How to Destigmatize Mental Health Treatment in Sports

By: Cameron Johnson, Camille Soriano, and Tiffany Tran

During the 2008 National Basketball Association (NBA) All Star Dunk Contest, Dwight Howard donned a red cape and yellow shield emblem on his chest, bringing his “Superman” nickname to life, displaying his talent on the way to a victory. This moniker reflected many fans’ beliefs that he, like other athletes, was invincible. However, as injuries piled up, he faded from prominence and was ridiculed by an unsympathetic fan base.

During an interview in 2013, Howard discussed his struggles in recovering mentally and physically from back and shoulder injuries, resulting in a headline that read “Dwight Howard Admits Seeing Psychiatrist Last Season.” A headline like this may imply to many people that seeking help to deal with the rigors of being an elite athlete is abnormal and/or something that should be concealed.

If idolized professional athletes receive a less-than-positive response after engaging in mental health treatment, other athletes (or non-athletes) in need of care may fear being judged if they seek their own treatment. Instead of engaging in preventative care, individuals today often wait until symptom severity reaches an intolerable peak, resulting in a need for more intensive treatment.

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What Does the Research Say?

Physical activity has long been regarded by mental health professionals as a protective factor and potential means of coping for those struggling with mental illness. Studies have linked physical exercise to decreases in anxiety and depression symptoms. Yet, competitive athletics does not make a person immune to mental health symptoms or illness.

Studies suggest that elite athletes are at a comparable risk of developing a mental illness. Many elite athletes suffer from over-training, which overlaps with symptoms of depression. Also, some illnesses seem to be associated with certain sports. For instance, women in distance running, gymnastics, and other “leanness sports” seem to have a pronounced risk of meeting the criteria for an eating disorder. Athletes with multiple concussions could be up to three times more likely to be diagnosed with depression, depending on their history.

Some risk factors that are unique to athletes may include:

• Threat of injury or anxiety about performance after returning from injury
• Concerns about post-career options and retirement
• Anxiety about being potentially released/traded
• The struggle of balancing academics and athletics (for NCAA Student-Athletes)
• Weight and strength requirements
• Pressure to satisfy fans

Although there are also other factors, this list illustrates how sports culture can come with a variety of special risk factors that interact with normal stressors and should be considered when recommending treatment or treating high-level athletes.

Athletes are also bombarded with messages like “Pain is weakness leaving the body” or “Be a Man,” which become mantras intended to promote mental toughness under stress. These ideas might contribute to the stigma around mental health in sports.

Kevin Love, power forward for the Cleveland Cavaliers, wrote in his Player Tribune article that this viewpoint was personally challenged when he had a panic attack in the middle of a game. His experience prompted him to deal with the “perfect storm of things” that precipitated the event. Part of the struggle was figuring out how to talk about his inner struggles and his desire to defend against the perception of his weakness or unreliability. Early on in his career, the idea of seeing a therapist was unfathomable, but shortly after the incident the Cavaliers helped him set an appointment. From then on, he collaborated with the NBA and fellow players, like DeMar Derozan, to launch a nationwide campaign advocating for Mental Health Awareness.

Promoting Change

Kevin Love, DeMar Derozan, and so many other high-profile athletes are helping to reframe how players and people in general think about mental health. After being diagnosed with Borderline Personality Disorder, National Football League (NFL) receiver Brandon Marshall established two foundations, both dedicated to the education and support of mental health. Allison Shmitt, a four-time Olympic gold medalist swimmer, has become a relentless advocate after suffering with depression. Serena Williams, one of the best tennis players in history, has openly talked about her struggles with depression after winning major tournaments and after having her first child.

When people with this much popularity courageously talk about their mental health, it helps to ground some of the lofty expectations people impose on these superstars. It brings to the forefront that they are humans, like the rest of us, who struggle to overcome personal and professional obstacles. They become national and international role models, hopefully inspiring others to follow in their footsteps.

So how do you combat stigma in sports? Athletic trainers, coaches, and teams need to be educated about how to appropriately support athletes struggling with mental health problems. Research has found that those who attended a 4-hour applied workshop reported increased depression literacy, anxiety literacy, and confidence in their ability to address the mental health needs of their athletes.

Participation in sport has been an outlet for many athletes struggling with mental health. In fact, aside from the previously listed benefits, many players disclosed that their talents allowed them to express themselves or helped them escape tough environments growing up. Not to forget that sports can help entire communities heal after tragedies. “Boston Strong” became the rallying cry for Red Sox fans in the wake of the Boston Marathon Bombing. The Saints helped rebuild New Orleans in more ways than one in the years following Hurricane Katrina, culminating in a Super Bowl win in 2010. And here in Houston, the Houston Astros helped to mend our city when they won the World Series for the first time only a few months after devastating flooding was caused by Hurricane Harvey.

It is important to remember that just as we rally behind these extraordinary people and athletes, sometimes they need uplifting as well. As several sports leagues eye reopening, superstars from a variety of sports have noted their discomfort with league policies regarding sports activity during the pandemic. Players must weigh financial concerns, health concerns, extended separation from families, and other factors when determining if they might play. Basketball star JJ Redick recently noted during an interview that with everything going on, he felt frequent discomfort.

Regardless of whether you believe it is a necessary distraction from the worrisome state of the world, the personal decision to play should not be taken for granted. For these athletes, there could be a real psychological toll, and we should all be prepared to allow them to express their anxieties. Ideally, nobody should feel like they’re forced to roll with the punches alone. They should instead feel empowered to speak out about their mental illness while having a whole community in their corner.

About the Authors:

Cameron Johnson is a research assistant at The Menninger Clinic. Cameron collects and manages treatment outcomes survey data, which Menninger uses to help track the symptoms of patients. Cameron earned a bachelor's degree in Psychology from Rice University in Houston.

Led Camille Soriano is a research assistant at The Menninger Clinic. Her research interests include adolescents, adults, anxiety, and eating disorders.

Tiffany Tran is a research assistant at The Menninger Clinic. Her research interests include children and adolescent populations, family dynamics and relationships, and cross-cultural issues.