Sports Illustrated Magazine – Sept 8, 2003 – Jon Wertheim writes a great article here about the stigma of depression in sports, sport psychology and psychiatry. The story begins with Olympian Jimmy Shea and the work of his psychiatrist, Dr. Michael Lardon. Clinical and sport performance psychologist Dr. John F. Murray contributes to the understanding of athletes who are healthier than the general population mentally, but also perhaps at greater risk for difficulties due to the unique stressors in sports. The article touches on the growing awareness and evolution of legitimate sport psychology as a force to help teams and owners win more, as well as to help athletes achieve greater personal well being}

Mental illness still carries a powerful stigma in pro sports, but there are signs that teams are finally facing the problem and trying to help troubled athletes

He came roaring down the mountain at nearly 85 miles an hour, a blur in an aerodynamic Lycra suit. Headfirst on a sled barely bigger than a cafeteria tray, Jim Shea was inches from rock-hard ice, handling serpentine turns without the benefit of either brakes or a steering wheel. The running joke is that Shea’s exhilarating sport, skeleton, got its name for a good reason: One imprecise maneuver and he could be turned into a bag of broken bones. It was the winter of 1999, and when Shea rounded the final curve on his last heat .57 of a second ahead of the next-fastest guy, he was suddenly a world champion.

When coaches and teammates mobbed him on that cold afternoon in Altenberg, Germany, it was as clear as the mountain air that Shea, after thousands of hours spent training and traveling, had reached the pinnacle of his sport. His spot on the U.S. 2002 Winter Olympic team was all but guaranteed. And Shea felt … nothing. “It was total emptiness, like I didn’t even care,” he recalls. “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.”

The clinical term for this, he later learned, is anhedonia, and Shea relies on weather analogies–“fog,” “dark clouds” and persistent “gloom”–to describe the feeling. Still, at the time, Shea found nothing unusual about his lack of emotion in the face of what was, by any measure, a triumph worthy of unbridled joy. Shea’s grandfather Jack was a speed skating pioneer who won two gold medals at the 1932 Olympics. His father, Jim Sr., competed in the 1964 Games in Nordic combined and cross-country. The men in the Shea family were quiet, tough, bootstrapping types who lived by a Spartan code of stoicism and self-reliance. Emotions were best left bottled up. An uncle’s suicide, for instance, was not on the table for discussion. Since Jim had been in elementary school, he’d known there was something preventing him from experiencing emotional crests, an immovable force that kept him mired in lows longer than any of his friends. “But I figured those were the cards I was dealt,” he says. “For me it was normal.”

A U.S. Olympic Committee psychologist at the training center near San Diego thought otherwise and referred Shea to a local psychiatrist, Michael Lardon, who had worked with dozens of elite athletes. After one session Lardon ran through a checklist of symptoms–persistent sadness, feelings of emptiness, the inability to extract joy from pursuits that should be pleasurable, irregular appetite and sleep patterns, decreased energy–and noted how many applied to Shea. “Jim, listen,” the doctor said, “I think you suffer from depression.” Shea’s reaction was typical of people like him. Me? Depressed? How could that be? I’m an athlete.

It is an invisible incubus that will haunt 19 million Americans this year. One in six people will be affected by it in their lifetimes. It accounts for countless sick days and costs U.S. industry $ 44 billion annually in medical expenses and lost productivity. Depression is an equal-opportunity affliction, not discriminating according to class or social standing. Among the millions affected: Barbara Bush, Halle Berry and Winston Churchill, who called his depression “my black dog,” a companion that seldom left his side.

The list of athletes who suffer from depression, bipolar disorder or social anxiety disorder–three of the most common forms of mental illness–would make for a hell of a table at a charity dinner. Ricky Williams, the NFL’s 2002 rushing leader, suffered such overwhelming social anxiety that he couldn’t bring himself to leave his house to mail a letter. Terry Bradshaw, the star quarterback and irrepressible NFL broadcaster, was once so depressed that he would go to bed crying. On the eve of last January’s Super Bowl, Oakland Raiders center Barret Robbins neglected to take medication to treat his bipolar disorder, went on a Tijuana drinking jag, considered committing suicide and was in a hospital during what should have been the biggest game of his career. Mike Tyson was in the clutches of depression long before he turned into a pitiable sideshow.

And those are among the few who have come to the public’s attention. Innumerable other athletes are familiar with the Via Dolorosa traveled by the PGA golfer who contemplated suicide last summer after failing to make the cut at the Greater Hartford Open. Or the top pick in a recent major league draft whose deep melancholy has forced him to take an indefinite leave from baseball. Or the former NBA All-Star whose decline is widely attributed to alcoholism but who actually suffers from crippling depression. “An amazing number of athletes have these illnesses,” says Lardon. “It’s way more than you’d ever guess. I mean way more.”

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.”

In the U.S. more than twice as many women as men suffer from depression. Since there is little evidence that brain chemistry is markedly different between genders, many believe that women are simply more attuned to their emotions and more likely to seek treatment. Anecdotally–no statistics are kept on how many athletes suffer from or seek treatment for depression–the sports world seems to mirror society at large. Though the majority of professional athletes are men, some of the most high-profile jocks to speak openly about their struggles with depression have been women. Julie Krone, the Hall of Fame jockey, was so up-front about her battle with depression that she landed an endorsement deal with Pfizer, the maker of Zoloft. In her autobiography, Picabo: Nothing to Hide, gold medal skier Picabo Street wrote about the depression she endured while rehabbing from a gruesome knee injury. Los Angeles Sparks point guard Nikki Teasley, the MVP of this summer’s WNBA All-Star Game, says of her depression, “It’s part of who I am.”

But for half a century, since baseball player Jimmy Piersall achieved notoriety after suffering a nervous breakdown, the sports world has remained largely in the dark on matters of mental health. “If you go into a locker room, there’s no faster way to alienate yourself than by saying the word psychology,” says John Murray, a Miami-based clinical psychologist who treats athletes. “It’s definitely a taboo, and we can only speculate why.”

Perhaps it’s because males in general (and alpha males in particular) are much less likely than women to acknowledge their mental illness. Perhaps it’s because of the enduring misconception that mental illness somehow indicates inner weakness–a sentiment that, according to the National Mental Health Association, is particularly common in the African-American community, from which a disproportionate number of athletes hail. Or perhaps it’s because mental illness, unlike a broken bone or a torn rotator cuff, doesn’t readily appear on an X-ray or an MRI.

The abiding irony is that athletes–our indestructible gladiators, our iron-clad warriors–might be more prone to mental illness than the population at large. “Athletes are so paradoxical because physically they are so much healthier than the average person,” says Murray, “but from the clinical side of things, they are very much an at-risk population.” Among the reasons why:

–STRESS After heredity, the biggest risk factor for depression is stress. Performing in front of thousands of fans, having your work scrutinized and judged regularly, laboring in a field where success and failure are so clear-cut–all that can exact a huge psychic toll. There’s also the stress of knowing that your career, and thus the window of opportunity to make millions, is narrow. The stress can be equally intense in the less prominent sports. An athlete such as Shea might not perform nightly in front of multitudes, but he spent four years preparing for a single event. “I knew, one mistake and it was over,” he says. “That’s a lot to bear.” Not for nothing does the USOC have a phalanx of full-time psychologists on staff.

–LIFESTYLE Social stability and a solid home life improve mental health. And athletes, regardless of the sport, live out of a suitcase for months on end.

–CHILDHOOD TRAUMA Researchers know that exposure to trauma at a young age can lead to an increased likelihood of depression and mental illness later in life. (Studies have also shown that growing up in a single-parent household can increase the risk.) The sports world is awash with athletes who have endured circumstances that are deeply abject. “Think of how many athletes you read about who grew up in terrible poverty, or had relatives who were murdered, or don’t know their dads,” says Joe Schrank, a former practice-squad defensive tackle at USC who is pursuing a master’s degree in social work with an emphasis on clinical issues associated with athletes. “It’s off the charts.” For instance, Leon Smith, a former Chicago hoops star, was raised in a world inconceivable to most of us. A ward of the state, he was shuttled among group homes, and he talks of having slept in cars. In 1999, after he was drafted out of high school by the San Antonio Spurs and immediately traded to the Dallas Mavericks, he suffered a breakdown that doctors say was caused by depression. After slathering green paint on his face, he threw a rock at a car, then swallowed 250 aspirins in an apparent suicide attempt. Smith never played for Dallas and most recently appeared in the L.A. Pro Summer League, more than a long jump shot from the NBA.

–HEAD INJURIES Athletes are at a far greater risk than the general population to suffer cranial injuries, which can alter brain chemistry. Studies show that someone who has endured multiple concussions is up to four times more likely to suffer depression. Not surprisingly, anecdotal evidence suggests that depression is common in hockey, a sport in which there are nearly as many concussions as dislodged teeth. This off-season alone, two professional players have committed suicide. Pat LaFontaine, the former NHL All-Star, suffered a nasty concussion in 1996, and virtually overnight, hockey lost all significance to him. Team doctors puzzled over his lack of passion. Only after a trip to the Mayo Clinic was his condition diagnosed as depression, the result of postconcussion syndrome.

What about the notion that the incidence of mental illness in sports should be lower because the weak have been winnowed out? Wouldn’t anyone battling an incapacitating case of depression simply fail to make it to an elite level? Not necessarily. “Depression often doesn’t kick in till someone hits his early or mid-20s,” says Dennis Charney, chief of the Mood and Anxiety Disorders Research Program at the National Institute of Mental Health. “So you could grow up fine, then have your [onset] once you’ve made it to the pros.”

Take Bradshaw, who led four Pittsburgh Steelers teams to Super Bowl titles and won the NFL’s MVP Award in 1978. He was the picture of calm on the field, but when the game ended, he would hemorrhage sweat and dissolve into tears. “People say, ‘You couldn’t have been depressed–I saw you throw for all those touchdowns,'” says Bradshaw. “Shoot, the football was the easy part. I could concentrate for three hours, and the games were an escape. It was the rest of my life that was going to hell in a handbasket.” Despite a jovial public persona that splinters the stereotype of how someone who’s depressed acts, Bradshaw grew more melancholy after retiring from football. Finally he sought help. After going to counseling and taking Paxil (an antidepressant he is now paid to endorse), he stopped experiencing the inexplicable lows. “And the rest,” he says, commencing his familiar cackle, “is history, baby.”

Although it’s commonly thought that physical activity and the pursuit of goals have a salutary effect on mental health, those alone don’t necessarily reduce athletes’ risks. While exercise in conjunction with therapy and medication can help elevate mood, alone it is no match for depression. “Anyone who has had depression will tell you, it’s not the kind of thing where you can go for a run and suddenly feel all better,” says Charney. “That’s a big misconception.”

Athletes also have at their disposal a raft of handlers, apologists and other sycophants who help excuse behavior that would otherwise seem pathological. Consider Ricky Williams, who struggled for years with social anxiety disorder before finally seeking successful treatment. When he was a high school football star in San Diego, he sensed that he was “wired differently” from classmates. He would recoil from social situations, even from speaking in class. He believes that because he was a football star, his extreme introversion was shrugged off as behavior typical of a coddled athlete. “It was always, ‘Oh, Ricky’s just aloof,’ or ‘Ricky’s moody,’ or ‘Ricky’s arrogant,’ when it was really so much more,” he says.

As Williams developed a national profile at the University of Texas, he turned further inward. As his anxiety worsened, he enlisted what he wryly calls “a support system” to run interference. “If I didn’t want to honor an obligation,” he says, “I knew someone would cover me. If I didn’t want to do something, they said, ‘Don’t do it.'” Boosters, for example, would be waiting to meet Williams only to have an athletic department flack explain that Williams’s car had broken down, or that he was sick, or that his mom was sick. “A lot of people made it easy for me to hide,” he says.

By the time he had won the 1998 Heisman Trophy and been drafted by the New Orleans Saints, Williams’s social anxiety had intensified to the point that he would conduct interviews without removing his helmet. He would seldom make eye contact–much less speak–with teammates unless absolutely necessary. He would quickly leave practice and head to the Burger King drive-through, only to realize that he’d have to interact with someone to place an order. So he’d head home and spend the rest of the day in seclusion. “At practice my teammates would be like, ‘Hey, what did you do last night?'” he says. “I’m thinking, I went from the living room to the office to the bedroom.”

During a disappointing second NFL season–exacerbated by a risible performance-based contract–Williams broke his ankle. His recovery was treated by the team as a matter of vital importance. Trainers and rehab specialists oversaw his every move and asked for near-daily updates on his condition. Williams marveled that while his bum ankle was getting all the attention, his wounded psyche was going unnoticed. “There’s a physical prejudice in sports,” he says. “When it’s a broken bone, the teams will do everything in their power to make sure it’s O.K. When it’s a broken soul, it’s like a weakness.”

Finally Williams decided to get help. He tooled around the Internet trying to diagnose his symptoms and confided in the mother of a childhood friend. Together, they concluded that he suffered from social phobia, or social anxiety disorder. He went to see a therapist, who confirmed the diagnosis. Williams approached the Saints’ coach, Jim Haslett, to explain that he was seeking treatment for a psychological issue. Williams says that Haslett used profanity to tell him, in so many words, “to stop being a baby and just play football.” (Haslett did not respond to SI’s questions about the incident.)

Williams’s story nevertheless took a happy turn. With the help of psychotherapy sessions (which included going to malls and other crowded public spaces) and a daily dose of Paxil, he grew increasingly comfortable in social situations, so much so that he agreed to be a spokesman for GlaxoSmithKline, the maker of Paxil. In the 2002 off-season Williams was traded to the Miami Dolphins, and the new environment is serving him well. With no funny looks from teammates and with a franchise that has more than a passing familiarity with mental illness–in 1999, Dolphins defensive tackle Dimitrius Underwood, affected by bipolar disorder, took a knife to his neck–Williams has thrived. Quite apart from his status as an elite running back, he cuts a genial, confident figure. “Just going into a mall or walking through the airport now and not worrying about it, I can’t describe how good that feels,” he says. “It’s like I got my old self back.”

New Orleans fans would be within their rights to wonder if the league’s top rusher wouldn’t still be in the Saints’ backfield had the team been more enlightened about Williams’s social phobia. But the Saints’ reaction was hardly atypical. “That’s how it is in football,” says Bradshaw. “We’re supposed to be big, tough guys. ‘You have depression? Shoot, that’s not depression. That’s weakness.’ That’s how the thinking goes.”

Take the case of Robbins, who got scant sympathy from his teammates after he missed the Super Bowl. The memorable postgame quote from Robbins’s linemate Mo Collins spoke volumes: “Whatever rock he came up from, he can stay there as far as I’m concerned.” Even after Robbins’s circumstances came more sharply into focus and the team was given a crash course in mental illness, players’ statements of support seemed forced at best. “I’ve heard his teammates saying things like, ‘The ball’s in his court,'” says Bradshaw. “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’?”

Robbins is uncomfortable talking about both his Super Bowl weekend episode and his bipolar disorder. During the off-season he turned down numerous opportunities to speak publicly about his condition. When groups sought his services in campaigns to raise awareness and even when pharmaceutical firms offered endorsement deals, he politely demurred. Profusely apologetic, Robbins declined a request to be interviewed one-on-one for this story. “I just want to move on,” he said through his agent, Drew Pittman.

Not that insensitivity toward mental illness is confined to football. When pitcher Pete Harnisch, then with the New York Mets, suffered what he later learned was a depressive episode around Opening Day 1997, he discovered just how clueless teams can be. First he told Mets manager Bobby Valentine that he had not slept in five days, and Valentine responded, “Good April Fools’ [joke].” Harnisch then complained to other team personnel, and according to multiple sources, a trainer offered him Benadryl, a drug usually administered to counteract allergies, to help him get some rest. The Mets then speculated that Harnisch was experiencing severe tobacco withdrawal and then Lyme disease before concluding that he suffered from depression, an illness that figured prominently in his family history. Later in the season Harnisch accused Valentine of, in effect, calling him “gutless” in front of the team and says he angrily confronted the manager in the lobby of the team hotel. (Valentine denies having talked about Harnisch in front of the team.) Valentine told reporters he was instructed not to address Harnisch’s situation because “I was told by Dr. [Allan] Lans [the Mets’ team psychiatrist at the time] that he might be suicidal.” Several days later Harnisch was traded. (Harnisch was released by the Cincinnati Reds this season.)

The media are not always helpful in burying stereotypes, either. When Shayne Corson, an enforcer for the Toronto Maple Leafs, suffered panic attacks last spring that caused him to leave the team–and surrender millions of dollars of his salary–midway through a playoff series, members of the press unsheathed their daggers. PRIDE HAS BIG PRICE TAG: SHAYNE CORSON’S WALKOUT WILL COST HIM DEARLY, AND HE KNOWS IT screamed the headline of one column. Likewise, a thoughtful article on Robbins that recently ran in the San Jose Mercury News was accompanied by an online poll asking readers how they would handle him. One of the four choices presented: Robbins “should be tied up and stoned.”

Even teams and leagues with the best intentions often fall short in their efforts to help athletes. Though sports psychologists are now in vogue, there’s a world of difference between glorified performance coaches who help athletes “enter the zone” and “reach peak performance,” and psychiatrists or clinical psychologists trained to diagnose and treat mental illness. While the players’ associations in all four major sports have programs to aid athletes with mental health issues, those, too, can be inadequate. When he played for the Seattle SuperSonics, forward Vin Baker was perpetually melancholy and took the brave step of acknowledging his depression. He contacted the NBA Players Association for guidance, and it arranged for counseling sessions not with a mental health professional but with former players Dirk Minnifield and Cliff Robinson.

Apart from simply doing the right thing, teams would benefit financially if they were more attentive to players’ mental health. Just ask the NFL franchise that recently lavished millions on a high-profile quarterback without, a team source says, giving him a basic psychiatric evaluation. When the player acted erratically–behavior subsequently attributed to untreated bipolar disorder–he was released, and the team swallowed the bulk of his contract. “We’re not nearly as thorough [as we should be] about mental history,” says the general manager of a team in the NBA’s Eastern Conference. “We–and I think we’re like most teams–interview guys and give a personality test [which is not intended or able to diagnose depression or anxiety disorders], but we’re probably not comprehensive enough. Maybe if we get burned, that will change.”

The wheels of change do turn in sports, however slowly. In interviews, nine mental health experts who treat athletes unanimously asserted that disorders of the mind are gradually shedding their stigma in sports. In some cases the shift in attitude is merely a matter of semantics. When Murray was doing his doctoral work, he approached the soccer coach at one university and asked if he could consult the team on matters of sports psychology. “He wouldn’t even listen to me–I had said the magic word, psychology,” says Murray. “Then I came back a while later and called what I was doing ‘mental coaching,’ and he got all excited.” Similarly, Lardon stresses to his athlete-patients that depression is “an imbalance in brain chemistry,” so it is less abstract and subjective. When appropriate, he shows patients their brain scans, giving them tangible evidence of a problem, not unlike an X-ray revealing a cracked rib.

When Lardon diagnosed Shea’s depression, the athlete went on the defensive. “Prove to me that I’m depressed,” Shea snapped. But it was a facade. He was relieved to hear what Lardon told him. Lardon said that in three out of four cases, depression is treatable with medication. After some trial and error, they settled on Effexor XR, which inhibits the reuptake of serotonin and norepinephrine, neurotransmitters that affect mood. “Right away,” says Shea, “I noticed a big change in achieving general day-to-day happiness.”

The big test came in January 2002. The Salt Lake City Games were less than three weeks away, and Shea was trying to treat a nagging injury to his left leg. Late one night he received word that his 91-year-old grandfather had been killed by a drunken driver. Lardon knew that such news could plunge Shea back into depression. He and Shea spoke often in the days before the Games and were able, as Lardon puts it, “to integrate Granddad’s death in a positive way instead of catastrophizing it.” Which is to say, Shea put a photo of his grandfather in his helmet. During the Olympics, Jack Shea wouldn’t be in the stands, as the family had planned, but he could ride down the mountain with his grandson.

The rest became the stuff of Olympic lore. Shea was chosen by his U.S. teammates to take the Athletes’ Oath at the opening ceremony, just as Jack had done 70 years earlier, and Jim went on to win the gold by .05 of a second. In one of the enduring images of the 2002 Games, Shea’s first reaction after looking at his winning time was to pluck Jack’s photo from his helmet and, obscured by falling snow, wave it tearfully. It was as if all the joy and emotion that he had missed in his first 33 years of life had suddenly flooded him.

Basking in the afterglow of Olympic victory, Shea figured he had also defeated his depression, so he stopped taking his Effexor XR. Literally overnight, his feelings of despondency came screaming back. He promptly went back on his medication, and now, before going to bed every night, he pops a small beige capsule.

As Shea prepares for the 2006 Games, he marvels at how different the experience is this time around. Part of it is his status as the defending gold medalist. But that pales in comparison to the change in his mental health. The fog that enshrouded him? It’s lifted. The jock culture that had long considered depression an earmark of weakness? “Listen, unless you’ve been there, you have no idea,” Shea says. “Winning a gold medal is the ultimate. But I wouldn’t trade happiness for it. Not in a million years.”

“Winning a gold medal is the ultimate,” Shea says. “But I wouldn’t trade happiness for it. Not in a million years.”

“In sports,” Williams says, “when it’s a broken bone, teams will do everything in their power to make sure it’s O.K. When it’s a broken soul, it’s like a weakness.”

“Football was the easy part,” Bradshaw says. “I could concentrate for three hours, and the games were an escape. It was the rest of my life that was going to hell.”

Robbins engendered scant sympathy from his teammates after he missed the Super Bowl. “Whatever rock he came up from,” one said, “he can stay there.”