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Mental Illness in Elite Athletes

According to statistics from the National Institute of Mental Health (NIMH), in 2014 there were an estimated 43.6 million adults aged 18 or older in the U.S. that suffered from some form of mental illness. That is more than 18% of all adults. And if casual readers were to associate mental illness with the common population, they would be wrong. Depression, bipolar disorder, anxiety disorders and all other mental conditions respect no class or profession. Not even elite athletes.

Risk factors in athletes

Whereas physical sports activity represents a health benefit, it is not without its negative effects. Some of the reasons accounting for their vulnerability include the huge investment of time and energy required, often resulting in a loss of personal autonomy and ‘identity-foreclosure’, leaving athletes few other avenues through which to shape and reflect personality. Elite athletes, such as those preparing for the Olympics, typically train no less than four daily hours, six days per week. That would amount to 4,990 hours in four years, a sum voluminous enough to envelop an identity whole.

There is also overtraining: a long term decrement in performance, usually with various physiological, immunological, hormonal and metabolic changes that are remarkably similar to those in Major Depressive Disorder (MDD), the only difference being the nature of the role dysfunction: athletic performance in the case of the overtrained athlete; social, cognitive and work in the case of the depressed patients. Burnout, the most extreme end of the overtraining continuum, is reported in approximately 10% of elite athletes.

High athletic identity has been linked to psychological distress when this function of identity is removed, as is the case in injury, competitive failure, ageing, retirement from sport and other psychosocial stressors. The injury experience of an elite athlete has been likened to the grief process observed following bereavement. And a dose-response relationship exists between physical activity and the likelihood of injury, thus pertaining to the overtraining phenomenon.

Other vulnerabilities are also described, such as eating disorders (with a reported prevalence of 17.2% in men and 32% in women) and risk-taking behaviors, such as hazardous drinking, driving while intoxicated and unprotected sex.

The unseen opponent

So it should go without saying—athletes are as susceptible as the rest of the population. A small-scale research conducted between collegiate athletes reported a 17% prevalence of depression, a percentage in line with that of all adults in the U.S. The problem lies in underdiagnosed and inadequate treatment, as these issues are viewed from a narrow physiological perspective rather than a broader psychosocial one.

There lies their much more difficult route towards acceptance—the athlete is not sick; he is considered irresponsible. He is seen as privileged to such an extreme degree, that he can’t possibly have feelings of depression or mania. And this is not a sports-specific problem, but rather ingrained on a societal level. The pervading taboo surrounding mental health makes coming forward a potentially career-altering decision. Yes, they want to have somebody to talk to, but they don’t want their teammates or their coach to find out because of the stigma.

Team and league initiatives still are not on par with the problem. The overall goal of sport psychology professionals is to enhance the player’s game, to make him or her a better teammate and performer—not to diagnose mental illness. And the work schedule of elite athletes, including travel and time away from home, make it hard for them to seek out psychologists outside the team. As a result, they are left with no access to care.

Sadness, isolation, irritation, lack of motivation, anger, frustration, changes in appetite and/or sleep pattern, disengagement. They are all there, just lurking, waiting for their moment to seize you. But they are not stronger than you.

Acceptance is the only solution

Patients—and athletes included—reject the implications of loss of control, diminished vitality and inadequate coping skills that come with the diagnose of a mental illness, and often vow to work harder as if to overcome their shortcomings, which usually leads to even more severe symptoms and dysfunction. But that is not the solution. It is acceptance. You must imprint on your mind that mental illness is not a weakness—rather a medical condition as any other; nor is it your fault—it is a simple result of your neural pathways. Accept yourself, for that, is the true definition of strength.

And seek help. As any other medical condition, it requires treatment. There is an endless number of both psychologists and psychiatrists ready to hear you, guide you and dispense medication. Doing that is the exact opposite of admitting defeat—it is an expression of courage, being ready to fight with teeth and nails against the enemy. Some elite athletes have claimed that treatment has diminished their performance, but never as much as mental illness can. And, what is even more important, you must take care of your future—life beyond the sport. Most athletes are able to keep their disorders in line, yet as soon as retirement comes, mental illness swallows them whole. Opportune treatment shuts off this alternative.

For each athlete that has admitted to having a mental illness is a great step forward. Such openness helps other athletes and the general public. It helps psychology and psychiatry experts too, by providing a role model for patients reluctant to take the medication. Only by realizing that athletes have lives and cares outside of their professional sports can we begin to address mental health needs holistically.

You are not the only one

Countless elite athletes have experienced and battled mental illness. While some met tragic ends, victims of their reluctance to seek treatment, most of them are still hitting the courts and fields or have completed successful careers. Depression is no one’s friend, and has battled the likes of historic boxer Sugar Ray Leonard; U.S. soccer superstar Hope Solo; NFL powerhouse Terry Bradshaw, who also suffered from anxiety; Olympic gold medalists Derrick Adkins and Kelly Holmes, hurdle and distance respectively; and English first-class cricket player Marcus Trescothick.

Bipolar disorder is an even harder diagnose, admitted by athletes such as still active NBA player Metta World Peace; NFL hall of famer Charles Haley; multiple World series champion Darryl Strawberry; rugby record-breaker Andrew Johns; professional golfers David Feherty and John Daly, the latter also confronting alcoholism; The Flying Scotsman, cyclist Graeme Obree; heavyweight boxing champion Frank Bruno; and number one professional tennis player Ilie N?stase.

There is also three-time NFL Most Valuable Player, Earl Campbell, who suffered from panic disorder, just as Dennis Bergkamp did, Netherlands’ goalscoring machine; tennis eminence Mardy Fish, victim of anxiety; the first female jockey to win a Triple Crown race, Julie Krone, who suffered PTSD after a fall from her horse; and there is Ricky Marshall and his borderline personality disorder, wide receiver for the New York Jets, still amassing records and milestones as well as being an eloquent and passionate spokesman for a greater awareness of mental illness.

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