The writer, the fighter, the doctor and the widow all look down into the darkness and damage of boxing. They understand the previously untold story of brain trauma in the ring. As they talk to me, their moving testimony underpins a shared belief that change must come. There is a measured urgency to their words, for they love the fighters and they want to offer their knowledge to help make this brutal sport a little safer.
Damage and death have always framed boxing. This harsh truth means that, despite the chaos outside the ring, boxing is shockingly real. It can maim and even kill, but boxing also makes most fighters feel more intensely alive than anything else.
Tris Dixon is the author of the recently published Damage: The Untold Story of Brain Trauma in Boxing. It is the book that boxing has always needed. Dixon, the former editor of Boxing News, now a freelance writer and the host of the Boxing Life Stories podcast, confronts the damage done to fighters with unflinching honesty.
Illustration: Constance Chou
The book is shattering yet tender, as Dixon charts the history and science of chronic traumatic encephalopathy (CTE), a brain condition caused by repeated blows to the head.
He explains how it was called “punch-drunk syndrome” and “dementia pugilistica” as neurologists struggled to explain the slurred speech, memory loss, shakes, violent mood swings, depression and other symptoms. Dixon’s book reads powerfully because he is such an authority on boxing, and he writes about fighters with deep affection and respect.
Dixon also talks to boxing widows. The most interesting is Frankie Pryor, who tells me how she met her husband in a drug rehabilitation program 30 years ago. Aaron Pryor, revered in boxing as “The Hawk,” was twice a light-welterweight world champion who fought professionally from 1976 to 1990, and won 39 of his 40 fights.
Pryor was friends with Muhammad Ali, but they were irreparably damaged. Boxing spares no one. Pryor died in 2016, aged 60, and his widow explains his deterioration and the salvation boxing once offered.
Tony Jeffries is the fighter. The 36-year-old from Sunderland, England, and his family are “living the dream” in Los Angeles, where he runs two successful gyms. Jeffries won an Olympic bronze medal in 2008 and was an unbeaten professional after 10 bouts when, in 2011, his fragile hands forced his retirement.
Jeffries hopes he “dodged a bullet” — CTE. He boxed from age 10 to 27 and, according to his calculations, was punched in the head “between 40,000 and 50,000 times,” and waits anxiously for potential consequences.
Those numbers are described as “scary” when I share them with Margaret Goodman, a Las Vegas neurologist who worked as a ringside physician from 1994 to 2005. She tended to fighters in more than 500 professional bouts. Goodman eventually became exhausted from the work required by the sport and founded the Voluntary Anti-Doping Association, a nonprofit organization that helps test for performance-enhancing drugs within boxing and mixed martial arts.
“Boxing is a beautiful sickness in so many ways,” Goodman said.
The widow, the fighter and the doctor feature in Dixon’s book. They recognize its significance, which comforts the writer.
“I am worried the anti-boxing brigade might use my argument against the sport,” Dixon tells me. “But the direction of the book is to say: ‘We don’t talk about it, but this is what needs to be done to mitigate the risks and to make sure these guys have a better life after boxing.’ I don’t want a scrapheap of damaged fighters.”
Dixon has been immersed in the sport for decades. Does he feel fresh hope that boxing might examine the damage it causes fighters, who generate billions of dollars for wayward governing bodies, promoters and managers?
“No, but it’s time to find out who cares,” Dixon said. “Who wants to look after fighters? If these people want fighters to be okay after boxing, then I’m not going to have the ego to say they must read the book. But I suggest they learn about CTE, tau protein and links with Alzheimer’s, dementia, Parkinson’s and ALS [amyotrophic lateral sclerosis].”
Dixon said that governing bodies must regulate how much sparring fighters do, but that it is “also down to the fighters to not be so macho. Fighters and trainers need to know what’s going on with their brains.”
INSIGHT FROM FOOTBALL
Dixon, Pryor, Jeffries and Goodman list the causes and possible solutions to brain trauma, but it is instructive to hear about the book’s origins.
“It was only when I read League of Denial, about the NFL’s concussion crisis, that I started to piece the puzzle together,” Dixon said, referring to the US National Football League. “I read about the erratic behavior of Mike Webster [who won four Super Bowl matches with the Pittsburgh Steelers in the 1970s]. He fell on hard times and ended up living in his car.”
Dixon saw the relationship with boxing injuries.
“It was a big epiphany for me,” he said. Dixon thought to himself: “Hang on. The NFL are addressing this, but we do nothing in boxing. I had been in boxing 25 years and I didn’t know about CTE, tau protein and things that should be a staple.”
Dixon could see that boxing was more dangerous, and wondered why the same attention was not being given to the sport.
“The NFL concussion debate started with the Webster case in 2000,” he said. “Boxing turned its back for nine decades and we haven’t had our Webster moment yet.”
The historical sweep of Dixon’s book shows how, in 1928, a doctor named Harrison Martland wrote a paper called “Punch Drunk.” It was a groundbreaking study, but Martland incorrectly made the case that punch-drunk syndrome only affected mediocre boxers. Damage is a salutary reminder that almost all great fighters — from Joe Louis and Sugar Ray Robinson to Muhammad Ali and Aaron Pryor — had their senses obliterated by boxing.
Dixon and Frankie Pryor said that boxing missed a huge opportunity to educate people during Ali’s tragic case.
“The old punch-drunk terminology was rarely used with Ali,” Dixon said. “Perhaps they thought it too cruel a label for a man who gave so much and awed the world with his brutal elegance. The stigma remains that punch-drunk syndrome happened to guys who aren’t very good. Maybe Ali was too vain to say: ‘Boxing did this to me.’”
Pryor agrees.
“The one fighter who could have brought lots of attention to this was Ali,” she said. “Ali’s family chose to say: ‘Oh, he has Parkinson’s, it has nothing to do with boxing.’ It has everything to do with boxing.”
Dixon’s book is compassionate in the company of Pryor and Brenda Spinks, whose husband, Leon, shocked a faded Ali in the first of their two fights in 1978. Leon Spinks, who fills the final pages of Damage, was a slurred wreck before his death in February.
“At the end, I wrote that the neurologists were as much the heroes to me as the fighters,” Dixon said. “If I could rewrite that sentence, I’d say the wives, women like Frankie and Brenda, are the real heroes. Their strength of character is what boxing needs to address the damage. The fighters I’ve met who don’t have these women to look after them, to feed or clothe them, end up homeless and suicidal.”
LACK OF OVERSIGHT
Frankie Pryor spoke with warmth and humor — and a little anger at boxing’s failure to discuss the damage it did to her husband and most fighters.
“I took care of everything,” she said of her 30 years with Aaron. “I didn’t understand the damage was caused solely by boxing until he started showing anger. Aaron was so easygoing until then. I started taking him to a neurologist around 1994. At that point we didn’t know [it was CTE]. Initially it was just front temporal lobe damage, but he never stopped going to a neurologist until he died. A neurologist said: ‘This is the only Hall of Fame fighter I’ll ever work with and we need more proof to confirm what we believe.’”
Was there sufficient proof that her husband had been brain damaged by boxing?
“Oh yes. You see that damage in every old fighter, without exception,” Pryor said. “I noticed all the fighters acting the same when we got together. His wife would go to the restroom and that fighter would get confused. One of us other wives would handle the situation. We educated ourselves about CTE because it’s not something you talk about to your regular girlfriends. We had this group — me, Brenda Spinks, Marvin Hagler’s wife, Kay, Ken Norton’s wife, Rose.”
Does Pryor think that their experience of CTE will be shared widely?
“Boxing is a mess, and that’s why I have no hope this will ever get solved unless there is one central governing body,” she said. “I’d talk for hours if you get me started on the crooks in boxing. It’s awful and they take such advantage of dedicated fighters who love their sport. Nothing will ever originate from boxing itself.”
Pryor believes that the only hope is to educate a new generation of fighters and trainers about CTE.
It was too late for her husband but she stresses: “I’ve no hate for boxing because Aaron loved it so much. It took my husband, but his choice to box came before me. One of his nurses said: ‘Don’t you wish you’d never boxed?’ He said: ‘What do you mean? No. What would I have done?’ Aaron was a fighter. Whenever we went out people always yelled: ‘What time is it? Hawk Time!’ Aaron was born for it and his great achievement was to become this amazing athlete, The Hawk, who came out of a desperately troubled childhood.”
She laughs when asked if she also called him The Hawk.
“Of course. I’d say: ‘Even The Hawk has to take out the garbage.’ He was The Hawk the day he died,” she said.
BLOWS TO A YOUNG HEAD
Tony Jeffries was called “Jaffa” or “The Mighty Mackem” when he boxed. We talked on a beautiful morning in Santa Monica, where he teaches boxing exercise to fitness professionals at his Box N Burn Academy. He retains his hometown accent as he remembers being punched in the head as a 10-year-old.
“I got the black flash,” he said. “When I was 12, there were times sparring where I would cry because I’d been hit that hard, but I got through it.”
Ali spoke of “the black lights” a fighter sees when hit by a concussive blow.
“Yeah, it’s like you’ve closed your eyes for three seconds then, boom, they’re open,” he said. “In the European final, when I was 16, I fought this Greek guy who was knocking everyone out. He hit me so hard my legs went like jelly. I got a standing eight count and won the fight. Twenty minutes later, I went on the podium, got the gold medal, and I didn’t have a clue where I was. I said: ‘Did I win?’ That’s pure concussion.”
“A few years later, after I got hit so hard, I was in my room when my phone rang. ‘Sarah? Who is Sarah? Oh, my girlfriend,’ but you just think, ‘This is boxing,’” he said.
Jeffries calmly tells me how many times he was hit in the head.
“I had 106 fights. I averaged four rounds a fight,” he said. “That’s 424 rounds. Let’s say I got hit to the head an average seven times a round. That’s 2,968 punches. If I sparred 10 times for each fight and each spar was six rounds, that’s 6,360 rounds. Seven headshots every round makes 44,520 blows. It could be a little less or a little more, but 40,000 to 50,000 punches landed.”
This methodical calculation underpins a key point that could change boxing: There should be a limit on the amount of sparring where fighters take head shots.
“After just about every spar, as a pro, I would have a splitting headache,” Jeffries said.
He acknowledges it would be hard to regulate sparring, so the only solution is for trainers and fighters to educate themselves about the damage it does and restrict most of their training to body punching.
Jeffries highlights medical evidence proving that punches to the head of a child under 14, when the brain is still developing, are especially dangerous.
“I was punched in the head 4,000 times by the time I was 12. You don’t have to be a genius to think that’s not good for the brain,” he said.
Five years ago, Jeffries met Charles Bernick, a physician who runs what Jeffries calls “the biggest fighter brain study in the world,” examining the neurological status of fighters over a long period.
“When I first went, I was worried,” Jeffries said. “After the test, they said: ‘Your brain is average for a 31-year-old.’”
Jeffries was relieved to hear the result, but the researchers told him that he had to return for examinations for several years, as his brain could have been above average to begin with, or deterioration might occur later. There was also some concerning news.
“They told me I’ve got a big split in my membrane, which attaches the brain to the skull,” Jeffries said. “That’s after being punched in the head. It’s scary. If I forget my car keys or slur my words, I think: ‘Boom, brain damage,’ but I’m doing all I can to help my brain. I haven’t drunk alcohol since 2019. I want to do what I can for my brain so I can be as good as possible for my kids.”
Jeffries emphasizes how much he owes the sport, as it sparked his booming new career.
“Boxing is great, but it has that sad end, and the only way to fix this is by changing boxing culture,” he said.
MAKING BOXING SAFER
Goodman believes that 99 percent of brain damage comes from sparring, and agrees that the sport needs to change its approach to fighting and training.
“Too many fighters go into a fight with concussion, or mild concussive symptoms,” she said. “So much brain trauma is based on sub-concussive blows. I think of Terry Norris [a three-time world champion in the 1990s], a boxer of great skill, and a beautiful person, but he thought it was better to take punishment, especially to his head, in the gym. We see the damage that did.”
Boxing is chaotic, with four major governing bodies, but not one that is international and overarching. Does Goodman believe that educating trainers and fighters can curb the damage?
“I really do,” she said. “We need to get boxing out of the dark ages because this information is at their fingertips. It amazes me boxing does not help fighters in this way.”
What else should be done to make such a perilous sport safer?
“Fight at the right weight,” Goodman said. “So many fighters are put in the wrong division and end up cutting weight. If they were in the correct weight class, it would stop so much damage and prevent eating disorders. They also need to avoid all performance-enhancing drugs. Even those that are not prohibited are detrimental. Alcohol, too, because it can rot a fighter’s brain.”
Goodman added that fighters are intelligent and have the ability to take the correct action for their wellbeing.
“They have the knowledge to say ‘no’ to a fight or sparring,” she said. “Taking that responsibility is the most important way we can change boxing.”
She mentions Floyd Mayweather Jr, the most successful and richest boxer of the 21st century.
“I worked on his first championship fight and he is the quintessential professional,” Goodman said. “He looked at his Uncle Roger [a fighter who suffered brain damage before his death in March last year] and understood that staying in shape was vital. Floyd was so smart about sparring so little.”
However, Mayweather could be spiteful, and his care for himself did not always extend to other fighters in the gym.
Goodman suggested George Foreman as another example, because “he never sparred much either. Even after all those tough fights, he’s healthy today.”
She also believes that doctors should lessen the pressure on fighters by ending bouts earlier.
“What bothers me more than anything is that ringside physicians don’t want to be the one pulling the plug,” she said. “Fighters are willing to go out on their shields, and if they don’t, then they get ludicrous abuse. The physician should take the responsibility off the fighter and the corner.”
She knows it is not easy.
“I’ve been the brunt of terrible criticism and felt like I needed to check my brakes before driving home,” she said. “You develop so many enemies.”
Goodman was so consumed by the work of safeguarding boxers that, before being ringside, she studied their previous bouts for signs of neurological damage. She was also the ringside doctor when two fighters, Pedro Alcazar and Leavander Johnson, lost their lives. Finally, drained and exhausted, she stepped away. Does she ever think boxing should be banned?
“No. We can make it safer,” she said. “I don’t think boxing should be banned — ever.”
The doctor, the widow, the fighter and the writer have witnessed the worst of boxing. Yet they still support its existence and its human qualities of courage, resilience, skill and intelligence.
Goodman sounded uplifted when she remembered working with fighters.
“It was such a privilege to examine and talk to fighters who have been among the most famous and brilliant in boxing,” she said. “Just to understand their motivation was inspiring.”
She also said that fighters were the best patients she had ever treated.
“I don’t want to insult the patients I have now, but sitting with a fighter at the weigh-in, in the corner during a fight and then afterward, was more dramatic, incredible, educational and amazing than anything else,” she said. “Oh my God, to be with a fighter after a fight? To see the emotion after winning or losing? It almost seemed inappropriate to have been privy to that. So from a medical and a personal standpoint I never had anything I enjoyed more than boxing. We know the damage but, oh, the fighters are incredible. We just need to take care of them and help them take better care of themselves.”
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