Mental health was once considered a taboo subject in the hyper-competitive and macho world of sport.
But as wages soared, social media gave fans a platform to vent and a global pandemic heightened the psychological toll, pressure and scrutiny mounted. So has the number of top athletes who have spoken publicly and candidly about their issues with anxiety or depression.
For insight into the changing mental health landscape in the sports world, The Chronicle reached out to Dr. Francesco Dandekar, associate director of sports psychiatry and clinical assistant professor at Stanford. Dandekar is involved with the school’s sports psychology and sports psychiatry program, which assesses and treats Bay Area professional, Olympic and college athletes.
This interview has been edited for clarity and conciseness.
Q: How has the profession of sports psychologist evolved in recent years?
A:
From a psychological point of view, it has expanded a lot. It used to be that people thought about visualization or breathing techniques, things that were reserved for performance: “On the basketball court, I have to shoot free throws in front of a large crowd, how do I center myself?” Historically it has focused more on how to use it for performance. Recently a shift has occurred where if I am overall happier and can integrate my athletic self and my
self
myself, I will tend to perform better in general. If you want to do something at an elite level for a long time, it has to be sustainable. Many more athletes realize that if they want to do this long term, they don’t know if the coping strategies they’ve used will be enough. They talked about it like, “If I’m not dependent on substances to get out of this, if I’m not depressed in my hotel room for two days, I’ll feel better as a human being and I’ll be more efficient. .” There is therefore more integration of the person and the athlete.
Q: Do you need different tools today than in the past?
A:
It’s a bit different from a psychiatric point of view. The people who provide the best services are able to do more than sports performance psychology. I think there’s more need to be better at a lot of things. People might say, “I want to perform better,” but they might be suffering from PTSD due to childhood trauma. You have to be aware that a lot of things are going on. There’s always a stigma, but I think it’s phenomenal that a lot of top athletes are speaking out (about mental health). In many cultures, athletes and actors can change the conversation.
Q: What impact has this had? Several NBA players, such as DeMar DeRozan, Kevin Love and John Wall, have spoken openly about their mental health issues.
The world of sport is facing a mental health problem. This story is part of a series examining the challenges faced at all levels of competition and how they are overcome.
A:
I think one of the worst pains a human being can feel is isolation, and especially isolation in their suffering. And when you have someone who, by all external measures, has been successful – you’re in the NBA and you’ve got all that money – and wait, you were really anxious? And you didn’t want to go to the grocery store because you would see people? Did you want to kill yourself? You hear Michael Phelps talk about things, and the relatability factor is huge. You start thinking, “Maybe I’m not that different. We all think that what we live is unique. When we hear people we revere say they struggle with similar things, it makes us feel less alone. That in itself can be helpful – it encourages people to see it as another part of life. … It’s really brave and empowering to have a lot of these top athletes sharing their stories. They definitely push the conversation.
Q: In what other ways has the conversation evolved in sports? How has the pandemic helped highlight some of these mental health issues?
A:
I think the pandemic has highlighted a lot of things for a lot of people. It’s really hard to be so socially isolated. People in general are social creatures. Athletes couldn’t compete, maybe their sponsorship contract ended in a year and now they may not have a job (during the pandemic). There is a lot of pressure at this level to stay at this level. While swimming pools, gymnasiums and courts are closed, athletes train in parks. It made life difficult for many people. We are all still dealing with how to reintegrate into the world.
Q: How has all of this dynamic been impacted by the proliferation of social media?
A:
Oh yes, it can be really brutal. Anyone who undergoes a sudden change to notoriety, with large sums of money or profits, no one teaches you how to handle it. So if you miss a basket and 50,000 people and the sports media say you’re an asshole, it’s tough. Or if you’re trying to take a free kick and everyone is screaming murder at you, it requires coping skills in the moment. Social media is tough, especially in March Madness and college football. They are children, and that increases the pressure a lot. I don’t know if I could handle some of the pressure these kids are facing. … If someone comes in, I ask, are you on social media? What does it look like? Some people have to be on social media, it’s their only way to make a living.
Q: Are antidepressants a form of treatment? Should they be?
A:
I think medication can sometimes be very helpful. I have no religion about drugs. Some psychiatrists say it always helps and others say it never helps. On the psychiatry side, I will see people with anxiety and depression. Substance use is common, as it is for most people around the world. I think drugs are sometimes very useful and can save lives. An athlete is a person with highly specialized skills, and as a society we tend to idolize athletes. We guess lawyers can be depressed, but we don’t want athletes to be depressed. We want LeBron to be LeBron. … If you have significant ADHD, depression, or bipolar disorder, therapy probably isn’t enough.
Q: Who is most at risk right now?
A:
I think it was really difficult during the pandemic. You had college-aged kids at home and socially isolated, and for some people, home isn’t the best place for them. They are back to a place they thought they were getting away from. There has been an awful lot of chaos introduced into the lives of student-athletes, as well as professional athletes. I kind of think now that COVID is becoming less overwhelming, some of that is starting to subside. But I think if you zoom out, as the money goes up, the pressure increases. If you’re in the top 50 in the NBA, you’re doing a lot more than the top 50 in athletics. This disparity adds more pressure. … There’s this bias in general: are things more common now, or are we much better at recognizing and diagnosing? We used to say that Jimmy liked to have four or five drinks to relax. Now, you could say that’s a lot of alcohol. Is the pressure mounting? It’s hard to say.
Ron Kroichick is a writer for the San Francisco Chronicle. Email: rkroichick@sfchronicle.com Twitter: @ronkroichick
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