How to think about Mental Health (and Athletes)

Special guest post by Dr. Niels Rosenquist

[Editor’s note: The following is a special guest post by Dr. Niels Rosenquist].

I was born, raised, and educated in Philly. For the past 15+ years, while I have lived and worked in Boston, I did not change my rooting interests. I’ve continued to follow teams in the 215, especially the Sixers and Eagles.

I’m also a psychiatrist. So, as opposed to Nick Sirianni’s play calling, Howie Roseman’s draft record, or Doc Rivers’ defensive rotations, the conversation/debate over mental health and Philly athletes like Lane Johnson and Ben Simmons touches on a topic that I actually have some expertise in (well, that and talking trash with Boston fans). A number of friends have asked about my take on the topic and I thought it might be worth posting some answers to their questions. These opinions are only mine and should be taken that way.

Do Ben Simmons and/or Lane Johnson have depression or some other mental illness?

Short Answer: I have no idea.

Longer Answer: Most clinical diagnoses in psychiatry fall into what are known as Axis I diseases. These represent conditions such as depression, anxiety, substance dependence, and schizophrenia; essentially most of the disorders that people think of as mental illness. The diagnoses are made by trained clinicians who combine answers to in person and/or written questions with observations made during appointments along with any collateral information from family and friends. I generally think my field does a good job of determining what a person is suffering from and, most importantly, what kinds of therapy and/or treatment might help. That said, diagnosis is not easy. There is no blood test, no ekg, no MRI that can I use to help making a diagnosis, and even then there can be a lot of ambiguity even with detailed, in-person evaluations. With this in mind, I think that any takes that state someone has clinical depression, anxiety, whatever based upon on video or social media posts are in all cases bad ones and not helpful.

How should we feel about athletes pointing to mental illness as a reason for any on or off the court/field problems they might have?

Short Answer: However you want to feel.

Longer Answer: We follow sports for a bunch of psychological reasons. Biologically-driven (and relatively healthy) tribalism, an inherent need to find heroes (and villains) to follow and find meaning in our own struggles by projecting onto theirs. Heck, I used to assume that I was at least a parital masochist for following Eagles and the Sixers over the past few decades. The point is most of the reasons we follow and comment upon sports is not because we actually know these people or have been professional athletes ourselves. Rather we use them as a reflection of ourselves, even if an actual person is behind the mirror. To that end, when we are commenting on Ben Simmons or expressing sympathy for Lane Johnson, we are usually using their situations as a way to build and maintain ties with other fans while reflecting on broader societal issues. In such a world, arguing that “Ben is actually ill and we shouldn’t make light of mental illness” or “Of course he’s faking it and he’s a coward” or “He’s wrong, but he’s dealing with a lot of stuff right now” are all valid. Why? Because they are simply our own, different, perspectives on a situation none of us are really privy to. Besides, more than one, or even all, might be true at some level at the same time.

Is suffering from mental illness a sign of weakness?

Nope. (see below)

Is mental illness unfairly stigmatized by society?

Yep. (see above)

Why is mental illness stigmatized? Is it worse for professional athletes?

Stigma happens for a lot of reasons. “Losing one’s mind” is really scary for most of us to contemplate. As such, many of these conditions (especially when the causes and pathways responsible for them remain complicated and ambiguous) are even harder to define. This means it’s easy to conflate clinically relevant symptoms with other behavioral traits that might be described as mentally weak. While we have come a long way towards accepting mental illness as a “thing”, there will always be the gray area where we will choose to attribute successes and failures of others (and ourselves) to a mix of things perceived as outside of our control (such as depression) and inside of it (improving our game, getting stuff done, etc). I think that the stress of trying to balance multiple explanations at the same is in and of itself stressful, even if it reflects actual reality.

As for the question about pro athletes and mental health, I can already hear the WIP callers in my head:

Caller 1: Mike from Fishtown: They are paid millions of dollars to perform, they need to suck it up and stop making excuses!

Caller 2: Steve from Media: Mike is full of ****. They are human beings and have real problems just like us!

Caller 1 calls back: “Steve is full of ****”

(and so on until someone calls to change the subject and complain about the Phillies’ bullpen)

The truth is, again, all of this can be whatever you want it to be because each take is mainly about you and your point of view.

For what it’s worth, I tend to be less judgmental of pro athletes. I don’t see any myself but the patients I do work with (MIT students and resident physicians) are similarly driven, talented, and accomplished. They faced long odds to get where they are and operate under very stressful conditions. The thing is, while their work is very important and (for the MDs) life and death outcomes are often in the balance, they don’t have their every action analyzed and reflected upon by millions of people who, in the age of social media, have greater and greater ways to focus their frustrations upon the athletes; people who have the only job on earth where you are evaluated on a nightly basis under great physical and mental stress for all the world to see and comment on. As such, I try to remind myself these things even when these athletes fail on or off the field and seek to deflect blame to something or someone else. It’s not always easy for me to do, but I rarely feel bad about it after the fact when I can.

One additional, point I think is important:

I think that the increased focus on mental health over the past few years is no accident. We all have been, as I say to my patients, “hit by a bus”. While meant as a metaphor, the actual suffering caused by the pandemic on the vast majority of society has been profound if less clearly visible than a broken leg. Lots (and lots) of data points to depression being as bad for our health and longevity as heart disease, which means that an acute stressor like COVID, on top of chronic stressors (civil discord, economic strain, and others) is for all intents and purposes a bus that runs into us when we already may be in a bad place. I hope that if you don’t realize that already, you can think about it going forward so that you might be a bit easier on yourself and, by extension, others in your life.

A few final things.

How can I learn more about mental health?

My colleague wrote a great book that I always recommend for lay people. It’s a good place to start

How can I get help for myself or someone else?

NAMI (the National Alliance for Mental Illness) has a number of links to great resources. You can also reach out to your primary care provider.

Go Birds.