Useful tool for practitioners working with athletes experiencing mental health issues

Frida Wågan
Nord University, Norway

In the middle of 2015, Michael Atkinson, a Professor in the Faculty of Kinesiology and Physical Education at the University of Toronto, was asked by a coach for a girls team how she could help an athlete suffering from depression. As a sociologist and not a psychologist he felt limited in his ability help, and he developed the idea of this anthology on differential mental health issues within sports as his “contribution” to all athletes and sports personnel dealing with mental illness within the sporting context. As Atkinson states initially, the goal of the book is “to press for a larger conversation regarding how mental health issues, like Durkheim (1897) instructed over one hundred years ago, are not only observable as patterns across clusters of minds in society, they are produced in relation to the unfolding societies over time” (p. 2).

In line with this goal, and like Michael Phelps problematizes in his resent movie Weight of gold, the book takes a closer look at athletes’ mental health from a wide range of perspectives. In the sociological spirit, each chapter emphasizes how the cultural, political, economic and social context must be understood in order to gain a better understanding of the unique cases of mental illness in sports as well as the bigger picture. Perspectives like masculine hegemonies, identity work in a symbolic interactionist manner (see Goffman, 1959; Mead, 1934) and the ideals of “the good athlete” (Thompson and Sherman, 1999) as well as “mental toughness and the sporting ethos” (Bauman, 2016) are offered to frame different aspects of mental illness in each chapter. For example, Papathomas in chapter 6 illustrates how the sporting ethos and the ideal of the mentally tough athlete in many ways works to complicate the recovery from an eating disorder because the ideal athlete and the eating disordered athlete share a range of personality traits common to what Goffman (1959) once called “the four elements of character”, namely courage, gameness, integrity and composure.

Inspired by both Durkheim, Goffman, Foucault, Blumer and existentialist philosophers like Sartre and Heidegger, Atkinson initially addresses social legacies, absences and controversies of mental illness in sports by looking at the development of the sociological understanding of mental health and mental illness. Following Atkinsons introduction, Elisabeth J. Pike in chapter 1 reframes the mental health stigma in sports using Goffmans conceptualization of stigma. Next up, Kristina Smith, in chapter 2 offers a new and integrative perspective on pain by looking at “total pain”, where pain is seen in light of both physical, psychological and emotional pain including personal understandings and experiences with pain as well as the dominant understanding of pain in the culture surrounding us.

In chapter 3 Julie M. Maier and Shannon L. Jette look closer at “how gendered identities play a role in the experience of obsessive-compulsive disorder (OCD) and eating disorders” (p. 6). Melissa Day shreds light on how sport may act as both a potential producer and a potential manager of athlete trauma in chapter 4, before Andy Smith in chapter 5 addresses the state of the knowledge of athlete suicide and depression, or as Smith underlines – the missing data regarding depression in the athlete population. Anthony Papathomas discusses the case of disordered eating in the sporting context, and how this is both a valued and a devaluated behavior by coaches as well as athletes.

In chapter 7, Catherine Palmer reviews drug addiction and alcoholism – namely “the male problem in sports”. In light of a case study of people with epilepsy engaging in trail running, Michael Atkinson, in chapter 8, discusses issues associated with the management of “hidden” mental conditions like epilepsy. Media’s role in framing mental illness is examined in chapter 9 by Kass Gibson and Paul Gorczynski, and in the 10th chapter, Ruth Jeanes, Ramon Spaaij and Jonathan Magee give us insight into four examples of projects where sport (here: football) is used to contribute to recovery from mental illness among male youth in the UK.

Another important reflection in the book is how the mental illness stigma in sports is reinforced by the selection processes of which stories about mental illness are told and which are silenced.

In the last chapter, “In it for the long run: Researching mental health and Illness” David Carless and Kitrina Douglas discuss issues in both societal understandings of mental illness and the existing research literature in order to provide guidelines for future research by addressing needs for both methodological diversity and a more nuanced picture of different expressions of mental illness in the sporting context. Their proposal for future research is to engage in more fieldwork to get a better understanding of the cultures surrounding the mentally ill athlete, and the social and cultural mechanisms affecting mental illness in the sporting context. In addition, this will contribute in creating a platform where athletes have the opportunity to start opening up about their experiences.

In all, this book is an important contribution that puts athletes’ mental health on the agenda. It offers new perspectives for the mental health debate in sports, highlighting the duality characterizing the sporting context when it comes to mental illness insofar as being a potential contributor, as well as a tool, to recover from mental illness. For me, the book was in some ways eye-opening when addressing the social stigma of mental illness in sports (chapter 1), as well as the naturally occurring bidirectional relationship between mental illness and sporting culture (chapters 6 and 7). Another important reflection in the book is how the mental illness stigma in sports is reinforced by the selection processes of which stories about mental illness are told and which are silenced. By focusing solely on the stories expressing the “growth narrative”, where the athlete reports coming out of mental illness like a trauma or a depression “mentally stronger” than before, the mass media and the different sporting contexts indeed contribute to strengthening the ideal of “mental toughness” as an essential mentality to be considered successful in the sport environment. In line with previous reviews (see Roderick et al. 2017) each chapter the book including Douglas and Carless in the last chapter, stresses the need for more sociological research in the area of mental illness in sports.

The few sociological studies (see Roderick et al. 2017 for a review) on mental illness in the sporting context are in most cases narratives or ethnographic studies, which is informative in many ways in contrast to the dominating medical studies and the positivist-reductionist approach. Yet, as Melissa Day points out in chapter 4, many of the ethnographic studies are good at describing the actual culture surrounding the athletes, because the main focus lays on the mentally ill athlete and not on the culture, which in many cases has played a partial role in the development or maintenance of the mental illness. Thus, the sociological understanding of mental illness in sports is still quite narrow, and this area needs more sociological studies informed by a bigger variety of methodological approaches to develop further. For instance, the possible discrepancy between the lived experiences of mentally ill athlete and the pronounced practices around the suffering athlete, as well as how the mental illness affects the athletes identity and meaning, is still relatively unexplored, both in this book and in other research literature. One exception to this, that may act as an inspiration to further studies is Douglas and Carless (2008) study on how mental ill men restore their lives and their identity through sports. Their research methods, using narratives and autoethnographic methodology, may act as ´inspiration for further research in creating a more methodologically diverse literature on the field of mental health in sports.

Despite the notion that the sociological understanding of mental health is still quite narrow, this book makes a great starting-point for sociological researchers who, like Atkinson, want to press for a larger conversation regarding how mental health issues are understood in the sporting environment. The book may also act as a useful tool for coaches, sporting personnel and medical staff working with athletes to enhance their understanding of mental health dynamics, as well as reflecting critically on the sporting culture.

Copyright © Frida Wågan 2021

References

Bauman, N. J. (2016). The stigma of mental health in athletes: Are mental toughness and mental health seen as contradictory in elite sport? British Journal of Sports Medicine, 50, 135-136.

Carless, D., & Douglas, K. (2008). Narrative, identity and mental health: How men with serious mental illness re-story their lives through sport and exercise. Psychology of sport and exercise, 9(5), 576-594.

Durkheim, Emile. 1951 [1897]. Suicide. New York: Free Press.

Goffman, E. (1963). Stigma Notes on the Management of Spoiled Identity. Penguin, London

Goffman, E. (1959). The Presentation of Self in Everyday Life. New York: Anchor Books

Mead, M. (1934). Mind, self and society. Chicago: University of Chicago Press.

Roderick, M., Smith, A., & Potrac, P. (2017). The sociology of sports work, emotions and mental health: Scoping the field and future directions. Sociology of Sport Journal, 34(2), 99-107.

Thompson, R. A., & Sherman, R. T. (1999). “Good athlete” traits and characteristics of anorexia nervosa: Are they similar?. Eating Disorders, 7(3), 181-190.