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Daredevil, Superheroes,
And Concussions

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A Concussion Expert Breaks Down The Daredevil Netflix Documentary And Discusses The Ways That Vigilantism And Entertainment Spur On The Concussion Epidemic

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By Dr. Phil Eye
Special For Modern Times Magazine

July 12, 2016 — American culture is fascinated with moral ambiguity. It pervades every aspect of film, television and literature. Inscrutable heroes such as the Lone Ranger and Superman have fallen out of vogue and are replaced by well-intentioned but conflicted protagonists. Complex characters such as Walter White and Don Draper have formed the cornerstone of two of the most successful shows in television history. For decades, newspapers and magazines detailed the exploits of heroes that carefully tread the line between justice and revenge, between morality and narcissism. Recent documentaries focusing on Batman, Jessica Jones, and Daredevil have thrown their psychic split into the limelight.

In the case of Daredevil, AKA Matthew Murdock, the hero is torn between loyalty to his hometown of Hell’s Kitchen and the knowledge that to protect it illegal vigilantism is required. To reconcile that internal struggle, he has adopted a vow to never take human life. This is a common theme among heroes when a righteous cause proves insufficient justification for gratuitous violence.

In Mr. Murdock’s case, the recent Netflix documentary about his efforts in crime-ridden Hell’s Kitchen is more palatable to viewers knowing that, despite the quite brutal and graphic violence which is honestly portrayed, the value of human life is respected.

Unfortunately, the reality of Mr. Murdock’s actions is less acceptable. His “no kill” resolution is a failed attempt to rationalize his actions and an attempt to suppress the knowledge of the aftermath that such violence inevitably reaps. Human life is not a binary condition. As any medical provider will tell you, life is not a question of dead versus alive but a spectrum of health and wellbeing. In the season finale of the second season of the documentary Daredevil, there are no fewer than 50 clear concussions and no evidence of the victims receiving any medical attention.

This is not an anomaly, but representative of a pattern of a superficial concern for the wellbeing of Daredevil’s opponents with actual priority given to preserving his conscience over the life and wellbeing of his opponents. While this type of superficial regard for human life may be acceptable of figures and institutions to whom we look for entertainment and not for moral repute, such as Commissioner Roger Goodell and the National Football League, this is unacceptable of someone donning the robe of a hero.

The first step to understanding the devastation that vigilante justice inflicts is to investigate the nature of concussions. Concussions have effects on multiple neurologic domains including sleep, headache, cognition, attention, and balance. Additionally, concussion is commonly seen in the setting of depression, PTSD, and chronic pain.

Recovery from mild traumatic brain injury can take up to six months and symptoms beyond that point constitute the post concussive syndrome. Symptomatic treatment is currently all that is available and adverse effects of these medications can worsen other post-concussive symptoms. Commonly, pain, headache, and sleep medications can worsen the cognitive disturbance in these patients.

The hallmark of concussion management, in addition to symptomatic control, involves avoidance of further injury and gradual return to normalcy with reintroduction of work and exercise. Because the threshold for a head injury causing concussion is decreased with every successive concussion and because the recovery from concussion is prolonged and more challenging after additional traumatic brain injuries, avoidance of further head injury is critical, especially in the acute setting after the initial injury.

This is one of the justifications behind removal from athletic play after concussion. Reintroduction of work, exercise, and cognitive effort is done gradually after injury following one to two days of rest in a process known as subthreshold stimulation wherein a patient can exercise or work until they experience symptoms, at which point they take a break and withdraw from the offending activity.
    
In an interview with a prominent Washington, D.C.-area neurologist and published author on the subject of TBI who wishes to remain anonymous, I discuss the unintended consequences of Matthew Murdock’s attempts to incapacitate but not kill the criminal population of Hell’s Kitchen as well as his prospects of having a normal life. On the subject of what criminals can expect after being rendered unconscious by a blow to the head from the vigilante, our neurologist indicated that, “the complete loss of consciousness is likely to involve a prolonged recovery and, at a minimum, days to weeks of pain, confusion, and a struggle to return to normalcy. I am especially pessimistic regarding the recovery course in these cases, because we have seen that less ethical organizations are unlikely to make the health of their employees a priority. If the NFL will send a clearly concussed Wes Welker back into the Super Bowl after he walked towards the wrong sideline, it would not surprise me to find out that The Hand has even less strict “return to crime” guidelines.”

The population of criminals and hired muscle raises other concerns regarding their susceptibility to concussion. A high ranking, Boston-based martial artist who prefers to remain unnamed noted, “You don’t get that good at fighting without having your bell rung a few times.” It is therefore likely that a violent criminal who has achieved a mastery over ninjutsu has sustained multiple concussions and is therefore at increased risk for concussion. The American Academy of Neurology currently takes the stance that susceptibility to concussion involves a combination of environmental factors such as mechanism of injury, prior concussion, and axial musculature as well as genetic factors.

While, in the case of the NFL, it is unlikely (though not impossible) that a reasonable person would continue playing the sport if they encounter frequent symptomatic concussions, one would imagine it is far more challenging for a hardened criminal to opt out and pursue a different career path.
    
As troubling as the susceptibility and inevitability for concussion is, our neurologist stated that being knocked unconscious is not the end of the story. “There is absolutely no way to know whether these criminals have sustained subdural hematomas, subarachnoid hemorrhage, or epidural hematoma. If one of them has a Chiari brain stem malformation, which is usually asymptomatic, those head injuries can result in tetraparesis.  Even without clear structural injury, we do not typically observe return to consciousness during the Daredevil’s fights and this could indicate seizure or a moderate to severe TBI. The way Daredevil just walks away and engages with the next combatant is almost more heartless than impaling them with a sai. Despite insistence to the contrary, there is no way to determine whether Daredevil is still in fact killing criminals.”
    
One interesting point brought up by our neurologist was that the proclivity of the Hell’s Kitchen criminal population to violence may be an effect of and not the cause of their head injuries.

“A lot of these criminals/ninjas may have been forced into this life by financial or familial pressures. Interestingly, the first sign of chronic traumatic encephalopathy is behavioral instability. It is therefore possible that the Daredevil’s opponents are truly victims of circumstance who tend towards violent crime due to brain injury. To punish them for that behavior with the very same abuse that may be contributing to their behavior is a sick irony.”

When asked if this is in any way analogous to the NFL penalizing players for violent behavior, our neurologist replied, “That’s like comparing apples with slightly less red apples.”
    
One potential protest to equating normal concussion physiology to The Hand is their supposed immortality and that this recovery may prevent or improve recovery from concussion. Our neurologist dismissed this point quickly.  “Immortality without cognitive decline may imply some protective effects on neurons, but I find it hard to believe that neurons, which do not replicate and have more limited healing potential than any other cell type, are completely protected while the skin of Nobu’s face remains irreparably scarred. Epidermis and epithelial cells have rapid replication and turnover; it therefore is highly improbable that the immortality elixir guarantees neuron health when it cannot guarantee recovery of the most resilient cell type in the human body.”
    
And what of the young vigilante himself?  What does his fate hold?  The author has noted at least two definite concussions sustained by the vigilante in the past season with innumerable possible concussions.

“While Matthew Murdock shows almost no signs of lasting damage, he is a young man with an exceptional cognitive reserve and this may blunt appreciation of any impairment. The initial signs of CTE are difficult to detect and Mr. Murdock’s poor work performance resulting in the dissolution of the Nelson and Murdock law firm as well as his unstable relationships with longtime friend Foggy Nelson and love interest Karen Paige may be early signs of decline. If he continues down this path, even with extraordinary reflexes and lacking a genetic susceptibility (his father was a career pugilist), it is almost inevitable that he will develop dementia, ALS, or some other neurodegenerative condition before he reaches retirement.”
    
Equipped with only a layman’s knowledge of the nature of head injury and concussion, it is clear that Daredevil’s “no-kill” philosophy at the very least raises interesting questions for which the utilitarian logic espoused by the Netflix documentary team is grossly inadequate. Perhaps Matthew Murdock is doing more good than harm in his actions, but that argument is reductionist and implies that the only two options are to allow crime to run rampant or to allow a masked vigilante to inflict severe and lasting brain injury on criminals who may not be fully accountable for their actions.  

The actions of the Daredevil may ultimately prove to be necessary, but it is our responsibility to ask whether there is a better path. Starting with the premise that normalizing concussions for pure entertainment is abhorrent, we need to ask under what conditions we can condone such lasting and permanent brain injury. Regardless of exactly where necessity justifies such drastic intervention, it is simply not sufficient to solely look at fatalities when assessing the impact of vigilantism.  

Dr. Phil Eye graduated from medical school at Boston University and from residency at Walter Reed National Military Medical Center. He is a neurologist, aspiring author, lifelong student, and superhero aficionado.  This is his first satirical publication and he is grateful to have been given the opportunity to combine so many of his interests on this project.
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