Long Neglected, Athletes' Mental Health Gains the Spotlight

Jeffrey A. Lieberman, MD


October 01, 2021

This transcript has been edited for clarity.

Hello. This is Dr Jeffrey Lieberman of Columbia University, speaking to you today for Medscape. My topic is something that has been in the news quite a bit in recent months: the mental health of competitive athletes.

You may have noticed this past summer, as competitive athletes spoke out publicly about their mental unwellness. This was particularly true of Naomi Osaka, the world's number-one tennis player, who discussed her challenges with the refreshing candor and youthful naivete that she's become known for. In doing so, the superstar may have invited more public scrutiny and media attention than she bargained for. At the same time, her refusal to participate in a postmatch press conference, decision to bow out of the French Open, and now her move to take a leave of indefinite duration from tennis has brought much-needed attention to the long-neglected topic of mental health in athletes and the illnesses they may be particularly vulnerable to.

I'm not able to, nor do I want to, speculate on what ails Naomi Osaka. However, despite the pain she's been caused by becoming the target of a media firestorm, the fact is she's done us a great service. This is a big win for everyone touched by mental illness, whether you're an athlete, a sports fan, or one of the tens of millions of people grappling with their own mental illness or that of a loved one.

Athletes Stimulate an Overdue Conversation

There's much to debate about how this matter and others have been handled by both the athletes themselves and the governing bodies in the professional sports world. Was Osaka's decision to use Twitter to communicate her choice not to do media interviews the right one? In responding to this, did the French Open tournament officials sound unsympathetic and act too heavy-handed? Should rules requiring players to engage with the media as a part of their performance be changed? How do professional athletes balance their obligations to fans, the tournament, or event sponsors against their own well-being and need to be at their competitive best?

Apart from these issues, there is an overriding need to determine what can be done to ensure the mental health of athletes and prevent any threats to it. For an athlete to reach the competitive level of professional sports, they must be strong, disciplined, hard-working, willing to sacrifice, and able to tolerate pain. However, the conditions and pressures that professional athletes face are enormous, and they're only human. They're not invulnerable, and wealth and fame do not protect. Indeed, it's often the contrary that's true.

The issue of professional athletes' mental health has been suppressed and neglected for too long, and only arises briefly when a rare crisis or public incident occurs.

During the Olympics this summer, Simone Biles eloquently and bravely made a statement about not feeling up to competing and needing to take a break. Previously, the Olympic swimmer Michael Phelps admitted he suffered from depression and addiction, and he is now in a second career as a spokesperson for both. The NBA basketball star Kevin Love spoke candidly about his mental health struggles following a public panic attack. Mardy Fish ended his career as one of the leading tennis players because of bouts of anxiety that he couldn't control and couldn't compete with.

We all know about Tiger Woods' serial issues with substance abuse and promiscuity, which were chronicled in a recent documentary showing the extensive toll and pain they caused him. And just days after Osaka's announcement, professional golfer Bubba Watson spoke out about his own struggles with anxiety and depression, which was followed by golfer Rory McIlroy saying much the same. Other athletes have also talked about how they've contemplated suicide, and in some cases, tragically, these individuals have in fact committed suicide.

New Pressures Require New Interventions

It's worth noting that the situation of professional sports has changed. Back in the day, there wasn't a great demand for athletes to promote their sport with all kinds of media interviews and events. But now, in addition to those responsibilities, athletes have the means to regularly communicate with fans and the public via social media platforms. For example, when Naomi Osaka announced her intentions to take a break from tennis on Twitter and Instagram, it was to millions of her followers.

Regardless, the bottom line is that we need to have compassion for the people providing these great achievements in the field of competitive athletics and entertaining us. If they're struggling, and even if it's not obvious with what, the professional sports oversight organizations need to find ways to help them, ensure that they can be at their best, and also that they do not succumb to any type of preventable tragedy due to mental illness.

These oversight organizations need to do more to look out for athletes' best interests, not just while they're playing but also after they retire. If athletes have access to the best trainers, physicians, and orthopedists while they're playing, why shouldn't they have the same in psychiatrists or mental health providers? Many athletes work with sports psychologists, but that's not the same thing. Sports psychology helps to enhance performance, but not to treat mental health issues.

Another useful step would be for the oversight organizations to offer athletes health insurance with generous and equal benefits for mental healthcare from a preferred vendor. It's time for professional sports overseers to step up and look after their charges.

I would also note that professional athletes speaking out, and female professional athletes in particular, would not have happened years ago. Maybe Billie Jean King was the first to speak out and represent the players in terms of what their needs are. But now young female athletes like Simone Biles and Naomi Osaka have spoken out on behalf of themselves and called attention to a long-neglected topic. This is a sign of social progress, which needs to be responded to. These athletes are to be admired for their efforts to spotlight this issue at great pains and risk to themselves. This should be a call to action, and not be in vain.

Thank you for listening. This is Dr Jeffrey Lieberman at Columbia University, speaking to you for Medscape.

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