A guy suffers a hairline fracture but plays through it. Another drops in front of a puck, taking one for the team, but loses a step for a while until he mends up. A fellow player develops cancer, and while able to play is quite obviously not doing so at his optimal level.
What do these situations have in common? Well, there is no concrete or correct answer to this per se, but we can throw a few likely things out there. One, each player is likely to be given some slack over their performance given their affliction. Two, each of these guys is very likely to be lauded for their "heroic" play given that they continue to play despite the severity of their physical difficulties. Third, and perhaps the most important, their struggles can be directly observed or measured medically, whether by X-Ray, diagnostic imaging or through the observation of abnormal blood samples.
Now take another player. He has been underperforming for some time and people suspect he is dealing with some form of injury. He is, in fact, suffering from an illness that has significantly reduced his energy level, has him unable to get out of bed many mornings and unable to sleep most nights, has negatively impacted his reaction time and concentration, and has left him without a drive to perform. Sounds pretty serious, doesn’t it? Most people would find it hard to argue that point, until you identify what the individual is dealing with: depression.
While movement is being made, the stigmas present in society are even more firmly entrenched in the sporting world when it comes to mental illness and depression. The individual who suffers (and I intentionally use the word suffer as that is exactly what they do) from depression is oftentimes viewed as weak, less of a man, lazy, a wimp, or letting down their teammates. I mean, they could get out of the mood if they wanted to, right? Just don’t think negative and things will turn around, right? Well, it doesn’t work in the regular public, why should we expect it from an athlete? Perhaps both sides of the coin are best described through the following quote: "They are ordinary people doing extraordinary things". It is their ability to do things the average person cannot that has us, and oftentimes the individual themselves, thinking they are too strong to possibly be knocked down by something “in their head”. Conversely, it is the fact that in the end they are merely “ordinary people” that leaves them just as vulnerable as anyone else would be, so why should we be surprised? Yet we are. Here are a few examples from the sporting world to chew on:
Suffering from a manic episode triggered by the stress of the upcoming Super Bowl, Oakland Raiders center Barret Robbins blatantly breaks team rules by vanishing for 24 hours 2 days before the big game. He went on a drinking binge and ended up hospitalized to stabilize him from the manic depressive episode he had just been through. Robbins received no sympathy or concern from his teammates after he missed the Super Bowl. (Robbins's line mate Mo Collins: "Whatever rock he came up from, he can stay there as far as I'm concerned.") A 2003 Sports Illustrated article by Jon Wertheim noted that in the aftermath of the incident the team was provided with a “crash course in mental illness” but that players' statements of support even following this seemed “forced at best”. Terry Bradshaw was quoted as saying "I've heard his teammates saying things like, 'The ball's in his court. The ball's in his court? The guy's brain chemistry needed to be regulated. Can you imagine if a diabetic had suffered from insulin shock and the response was 'Hey, the ball's in his court'?"
Jim Shea was suddenly a world champion in the skelton, having bested his closest competitor by .57 of a second. He was guaranteed a spot on the U.S. 2002 Winter Olympic team. How did he feel? "It was total emptiness, like I didn't even care. The joy of winning? I could have broken a world record and won the lottery on the same day and not been happy about it."
Terry Bradshaw. Led four Pittsburgh Steelers teams to Super Bowl titles. The NFL’s 1978 MVP. Calm on the field, when the game was over Bradshaw would fall apart, breaking into uncontrollable sweats and tears. Only counselling and medication in the years after retirement made things better for him.
After battling depression during his teens and playing days, Ron Ellis, Stanley Cup champion with the Toronto Maple Leafs, hit the wall after retiring and going into business. He describes sitting in his car in an underground garage for one to three hours at a time, unable to face the feelings of low self-esteem, self-confidence and self-respect within the confines of an office environment.
In 2003, Philadelphia Flyers forward Claude Lapointe voluntarily entered the NHL's substance abuse treatment program to deal with depression. In 2009, veteran winger Theo Fleury revealed his long history of depression and addiction that led to a lost career, suicide attempts, and years of hiding his experiences of abuse at the hands of his former junior coach Graham James.
Before one can get into any extensive discussion on this topic, we need to address the fundamental question: What is depression? In layman’s terms, depression involves severe feelings of worthlessness and self-blame, sadness, disappointment and emptiness. These feelings become “clinical” when they last for several weeks and interfere with an individual’s day to day functioning. Symptoms can include:
• feeling worthless, helpless or hopeless,
• sleeping more/less than usual,
• eating more/less than usual,
• having difficulty concentrating or making decisions,
• loss of interest in taking part in activities,
• decreased sex drive,
• avoiding other people,
• overwhelming feelings of sadness or grief,
• feeling unreasonably guilty,
• loss of energy, feeling very tired,
• thoughts of death or suicide.
The tricky thing is that men with depression often present as feeling irritable, angry and discouraged, making it harder to recognize than the stereotypical “sad” depression. Other numbers to crunch:
• Estimated number of individuals diagnosable with depression in the US: 20 million out of the 300 million US citizens (15%). In Canada? Approximately 11% of men and 16% of women.
• Recent statistics suggest roughly seven of every one hundred people suffer depression after age 18 at some point in their lives.
• Most people diagnosed with major depression receive a diagnosis between their late twenties to mid-thirties.
• Only 80% of persons suffering from depression actively seek help
• Fifteen percent of women suffering from depression will commit suicide
• Men commit suicide three times more often than women
• 25% of all depression suicides are committed by the elderly
• The third leading cause of death in the age group 15 – 24 is suicide
• By the year 2020, depression will be the 2nd most common health problem in the world.
• Depression often exists with other diseases, including chronic pain, arthritis, diabetes and HIV patients.
• Depression is also known to weaken the immune system, making the body more susceptible to other medical illnesses.
• People with depression are four times as likely to develop a heart attack than those without a history of the illness. After a heart attack, they are at a significantly increased risk of death or second heart attack.
• 27% of individuals with substance abuse disorders (both alcohol and other substances) experience depression.
As far as what causes depression, it is difficult to say with certainty, although there are different factors we know can be at play, including trauma, distressing life events, neuro-chemical imbalances, psychological factors and genetics.
What is well known is the impact of depression in the workplace. This is likely the best parallel to provide a glimpse at what the professional athlete deals with in terms of attempting to excel at their given craft while under the cloud of a depressive fog. In instances of a more general onset, changes in the individual will mostly often be seen gradually, while in response to more traumatic or grief-based events (i.e., serious injury/illness, sudden lifestyle change) symptoms can be a continuance of the regular grieving process. Nevertheless, changes are most often observed in the individual themselves and in their workplace presentation. Personal changes may include:
- Irritability/hostility
- Withdrawal from, or extreme dependence, on others
- Hopelessness/despair
- Slowness of speech
- Chronic fatigue
- Alcohol/drug abuse
At the same time, workplace changes can include:
- Difficulty in making decisions
- Decreased productivity
- Inability to concentrate
- Decline in dependability
- Unusual increase in errors in work
- Being prone to accidents
- Frequent tardiness, increased "sick" days
- Lack of enthusiasm for work
Perhaps not surprisingly, it is in the workplace that individuals will try hardest to hide their depression, while fear of being reprimanded, dismissed or stigmatized for, and feelings of shame about, their illness will prevent them from seeking help. I would say that nowhere would this be the case more than in the sports world, where toughness, motivation, performance and confidence are valued more than any other workplace out there. Former Tampa Bay Rays infielder Russ Johnson summed it up nicely in the Sports Illustrated piece:
“But in a culture suffused with testosterone and seldom characterized as either sensitive or progressive, mental illness remains largely stigmatized--and, not surprisingly, largely undiagnosed. "Blow out your knee, get into trouble with the law, fail a drug test, and the team will help you back," says Russ Johnson, a former Tampa Bay Devil Rays infielder whose depression was diagnosed last year and who now plays for the Mets' Triple A affiliate. "Suffer a mental or emotional injury, and it's a big mark against you."
Need to hear it from a hockey guy? Here’s Pat Lafontaine:
Athletes are afraid to disclose any psychiatric symptoms for fear that it will be revealed and exploited as a sign of weakness and therefore do not seek professional help. Athletes who experience depression try to cure themselves, mistakenly believing that depression is only a state of mind that a person can snap out of, rather than understanding depression as a disease.
‘“As athletes, we are taught to be tough,” said former NHL all-star Pat Lafontaine, who has battled depression.
“You get up and shake it off. But you can’t do that with depression. For me, the harder I tried, the worse it got”
(Psychology of Sports)
In a cruel twist of fate, many would argue that of all people, athletes are also perhaps the most susceptible as a whole to having such debilitating experiences triggered during their career. The risk factors are quite prevalent amongst this population, including stress (the pressure of having to perform in front of large audiences; having your performance scrutinized under a microscope), instability (living on the road much of the year, away from home and family), excess (higher exposure to drug/alcohol-based lifestyles) and physical injury/pain (particularly head injuries, to be discussed shortly in further detail). Yet still there remains little understanding for these individuals as much of the public cannot fathom how the rich, “playing a game for a living” athlete with the model wife could possibly have anything to complain about, much less be depressed over.
Yet the effects are real and they are stark. Check out this description from Jason Blake of the Toronto Maple Leafs conducted in September of 20087 where he talks about the depression the gripped him following his diagnosis of cancer:
"When I found out, it wasn't, 'Why me,'" Blake said at the time. "I looked at it like I'm the lucky one. This is something that is thrown at me, and things get thrown at you for a reason. But I can play hockey and (live a normal life), so I feel like the lucky one."
Blake, who had watched his wife successfully battle thyroid cancer during the 2000-01 season, admitted recently that in the months following his diagnosis, he indeed struggled with "Why me" emotional and mental symptoms, questioning his desire to still play hockey, and at times, "hating life and everyone." Despite being able to play the remaining 79 games after his diagnosis, Blake confessed that he was never fully engaged on the ice and battled self-pity, depression and a lack of motivation off it.
"I spent the first two months of the season after I found out about my condition just banging my head on the pavement and trying to figure out 'Why me?'" he said. "It was just really difficult to comprehend the magnitude of it. I tried my best to move on and played 82 games, but deep down inside it took its toll on me. Physically, I lost 12 pounds in the first month on the medication. I'll be the first to admit I wasn't a great person to deal with and I wasn't always the best teammate over the year.
Last year there were times where I just hated life and hated everybody, and just kept asking, 'Why me?' I didn't want to go play sometimes and I just didn't have the desire anymore. It's scary when that happens. But I was just questioning a lot about my life and hockey just seemed to take a back seat at times."
As the season wore on through, Blake said the constant love and support from his family and the outpouring of support from friends, teammates, the Leafs organization and the hockey community made him realize how lucky he was.
Sound like a guy who could just “snap out of it”? Here’s a guy who had to live through a serious illness with his wife only to be battling himself a few years later. Want to tell him to “man up”? Think he’s being a wimp? I think not.
The NHL, and sports in general, are coming around to the need to address depression, and it’s happening none too soon. The fact of the matter is that as research develops out of the realm of concussions it is becoming more and more apparent that depression is a reality for a vast majority of athletes having experienced this brain trauma. Remember the proportion of the population experiencing depression in Canada? Approximately 15%. Among the population of athletes having experienced a concussion the prevalence rate jumps to 40%. Furthermore, researchers in Montreal have discovered that the brain activation of a concussed athlete is very similar to that of an individual suffering from major depression, while numerous other studies have found that a history of concussions can increase the likelihood of developing depression later in life (three times higher than players without a history). Look at the high rate of suicides amongst athletes having a history of concussions, especially football players, and one can also appreciate the need to proactively address the depression that may facilitate the relationship between the two.
Depression is a powerful and debilitating disorder that can impact anyone, regardless of age, gender or occupation. This includes the professional athlete, who perhaps in many ways suffers from greater stigma in relation to depression than anyone in the general public. This is in many ways due to the fact that we want our athletes served up one way: rough, tough and ready to win. They represent in many respects that infallible “object” that we can hold before us and wish we could be. As such it is understandable that many are resistant to acknowledge perceived weaknesses or “flaws” in these men and woman. Inherent in this piece, however, is the idea that a professional athlete battling depression is neither flawed nor weak. Rather they are that much more the rough, tough and ready to win individual we crave in that they are able to battle not only the symptoms of a disease that is crippling in its physical and emotional impact, but also fighting against the stigma that would see them suffer alone rather than admit their pain.
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