Grand Rounds

Why we do the things we do.

The Goalie Has to Hurl: Musings of a Soccer Dad

What makes an athletes' stomach churn?

Sacred places are never a function of cubic feet, and they have little to do with monetary value. They are sacred because they are declared sacred via rules and rituals that go unquestioned and obeyed. Some old Shaman, probably as a joke, decided to tell everyone who would listen that this scrappy rock or that barren mountain mattered, and then, because people listened, it started to matter. O, how the gods must laugh.

Today I watched my daughter in just such a place. She turned her back on the rough and sacred land, the small rectangle of magic that was hers to keep safe and uncontaminated, and instead she focused through battle-hard eyes on those around her, all of them friends less than an hour before, but who now made their wonton intentions clear. They planned, without a single regret, to rob her of her holiness.

My God, no wonder she feels like puking when it is her turn to play goalie.

I know very little about soccer and a whole lot about anxiety, so I have had all sorts of time to study the fear of playing goalie carefully. Unlike a well-versed soccer Mom, I am in fact a soccer moron, so, naturally, I am the assistant coach. Over three years of coaching, I have been like an anthropologist, trying my best to characterize the anxiety of being goalie across both gender and development. I recognize as well that I have a scientific obligation to name this syndrome and thus confer it with well-earned validity.

Though I considered briefly "Schlozman's Disease," it seemed on reflection too non-specific, summing up instead the myriad worries that characterize my temperament and the potential temperaments therefore of my unfortunate progeny. After careful consideration, I have decided to go with "Severe Goalie Anxiety Syndrome," S-GAS for short, thus calling attention to the gastrointestinal changes that accompany the anticipatory hyper-adrenergic state occurring just before the Goalie Uniform is donned. (This is invariably made worse by the round of generously brought cupcakes grabbed quickly from a super-market "bakery," distributed with great fanfare to the warriors before the start of battle. Lest you should see cupcakes as confounders challenging the validity of the syndrome, rest assured that I am trained as a scientist. There is flatulence without cupcakes. Just less flatulence.)

So, the response of my daughter and her friends to the role of guarding the goal allows the thoughtful observer many opportunities to ponder. Is the pressure greater or less because you can use your hands in the goal? Do the special gloves confer the comfort of being different, or the anxieties of unique privilege? All high priests have their outfits, their robes and hats and incense, and they must feel different and a little bit awe struck when they face the common folk in the audience, the holy space now at their backs.

The Goalie dresses differently, acts differently, is blamed too much for the loss and celebrated too much for the win. All this talk about it being a "team effort." HA! I betcha professional goalies have a lot more superstitions than their non-goalie team mates. A goalie on a hot streak will never, ever, change his socks.

But how, on a neurobiological level, do we understand the almost nearly universal tendency for players who are not themselves determined goalkeepers to feel the need to expectorate as their turn in the goal grows near? Vomiting, it turns out, is a relatively complex physiologic event, something much more adaptively sublime than words like "hurl" or "puke" might evoke. It is first and foremost a primitive mechanism. The Area Postrema is present in all sorts of brains, from shrews up to humans (and perhaps aliens as well, though this would require a significant tangent to this particular post). It is adaptive, as it is good to throw up that which can kill you or at least ruin your day. The smell of rotting flesh is nauseating, the evolutionary biologists tell us, because we would prefer our brains to reject the potential nourishment of rancid food given the risk of disease and great discomfort. Thus, the Area Postrema "listens" to the Olfactory Bulb, sends a text message to the Solitary Nucleus in the brainstem, and the eject button is viscerally and profoundly triggered.

However, we cannot entirely implicate the Area Postrema. My daughter does not eat the goal, and though the cupcakes she feeds herself prior to competition are enough to make me lose my cookies, I have seen with my own eyes her capacity to down these sweets with intestinal impunity in the absence of an impending game.

It is the IDEA of the goal that is threatening, just as the Areas Postrema receives the news from our higher cortical regions that the IDEA of rancid meat is intrinsically bad. And here is where we declare ourselves as wonderfully social creatures. The biology of mirror neurons suggests that if one player sees another fare less than wonderfully while guarding the goal, the observing player will recruit regions of her brain associated with the assumed emotional response of the actual faltering goalie. Assumption is a key element here, because it may in fact mean not nearly as much to the kid in the goal that she has let a few wayward balls cross the line.

For my daughter, however, a goal scored by the opposing team suggests a fundamental breech in the order of things. The goal is sacred, profound, not to be trampled and besmirched by opposing heretics. The IDEA of disrupting the natural order of things is sickening, disorienting, even fragmenting. Today, the Hawks (my daughter's team) were invaded by the Tigers (hardly a fair fight, as the Hawks were precluded from flying), and the sacred Hawk goal was transgressed more than once. We Hawks suffered a contagion, S-Gas spreading among the usually steadfast raptors like a rare swine flu. (!)

We recovered with ice cream and a play date, but that does not mean that there wasn't suffering in between. Those who hate crossing bridges will tell you that in retrospect the fear during crossing seemed silly and mundane. They realize, though, with feigned nonchalance, that there are always more bridges. And then even cupcakes don't help.



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Steven Schlozman, M.D., is an Associate Director of Medical Student Education in Psychiatry for Harvard Medical School.

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