The Midtown Manhattan shooting involving Shane Tamura, a former high school football player, recalled previous cases of violent behavior — including murder and suicide — by other former players who believed they were suffering from brain trauma sustained on the field.
It also echoed a case that had nothing to do with football: The murder of Brian Thompson, the chief executive of UnitedHealthcare who was killed in Midtown Manhattan in December by a gunman who said in a manifesto that he saw the killing as a direct challenge to the health care industry’s “corruption” and “power games.”
After years of public relations crises over the sport’s long-term cognitive and neurological toll on players, the N.F.L. seemed to largely move past the subject with a legal settlement that has paid out $1.5 billion since 2017. But the subject of chronic traumatic encephalopathy, the degenerative brain disease known as C.T.E., arrived at the league’s front door on Monday in a terrifying way. The building that houses the league’s headquarters became the scene of a shooting spree that left five people dead.
It is not clear whether the gunman’s claims of cognitive issues were related to playing football, or whether he had any connection to the N.F.L.
Yet the police believe Mr. Tamura, a former high school football player, was seeking vengeance on the league. They cited a three-page note found in Mr. Tamura’s wallet that referred to C.T.E., which has been associated with repeated hits to the head, and which can only be definitively diagnosed after death.
The note, from which the police released excerpts, also inveighed against the N.F.L., which has offices at 345 Park Avenue, where the shooting took place, saying it had concealed the danger of the sport in favor of profits.
The note made reference to Terry Long, a former N.F.L. player, and drinking “a gallon of antifreeze” — the way Mr. Long killed himself in 2005.
Mr. Tamura shot himself in the chest, rather than the head.
“Study my brain please,” the note said. “I’m sorry.”
It may take several weeks or more for the medical examiner’s office to determine whether Mr. Tamura, 27, had C.T.E. And even if he is found to have had the disease, it will be difficult to know whether it was caused by head trauma sustained in football or elsewhere, or whether other conditions played a role in his actions.
“I would never draw a direct line between someone’s brain pathology and any specific violent act because the majority of people who have C.T.E. never committed anything like this,” said Dr. Daniel H. Daneshvar, chief of brain injury rehabilitation at Harvard Medical School.
“The majority of people with C.T.E. never engage in violent behavior at all,” he added.
Mr. Tamura does not appear to have played football in college, let alone in the N.F.L. It is unclear whether he had any contact with the league before Monday. A league spokesman did not reply to a request for comment.
“The short answer is we all think this is undeserved to place this at the feet of the N.F.L., but it is sadly part of being the biggest league,” said Robert Boland, a professor at Seton Hall Law School who worked as a New York City prosecutor and an N.F.L. player agent. “Football still exists and it is important that everyone involved in the game do what they can to make it safer.”
For decades, the N.F.L. celebrated violence in its promotional films and broadcasts. Popular players had nicknames like the Assassin and the Purple People Eaters. That changed in the 1990s, when several players retired from the effects of too many head injuries. Then, in 2002, C.T.E. was discovered in the addled brain of the former Pittsburgh Steelers center Mike “Iron Man” Webster, who died at age 50.
The disease had been found in boxers decades earlier. But football was the nation’s most popular, lucrative and glamorous sport. For years after Mr. Webster’s diagnosis, the league was dogged by accusations — from former players, fans and researchers — that it was covering up growing evidence that football was linked to brain disease, and that the league was not doing enough to shield players from the ravages of the game.
The league’s Mild Traumatic Brain Injury committee published numerous reports that downplayed the growing body of research linking head hits to brain damage. It wasn’t until 2016, after the league’s settlement was initially approved, that an N.F.L. executive acknowledged that there was a link between football and degenerative brain disorders like C.T.E.
By that point, dozens of former players had been found to have C.T.E.; Dave Duerson and Junior Seau had shot themselves in the chest to preserve their brains so they could be studied. Former players pledged their brains to science, and the 2015 movie “Concussion,” starring Will Smith, lionized the doctor who found the disease in Mr. Webster’s brain.
Nervous parents began steering their sons toward soccer, baseball and other sports. Worried that the pipeline of young players might dry up, the N.F.L., a $23 billion league guided by lawyers and marketing executives, tried to reframe the conversation and move past accusations that it sanctioned junk science.
The league held clinics that taught young players and their mothers “safe tackling” techniques, eliminated some dangerous plays from the game and, prominently, reached a landmark settlement with former players that included up to $4 million to families of deceased players found with C.T.E.
The league’s efforts largely worked. News of the disease popped up less frequently, though sometimes in disastrous ways. Aaron Hernandez, a tight end for the New England Patriots who was convicted of murder and killed himself in prison, was found to have a severe form of C.T.E. In 2021, Phillip Adams, a cornerback who played six seasons in the N.F.L., shot six people and himself in his hometown, Rock Hill, S.C. By that point, Mr. Adams had been out of the league for six years. His motivations remain unclear.
In recent years, the league has promoted flag football as a safer alternative to the tackle version of the game, particularly for younger athletes. It has also eliminated some of the most dangerous plays and strengthened protocols to remove players who may have been concussed during games.
Yet C.T.E. is still associated with repeated hits to the head and remains a vexing problem for all collision sports, including football, hockey and rugby.
Juliet Macur contributed reporting.
Ken Belson is a Times reporter covering sports, power and money at the N.F.L. and other professional sports leagues.
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