According to abbreviationfinder.org, depression in elite sport attracted media attention at the latest after the suicide of goalkeeper Robert Enke. However, the topic has not yet been adequately dealt with. Although the disease has long since arrived in society, there has not yet been a bridge to top-class sport, despite the many calls for help from athletes and those responsible. On the contrary, it must be assumed that the topic will continue to be taboo, despite prominent stakeholders and widespread use. In addition to this cloak of silence, it must be added that despite the alarming figures from Deutsche Sporthilfe (9.3% of the athletes surveyed suffer from a depressive illness), little initiative was taken to counteract the problem.Survey by the Federal Institute for Sport Science. Although 49.8 percent said that they were not depressed, another 40.9 percent abstained from the question. This shows that the subject is still taboo in sport.
What is Depression?
In order to be able to adequately present the topic, an explanation must first be given of what depression actually is and which symptoms can occur.
Definition: ” Depression are mental disorders in which characteristic symptom patterns with pronounced mood changes, in particular depression, joylessness, emotional emptiness, lack of interest and loss of drive, persist over long periods of time. A wide variety of physical complaints often occur in connection with this. ”
First, a chapter explains the causes that can cause depression. We should particularly speak of stress, excessive demands, injuries and the associated failure to perform as required. Another point to be mentioned is the experience and processing of failures as the cause of depression. Chapter two deals primarily with the preventive measures that have been established in isolated cases after Enke’s death.
Some prominent cases are described in chapter three. This not only in view of the widespread spread of the disease, but rather with regard to the prevailing taboo and shame on the part of athletes to turn to the public because of the disease.
The last chapter summarizes the results. In addition, an outlook is dared. Is it realistic to break a taboo and how will society deal with the disease in the future? What development can be expected? These are the central questions that need to be answered in conclusion.
For the most part, athletes are rated based on their performance. A player who also defines himself through his performance is exposed to considerable pressure and is particularly prone to depression if he does not perform. The triggers of depression also include several factors. On the one hand, biological reasons, i.e. stress hormones and messenger substances in the brain, are decisive.
These neurotransmitters transmit information between synapses and affect daily life. On the other hand, some psychological factors play a major role. Permanent excessive demands at work or stressful life events are situations that can trigger depression. Applied to the field of top-class sport, the following triggers can be named.
Symptoms, ailments & signs
Depression in a top athlete is usually very difficult to diagnose, as the environment very often lacks the necessary attention. Nevertheless, it is a very common disease that can be triggered by pressure to perform and succeed in combination with self-doubt and sometimes setbacks.
Most sufferers try to hide their illness and the associated emotional fluctuations as best they can and often develop very great skill in the process. The symptoms, however, are just as noticeable as with any other depression: The joy in one’s own life disappears, lethargy sets in and leads to a lack of motivation and lack of drive.
This has a negative effect on the training behavior and the training effects. In addition to the pressure to perform, the person affected is now under additional pressure to hide their inadequate performance and the illness that they have often not recognized themselves.
As a result of the repression, further symptoms occur, these can range from loss of appetite and insomnia to psychosomatic illnesses. Very often there are also disturbed eating habits, digestive problems and symptoms that are wrongly classified under the category of allergies.
With progressive, undetected and untreated depression, the clinical picture develops so strongly that sooner or later the patient will no longer be able to practice his sport at a performance level.
Trigger or trigger
Stress: Many athletes mention the enormous stress that rests on the athlete. A distinction is made between competition-related and everyday-related stressors. Fears of failure and conflicts with trainers, partners or the family should be mentioned here in particular.
The sports psychologist Nixdorf and her colleagues Beckmann and Hautzinger have this condition in their publication: “Prevalence of depressive symptoms and correlating variables among German elite athletes: First insight. J Clin Sport Psychol “applied to top-class sport and worked out a correlation between chronic stress and depression. Other sports psychologists, however, argue that psychological stress is not enough as the sole trigger.
Excessive demands: The physical strain an athlete is exposed to is another reason for the development of depression. These high loads are necessary to increase performance. The demands on the athlete are increasing and they can no longer meet the expectations without permanent increases in performance. The problem, in such cases, the recovery phase is often ignored. As soon as the relationship between exercise and recovery becomes unbalanced over a longer period of time, the risk of overtraining increases. This is due to fatigue, weight loss, loss of appetite, emotional lability as well as insomniamarked. A comparison with a conventional depression shows the similarity of the symptoms and also shows how quickly the athlete can fall into this trap.
Injuries: Serious injury is another trigger that can lead to depression. Injuries such as a cruciate ligament tear or a broken tibia and fibula can incapacitate athletes for several months. Not everyone has the patience and the motivation to fight their way back into the ranks of top athletes. If, moreover, the recovery does not go according to the wishes of the athlete, but rather takes a long time and he can no longer achieve the previous level of performance, the risks of a depressive illness increase.
Because in such cases the athlete falls short of his own expectations and those of the fans and supervisors. This article provides information about the possibilities to prevent these injuries. Accordingly, the three most important aspects of prevention are often disregarded. Correct warming up, stretching and cooling down should be heeded by every athlete during higher loads.
The survey by the German Sports Aid also showed that female athletes in particular suffer from depression after an injury. This was also confirmed by the psychologists Appaneal, Levine, Perna and Roh in their publication in 2009: “Measuring postinjury depression among male and female competitive athletes”. The study by Sporthilfe also found that around 10 to 20 percent of injured top athletes suffer from depression. Here, however, the number of unreported cases is very high, so the true number is more speculative.
Failures: Failure to process common failures is another trigger for depression. In addition, professional sport is now an important economic factor. The advertising money that flows annually is particularly immense. Athletes who act as advertising media are usually also the top performers and are particularly prominent in public life. It becomes critical when these players in particular have to deal with frequent failures. On the one hand, because they enjoy a high level of media attention and are therefore shown regularly, and on the other hand, because fans and fans of the teams are more likely to hold the “lead wolves” responsible than those who are less in the limelight.
According to studies, an athlete reaches the aforementioned state of overtraining at least once in his career. This is accompanied by depressive symptoms, which in the worst case can end in depression. But how is this noticeable? Some of the symptoms have already been mentioned in brief.
Basically, depression is not just noticeable through sadness. This rumor is circulating in society, which shows how little this disease is reflected in the population. Because the symptoms of depression are varied. In addition to the increased pessimism, a loss of sexual interest can also be seen.
This can culminate in suicidal thoughts. In addition, depression becomes noticeable through impaired concentration and the inability to make decisions. Physically, symptoms such as tightness in the chest area, diarrhea and constipation should also be mentioned.
In the worst case, depression in top-class sport can lead to suicidal thoughts and ultimately suicide. In most cases, suicide is preceded by long periods of sadness and depression. The psychological complaints have a very negative effect on social contacts and also on athletic performance.
The patient often feels sad and weak and loses meaning in life. Often there are also feelings of shame and inferiority complexes, which can further exacerbate the psychological complaints and depression. Often, depression in top-class sport also results in physical complaints and complications, such as dizziness, headaches and vomiting with diarrhea.
Concentration disorders and perception disorders also occur. It is not uncommon for patients to suffer from anxiety and no longer have their life completely under control. In most cases, treatment is provided by a psychologist. In serious cases or in a self-harming condition, admission to a closed clinic may be necessary.
In most cases it takes a long time before the treatment of depression in top-class sport is effective and the patient becomes aware of his or her illness. The treatment is often successful and no further complications arise. However, there is a risk that the patient will relapse again.
When should you go to the doctor?
Top athletes very often suffer from the emotional pressures they feel exposed to in the course of their careers. As soon as you notice a listlessness that lasts for several days, you should check whether you want to work with a therapist for support. Since depression develops slowly, it is advisable to contact us in good time.
If several wins occur as secondary placements, in most cases the feeling of failure increases and doubts about one’s own abilities arise. It is therefore advisable that the internal perceptions are always discussed with a doctor after a competition. The latter can assess more neutrally whether further help is needed. If the person concerned has the feeling that his services do not correspond to his possibilities, a doctor or therapist can help to find a solution.
If the feeling arises that the athlete does not feel understood by his coach or team members, he needs people they can trust. He can often find this with a therapist outside of the club’s members. If the joy and fun of sport is lost, the causes must be researched. If, despite previous experiences of success and competition wins, no feelings of happiness occur repeatedly, a therapist should be consulted. When thinking of suicide or persistent listlessness, top athletes need help and emotional support from a psychologist or psychotherapist.
Athletes who experience these symptoms multiple times in themselves should see a doctor. It is advisable to visit your family doctor first for an initial objective assessment, recommends Dr. Dr. Frank Schneider, specialist in psychiatry, psychotherapy and psychological psychotherapist.
If the family doctor considers depression to be possible, the affected athlete is referred to a specialist in psychiatry and psychotherapy. There are several psychiatric-psychotherapeutic treatment offers that not only try preventively to sensitize athletes and carers, but can also intervene early in an emergency.
In order to alleviate the depressive thought patterns and the symptoms, psychotherapy is divided into three steps. On the one hand, a normal daily structure should be established. This means that on the one hand the patient should consciously perform pleasant activities, but on the other hand also have to cope with everyday duties.
The second step deals with breaking down negative thought patterns. The person affected should recognize that the one-sided, negative thought patterns can also be viewed from a different perspective, which may lead to a more positive conclusion.
The third aspect is the training of social skills. This is particularly important because people who are depressed have to learn, on the one hand, to get in touch with other people and, on the other hand, to confidently represent their own points of view.
It is not uncommon for people to resort to antidepressants for depression. For athletes, this means that the drugs must be checked against the list of the World Anti-Doping Agency. Because various substances are declared as doping agents and are forbidden in professional sport. This additional information will help you to find out which resources are forbidden in competitive sport. For this reason, it is important to check the drugs you have prescribed against the list. Basically, however, antidepressants are not on the list, but the guidelines must be observed.
Outlook & forecast
The prognosis for depression in elite sport is individual and depends on various factors. The course is unfavorable as soon as there are further mental illnesses. These often require several years of intensive therapy.
The prognosis improves with an open approach to the disease and an understanding social environment. Many athletes experience this as a relief. The combination of psychotherapy and medication is also helpful for a good prognosis. Since the drugs are subject to strict sporting guidelines of the Anti Doping Agency, special consideration must be taken. Alternatively, the use of natural remedies can be avoided.
Top athletes are subject to special attention and public interest. This presents a challenge in the treatment of depression that needs to be addressed. Since the private activities of top athletes are often monitored by the press and passed on to the public, the athlete’s privacy is violated. This has a negative effect on the prognosis for many people affected and can increase the risk of a renewed phase of depression.
If there is no sporting success, there is also the risk of a negative impact on the health of the top athlete. If the sick person manages to build up a sense of achievement outside of sport, well-being usually improves.
The Chair of Sport Psychology at the Technical University of Munich has issued a number of suggestions for preventive measures that are intended to help both athletes and those responsible in clubs to combat depressive symptoms. Particularly noteworthy here are coaches and supervisors who objectively assess the behavior of the players well and can thus recognize the disease at an early stage.
One of the preventive measures is to adjust the training load, because the condition of overtraining is a permanent danger in competitive sports. Furthermore, regeneration should be promoted. Varied recovery phases help the athletes to counteract the stress. In any case, the stress factor should be given greater consideration in competitive sport, because if an athlete can cope with it, then he reduces the risk of depressive symptoms.
Dealing with these situations also helps to process failures. Some athletes who cannot cope with the failures run the risk of breaking down from permanent failures. In addition, it is important that the athletes are offered an environment in which they have offers of help available at any time in the event of any symptoms and, if necessary, are also taken into account during training and competitions.
Depression in professional sport is a common but mostly taboo phenomenon. The problem of aftercare already arises from this sentence. If the sports world were to deal openly with this topic, every depressed competitive athlete could go to the therapist during the day and in public. He could receive adequate acute treatment and follow-up care so that he remains mentally stable afterwards.
The problem is that many competitive athletes with burnout, eating disorders, anxiety disorders, sleep disorders or depression have to hide their suffering. Some top athletes secretly go to a psychiatrist or a specialist clinic under a false name. Others are left without treatment for fear of losing their reputation. Follow-up care is difficult to implement under such conditions. In addition, hospital stays are often reported as injury-related hospital stays. So there should be no suspicion of mental illness.
Psychiatric aftercare would be particularly useful among competitive athletes. Most top athletes who are depressed remain active in top sport. So you are still exposed to stress, the compulsion to succeed and the pressure to perform. In addition, some of them take antidepressants. Some of them replace or supplement these with tranquilizers and the like on their own initiative. Therefore, top athletes with depression would have to be medically monitored – and not only in terms of their physical condition.
Preventive measures would be just as necessary by the sports clubs as follow-up care for depressed top athletes by trained specialists.
Consultation with a sports psychologist
Athletes and clubs should employ a sports psychologist on their advisory board. The psychological department of the German Football Association looks after both players and coaches of the national teams.
Hans-Dieter Hermann has been the men’s national team’s psychologist for ten years and confirms the findings that have been published in research so far. The fact that national players have to perform on the pitch and that their behavior is always assessed on the pitch can affect the athletes’ mental performance. Furthermore, it should not be forgotten that professional athletes also have a private life in which there can be a crisis every now and then. Accordingly, the sports psychologist does not necessarily only act as a sports therapist, but also as a contact person when private life gets out of hand.
However, it must always be remembered that the sports psychologist was employed by the “employer”. When it comes to the taboo subject of depression, it should be borne in mind that the athlete “comes out” at his club. Independent therapists or psychologists are therefore another alternative if the issue is not given the necessary attention within the association.
Reactions from associations and clubs
Robert Enke’s suicide five years ago not only aroused the public, but also clubs and associations. The German Football League (DFL) has now obliged the clubs to employ a psychologist. However, according to a report by the news magazine Focus, the scene has still not been sufficiently sensitized.
Maximilian Türk from the DFL confirmed that the clubs are obliged to do so. The focus is on preparing young players in particular for the tough business of professional football. In the fan camps, however, the initiatives of the clubs count relatively little. Here only success counts and if this does not happen, individual players have to face the screams and whistles.
The Robert Enke Foundation
After the goalkeeper’s suicide, the German Football Association, the League Association and the Bundesliga club Hannover 96 founded a charitable foundation that supports education about the illness of depression.
The Robert Enke Foundation informs the sport and the general public about the disease through studies and discussions. The initiative is enjoying great popularity. For example, a five-day special exhibition was recently held in Hanover, on the one hand to commemorate the goalkeeper and on the other hand to give people an impression of what depression can “feel” like.
This was represented in a separate room through different acoustic, social and visual stimuli. The foundation also offers advice to people who also suffer from this disease.
The former professional soccer player made his illness public in 2003. With that he broke a taboo in professional sport. At the time, the playmaker of the national team was just 23 years old. Four years later, he officially retired from his career after going through multiple therapies. In total, Deisler had to undergo operations on his knee and groin seven times during his career. Although he received understanding for his step, he was also referred to by some in the scene as a “nursing case”.
Gianluigi Buffon is an athlete who managed to conquer the disease and who later stood on the pitch as a professional goalkeeper. “The problems arose exactly at a point of intersection in my life. In the period of upheaval between youth and growing up. Many things have changed in my head. Now I’m fine again,” said Buffon, who was able to overcome the depression within six months.
Enke’s death in 2009 was a shock to German football. Before he committed suicide, the goalkeeper ran the gauntlet of professional football. First celebrated as an absolute talent in the youth selection and Bundesliga keeper at Borussia Mönchengladbach and later at Hannover 96. In the meantime, Enke went through various ups and downs that shaped him, but also plunged into the depression. For German professional sport, the suicide represented a turning point, after all, it was only at this point that the first initiatives were started to combat the disease in sport.
What has happened in public with regard to depression in top-class sport? This question is not easy to answer. The initiatives that were launched by the DFL on the one hand, as well as the foundations that deal with the topic, are certainly to be highlighted positively. In addition, it must be recognized that a large number of studies examine the subject from a wide variety of angles. A representative example here is the study by Deutsche Sporthilfe, which showed the urgency through an anonymous survey in professional sport.
Breaking a taboo
The thesis put forward in the introduction that depression is still taboo in professional sport cannot be completely refuted.
Although some prominent examples have shown that the disease on the one hand poses a high suicidal risk, but on the other hand can be overcome by professional therapeutic measures, there is still little understanding among the public for athletes struggling with depression.
Daring to take a look at this sensitive topic is therefore extremely difficult. The fact is, however, as long as society’s opinion on the disease does not change, professional sport will continue to make the topic taboo. Fan camps in particular continue to be characterized by ignorant tendencies that will not change unless the overall impression of the disease within society changes.
You can do that yourself
The illness of depression can adversely affect the lives and success of elite athletes. Anyone suffering from depression should immediately consult a specialist in the form of a psychiatrist or psychotherapist. In addition to medical treatment, numerous self-help tips can also have a positive effect on the clinical picture of depression.
Since top athletes are usually under great pressure to perform, it is important to relax sufficiently. In addition to the phases of tension, there should also be sufficient phases of relaxation in the athlete’s everyday life. Athletes should follow their inner voice and more often do activities that are good for them – whether it is a hot bath, a good book, relaxing music or a quiet walk. Everyone is different and has individual preferences and hobbies. Also, relaxation techniques such as autogenic training or progressive muscle relaxation can reduce the physical and mental tension and thus increase the satisfaction and well-being of athletes.
In addition, athletes should always pay attention to a balanced diet that is adapted to the increased physical activity. A good diet provides the body with all the nutrients it needs to function properly. Since a high performance pressure is usually part of the life of a top athlete, the athletes should always work on their self-esteem and their mental strength.