Beyond Winning And Losing

They’re members of an elite men’s club, celebrated for physical prowess that most can only dream about.

Professional athletes are models of strength and toughness in the game. Billions of dollars are riding on their muscle and hustle. Yet, underneath the Superman physiques and supersized paychecks, they’re ordinary men with everyday problems – including mental illness. 

One in five adults suffers from some form of mental health disorder, according to the National Institutes of Mental Health. Issues like anxiety, depression, eating disorders and substance abuse affect all segments of society, including professional athletes. For them, there may be longstanding, unresolved personal problems or psychological conditions that develop in the game. The physical and mental challenges of staying in peak performance mode can be overwhelming, and the pressure to perform under public scrutiny is enormous. 

The idea of mental illness as a sign of weakness in the “man-up” culture of sports – where the prevailing attitude has been that big salaries are the best therapy – shows some signs of changing. While we can’t yet call it a trend, more athletes are going public with their mental health issues, which is a step in the right direction. The message that’s it’s OK for men to ask for help is crucial for youth and collegiate athletes so that potential mental health problems can be addressed early.

Speaking Out

One of the first high-profile athletes to open up about his mental health issues in recent years was Olympic swimmer Michael Phelps, who revealed that he experienced bouts of depression and suicidal thoughts in 2014. He has since become an advocate for mental health and is a shareholder and advisory board member for Talkspace, an online counseling service.

“Once I opened up about that and things I had kept inside of me for so many years, I then found that life was a lot easier,” he said in the 2017 documentary “Angst.” “I got to the point where I understood that it’s OK to not be OK.”

Sports psychologist Mitchell Greene told Psychotherapy Networker magazine that Phelps talking about his mental health issues was a “game changer.” 

“Professional athletes now have a forum to speak directly to the public through social media and blogs. They’re pulling the curtain back on what it’s been like to be a professional athlete. And it’s not pretty at times.”

In 2015, Milwaukee Bucks power forward Larry Sanders went to a hospital for treatment of anxiety, depression and mood disorders. He left the NBA and has since been open about his struggles.

“It’s hard for people in my field to respect mental health,” he told ESPN.com. “We say that the game is 90 percent mental, but yet mental health doesn’t get the respect of, like, an ACL [injury].”

Bolstered by these athletes’ courage – and the positive public response – others soon followed. That same year, professional tennis player Mardy Fish talked about his anxiety disorder on The Players’ Tribune, former Yankee shortstop Derek Jeter’s online platform, and retired from the game. 

“Mental health is not a very easy thing to talk about in sports,’” he wrote. “We’re so trained to be ‘mentally tough.’ To show weakness, we’re told, is to deserve shame.”

When former Toronto Raptors forward DeMar DeRozan tweeted in February 2018, “This depression get the best of me,” he received an outpouring of support from fans and fellow NBA players. His actions spurred Cleveland Cavaliers forward Kevin Love to disclose in March 2018 on The Players’ Tribune that he had a panic attack during a game. The two athletes subsequently made a public service announcement for NBA Cares, the league’s social responsibility initiative.

“The best thing I ever did was to come out and say, ‘Hey, I need some help,’” Love said in a video.

Also in March 2018, Washington Wizards forward Kelly Oubre Jr. told NBC Sports that he, too, could relate to their problems. 

“We’re normal human beings,” he said. “I feel like people who are on the outside looking in don’t really understand because they see us as superheroes, but we’re normal people, man.”

Then, inspired by Love and DeRozan, former Minnesota Vikings wide receiver and University of Florida Gator Percy Harvin went public in July 2018, telling Sports Illustrated about his battles with anxiety, migraines and insomnia – issues that plagued him on and off the field during his eight-year NFL career. He quit the NFL in 2017 and is now back in Gainesville, mentoring young athletes.

“This whole journey has been surprising,” he told SI. “A lot of the stuff I struggled with, it just don’t affect me no more. That’s why I’m comfortable talking about it.”

Baby Steps

Despite this kind of progress, “denial still reigns,” says John McCauley, Ph.D., a clinical and sports psychologist in Boca Raton who has counseled medal-winning Olympic athletes. One of his specialties is working with athletes to develop personalized treatment programs for sport-specific mastery.

Dr. McCauley is not optimistic about a culture shift in professional sports, which “chews up and spits out athletes,” he says. A few high-profile athletes talking publicly about mental illness does not signal an opening of the floodgates, he believes. 

“An athlete will have difficulty acknowledging the [mental health] issue unless it begins to interfere with performance,” he says. “The level of personal suffering is the critical factor in whether or not an athlete seeks help.”

He notes that merely announcing the problem doesn’t necessarily mean the athlete is seeking help “because we really don’t follow up when that athlete does make an announcement,” he says.

The recent wave of disclosures begs the question: Are professional athletes, in particular, prone to mental health challenges? Some sports are more conducive to aggression, which may encourage and mask inappropriate aggressive impulses in athletes, according to Dr. McCauley. Plus, young athletes headed to the pros are still maturing physically and psychologically, so the pressures of the industry may exacerbate existing mental or emotional problems. 

Considering that so many members of society, not only athletes, struggle with mental illness, he thinks mental health education should begin in preschool to help teachers and parents understand the psychological and developmental needs of growing children.

Game Plan

Many believe that helping young athletes bolster their mental health – before they hit the pros – is crucial. And, fortunately, collegiate organizations are increasingly prioritizing the issue.

In 2016, the Sports Science Institute of the National Collegiate Athletic Association (NCAA) released new guidelines for managing mental health issues in college athletes, including pre-participation screenings and hiring mental health professionals who specialize in working with athletes. 

Raphael Wald, Psy.D., joined the staff at Lynn University in Boca Raton in 2017 to work with its 275-plus Division II student athletes as a sports psychologist. Also, he has served for six years as the team psychologist for Florida Atlantic University in Boca Raton, a Division I school with 500 student athletes, and is a psychological analyst for a Major League Baseball team. He’s the author of “The Seven Practices of Mentally Superior Athletes.”

He says that some schools and professional sports organizations are still trying to figure out appropriate models for their teams’ psychological support personnel. Recognizing the importance of mental health for student athletes is “still continuing to build,” he says. 

“I wouldn’t say that it’s as fully recognized as it needs to be, but it’s getting there.”

Dr. Wald counsels student athletes and also works on mental  health skills on a one-to-one or teamwide basis. He relies on the athletic training staff at Lynn and FAU to monitor student athletes and come to him with concerns. 

The athletic training staffs are “phenomenal in being sensitive to [mental health] issues,” he says. “Some coaches are better than others, and some sports have cultures that are more conducive to it, but overall everything from top to bottom has made a shift towards being better about mental health problems and paying attention to them.” 

Psychological problems and sports performance are “one big interconnected picture,” Dr. Wald says. 

“It can be difficult to separate problems in your personal life with what you need to do as an athlete. Very frequently, the problems as an athlete do relate to performance or a relationship with a coach. When you reach NCAA Division I or II, student athletes identify themselves by who they are within their sport and how they’re functioning within their sport. If they’re not doing well in their sport, they’re not doing well overall. Part of their identity is sick, so to speak. It’s all a continuum, on the court and off the court.”

Best Practices

Considering that an astonishing number of professional athletes come from the “Swamp” at UF – including 38 Gators on 23 NFL teams in 2018 – it’s only appropriate that the school have proper mental health programming in place for student athletes.

Up until about 2008, UF utilized on-campus counseling resources for this purpose, but it was difficult to get student athletes seen in a timely manner. The Sports Health Department began using mental health consultants, says Stacey Higgins, UF assistant athletic director and certified athletic trainer in the department. 

Her team coordinates the health care of UF’s 650 Division I student athletes, who, when needed, work individually with mental health care providers who are otherwise unaffiliated with the university. 

“We want to keep that line of confidentiality that the student athlete needs when they talk about mental health care,” Higgins explains. “They realize this person, not employed by us, is not divulging information to us. We keep that separation.” 

When the new NCAA best practice guidelines came out, the Sports Health Department reviewed them as a group and incorporated some of the suggested changes. 

“We were doing a good job, but you can always get better,” she says. 

One of the changes was adding a mental health prescreening during athletes’ physical exams. Mental health care providers are on hand to administer screenings and introduce themselves to athletes. They follow up with anyone whom they believe would benefit from services.

“That’s one of the main changes we’ve made, and that’s gone really well,” says Higgins. “It allows our mental health counselors to get in early with student athletes. It’s just as important as every other aspect of health care. It also sets the stage for taking the stigma away of mental illness.”

Attitudes toward mental health are changing – but not quickly enough. In January 2018, family, friends and teammates were shocked when Washington State University quarterback Tyler Hilinski committed suicide; he never asked for help with his depression. 

WSU alum and Super Bowl champion quarterback Drew Bledsoe wrote on Instagram after Hilinski’s death: “Reaching out for help when we need it is not a sign of weakness. Trusting your friends and asking for help is the ultimate sign of strength!” O