Damage: The Untold Story of Brain Trauma in Boxing

by Tris Dixon

The secret history brain damage in boxing has never been fully told―until now. From the story behind Muhammad Ali's deterioration, to first-hand accounts from the fighters themselves, including the beloved Micky Ward.

In Damage, author Tris Dixon delivers a gripping history of 'boxing's darkest secret' ― CTE (Chronic Traumatic Encephalopathy), which was known previously as 'Dementia Pugilistica' and 'Punch Drunk Syndrome.'

This highly-anticipated book has already generated intense discussion on social media about the inner-conflict that comes with being a fan of the 'sweet science,' and the difficulty involved in witnessing the devastating brain trauma suffered by the warriors who fight for the entertainment of millions.

Unfortunately, the promoters, managers, and other non-participants who profit from the violence have long looked the other way. Will this book finally drive them to address the issue and help fighters get the help they deserve?

Genres: Sports, Nonfiction

286 pages, Kindle Edition

Published May 25, 2021

Reviews

[Freddie Barr-Smith · Rating 4 out of 5]

Good. However was very disappointed to see that it didn't really dive deep into the risks of amateur boxing.

Pro boxers basically know they're playing Russian roulette with their brains but I think an unexplored area of research is how much damage amateur boxers fighting 10-25 fights, such as the author(himself an amateur boxer), can reasonably expect.

[Steve Hunt · Rating 5 out of 5]

Essential reading for boxing fans. Definitely not an anti-boxing book, as some might fear, but thought provoking and a wake up call for lovers of the sport. If there isn't a culture change in boxing now, no one can say this hasn't been made public knowledge.

[Adam · Rating 5 out of 5]

A fantastic insight into the toughest sport and the effects that it has on the boxers and their families.

A must read for all trainers, coaches and fighters to understand the effects of hard sparing and the accumulative trauma that often starts in childhood in gyms around the world.

[JC Adams · Rating 5 out of 5]

Any boxing fan has to eventually wrestle with the idea that the athletes competing are taking a tremendous amount of damage. Of course, they choose to compete, but do they understand the risks? The answer is surprisingly no.

Many boxers don’t understand CTE. They also start at a young age when they believe that something bad happens to others, not themselves.

How can you make a sport that’s goal is damage safer? How can you better educate athletes? How can you regulate an international sport with many different governing bodies?

These are all questions asked in Tris Dixon’s Damage.
Alongside stories of forgotten and struggling fighters once the curtains close. Muhammad Ali, Tommy Hearns, Sugar Ray Robinson, Joe Louis and many other world champions struggled with this disease. Along with many other journeyman who never reached the sports heights. This book should be required reading for athletes and fans alike and a reminder of what is being put on the line anytime a boxer makes their way to the ring.

[Carmela Borjas · Rating 5 out of 5]

This book was recommended to me by a friend and something about it struck my interest! I am not familiar with boxing other than my dad telling me what it was like watching “The Greats” box back in the day. Will I pay more attention to boxing? Definitely. This book did a great job for the outsiders of the sport (me) being that it was educational, easy to read, while still discussing each boxer’s grievances with grace and respect. I’ve recommended this book to so many people!

[Joel Robb · Rating 4 out of 5]

Being a concussion researcher, and one who has written medical articles on boxing/sports/military activity and concussion, I appreciated Tris Dixon's work. I appreciate his overview of the history of the medical evolution of brain injury in boxing from "punch drunk" to "dementia pugilistica" to "CTE," as well as the history of boxing itself, from bare-knuckled to today. It is sad to see the stories of "what happened to..." so many of the greats in boxing that I watched growing up, i.e. Leon Spinks. His book is full of the vignettes of boxers with brain conditions while in their 30's, 40's, 50's, and the sad and shortened lives they have. How do I feel about boxing? I am of the same opinion as Mr. Dixon is, that sports (boxing, football, soccer, hockey, wrestling, etc), are IMPORTANT and OFFER A LOT to our society--but we NEED TO BE SMARTER about them in many ways--from eliminating contact in youth sports, limiting the amount contact practices (or sparring sessions) and creating rules to prevent unnecessarily damaging activity, as well as a need for improved prevention, education, identification and treatment of concussion. You give a concussion a chance to get really bad when you don't report it, try to play through it and don't take care of it--know that concussions are treatable--but you are only worsening it by continuing to push through. In sport, the culture around concussion changed a little when the NFL started paying attention to concussion, but it has a long way to go. Mr. Dixon goes on to say boxing hasn't changed at all (some of it due to the structure of the boxing organization being so disparate--each state has a different organization). So, some of the blame is on the (lack of) organization. Others can be at fault too, including the medical staff or trainers, when they take the "unknowns" about concussion and the "lack of good tests" to mean that there is no evidence of injury.
It's simple. You don't need to be a scientist to know that hitting your head isn't good. And the more you hit your head, and the harder you hit it, the worse off you are going to be. Maybe not now, but it will take its toll. Granted, we are still teasing out the nuances of who is at more risk based on sex, demographics, sport status, years played, year started (as a youth), medical history (depression, anxiety, learning disability), equipment used (helmets, mouthguard), genetics, and/or neck strength, to name some of the biggest factors. Improved science from proteonomic biomarkers (blood tests to show markers of damage/inflammation to the brain), higher resolution MRIs to see the smaller structures of the brain, and/or objective testing of autonomic nervous system (i.e. pupillometry, eye response, heart rate variability, etc) will improve our concussion detection in the future and will help us make more informed decisions about brain health. Don't let the cases of "so and so boxed/played football all their life and they look OK" fool you -- I would bet they have brain changes too (tau protein accumulation, etc) -- they just got lucky and happened to be more resilient. I enjoy boxing (and football, hockey, etc) as much as the next fan, but I just want all those involved in the sport to truly understand the risks (so don't expose to full contact or sparring until an appropriate age/make sure brain health education is thorough and ubiquitous throughout the sport, encourage a culture of seeking care), as well as have everyone perform the appropriate medical treatment in the event of injury. Dixon advocates for the same approach to the sport. I appreciate Mr. Dixon's work, and I would recommend to sports fans and medical colleagues.

[Craig Adams · Rating 5 out of 5]

This is a very important book. Can’t say I enjoyed reading it, but glad it was written, and hope it gets the recognition it deserves.

Have long wondered whether the CTE risks from boxing were being downplayed, and this well researched book confirmed my worst fears.

There are a couple of details that as a boxing geek I’d like to bring up (sorry)!

1. My Kindle version lists Ted Lowry as a welterweight, when he was a heavyweight. This is likely a typeo.

2. It’s not entirely clearcut that Joe Louis had CTE, as there was also a history of serious mental illness in his family, something I feel should have at least been mentioned.

3. Jock McAvoy’s suicide was more likely down to depression from being crippled with polio, as much as anything else. Author should have provided a little more detail there.

4. While Archie Moore certainly remained in good health for a great many years despite boxing for so long, and enduring some terrible beatings, he did by all accounts succumb to what was probably CTE right at the end of his life, and the effects are apparent in some footage of him in old age, in particular on a boxing talk show.

But those are minor criticisms and do not detract from the book overall, hence I still gave it 5 stars.

What shocked me most reading this is just how many boxers have gone on to develop CTE.

It’s clear that some changes need to be made. I don’t think headgear is the answer as it does little to mitigate concussive force and only serves to make the head a larger and grippier target. Larger gloves are also problematic because heavier glover actually impart greater concussive force (I always preferred being hit with 10oz gloves). Certainly the standing count is a nonsense, and perhaps the 10 count is too. Perhaps it should be the case that a fight is stopped as soon as someone is dropped… but none of this really deals with the problem of sparring. The more a boxer spars, and the harder he or she spars, the more likely they are to win fights. The book hammers home that sparring is possibly the main culprit more so than actual fights. So where do we go from here? A lifetime limit on rounds, sort of like astronauts with a radiation exposure? Or do we just accept that everyone who does this for any length of time, particularly those who start young, are likely to end up terribly damaged by it?

[Joseph Hirsch · Rating 4 out of 5]

It's a trope familiar to everyone who knows anything about boxing, from the hardest hardcore head to the casual fan who can only quote a couple lines from "Rocky": the boxer with the slurred speech and zombie shuffle, the one who took too many punches to the head.

For a long time the perception in boxing was that only those fighters with a fan-friendly, face-forward style ended up punch drunk. Boxing, as the noble art of self-defense, was a hit and don't get hit game that rewarded supreme craftsmanship over supreme toughness. And yet boxing's arguably greatest technician, Muhammad Ali, ended up with more acute Parkinsonian symptoms than many a journeyman. Maybe the subject demanded a revisiting...

Tris Dixon's "Damage" presents perhaps the first book-length work on the subject (at least for the layman, as there have been medical texts in the past that dealt with dementia pugilistica). He takes us through the history, on a virtual journey through roughly a hundred years' worth of medical literature and ringside observations. As in his earlier works, he also wears out his shoe leather by making his journey a literal one, going from state to state, talking with various prizefighters who are brave enough to admit in print that they have suffered permanent cognitive damage as a result of boxing. The section with "Neon" Leon Spinks that appears in the final third of the book was especially poignant, as we get to see the Olympic Gold Medalist and conqueror of Ali both humbled in his debility yet consoled by a longsuffering wife and a therapy dog (not too mention a potent bat of medical sensimilla).

Dixon buttresses his argument with personal anecdotes both from his time as an amateur boxer, and as an observer at the International Boxing Hall of Fame in Canastota, New York, where legends of the sport who once ruled the ring now struggle to sign their names with trembling hands for their still-adoring fans. It's not quite as good as "The Road to Nowhere" or "Journeyman" but it's better than Dixon's somewhat rushed Mayweather Biography. Recommended, both for fans of the sport and its detractors, as well as those who are ambivalent or simply have an interest in CBT (Cognitive Brain Trauma). With photos.

[G.J. Minett · Rating 5 out of 5]

Such an important book, not only for the serious boxing fan but also for anyone with an interest in the moral and ethical debate surrounding the sport. Tris Dixon bows to no one in his love of the sport and his understanding of what it has done to turn around the lives of impressionable youngsters in deprived areas who might otherwise have been sucked in by gangland culture. He knows what it is like to lace up the gloves and put oneself through the gruelling ordeal of sparring and fight night itself. He's also moved on to make a name for himself as a boxing journalist and commentator and his respect for anyone who steps into the ring is beyond question.

That doesn't mean however that he is oblivious to the dangers involved and in recent years he has felt increasingly uncomfortable about the punishment boxers take and in particular their susceptibility to brain damage which so often seems to manifest itself later in life.

This is an unflinching assessment of CTE, the so-called 'punch drunk' syndrome, using medical case studies and his own affectionate memories of fighters whose gradual mental and physical decline he has watched from close quarters. The interviews with those closest to the suffering boxers are as distressing as they are alarming and even though the author's admiration and sympathies for the victims are undimmed, he doesn't for one moment shy away from asking critical questions about the future of the sport.

It's a very brave book, not least because he knew, from the outset, that the overall message and the conclusions he comes to would not be universally welcomed by those with a vested interest in looking the other way. To bite the hand that has been feeding you takes its own brand of courage and any book that is uplifting and uncomfortable at the same time deserves five stars as far as I'm concerned.

[Richard Wolff · Rating 4 out of 5]

This is a very good book for people serious about reflecting on ethical, medical and practical issues in the world of "the sweet science." Early chapters take a historical approach, tracing not only developing thought, studies and terminology in ports medicine about brain trauma and boxers, but also explicating the impact of head blows on actual boxers of each era. Later chapters emerge more topically, discussing various boxer's cases, or discussing proposed solutions to the problems facing safety of boxers. Here, the comprehensive coverage of various solutions to the problem (from proposing changes to boxing organizations and policies to providing education and life-long safety nets) and the challenges to implementing them are a clear strength, balancing a sometimes redundant discussion of how various boxers' relate to each of these, from being proponents of changes to examples of what may happen without them. Even so, the range of boxers included via interviews is helpful, representative and impressive. Truly a must-read for serious boxing fans.

[Leaf · Rating 5 out of 5]

As a person who has done Karate since I was 8, and have transitioned to Wrestling, Muay Thai, and Boxing respectively, this was a truly sobering and eye-opening read. As a boxer it feels it’s a general unspoken rule that, if you box for long enough, brain damage is just something you have to accept with the sport, it comes with the territory. Dixon does an amazing job covering the very early days of boxing, the first medical documents specifying Punch Drunk Syndrome, Dementia Puglistica and finally CTE as we know it as today. Real world accounts from boxers like Joe Calzaghe, Herol Graham, Leon Spinks, Micky Ward and tons of others paint a first hand account, as well as a grim picture of the secret fight these heroes of the ring are fighting after the last bell rings. Is a definite must read for any fighter in general, but also anyone interested in a decent deep dive into the world of boxers and one of their biggest opponents yet: CTE.

[Samuel · Rating 5 out of 5]

As Dixon mentions in the afterward, "all fighters should know about the risks of boxing, both chronic and acute". Dementia Pugilistica, a variant of Chronic Traumatic Encephalopathy (CTE), or ‘Punch-Drunk Syndrome’ as it was pejoratively referred to in boxing circles, had been an open secret for decades, despite appearing in medical literature as early as 1928. The stereotypes regarding this condition only seemed to hamper societal progress, as it was believed that only lesser skilled fighters who took “considerable punishment” suffered from this disease. The author went into great detail expounding on his reports. Citing interviews from medical professionals such as New York neurologist and ringside physician Dr. Nitin K. Sethi, Las Vegas neurologist and founder/chair of the Voluntary Anti-Doping Association Dr. Margaret Goodman. As well as trainers and former fighters including Freddie Roach, Roger Mayweather, Leon Spinks, Mickey Ward and Herol Graham to name a few.

[Michael · Rating 4 out of 5]

I contend that the NFL has shined a light on repetitive head trauma specifically chronic traumatic encephalopathy (CTE).

With American Football there is no more debate on what will happen with years of brain trauma. Repetitive trauma and/or collisions lead to premature aging, dementia pugilistica, dysplasia (troubles with walking), Parkinson's symptoms, and Amyotrophic Lateral Sclerosis (ALS)

The same can be said if not more so with the sport of boxing. But there is a problem. American football has a central governing body. The NFL Players Association represents these players to the owners, and the league and works to compensate injured players and reduce the odds of cataphoric injuries.

Boxing does not offer the same. Boxing is splintered. Boxers and their family are left to their own resources when it comes to compensation for injured fighters.

In the end, essentially every boxer who has had 50 bouts to their name ends up with serious brain damage.

[Jacob Bertram · Rating 4 out of 5]

Definitely required reading for anyone who has practiced, is practicing, or is planning on practicing striking combat sports. As a former kick-boxer, this book struck close to home. In a sense, it made me feel less alone (I was definitely a “sparring partner” with bad defense who copped a lot of damage). It is heartbreaking to read the tales of the former boxers who have literally lost themselves due to CTE. The book is accessibly written with informative, easy to digest scientific information to boot. It reads a partly as a series of mini bios of former fighters, and partly as an educational deep dive into brain trauma in boxing.

[Joe Stunner · Rating 4 out of 5]

An excellent study of what is now referred to as C.T.E. (chronic traumatic encephalopathy), but is to the rest of us "pugilistica dementia" (or "punch drunkenness"). How many boxers give everything for our entertainment with very little financial reward or personal legacy? The majority.

This book covers the life-long aftermath of violent careers that leave a permanent mark. If you love boxing, as I do, READ THIS BOOK. It'll ensure your conscience will never bury its head in the sand, regardless of your passion for what's going on in the ring.

[J. V. · Rating 5 out of 5]

Nothing short of an incredible and informative book. Dixon's prose and wording never fails to stun in his descriptions of how boxing impacts both body and soul, and all interviews given for the book are soul-wrenching accounts of CTE's impact in people's lives. I cannot recommend it enough if this subject at all interests you, regardless of how much prior boxing knowledge you may have.

[Markod0101 · Rating 3 out of 5]

Love Tris, and the content here is excellent and obviously written with passion.

I listened to the audiobook and was disappointed he didn’t read it himself, as I felt the narrator, while serviceable, lacked the passion Tria would have brought.

The afterword if very thought provoking and given his background as an amateur, searingly honest too.

Would recommend.

[Helen Perry · Rating 5 out of 5]

Im not a boxing fan AT ALL. In fact I mostly got this book as a form of research for a CTE in veterans project im working on. But this book is fascinating and does a great job of covering the history of “punch drunk syndrome” otherwise known as Chronic Traumatic Encephalopathy. The stories are interesting, the histories are shocking and overall I highly recommend this book.

[Jordan · Rating 5 out of 5]

An amazing book. Best I've read this year. Will be hugely influential in the future of the discussion surrounding concussion in sport, particularly boxing. Tris Dixon is a superb interviewer and so compassionate in his writing of this cracking book

[Vlod · Rating 4 out of 5]

An amazing and engaging read. A must for anyone who cares about boxing. My only criticism is that at times the same few points would get repeated several times throughout each chapter, making the book more drawn out and a little too long.

[Bobby24 · Rating 5 out of 5]

Superb book, well researched, very educational and well written, any young boxer should read it.

[Sav · Rating 5 out of 5]

Finished it in a day of on and off reading.

The prose and writing was easy to follow. I genuinely enjoyed the read, learned a lot and have a new found appreciation for my health now.