Invited Perspective

Concussion and Comedy: No Laughing Matter? Osman Hassan Ahmed, BSc (Hons), PGDip (Sports Physiotherapy), PhD, Hopin Lee, BPhty, MPhty, Anthony G. Schneiders, PhD, MSc, Paul McCrory, MBBS, PhD, S. John Sullivan, MSc, PhD Since the early days of film, depictions of concussion events have been regularly portrayed in comedy show broadcasts. Early comedians including Charlie Chaplin, Laurel and Hardy, and the Three Stooges frequently acted out incidents of head trauma for comedic effect, with audiences at the time enthralled by their slapstick humor despite the potential seriousness of these incidents. The introduction of cartoons in the 1930s continued this trend, with popular shows such as “Tweetie and Sylvester” (Looney Tunes), “Tom and Jerry” (Hanna-Barbera) and “Wile E. Coyote and the Road Runner” (Looney Tunes) regularly depicting direct blows to the head in an intentionally entertaining manner. Sitcoms such as “The Office” (NBC), Fawlty Towers (BBC) and “New Girl” (Fox) have also featured episodes focused around concussive brain injuries to main characters. Head trauma has been represented in mainstream comedy in this manner for almost a century; however, in recent years, there has been a shift in its portrayal. Rather than providing mere entertainment value, head trauma is being parodied in comedy shows and used as a social commentary. An example is an episode of the comedy show South Park titled “Sarcastaball” [1], which satirized the concussion crisis in the National Football League (NFL). The premise of the episode is that the fictitious town of South Park adapts the rules in their school football games to minimize head injuries due to the harmful consequences of concussion that are described by retired NFL athletes at the start of the program. This results in a new sport called “Sarcastaball,” with the focus of the game on hugging opponents and “being nice” as opposed to the big hits and tackles typically associated with football. Although few people will watch comedy shows such as South Park with the purpose of obtaining high-quality information on concussion, the attitudes of the general public may still be shaped by influences that they see and hear in media culture. Smedema et al indicated that comedy programs can affect how the public perceives persons with disabilities [2]. It is not unreasonable to infer that comedy shows portraying head injuries also have the potential to influence the views of a wide-reaching audience toward concussion in sports. The South Park episode of “Sarcastaball” also made reference to the controversial issue of chronic traumatic encephalopathy (CTE) and football, although no definitive association between the 2 was stated. It can be speculated that any potentially misleading or mixed-message information transmitted via these sources, including through YouTube videos on the Internet [3], may convey misconceptions about concussion to a wide and often impressionable audience. This influence of mainstream comedy shows on the topic of concussion has implications for the medical and public health communities to consider. Although television broadcasting companies are not necessarily dispensers of medical information, it may be argued that they have a social responsibility to consider how medical conditions included in their shows are portrayed and parodied. This is especially pertinent for topical issues such as concussion in sports. The general public has been shown to have misconceptions and incorrect beliefs about sports concussion [4] and brain injury [5,6], and trivializing the serious nature of head injuries in comedy shows may lead to the viewership getting distorted views and misunderstandings of the gravity of such injuries. Health professionals can be proactive in relation to this, by bringing their patients’ attention to high-profile episodes and highlighting that although these incidents may be funny, they are portraying what could potentially be a very serious injury. PM&R 1934-1482/14/$36.00 Printed in U.S.A.

O.H.A. The Football Association, FA Centre for Disability Football Research, St Georges Park, Burton-Upon-Trent, Staffordshire DE139PD, UK. Address correspondence to: O.H.A.; e-mail: [email protected] Disclosure: nothing to disclose H.L. Neuroscience Research Australia, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia Disclosure: nothing to disclose A.G.S. School of Human, Health and Social Sciences, Central Queensland University, Branyan, Australia Disclosure: nothing to disclose P.M. The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Heidelberg, Australia Disclosures outside this publication: consultancy—Horse Racing Association UK, Cogstate Inc, University of Otago, NZ; employment—NHMRC, Eastern Health, Private (patient consulting fees), University of Melbourne; grants/grants pending—NHMRC, Victorian Government, International Rugby Board, AFL Research Foundation, RACS, Glaxo-Welcome, Ipsen, Janssen Cilag, Schering, Novartis, Parke Davis (money to institution); royalties—McGraw-Hill; Payment for development of educational presentations— Axon Sports (2010 only); stock/stock options—Symphony Healthcare, Raptor Compression Technology; travel/accommodations/meeting expenses unrelated to activities listed—FIFA, IOC, Horse Racing Association (UK), American Academy of Neurology, Aspetar Hospital, Qatar. S.J.S. Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand Disclosure: nothing to disclose Submitted for publication July 16, 2014; accepted August 9, 2014.

ª 2014 by the American Academy of Physical Medicine and Rehabilitation Vol. 6, 1071-1072, December 2014



Ahmed et al

The portrayal of comedy incidents relating to head trauma has been occurring for many years, and is likely to continue into the future. It is not appropriate, and is possibly unfair, for the health industry to leverage control over the creators of comedy program. However, it can be argued that the scope [7] and possible consequences [8] of sports concussion means that television broadcasting companies can promote public awareness by presenting this injury in a responsible manner. Comedy is already used to varying degrees in public health campaigns for other medical conditions [9], and it may be the case that, in the future, comedy shows themselves could be used to limit misunderstandings associated with sports concussion.




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REFERENCES 1. South Park takes aim at NFL, refs and head trauma in Sarcastaball. Available at


sarcastaball-football-episode-1608-lamarr-woodley-peyton-manning. Accessed May 20, 2014. Smedema SM, Ebener D, Grist-Gordon V. The impact of humorous media on attitudes toward persons with disabilities. Disabil Rehabil 2012;34:1431-1437. Williams D, Sullivan SJ, Schneiders AG, et al. Big hits on the small screen: An evaluation of concussion-related videos on YouTube. Br J Sports Med 2014;48:107-111. Weber M, Edward MG. Sport concussion knowledge in the UK general public. Arch Clin Neuropsychol 2012;27:355-361. Swift TL, Wilson SL. Misconceptions about brain injury among the general public and non-expert health professionals: An exploratory study. Brain Inj 2001;15:149-165. Hux K, Schram CD, Goeken T. Misconceptions about brain injury: A survey replication study. Brain Inj 2006;20:547-553. Laker SR. Epidemiology of concussion and mild traumatic brain injury. PM R 2011;3:S354-S358. Cantu R, Register-Mihalik J. Considerations for return-to-play and retirement decisions after concussion. PM R 2011;3:S440-S444. Jones N, Twardzicki M, Ryan J, et al. Modifying attitudes to mental health using comedy as a delivery medium. Soc Psychiatry Psychiatr Epidemiol 2014;49:1667-1676.

Concussion and comedy: no laughing matter?

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