Monday, 19 November 2012

Depression and Sport

I’ve never been so glad to finish a book as when I finally reached the end of A Life Too Short: The Tragedy of Robert Enke.  While on the one hand I couldn’t put the book down, reading it was, at the best of times, an upsetting and difficult process.

The book details the life and death of Robert Enke, a German national goalkeeper who suffered from depression, and who, in 2009, took his own life.

Robert is just one of a number of high performance athletes who have been affect by depression.  Multiple Olympic swimming champion Ian Thorpe, Celtic FC Manager Neil Lennon, and double Olympic Champion Dame Kelly Holmes are just some of the high profile athletes who have made their depression public.  Andrew Flintoff, Marcus Trescothick, Paul Gascoigne and Frank Bruno are just a few other who have been afflicted by the illness.

When exercise is a common treatment for depression, why do so many of the world’s most talented sportspeople suffer depression at some stage in their lives?  It may not be surprising that most athletes suffer some form of 'down' after a major Championship into which they have put their heart and soul, or after retirement, when the world they have been such an integral part of ceases to exist, but this is not normally the type of mood which would cause an individual to take their own lives.

While depression, described as feeling blue, sad, or miserable, may affect most individuals for short periods at some stage in their life, true clinical depression (or major depression) is a mood disorder resulting in feelings of sadness, anger, emptiness, frustration or loss which has a major impact on everyday life for weeks, months or years.

The causes of depression are not fully know or understood.  There is a common misconception that tragic event must occur for an individual to experience depression.  While trauma is one cause of depression, it can also be the result of genetic factors and underlying medical conditions.  Many researchers and medical professionals believe that chemical changes in the brain, caused by defective genes or triggered by stressful events, lead to depression.  While there are strong family links, individuals with no history of depression can suffer from the illness.  The onset of depression most often occurs between the ages of 20 and 30 years, with a second peak between 30 and 40 years of age, though it can affect individuals of any age, even young children.
Some of the factors which may be result in a depressed mood, but not always a psychiatric condition include:
  • Medical conditions including long-term pain, underactive thyroid, multiple sclerosis or cancer
  • Drug or alcohol abuse
  • Use of certain medications (e.g. steroids)
  • Stressful life events including divorce, bereavement, retirement, menopause, job loss, isolation, child abuse or failing an exam.
Depression alters or distorts the way in which the sufferer sees themselves, their life and their surroundings.  They usually have a negative outlook on situations, and find it difficult to see a positive solution for situations or problems.

Symptoms of depression include:
  • Difficulty concentrating
  • Becoming isolated or withdrawn
  • Irritability, agitation an restlessness
  • Fatigue and lack of energy
  • Difficulty sleeping
  • Dramatic appetite and weight changes
  • Feelings of guilt, self-hate or worthlessness
  • Feelings of helplessness or hopelessness
  • Difficulty sleeping or oversleeping
  • No longer finding pleasure in activities that once enjoyed
  • Thoughts of suicide or death
  • Delusions and hallucinations in extreme cases
  • Poor memory and concentration
  • Reduced sex drive
  • Physical symptoms such as fatigue, digestive problems and headaches
  • In the US about half of those with clinical depression also suffer lifetime anxiety
After testing for other underlying physical or medical conditions which may result in similar symptoms to depression, patients are treated with medication and /or councelling or psychotherapy.  Depression may appear no more than once in and individual’s lifetime, and last no more than a few weeks, or could last a lifetime with a number of major depressive episodes.

Tips for those working with athletes:
  • The thought of retirement from sport may be a major cause for anxiety among athletes.  Encourage athletes to lead a balanced lifestyle and to prepare early for retirement.
  • Ensure that athletes receive psychological support following major championships, during and after retirement, and while recovering from major injuries.
  • Avoid placing unnecessary pressure on athletes.  Athletes are often highly self-motivated, and any pressure should come from them, and be manageable.
  • Encourage athletes to deal well with problems.
  • Create an environment in which athletes always have someone to talk to in confidence (even if that is not you), and provide support where necessary.
  • If an athlete is suffering from depression, encourage athletes to seek professional medical help.
  • Understand that performance may decrease in athletes who are adjusting to anti-depressant medication.  Create a supportive environment in which they can continue to compete (if they wish), but with manageable pressure.
  • Try to understand the illness.
A Life Too Short is a well researched and beautiful account of Robert Enke’s life and death, documented by his friend Ronald Reng, with whom Robert had discussed writing his memoirs.  It details the difficult phases that Robert went through in his life, the changes of environment, the death of his daughter, the late development of his talent, and most importantly how Robert reacted to important transitions in his life.  The real tragedy is that, while Robert received successful treatment for this depression during the first dark phase of his life, it was the fear of his illness becoming public and the potential of loosing his place in the national team that stopped him receiving professional help and treatment at his darkest hour.  With the World Cup in South Africa just months away, Robert couldn’t cope with the thought of his depression becoming public.  In the end, he never made it to South Africa; he was already dead.

The real beauty of the book is that the author puts forward all the facts and details Robert's reactions to certain events, and his perceptions of those around him, but doesn’t try to give all the answers or lead the reader in any way.  In places, the book could not have been more autobiographical if Robert had written it himself, but Reng doesn’t try to fill the gaps that will always exist.  Nobody knows why depression affected Robert at the stages it did, and the author accepts his inability to answer this question. 

I would strongly recommend the book to anyone who thinks that depression only affects the weak or those who are unsuccessful; who thinks that depression doesn’t happen to people like them; who supports high performance athletes; or who would like to understand the disease a little bit more.

Just make sure that you have a box of tissues close to hand.

Some useful resources and reading material: - Loss, retirement and depression in sport
Cycling Weekly - Depression in Sport

1 comment:

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