Mental health was once considered a taboo topic in the fiercely competitive world of sports.
But as salaries soared, social media gave fans a platform to vent, and a global pandemic exacerbated the psychological toll, mounting pressure and scrutiny. So have a number of high-profile athletes who have spoken out openly about their struggles with anxiety or depression.
For insight into how the mental health landscape is evolving in the world of sports, The Chronicle reached out to Dr. Francesco Dandekar, associate director of sports psychiatry and clinical assistant professor at Stanford University. Dandekar participates in the school’s Sports Psychology and Sports Psychiatry Program, which evaluates and treats professional, Olympic and collegiate athletes from across the Bay Area.
This interview has been edited for clarity and brevity.
Q: How has the job of a sports psychologist changed in recent years?
a:
From the perspective of psychology, it has been expanded a lot. Previously, people thought of visualization or breathing techniques, things limited to performance: “On the basketball court, I have to shoot free throws in front of a big crowd, how do I focus myself?” Historically, it has been more focused on how this is used for performance. Recently, there has been a shift if I am happier in general and can integrate my athletic self and me
Self
I tend to do better in general. If you want to do something at the elite level for a long time, it has to be sustainable. Many 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’ve talked about it like, “If I don’t rely on substances for my cognition, if I don’t feel depressed in my hotel room for two days, I’m going to feel better as a human being and I’m going to perform better.” So there’s more integration between the person and the athlete.
Q: Do you need different tools now than in the past?
a:
It’s a little different from a psychiatric point of view. The people who provide the best services are able to do more than the psychology of sports performance. I think there needs to be better at a lot of things. People may say, “I want to do better,” but they may have PTSD from a childhood trauma. It is essential to realize that there are a bunch of things going on. There’s still a stigma, but I think it’s great that you have so many high-profile athletes speaking out (about mental health). In many cultures, athletes and actors can change the conversation.
Q: How effective is that? Many NBA players, such as DeMar DeRozan, Kevin Love, and John Wall, have spoken out publicly about their mental health challenges.
a:
I think one of the worst pains a human being can feel is isolation, and especially isolation in their own suffering. And when you have someone who has pulled it off by all external measures — you’re in the NBA and you’ve got all this money — and wait, were you really worried? And you don’t want to go to the grocery store because you’ll be seeing people? You want to kill yourself? You hear Michael Phelps talk about things, and the relevance factor is huge. You start thinking, “Maybe I’m not that different.” We all think that what we go through is unique. When we hear people we hold dear say they struggle with similar things, it allows us to feel less alone. That in and of itself can be beneficial – it encourages people to see it as another part of life. … It’s really brave and helpful that so many of these outstanding athletes are sharing their stories. They definitely drive the conversation.
Q: What other ways has the conversation evolved in the sports world? How much has the pandemic been a factor in highlighting 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 being socially isolated. People in general are social creatures. The athletes couldn’t compete, their sponsorship contract may have expired in a year and now they may not have a job (during a pandemic). There is a lot of pressure at this level to stay at this level. If swimming pools, gyms and playgrounds are closed, athletes are working out 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 this dynamic been affected by the spread of social media?
a:
Oh yeah, it can be really brutal. Anyone who is faced with a sudden shift to the top spot, with large sums of money or profit, no one will teach you how to deal with that. So if you miss a field goal, and you’ve got 50,000 and the sports media is saying you’re smug, it’s tough. Or if you’re trying to shoot a free throw, and everyone is yelling bloody kills at you, that takes coping skills right now. Social media is hard, especially in March Madness and college football. They’re kids, and that adds pressure a lot. I don’t know if I can handle some of the pressure these kids are dealing with. … If someone walks in and 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 sometimes medication can be really helpful. I don’t have a debt about medication. Some psychiatrists say it always helps and some say it never helps. In terms of psychiatry, I would see people with anxiety and depression. Substance use is common, as it is with most people in the world. I think that sometimes medicines are very helpful and can save a life. An athlete is someone with highly specialized skills, and we as a society tend to embrace athletes. We assume that lawyers can get depressed, but we don’t want athletes to get depressed. We want LeBron to be LeBron. … If you have ADHD, depression, or bipolar disorder, maybe treatment isn’t enough.
Q: Who is most at risk right now?
a:
I think it was really hard during the pandemic. You’ve had college-aged kids at home and are socially isolated, and for some people, home isn’t the best place for them to be. They have returned to a place they thought they were away from. An enormous amount of chaos has been introduced into the lives of student athletes, as well as professional athletes. I kind of think now that COVID is becoming less stressful, and some of that is starting to subside. But I think if you zoom out, as the money goes up, the pressure goes up. If you’re a Top 50 NBA player, you’re making way more than the Top 50 track and field players. This disparity adds more pressure. … There’s this bias in general: Are things more common now, or are we a lot better at recognizing and diagnosing? We used to say Jimmy likes to have four or five drinks to calm down. Now we might say that’s a lot of alcohol. Is the pressure rising? It’s hard to say.
Ron Kruczyk is a writer for the San Francisco Chronicle. Email: rkroichick@sfchronicle.com Twitter: @ronkroichick