In N.F.L. Fight, Women Lead the Way

Eleanor Perfetto’s worker’s compensation claim on behalf of her husband, Ralph Wenzel, asserted that his early-onset dementia was an occupational hazard of his seven seasons as a lineman in the N.F.L. Having heard league officials say for years that high rates of dementia in former players either did not exist or could not be ascribed to football, Perfetto, who has a Ph.D. in public health, said she wanted to end all doubt in the courts.

Perfetto, who declared herself “one very pushy broad” while testifying before the House Judiciary Committee last October, is one of six women from diverse backgrounds who have redirected the discussion of brain trauma. They range from players’ family members to a former team president, from a congresswoman to a leading neuropathologist.

“There is a sense of: ‘What is she doing here? She doesn’t belong,’ ” said Representative Linda T. Sanchez, Democrat of California, whose blunt criticism of the N.F.L.’s concussion policies during last fall’s Congressional hearing led to changes in league protocol. “People underestimate you, and it makes you very powerful.

“That’s something that’s afoot here with these women. The N.F.L. is so male and macho and testosterone-dominated, I don’t think they figured that women were going to be a force to be reckoned with in this thing, and they’re finding out the hard way.”

Dr. Ann McKee, a leading neuropathologist at Boston University School of Medicine, has been the primary doctor to identify trauma-induced damage in the brains of former players, and to dispassionately connect that damage to football.

Gay Culverhouse, the former president of the Tampa Bay Buccaneers, not only blistered the league’s playing down those findings before Congress, but also began a foundation to assist players in need.

The eloquent personal appeals of Sylvia Mackey, the wife of the former N.F.L. tight end John Mackey, who was almost bankrupted by his early-onset dementia, persuaded the league and the union to start an assistance plan for families like theirs.

And much of the recent reform to concussion management — which extends to state legislatures covering high school sports — might never have been made without the efforts of Kwana Pittman, a niece of Andre Waters, the former N.F.L. safety who killed himself in 2006. Pittman persuaded reluctant relatives to allow an analysis of Waters’s brain tissue, and the finding of rampant damage made football’s concussion problem national news.

In recent interviews about their roles in the evolving discussion of football brain trauma, none of the six women condemned the sport, and most called themselves fans — just with a dash of compassion and clarity.

As Culverhouse put it: “Men look at the violence and they say, ‘Oh, yeah!’ When someone gets hurt, women say, ‘Oh, no!’ ”

A Search for Responsibility

Women have long shuddered at football’s inherent brutality. In November 1909, a New Jersey football game between Montclair Military Academy and Montclair High School was canceled just before kickoff. The New York Times later wrote, “The mother of nearly every one of the high school’s team had visited Principal H. W. Dutsch and informed him that if he permitted the game to be played and their sons were injured, they should hold him personally responsible.”

Responsibility is what Pittman also sought after her uncle’s suicide. She had watched Waters, her mother’s brother, transform from upbeat and playful to profoundly depressed in only a few years before he shot himself in the head in November 2006. Grieving, she received a startling call a few weeks later from Chris Nowinski, a former Harvard football player and professional wrestler looking into the effects of concussions. Nowinski asked her if researchers could examine pieces of Waters’s brain.

“I took some biology courses and I was interested in anatomy, so that helped, I think,” said Pittman, a middle school teacher in West Palm Beach, Fla. “My family and I, we couldn’t understand why Uncle Andre did this. We wanted some answers, and Chris promised that it would help people. I wanted to keep this from happening to other families.”

Nowinski said: “She could have hung up the phone. She could have not followed through by convincing her family to sign off on it. But Kwana really came through, and it changed everything.”

Waters was the third former N.F.L. player to have his brain identified with chronic traumatic encephalopathy, a degenerative disease whose only known cause is repetitive trauma. But it was his death, and the subsequent finding of trauma, that produced headlines and catalyzed debate.

McKee was not involved in the Waters case but was immediately drawn to the study of football brain trauma. She grew up a rabid Green Bay Packers fan in Appleton, Wis., idolizing the star safety Willie Wood, who now has dementia.