By: Sally A. Castellanos| Perspectives: Innovation, Technology, and the Law
Published on August 6, 2025 at 1:15 PM.
A reflection on CTE and the lasting toll of trauma-related brain injury and the human cost behind the game.
I began this article as a conversation—with ChatGPT.
I asked about trauma-related neurodegenerative disorders, specifically Chronic Traumatic Encephalopathy (CTE). I wanted to understand how the disease forms, how it’s diagnosed, who it affects. What emerged from that conversation wasn’t just information. It was a story. One that begins in locker rooms and stadiums, but extends far beyond.
I chose to write this piece using generative AI as a tool—to help organize research, challenge my assumptions, and give voice to a deeply human concern: the cost we so often overlook in our games, our industries, and our history.
This is not a piece about technology. It’s a piece about people. About how a disease like CTE hides in plain sight. About what happens when we praise sacrifice without asking what’s being sacrificed.
We remember the highlight reels. The roars of the crowd. The names on jerseys. The statistics.
But there is another side to the game—one we don’t see until years later, sometimes decades.
It shows up in forgotten names, broken relationships, withdrawn glances, and the slow erosion of identity.
Chronic Traumatic Encephalopathy (CTE) is a progressive brain disease caused by repeated head trauma, often over years of play. While public understanding has largely focused on concussions, medical research reveals a different truth: it’s the small, repeated, non-concussive hits that may cause the most lasting damage.
These impacts—known as subclinical traumatic brain injuries—don’t cause a blackout. They don’t send a player to the sidelines. They’re often called “just part of the game.”
But they accumulate. And over time, they can lead to the death of brain tissue, the buildup of toxic tau proteins, and irreversible neurological decline.
In 2017, a study by Boston University found that 110 of 111 brains of former NFL players examined showed signs of CTE. That number was shocking—but it didn’t surprise families who had watched the disease take hold.
CTE isn’t something you can see on an MRI. It can’t be officially diagnosed until after death.
Its symptoms begin gradually—memory loss, impulsivity, mood changes.
Later, it can resemble Parkinson’s or Alzheimer’s.
But unlike those conditions, this one begins with a choice. A sport. A series of collisions. A system that told players to “shake it off” and keep going.
CTE doesn’t only affect professionals. It has been identified in college athletes, high school players, and individuals exposed to repetitive brain trauma outside of sports.
In a groundbreaking 2012 study, neuroscientist Dr. Lee Goldstein and colleagues documented CTE pathology in the postmortem brains of U.S. military veterans who had been exposed to blast injuries during service. The tau-based neurodegenerative damage observed was strikingly similar to that found in young football players and a professional wrestler, confirming that explosive trauma—like repetitive sports impacts—can induce CTE (Goldstein et al., Science Translational Medicine, 2012).
Their mouse model of blast exposure replicated human pathology and provided causal evidence linking traumatic brain injury (TBI) in combat settings to the development of chronic neurodegenerative conditions.
But the risk of CTE reaches even further.
Emerging medical literature has drawn attention to survivors of intimate partner violence (IPV)—mostly women—who sustain repeated head injuries over months or years. Many of these injuries are undiagnosed, untreated, and unrecognized by clinicians. Research published in the Journal of Women’s Health estimates that up to 75% of women who survive IPV suffer repeated blows to the head or strangulation, placing them at elevated risk for long-term cognitive and neurological impairment (Zieman et al., 2017). Though CTE diagnoses in IPV survivors remain limited due to underreporting and restricted access to postmortem analysis, clinicians increasingly suspect a biological link between repetitive abuse and tau-related degeneration.
CTE is also a concern for industrial and manual laborers—particularly those who endure years of exposure to forceful vibration, mechanical shock, or low-grade repetitive impacts. Workers in demolition, construction, or mining often report cognitive complaints consistent with traumatic exposure. While more research is needed, occupational health studies have suggested parallels between these long-term exposures and the types of cumulative trauma known to lead to CTE.
Though less discussed than football or boxing, lacrosse has also emerged as a sport with documented risks for brain injury, including concussions and subclinical trauma that may contribute to long-term neurodegenerative outcomes.
A 2021 postmortem analysis conducted by the Boston University CTE Center identified Chronic Traumatic Encephalopathy in former lacrosse players. Among them was a former college athlete who had never been diagnosed with a concussion but who exhibited signs of CTE, supporting the conclusion that repetitive non-concussive impacts in sports like lacrosse can cause CTE even in the absence of a known concussion history.
It is not a disease of toughness.
It is a disease of repetition. Of silence. Of systems that reward denial.
Frank Gifford’s name is often associated with greatness. In The Glory Game, co-authored with Peter Richmond, he recounted the 1958 NFL Championship between the New York Giants and the Baltimore Colts—a game that changed the trajectory of American sports.
Gifford was elegant. Competitive. Charismatic. The kind of athlete people wanted to watch.
Years after that game, after a long broadcasting career and a celebrated public life, his family began noticing changes. Subtle at first. Then unmistakable.
In 2015, after his passing, they confirmed he had suffered from CTE.
They chose to speak publicly—not to indict the sport—but to educate. To warn. To give voice to a condition that has taken far too many without name or recognition.
Their courage adds to a growing call: to see CTE not as a rare side effect of football, but as a public health issue, a workplace hazard, and a societal challenge that touches families, communities, and institutions across the world.
The disease does not ask for headlines.
But it does ask for acknowledgment.
It asks for prevention. For education. For informed decisions—for coaches, for parents, for players, for policymakers, and for survivors of violence.
CTE also invites us to reflect more broadly:
On how we treat injury when it’s invisible.
On what happens when culture prizes endurance over health.
On the price of silence, and who pays it.
Whether in sports, medicine, labor, or the home, there’s a familiar pattern: those who give the most often suffer in ways the public never sees.
This article is not about Frank Gifford.
It is about the disease that took him, and others like him.
It is about what we owe—to those who made the game great, and to those who now live with its legacy.
It is about the quiet, unseen wounds of glory.
And the courage it takes to name them.
Author’s Note:
This piece was developed through an initial research-based discussion with ChatGPT, used as a generative tool to support narrative structure, legal framing, and scientific accuracy. All editorial decisions, reflections, and synthesis are my own. As with all work on Perspectives, this article is meant to raise awareness, encourage inquiry, and center the human experience behind our institutions and stories.
Special Note for Victims of Domestic Violence, Intimate Partner Abuse, and Manual Laborers:
Emerging research indicates that domestic violence survivors, who often endure undiagnosed and repetitive head trauma, may be at risk for long-term neurological consequences consistent with CTE pathology. Similarly, industrial and manual laborers exposed to repeated head impact or forceful vibration—such as in mining, demolition, or heavy construction—are increasingly recognized as populations that may face elevated risk of neurodegenerative conditions related to repetitive brain stress.
Domestic Violence Survivors and CTE
While formal postmortem diagnosis of CTE in domestic violence survivors is still limited, medical literature increasingly supports the biological plausibility and risk correlation between intimate partner violence (IPV) and repetitive brain trauma resembling that which causes CTE.
🔹 Key Source:
Zieman, G., Bridwell, A., & Cárdenas, J. F. (2017).
Traumatic brain injury in intimate partner violence.
Journal of Women’s Health, 26(6), 634–640.
This study highlights that up to 75% of IPV survivors may sustain repetitive head injuries and/or strangulation, many of which go undiagnosed or untreated. The authors emphasize that these survivors are at elevated risk for long-term neurological consequences, including cognitive decline and potential tauopathies.
🔹 Additional Source:
Stein, T. D., Alvarez, V. E., & McKee, A. C. (2015).
Chronic traumatic encephalopathy: A spectrum of neuropathological changes following repetitive brain trauma in athletes and military personnel.
Brain Pathology, 25(3), 350–364.
While the study primarily focuses on athletes and veterans, it explicitly notes the likelihood that similar pathology could develop in others exposed to repetitive TBI, including domestic violence survivors.
Industrial or Manual Laborers Exposed to Repetitive Head Impact or Vibration
Though CTE research in occupational settings is still developing, studies have raised concern about neurodegenerative effects from chronic exposure to forceful mechanical vibration or repeated head trauma in certain labor-intensive professions.
🔹 Key Source:
Feuerstein, M., & Berkowitz, S. M. (1986).
Work-related upper extremity symptoms: Prevalence, psychosocial risk factors and work adaptation.
Journal of Occupational Medicine, 28(12), 1159–1164.
Though focused on upper body symptoms, this study and others like it highlight neurological complaints consistent with vibration-induced subclinical brain injury in occupational settings (e.g., jackhammer use, mining, repetitive construction labor).
🔹 Complementary Evidence:
National Academies of Sciences, Engineering, and Medicine. (2016).
Preventing Cognitive Decline and Dementia: A Way Forward.
This report notes that occupational exposures, including repetitive mechanical forces and vibration, may be associated with increased risk of cognitive decline and neurodegenerative changes—though further study is needed to formally link these exposures with tauopathies like CTE.
Lacrosse and CTE Risk
Though less discussed than football or boxing, lacrosse has emerged as a sport with documented risks for brain injury, including concussions and subclinical trauma that may contribute to long-term neurodegenerative outcomes.
A 2021 postmortem analysis conducted by the Boston University CTE Center identified Chronic Traumatic Encephalopathy in former lacrosse players. Among them was a former college athlete who had never been diagnosed with a concussion but who exhibited Stage 2 CTE pathology, supporting the conclusion that repetitive non-concussive impacts in sports like lacrosse can cause CTE even in the absence of a known concussion history.
Lacrosse Players:
Nowinski, C. J., et al. (2021). “CTE identified in former college lacrosse players.” Boston University CTE Center, press release. Available via Boston University CTE Center
Supporting Research:
McAllister, T. W., et al. (2012). “Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes.” Neurology, 78(22), 1777–1784. This study included collegiate lacrosse players and showed changes in white matter integrity on imaging scans—even in athletes who had no documented concussions—suggesting cumulative microstructural brain changes due to sub-concussive trauma.