates the possibility viewers might enjoy what they are seeing, even if trained to do so. The footage is paired with haunting music and the sound of breathing which evoke the claustrophobia we imagine one might feel trapped in a helmet after suffering a trauma, challenging the viewer to identify with the harm suffered by the concussed athlete. Given this and despite the film’s independent distribution, we hold that it is a legitimate and important site for the analysis of competing representations of athletic labor particularly in the context of a general lack of scholarly interest in media depictions of athletic-induced head trauma (Grano, 2020). In short, the film warrants scholarly attention precisely because it provides an explicit rebuttal to much of the discourse surrounding athletic violence presented in mainstream media and by the NFL itself.

Hartman (1997) examines how violent racial spectacle was normalized within the US system of chattel slavery in part by transforming that violence into “an extreme and incongruous display” of “fun and feeling” through the horrific coffle – a procession of enslaved people compelled to sing and perform “contentment” en route to the market (pp. 34–35). The effect of this spectacle was to produce, for the white spectator, the illusion that this dehumanizing display was in fact bearable, even normal—familiar. Begley (2018, February 1) draws on the work of Hartman to situate his own intervention against the ways in which contemporary professional football (itself a racialized form of violent spectacle) likewise normalizes and legitimizes extreme and dehumanizing violence through a form of spectacle designed to elicit pleasure for the viewer. He writes:

I hope to make strange what has for many of us become normative: the spectacular, devouring moment of a football hit that knocks a player out cold. Rather than making a film about concussions with a flurry of hard hits, however, I am interested — inspired by Hartman — in looking elsewhere. How might we see the totality of this violence without just replaying the violence itself?”

Begley’s is fundamentally a project of defamiliarization and estrangement a la Bertolt Brecht’s epic theatre. Robinson (2008) has written of Brecht’s aesthetic politics that the project of epic theatre was essentially to “push his anesthetized audience to recognize and rethink and rework their alienated state,” (p. 193). One of the ways in which Marx (1994) understands alienation is in terms of the estrangement of human social relations in the context of capitalism: the alienation of workers from one another. In the context of Begley’s work, the estrangement at hand is the alienation of the audience from the athlete. The fan is alienated from the athlete in that the dehumanizing conditions of late capitalism invite the spectator to actually desire the sacrifice of the athlete (Kalman-Lamb, 2018, 2019, 2020), for in that sacrifice they achieve a sort of rejuvenation. Begley’s work, like Brecht’s tries to shake us from this state. By defamiliarizing us from football, we are in fact returned to a human relation (Marx (1994) might call this our species-being) to the football player. Similarly, Brecht is also trying to dislocate the audience from their complacency. As Robinson (2008) puts it, “Anyone who has come to the theater to feel and not to think, to merge empathetically with the characters and cry and laugh and not to learn, should simply not be there, should be turned away at the door,” (p. 194). Again, this is precisely what Begley accomplishes. He strips the pleasure from football so that we are left only with the pain and inhumanity, and from this we can learn. Jameson (1998) has characterized Brecht’s approach as an attempt “to make something look strange, to make us look at it with new eyes,” or what he suggests is a disruption of “a kind of perceptual numbness,” (p. 39). This intervention is fundamentally political, for it reframes “the familiar or habitual,” previously understood “as the ‘natural,’” instead as “made or constructed by human beings,” (p. 40). Ultimately, then, Brecht’s project is to expose the ethical underpinning of representation and its material relation to social structure and human well-being. Which is to say, how that which is harmful has been coded as natural, normal, even beneficial, and also, how that framing can be undone through alternative modes of representation that expose the actuality of harm and mobilize viewers to challenge the conditions that produce it. This is the work of Begley’s powerful work, a film that manages to stretch 5 minutes to the sensation of a lifetime.

The aesthetic politics of Concussion Protocol then, are not difficult to unpack; rather, what we are left with is the question of efficacy. To what extent can the work of defamiliarization in the terrain of violent spectator sport accomplish what other forms of representation have not? That is, is it possible for defamiliarizing film to actually retrain the very ways we watch and experience football?

Media Effects and Social Cognitive Theory

How do watching films affect audiences? How might films familiarize (and thus defamiliarize) viewers with previously unknown or unacknowledged topic areas? There is a robust body of work within the fields of social psychology, media studies, and communication that suggests media act as mediators in a social cognitive process that influences knowledge acquisitions across a variety of contexts. Social cognitive theory proposes the idea that people learn through the observation of others. This observation can take place in person, but importantly it can also occur latently through watching media such as television, movies, or documentaries (Bandura, 2001; Stern, 2005). The theory builds on social learning perspectives to hold that an individual’s knowledge acquisition can be influenced by observing frames and media provides the models for changes in attitude or behavior (Bandura, 2008). For example, numerous studies have explored how video and film augment attitudinal and behavioral changes on the part of observers in contexts like diversity, equity, and inclusion (EDI) efforts (Liu et al., 2022), sexual consent communication (Willis et al., 2020), social justice programming (Eagan & Simon-Roberts, 2024), and, perhaps most relatedly, youths’ understanding of violence (Chukwu-Okoronkwo et al., 2020; Felix et al., 2022). These studies highlight the important role that film framing plays in shaping both attitudes and behaviors of observers. Indeed, representations in film must be understood as part of a cognition process that influences the observer’s knowledge basin that then further connects to their actions, attitudes, and behavior in the future.

This approach has been widely influential in the field of media effects studies. For example, Bandura (2008) has found that people learn to perform behaviors through media modeling – or the frames that teach general rules and strategies for engaging and navigating a number of different situations. Stern (2005) has found that media depictions of smoking, drinking alcohol, and using drugs in teen-centered films may teach teen viewers that substance abuse is common, mostly risk-free, and appropriate for all. In the context of sport, Hardin and Greer (2009) examine the gender-typing of sports and found that sports media consumption greatly influences gender-role socialization that is correlated with gendered perceptions of sports in American College students.

In the context of sport, social cognitive theory has been used to understand the uptake and proliferation of advanced statistics in baseball (Arth & Billings, 2020), sports gender typing (Xu & Fan, 2019), understandings of mental illness from media representations of star athletes (Casillo, 2022; Parrott et al., 2019), in bringing new fans into sports (Shah & Williams, 2024), and in mediating responses to media violence (Waddell et al., 2019). These studies highlight how SCT can be used to frame the analysis of qualitative studies of media like text or mass media frames. Casillo’s (2022) work, for example, relies on SCT to inform a data-driven approach to allows the framing of mental health vis-à-vis media coverage of high-profile athletes Royce White and DeMar DeRozan. The common thread amongst these disparate empirical sites is that media imagery influences knowledge acquisition for viewers in a number of important latent and manifest ways. Media representations are thus powerful tools for teaching viewers lessons about social phenomena and appropriate modalities of action, attitude and behavior, and this may be compounded in a case where scientific evidence about phenomena remain relatively naïve – for example, in the case of scientific knowledge about TBI and violent head trauma. In the context of concussion research, however, much of the scholarly attention has been paid to how athletes themselves come to understand head trauma, and the social cognitive process that plays out in relation to decisions to participate in contact sport. For example, Sanderson et al. (2016) have explored the social cognitive processes that male and female athletes negotiate while making decisions to report concussions in their respective sports. More specifically, football has been a site of research on how media influences perceptions and attitudes of observers. For example, Bell, Applequist and Dotson-Pierson (2024) have explored the ways in which CTE has been framed as a public health crisis, highlighting media discourses within the sports/media complex have shaped representations about brain injuries like CTE. Finally, Cummins and Hahn (2013) have used experiments to document the relationship between instant replay and perceived violence among football observers, finding that replay impacts perceived violence for fans. How media plays a crucial role in the process whereby observers come to understand the realities of head trauma in contact sports like football, however, remains relative under-explored. We thus approach media representations as one avenue through which cultural understandings of violence, trauma, and, more specifically, brain injury are understood and engaged with by viewers.

Methods

The data in this exploratory study was collected in a first-year intensive academic writing seminar on “Social Inequality and Sports,” the first author asked students to engage in brief reflective writing in order to situate their own attitudes and assumptions about sport and violence. Given the relative lack of scholarly interest in non-hegemonic media representations of head trauma in the cultural apparatus, as well as the difficulties in study design associated with film analysis, we hold that this intervention (an exploratory intervention) is both necessary and sufficient to shed first light on a topic that should be more widely received by academic communities. The present study, we maintain, represents an important exploratory first intervention to illuminating the ways in which counter-cultural artefacts related to football and head trauma are taken up and made sense of by audiences. At the beginning of the semester, following from, and in line with, IRB approval, I invited students in two sections of the course to participate in a five-minute automatic writing exercise in response to the prompt, “Sports are….” Students were expected to reflect on their most immediate reactions to the prompt and to write for the entirety of the five-minute period. They were not required to reveal their responses to peers in the class. Later in the semester, the same students were shown the film Concussion Protocol and then asked them to engage the questions, “How did it make you feel? What did it make you think?” They were allotted 5 minutes to address each question. In this case, the written response, which did not have to be shared with classmates, was used as the inspiration for a discussion about the film. Students were then given an additional 5 minutes to write a more general analytical assessment of the film in response to the prompt “what was the argument and how did they substantiate it.” Students could opt out from responding at any time, including from having their responses used in the study.

On the subject of prompting, students had been exposed to classes offering a Marxist critique of sport via Brohm. They had also performed readings related to social reproduction, violence, and athletic labor. They had not been exposed to any class discussion on those readings, nor had they had any discussion yet on semiotics in the context of sport or otherwise. Students were offered a trigger warning in advance of watching the footage in terms of the fact that they might find the imagery disturbing, particularly if they participated in the sport. Our personal reflection on the subject was that the viewing of these images was far in no way comparably harmful to participation in the acts being depicted in the images, and in fact, that sheltering players from these images is precisely how players are denied informed consent for participation in the sport. Despite this, the first author sought out and received IRB approval to ensure harm was minimized and alleviated.

A convenience sample of 18 students enrolled in a sports class at a university were selected. During the semester that the first author conducted this exercise, they taught a total of twenty-four students across two sections. For the purposes of the exercise, responses had to be submitted to a learning management system. Some students were absent on one or both dates of the in-class writing prompts and thus were unable to complete the assignment. Thus, of the total number of students enrolled in the course, eighteen were both eligible and consented to have their work included in the study. At the beginning of the course, seven of those students identified as men and eleven as women. Six were NCAA athletes.

In what follows, we examine student responses to unpack the way in which the film affected students’ naturalized assumptions about sport. To this end we adopt a grounded theoretical approach to critical discourse analysis, which focuses on analyzing how power relations are reflected in text and words (Fairclough, 1992, 2013). This allowed for a data-driven analysis of emergent themes from the text that we could develop theory from – in our case, the grounded theoretical approach allowed us to analyze the resultant text and find themes and patterns as they emerged which could then be used for theory generation (i.e., to inform our application of SCT). We use these techniques to study the ways in which students’ responses are structured and situated in such a way as to reflect certain social cognitive processes that frame changes or disruptions in knowledge about the topic of TBI and head trauma in football. Close textual analysis of those words, then, can be conducted on the basis of critical discourse analysis to illuminate some of the ways in which this social cognitive process frames attitude, behavior, and approach to the broad theme of violence in football. We coded both sets of responses according to recurring categories to sketch the general prevalence and for comparison and contrasting. The text was coded based on several emergent themes that provide the foundation for our categories of analysis in the findings section – including the genres aesthetic/formal, emotional, perceptual shifts, as well as more general themes related to general injury, brain injury, athletic labor, spectacle, previous understanding of football, and perceived changes in understanding. The resultant codes were then collected and analyzed based on principles of CDA which highlight the socio-linguistic construction of ideas and understanding represented in student responses. In the succeeding discussion we will explain each of the most prevalent categories of response and then provide examples of the testimony within each in order to examine the efficacy with which Concussion Protocol was able to defamiliarize attitudes towards brain injuries and dislocate normalized modes of athletic fandom – that is, ways of watching/seeing football as a form of harm. Importantly, there are conceptual and linguistic differences between head injury, brain injury, TBI (as a specific injury), concussions, and CTE. While these conceptual differences are beyond the scope of this paper, we are focusing on attitudes and behavioral changes associated with brain injuries generally, with resultant injuries like TBI and CTE being manifestations of participation with football as represented in Concussion Protocol (see Bell et al., 2019).

Findings

First, it must be noted that every single student who participated in the study framed their answer to the prompt “Sports are…” with a favorable or positive understanding of sport. That is, none characterized sport through critique, for instance viewing it in some way as a site of harm or antisocial conditioning. For instance, students framed their favorable and/or positive understanding of sport as being exclusively positive for physical and mental well-being, socialization, work ethic, and stress. For example, one student noted, “sports are beautiful, sports encompass human triumph, defeat, hard work, and passion. They can relate to countless situations outside of sport, teaching us lessons about life far beyond what might appear on the surface.” Another non-athlete student suggested,

“sports are a way for us to compete against each other in a healthy way. Athletics foster principles of competition and drive us to perform at our best. As children, we grow up playing team sports, which teach us how to communicate and work with our peers. As a member of a team, we learn to put the overall outcome ahead of ourselves… overall, athletics are a hugely important aspect of our childhood and the lessons we learn from sports go beyond just physical components.”

Finally, another non-athlete, non-white, male student noted that “for some people, sports are a way to unwind, allowing people to distract themselves from the stresses of normal, everyday life.” Indeed, a different non-athlete agreed with this sentiment: “sports are a way for people to forget the hardships of their daily lives and simmer down.” While the prompt did not highlight football specifically—and thus did not invite meditation on questions around violence and harm in particular—the lack of concern articulated by this sample students is salient in that it indicates a relative comfort level with and endorsement of the conditions of high-performance sport among participants. This stands in stark contrast to the responses of students after viewing Concussion Protocol. We have sorted these responses into three different genres, each of which we will explore further in greater detail below. These genres are: A) aesthetic/formal, B) emotional, C) perceptual shift.

Aesthetic/Formal

Defamiliarization is a formal practice or aesthetic methodology with a political end. Brecht (1964) refers to the methods of his epic theatre as an “effort to make the incidents represented appear strange to the public,” (p. 91). Thus, in Brecht’s work, “the audience was hindered from simply identifying itself with the characters in the play. Acceptance or rejection of their actions and utterances was meant to take place on a conscious plane, instead of, as hitherto, in the audience’s subconscious,” (p. 91). By challenging an audience’s perception of what is normal and natural, defamiliarizing art “concentrates entirely on whatever… is remarkable, particular and demanding inquiry,” (p. 97). Brecht’s description of the formal dimensions required to produce an alienation effect in a viewer help us understand what Begley (2018) is trying to accomplish in his depiction of the “perfectly everyday event” of professional football in a way that makes it “appear strange,” thus prompting the fan to examine the violence of the sport “on a conscious plane,” rather than through the conventional normalized modes of athletic spectatorship that figure such violence as natural, necessary, and, indeed, pleasurable.

Student responses to Begley’s film speak to the impact of his unorthodox (in the context of mainstream sporting culture) aesthetic approach. Stylistic/formal remarks appeared frequently among responses, tied for most overall at nine mentions. Students were particularly struck by the music, and slow and reverse-motion strategies employed by the filmmaker. These comments included: “The music was sort of unconventional, and therefore off-putting, which made me more uncomfortable watching the footage than I otherwise would’ve been,” “The music and constant reverse film caused me to understand more fully the emotions of the athletes,” and “The music that was repeated only dramatized the injuries as it sounded much like a loss of breath. The video maker also used techniques of slowing down the various clips and showing replays to show just how hard of an impact much of these athletes were embracing.” Some students also explicitly connected formal choices to their emotional reactions: “When the footage was slowed down, and hits from different games were put together, the film was definitely discomforting to see. It was also unnerving to see, when the footage was played backwards, players celebrating with teammates after making a hit,” and “Every time a player made head-to-head contact with another player, or contact with the ground, I felt as though I could almost experience the impact, especially with the booming music in the background and the non-stop repetition of all of the different collisions.” To put this differently within a social cognitive process, students seemed to report that the aesthetic characteristics of the film modelled student attitudes towards head contact by translating knowledge through mimicking the experiential aspects of its harm. The film conditions what Bandura (2008) calls outcome experiences, or the expectations that viewers have about risks associated with football. In this context, the aesthetic appeal of Begley’s film influences the environment that the observer might expect if they were to engage in the same behavior. In other words, the film allows students to learn about the possible consequences of head trauma through its use of violent aesthetic imagery.

Perhaps most notable about these responses is the emphasis upon how the film is able to disrupt the viewers positionality in relation to the subjects being depicted. While conventional viewership of sport invites an objectification of the athlete as the instrument of a team’s success or failure, in effect depersonalizing (even dehumanizing) them, Begley’s approach invites the viewer to identify with the athlete. In this sense, Concussion Protocol reorients athletic spectacle so that the athlete shifts from the object of the viewer’s consumption to a subject with whom they can empathize. Rather than merely looking at the player as object, they are placed instead in what Levinas (1985) has described as a face-to-face encounter that produces a sense of “response or responsibility,” (p. 88). This is perhaps most evident in the way students wrote of being able to “almost experience the impact” of a collision and of how the film allowed them to “understand more fully the emotions of the athletes” because it confronted them with the sensation of visceral experiences such as “a loss of breath.” Within the social cognitive perspective, learning takes place at the nexus of personal identification – or self-efficacy – between the observer and the violent imagery (Bandura, 1989). As Begley’s film allows for students latently experience the impact of harm (in sometimes quite visceral ways), they latently learn about its possible implications and consequences.

Emotional Response

If we can accept the premise that Concussion Protocol’s formal dimensions, along with the course material and topics discussed, generally successfully defamiliarized students from their naturalized understandings of US football by engineering a novel form of identification with the athletic laborers being depicted, the next question to consider is whether that identification provoked a meaningful emotional impact that might disrupt other forms of affective investment spectators conventionally extract from athletic spectatorship. It is thus salient that the most frequently recurring response from students to the film was emotional. In total, there were twenty-two mentions of an emotional reaction among the eighteen student responders. The most frequent of these responses was a sense of what I have characterized as ‘fear,’ with nine students mentioning such a reaction. One wrote:

“One main feeling being fear for those athletes that put on helmets every day and report to work. For me, I know a lot of football players and what they go through daily, not just with the sport itself, but injuries such as concussions. Being an athlete who has also suffered from numerous concussions, it gave me chills to watch such violence being spilled out onto the field and into one sport’s job.”

Another put it this way:

It made me feel scared for football players and for that matter any athlete. It seems so easy to get a concussion and it happens so quickly that you can’t even stop to think about how it happened. I am shook. When I watched the footage of the guys getting hit or hitting the ground I honestly cringed because I knew that they had taken a hard hit and I knew that they had a concussion.

The next most frequent emotional response – and third most commonly cited overall, with eight mentions, was generalized negative feeling. This manifested in a range of forms of unpleasant affective response less precise than “fear.” Some examples include: “The video made me feel bad for the players who were injured,” “The short film Concussion Protocol was overwhelming in terms of the stimulus it was providing,” “After watching the video on the concussion protocol, I was appalled at the true violence in the game of football,” and “The short film made me feel uneasy about the safety and future of football players.” These reflections clearly demonstrate how Concussion influenced students’ perceptions following observation of the film. Student perceptions of the film were thus quite formative in the social cognitive process of learning about violence in football – as is clearly evinced by associations made between the violent imagery and the so-called ‘true’ nature of the game (Bandura, 2001). The third most frequently remarked upon form of emotional response and seventh most cited overall was “grief” specifically, noted five times. A representative example of this was the student who explained, “I was extremely saddened by the fact that I had never fully understood what athletes go through in order to make the fans, including myself, have an emotional rush of excitement while watching football.”

Each of these emotional responses testifies in some way to the efficacy of Begley’s (2018, February 1) attempt to “‘defamiliariz[e] the familiar,’” as he puts it via Hartman in his commentary on Concussion Protocol. In line with SCT, this illuminates how the creation of the film itself is characterized as a modality through which social learning is intended to occur. The use-value of the commodity spectacle of professional football is the sense of pleasure and meaning—and concomitant affective investment—it can elicit from fans. This is to say that the intended signification of the sight of violent collision in the context of a football game is emotional, but emotional on a euphonious register. Yet, as we see in the above responses, the exact visual images that conventionally evoke pleasure can be reworked instead to provoke a sense of abjection – perhaps especially so when paired with readings on athletic labor and sport injury. The familiar violence of football becomes “chill”-ing, “uneasy,” “overwhelming,” or “cringe”-worthy – fundamentally unfamiliar and disquieting. To put this in social cognitive terms, students reported that these emotional reactions evoked feelings of similarity with the content of the film (Bandura, 1988), suggesting that the observers were more keen to understand the film through its intended end. In other words, the film’s imagery evoked a sense of what Bandura calls identification between the distant observer and the abstract and narrow experiences of those within the film experiencing violence and harm.

Perceptual Change

The discomforting sense of defamiliarization wrought by a viewing of Concussion Protocol seems to have impacted students on the “conscious plane” sought by Brecht (and Begley). That is, while perceptions may certainly be impacted in part by other readings and topics discussed in the class, a single viewing of the film followed by a brief period of reflection caused students to articulate a shift in their understanding of the violence in the commodity spectacle of professional football – and thus illuminate the knowledge acquisition that has taken place. We have coded student responses that reflect this attitudinal shift according to the following categories: changed perceptions, the imperative for football to change, and complicity and responsibility.

Perceptual change ranks as tied for the fourth most cited form of response overall, and was acknowledged by six students in total. Some students articulated this shift in concise terms: “I always knew that football caused a lot of brain injuries but actually seeing them occur was very different,” “It was weird to think about how I had seen a lot of these hits before while watching games but never realized as much how much damage was actually being inflicted,” and “This for me put into perspective the brutality and trauma that the footballers are putting themselves through as you hear about a concussion but don’t always truly think about the significant damage that occurs to their brains also the impact that it has upon them as players but also them as people.” These forms of verbal persuasion on the part of the film’s narrative highlight how observers are encouraged and enabled to change their perceptions about the topic of concussions in sport and its associated harm (McAlister et al., 2008). This verbal persuasion can then reinforce the self-efficacy of the students’ beliefs about violence and harm in football – which allows them to form courses of action required to “manage prospective situations in the future” (Bandura, 1995, p. 98). Put differently, the film develops one’s knowledge about head trauma in sport which provides the motivation, agency, and ability, to speak confidently about it and to, potentially, change behaviors moving forward.

A couple students went even further, explaining in considerable depth how the viewing of the film caused them to rethink their own disposition to the game. One of these students wrote,

One of the clips was from the Eagles-Patriots Super Bowl game, and I remember seeing that hit and remarking that it was a hard hit, but my thoughts quickly moved on to the rest of the fame. Because the player that was hit was not a member of my team and I was focused primarily on my team’s winning the game, I quickly forgot about [it]. Upon seeing the same clip in this video, I remembered [it], and I was emotionally affected by it. To me, this brings up the question of how much we compromise our morals/empathy when consuming sport. In my daily life, I would rush to help someone who got a concussion in some way, but because I saw it happen on TV to someone on my least favorite team in the NFL, I somehow lost any sort of empathy.

Another student wrote,

The footage paired with this cinematography made the NFL look like a cruel institution that supported making the players their [pawns]. It almost made me feel as if a football arena was similar to the ancient roman coliseum, where humans were exploited to fight for personal enjoyment. Many of the players participating I am sure are brainwashed or don't know any other life different than football, so they don't question the system, and seek another lifestyle solution. It made me wonder why more people have not questioned this cruelty. My family and I are big football fans, but after seeing this video I question why we are. People continue to go to games, watch televised games, and invest so much into the NFL, even when so many people are severely damaged for the rest of their lives.

It is quite remarkable to observe just how successfully Concussion Protocol can be seen to have defamiliarized student understandings of professional football and, through that process of dislocation, actually prompted a conscious reassessment of the entire “institution” of this commodity spectacle. This is perhaps most evident in the way that one student is able to retrace their original consumption of the footage from “the Eagles-Patriots Super Bowl game,” reevaluate it based on the new context of its situation within a broader array of violent incidents, and then, crucially, make a sophisticated critical assessment of the dehumanization that occurs through athletic spectacle. Likewise, it is startling to see another student suggest that despite being raised as a “big football fan” – that is, despite having been socialized in the context of persistent naturalization and instrumentalization of athletic violence – they nevertheless began to “question” that “invest”-ment and the “damage” it contributed to after watching this very brief film.

So how might watching films like Concussion Protocol affect audiences? And how might they familiarize (and also defamiliarize) their viewers? SCT reminds us that the cultural milieu (inclusive of media) can promote certain influences on audiences, and those audiences may in turn learn and act according to those influences. Our findings here indicate that, just as many respondents experienced a change in their own attitudes towards football and injury after viewing Concussion Protocol in concert with critical readings on athletic work and sport injury, so too did an equal number push further, reflecting on the film as a “call to action” against football itself. This response tied for fourth most frequently cited with six responses. One student said, “I began to wonder how many concussions would it take for the NFL to take initiative and make drastic changes not just within protocol but also in the very structure of the game.” Another suggested, “I think change needs to come… As viewers and bystanders, we are people who can make a change in an environment like this, and I feel as if this video was a call to action.” A third pointed out, “Player safety has been improved over the past few years, but it is clearly not good enough.” Finally, a fourth argued, “Football presents serious health implications to its players and regardless of the plays the teams may run, injuries to the head will forever be present in the game as long as it stays how it is.” Indeed, one student took this line of thought to its logical conclusion: “Watching these specific clips, I almost feel like an immediate ban on the sport of football should be put in place to protect these individuals, and while this is an unlikely solution, I think that the National Football League could do a better job of enforcing rules on head to head contacts and providing punishments to players who do not abide by those rules.” The data here are important insofar as students in the sample reported that the film provided the knowledge acquisition necessary for understanding of the topic to promote self-efficacy of not only attitudinal change but also the stimulation of corresponding action (Bandura, 1988). In other words, the film’s imagery offered an impetus for the belief in one’s knowledge and capability to execute courses of action to change situations in the future. Even if only temporary, and future work may uncover the longevity of these attitudes, it may be that students decide to boycott the sport, or it may take the form of advocacy in support of victims, but students in this sample often reported changing more than just their attitude but also changing their engagement with and activities surrounding the game of football within an advanced capitalist system. This highlights an important theme for future research design – to text the longevity of supposed attitudinal shifts that extend over time.

Part of the process of reflecting on the need for change is also the assessment of accountability. Six student responses indexed the issue of fan complicity in the violence, while three gestured to the responsibility of the NFL. In one response, complicity was directly named: “The video does call into question how complicit spectators are in the culture of not treating concussions as we should, because I think that most spectators would be emotionally affected by that video but are not affected when they see those hits occur in the context of a game.” This tension left another student feeling culpable: “As a football fan myself, it made me feel conflicted. Although I love sitting down every Sunday to watch the Patriots play and any other primetime games on that day, knowing that these players are putting their brains on the line for this game certainly makes me feel guilty about watching the sport.” A third articulated a personal sense of responsibility to do something about it: “I felt as if I was at fault here even though I didn’t have anything to do with the specific plays. I also felt as a call to action. I don’t know what I should do. I just know that something must be done since we as a society have taken recreational sports too far.”

For other students, the responsibility for harm falls directly to the NFL. As one put it, “The worst part is that this type of suffering is willful suffering to a certain extent. The NFL and coaches understand the repercussions of this sport, and the long-lasting danger, but the players are still exploited for a money-making scheme and for a sport culture where football is one of the most popular forms of entertainment.” Or, as another framed it,

The film made me question the intentions and goals of the NFL and other big organizations. Do they really care about their players or do they just want to make money? This film reminded me of the movie concussion, this movie illustrated the intentions of the NFL, they will do anything to continue to make money. They are trying to keep the severity of the long-term injury football has on the down-low so they can keep their profits up.

Discussion

This article explored the question of forms of representation that challenge and defamiliarize fans’ naturalized beliefs about the legitimacy and necessity of spectacular violence and sacrifice in sports might reshape fan attitudes and emotional investments. Specifically, we investigate how first-year students, who express an interest in high-performance sports, experience a shift in social cognition and attitudes toward brain injury and injury in American football after watching Josh Begley’s 2018 short film Concussion Protocol together with readings and discussions related to athletic work, commodity spectacle, and bodily trauma in sport. By comparing students’ responses at the beginning of the semester with their reactions immediately after viewing the film, this study demonstrates how confronting fans with the realities of athletic labor can disrupt existing assumptions about normalized violence in sports, potentially fostering a more humane perspective on athletic spectatorship.

While studies have indeed explored the ways in which media shapes public understanding of football (Oriard, 1993) and the social cognitive process involved in influencing understanding of the sport and its inherent harms, including brain injury. Across different empirical settings, a shared theme emerges: media imagery significantly shapes knowledge acquisition for viewers in both subtle and overt ways. Media representations, therefore, serve as powerful tools for teaching audiences about social phenomena and guiding appropriate attitudes, behaviors, and actions—especially in areas where scientific understanding remains limited, such as traumatic brain injury (TBI) and violent head trauma. In the context of concussion research, much of the scholarly focus has been on how athletes themselves perceive and understand head trauma, and the social cognitive processes involved in decisions about participating in contact sports. For example, Sanderson et al. (2016) examined the cognitive processes male and female athletes navigate when deciding whether to report concussions in their sports.

Football, in particular, has been a key site for studying how media influences the perceptions and attitudes of spectators. This is in line with what Bell et al. (2024) have argued about how CTE has been framed as a public health crisis by sports media. Despite this body of work, the role of media in shaping how spectators understand the realities of head trauma in contact sports like football remains relatively underexplored. The present study builds on this literature by approaching media representations as a key pathway through which cultural understandings of violence, trauma, and, more specifically, brain injuries, are shaped and engaged with by audiences. To this end, we advance knowledge in this area by exploring how media explicitly focused on representing brain injury in football might influence observers and their specific attitudes and beliefs related to injuries such as TBI and CTE – and the potential that media like films have to inform such attitudes.

This testimony powerfully expresses the ambivalence that is so clearly a function of having to simultaneously comprehend and experience risk and harm. The explanation provided for participation is not pleasure or desire; it is need. Football, after all, does not exist in a vacuum, but rather the context of an ever-increasingly stratified nation. When considering the cost of football, then, and as we displace the question of just how dangerous exactly football is based on what the evidence does or does not definitively tell us (e.g., Chen, 2020; Stewart et al., 2019), we would do well to consider who we are inviting to take these risks, and who it is that benefits from them. The solution to the responding student’s fundamental desire for a just portion of life chances is clearly not simply a prohibition on football. The structural inequality systematically enshrined by racial capitalism still remains as root cause. Yet, it may nevertheless be viewed as a partial remedy, for no society that calls itself humane can in the same moment knowingly sacrifice its young to brain trauma, which appears to be precisely what is occurring.

Conclusion

While as we have noted, there has indeed been an increase in knowledge about how harmful TBIs like CTE are and how they can be causally linked with participation in violent sports like football. While some have pointed to the successful embedding of the “informed soldier” trope within football culture (Furness, 2016), scientific communities know more today about brain trauma from football than ever before and are increasingly urging us to heed their warnings and reconsider various aspects of the game. Yet, as we know, participation in the game has yet to be widely influenced by such scientific warnings, as both TV viewership and youth participation in football remain relatively unchanged. This may in part be owing to the simple reality that facts do not tell powerful stories. They do not win hearts and minds. And, in fact, the way US viewers have been conditioned to watch football – extract pleasure and meaning from it – has historically instructed them to ignore the harm and violence occurring in front of them, while in some ways inviting them to celebrate that violence. Or, at least, it has invited them to code that violence in ways that rationalize and instrumentalize the harm it causes in productive ways. The classic athletic truism “no pain, no gain” is instructive here. Such a dictum conditions us to view violence in sport as a question of pain, and pain threshold, instrumentally linked to outcome. Embedded in this logic is the assumption that pain itself is ephemeral, something to be endured, on the pathway to victory and glory. Thus, when we watch athletes experience suffering, we are conditioned to see it as temporary rather than permanent. And yet, what new concussion science indicates is that the harm inflicted by football, among other violent sports, is both permanent, and, perhaps, inevitable. When spectators view harm that is above and beyond the scope of a game in other athletic contexts – for instance, consider a compound fracture in basketball – most fans experience it through the prism of horror. And yet, when we witness less reparable harm in the context of a football game, we all too often look on without flinching. This is to say, then, that the project of disrupting spectatorial and direct participatory investments in US football as a public health project (Bachynski, 2019) may require more than the accumulation of data, valuable as it is. It necessitates a reformulation of the stories we tell about this devastating game, even a retraining of our very capacity to see and comprehend what it is we are seeing.

It is evident from the responses discussed above that students who initially had a positive disposition towards sport experienced a seemingly profound response to a viewing of Concussion Protocol. Indeed, all eighteen student responses evinced some form of negative emotional response and/or perceptual change upon watching the film. In this sense, Begley appears to have succeeded in his project of defamiliarization. While indeed there are notable limitations to this study only focusing on 18 first year college students, whose representativeness to all population groups might not be generalizable, we hold that these findings are certainly important and instructive of how younger students may be more keenly aware of the relationships between harm, violence, and spectatorship in the context of football. It is also important to note that the fact that this study occurred in a classroom setting might have some bearing on the results, so we urge future research to take these exploratory findings and developed more nuanced and robust analyses of broader social groups. Future research in this area is, in our view, quite clearly justified by our findings and we urge researchers to explore similar patterns in non-student populations outside of classroom environments. There is also much potential for the broadening of the experimental nature of this study in line with other work done within the social cognitive perspective. Indeed, the student responses are important in the context of SCT precisely because the theory holds that social environment influences audiences who, in turn, often change behavior or perspective from what they learn from that environment. In this way, exploring how media that form part of the social milieu might work to influence such perceptions provides a concrete (albeit localized) set of observations that help demonstrate the process of cognition change that SCT describes. While the current study is notably limited by its lack of true experimental design – most notably with respect to the lack of a control group – the present study explicitly aims to lay the foundation for future research that takes into account influences like the instructors teaching type and quality, sample demographics, and non-student groupings. While these limitations are indeed important, we hold that our findings are legitimate and useful for the advancement of sociological knowledge about how media impacts knowledge acquisition about head trauma, violence, and harm in football that can be used in future research.

Yet, although these data are illuminating, the implications are unclear. Will these students actually stop watching football? The project to make strange is a meaningful intervention against the ways we view football, but it requires consolidation and repetition, like all forms of learning and un-learning. While, as we noted, the film “manages to stretch 5 minutes to the sensation of a lifetime,” it also importantly requires repetition; implying that it may take multiple lifetimes’ of experiences to yield practical and tangible change. In this sense, the comment of the last-quoted student responder – “this film reminded me of the movie concussion” – is salient. It is not necessarily that one form of cultural representation or another is the required rebuttal to a lifetime of inculcation within a popular culture that celebrates a form of extreme violence and harm to the body as sport. Instead, perhaps it is the accumulated and cumulative impact of such interventions, whether defamiliarizing, narrative, or documentary, that can reposition athlete and spectator face-to-face with one another as fellow subjects. The responses of students in this study suggest that this effort is no mere vanishing point. For, despite the range of investments that may lead fans to dehumanize athletes in their own ever-displaced pursuit of meaning, ultimately re-humanization and empathy are always possible.

The stakes could not be higher, and are perhaps best exemplified by the following response:

My initial reactions to that video is fear, fear because that is the very sport that I play. Even though I know that there is a chance that I could receive a concussion I feel as though it Is a part of the game and it’s a possibility, but it won’t deter me from the game. I know that in high school they showed similar videos to the one that we just watched, and it made people afraid to play the game, but I know that when you play this sport this is what you are signing up for. Yes, there are risks, but the opportunity to take care of myself and the people around me is nothing compared to taking a couple of shots. The risks are huge now with the introduction of studies that link CTE and concussions, but for myself and others I wouldn’t be where I am in life right now [without] sports.”