Addressing the Big Black Dog in the Room Part 1 by Stefan Grassegger
The importance of mental toughness is somewhat of a buzz-term we coaches like to use when describing an ideal athlete. Michael Jordan was mentally tough as he demanded nothing less than excellence of himself and his teammates. And as we all know, he more than often delivered. Other elite athletes like Cristiano Ronaldo, Lionel Messi, Tom Brady or Michael Phelps were able to succeed at the highest levels imaginable. They could not have done it without being mentally fierce competitors. You might wonder why Michael Phelp’s name is in bold. A quick google search yields an answer and very interesting information.
Phelps, who will go down as the most decorated Olympic athlete of all time, admitted to struggling with depression and anxiety in 2019. This seems like a binary and dichotomous statement. How could such a mentally strong and successful athlete suffer from a depressive disorder? The answer lies within a misconception of many working within competitive and professional sports — that misconception being: Mental toughness = mental health. But in reality, mental toughness does not equate mental health. A fact that Michael Phelps exemplifies.
When looking at a more sport-specific context, it was DeMar DeRozan — alongside Kevin Love — who have shed light on the issue of mental health problems among basketball athletes. Recently, the Euroleague hosted a table talk where Jayson Granger, Coach Aleksandar Džikić, Maurizio Gherardini and former Olympiacos and Maccabi big man Sofoklis Schortsianitis discussed mental health. This shows that the issue of depressive disorders among elite athletes has become more of a talking point in the world of professional sports.
As many of you may know, I recently graduated the University of Vienna. My diploma thesis focuses on the mental health of competitive athletes. In more detail, the paper investigates the relation between mental health issues and perfectionism and sleeping habits. In order to be able to do so, I conducted a study with 225 athletes from different sports (basketball, soccer and individual sports). While Iwill not be able to cover everything in this blog post, I will try to summarize the most important parts and findings here. If you are intrigued by and interested in the topic, please contact me. I’d be happy to forward you further information.
I believe it is very important for coaches to understand the symptoms and characteristics of depressive disorders so they can recognize them. It is also important to consider what kind of factors can influence it and what coaches can do to help their athletes. This blog post is by no means an all encompassing coverage of the topic. However, I hope it can serve as a starting point for education on the topic
What is Depression?
Before we look at potential, athlete-specific factors (i.e. perfectionism, lack of sleep quality / quantity) that might influence the onset of depression, it is important to shortly define what depressive disorders actually are. All too often, depression becomes confused with “plain” sadness. While spells of sadness are indeed a symptom of depressive disorders, they are more complex. Generally, symptoms can be distinguished into the following subcategories: affective, behavioral, cognitive and physiological.
Since depression is often characterized as an affective disorder, the affective symptoms are the ones we mostly associate with depressive disorders. Sadness, despair, dejected mood, and a loss of interest in social activities are common warning signs. Behavioral symptoms typically manifest themselves in social interactions. Psychomotor agitation or retardation (think agitated / restless or slowed down speech and gestures) can be observed. More importantly, however, depressed individuals often experience a loss of interest in previously enjoyable tasks. Also, affected persons can have trouble with motivating themselves to carry out (seemingly) mundane tasks such as personal hygiene. Cognitive symptoms show themselves in forms of negative thoughts such as self-doubts, worrying, anxiety, rumination, and a generally low self-evaluation. Also, even more important in a sport context, depressive disorders can impair the individual’s ability to make decisions. Finally, physiological symptoms can range from weight loss or gains and changes in brain strutcture to a decrease in terms of sleep quality.
Also, we should not forget about athlete-specific symptoms. While high-level basketball players, soccer player and the like experience the same type of symtpoms as the general public, some symptoms are specific to their profession. The probably most logical symptoms to observe are drop-offs in performance. However, they might be difficult to attribute appropriately. Is a bad performance just a bad performance, or is it related to a depressive episode? From the outside, these distinctions are difficult to make. Hence, depression among athletes often goes undetected. Also, drop-offs in performance or increased anxiety levels can lead to unhealthy coping mechanisms (think: excessive partying etc.).
Taking all these symptom types into account, the WHO / ICD-10 defines depressive disorders as follows:
“In typical mild, moderate or severe depressive episodes, the patient suffers
from lowering of mood, reduction of energy and decrease in activity.
Capacity for enjoyment, interest and concentration is reduced, and
marked tiredness after even minimum effort is common. Sleep is usually
disturbed and appetite diminished. Self-esteem and self-confidence are
almost always reduced and, even in the mild form, some ideas of guilt or
worthlessness are often present. The lowered mood varies little from
day to day, is unresponsive to circumstances and may be accompanied by
so-called ‘somatic’ symptoms, such as loss of interest and pleasurable
feelings, waking in the morning several hours before the usual time,
depression worst in the morning, marked psychomotor retardation,
agitation, loss of appetite, weight loss, and loss of libido. Depending upon
the number and severity of the symptoms, a depressive episode may be
specified as mild, moderate or severe.”
Personally, I really like the image of the big black dog that accompanies the depressed individual. The WHO has produced a video based on the artwork by Matthew Johnstone. I think that it is a beautiful metaphor for the different shapes and manifestations of a depressive disorder. Therefore I chose to borrow it for the article. Please refer to the video — the 5 minutes should be well worth your time!
Perfectionism and Depression
The onset of depression is most often described via a stress-vulnerability model. It would go beyond the scope of this blog post to explain all theories regarding the onset and the development of depressive disorders. Hence, this post only focuses on how perfectionism and sleep quality are related to depressive disorders. Let’s start with perfectionism. Generally, perfectionists can be categorized into two groups: those who strive for perfectionism (perfectionistic strivings / positive perfectionists / PS) and those who fear imperfection (perfectionistic concerns / negative perfectionists / PC). Positive perfectionists have a tendency to set high goals for themselves, strive to achieve them and look to be the best version of themselves. Athletes who are perfectionistic strivers have shown to have more self-esteem and self-confidence. Negative perfectionists, on the other hand, generally display fear of not meeting their performance standards and are afraid of failing. These kinds of individuals / athletes have a more negative outlook on their performance in competition. In other, oversimplified, terms, PS athletes strive to win games (or competitions), PC athletes are afraid of losing and making mistakes.
Perhaps it comes as no surprise that multiple studies have indicated a correlation between depressive disorders and perfectionistic concerns. The study underlying my thesis could support these findings. Whereas perfectionistic strivings showed no correlation with depressive disorders, the occurence of PC indicated a higher likelihood of depression among athletes.
As a result, knowing if our athletes tend to be perfectionists and if they display PS or PC can help us in detecting whether our athletes can be more prone to depressive disorders.
Stay tuned for Part 2! We will cover the correlation between sleep and depressive disorders. Furthermore, we will address what coaches can do to help their athletes.
