Olympic Sports: Bad for the Brain?
Medscape:Can you elaborate on the mental health systems in place for young athletes? What improvements are needed to improve mental health outcomes in this population?
Dr. Glick: I think there's a lot of improvement needed. Everybody I've spoken to, the athletes and other sports psychiatrists, say that youth athletic programs are slowly bringing mental health into the picture. But it's a very slow process and it's very difficult to get psychiatrists and psychologists involved, especially psychiatrists. Psychologists seem more socially acceptable because they're there presumably not because there's something wrong with the athletes but because they're helping them to do better in their sport. And some of the pro leagues, like the NBA, have very extensive programs for helping athletes. They work with the rookies. They have people in their office that they bring in to talk to them about life, relationships, and working with coaches. But they're really the exception. So, it's slowly changing, but very slowly. And what we're advocating is much greater use of professionals in both youth and adult programs -- the same way it would be unheard of now to have a program without a trainer or an internist or a general or family physician.
Medscape:Olympic athletes can compete at as young as 15 years of age. Does the fact that such a person is still developing, yet competing at the elite Olympic level, change the management approach?
Dr. Glick: They have incredible physical attributes, but mentally they're just kids and their brains are just developing. Their personalities are developing. And again, nobody is following this. Nobody has done a long-term, follow-up study to know for sure the science of this. Obviously, the media speculates that there might be longer-term problems with them. You can argue that these are people with terrific personalities; they're able to use their personality to become good at a sport. Or you can say that there are terrific stresses here. And a lot of these kids are going to end up with long-term problems. All you read about are those who have done well. Once a year there's a story on a gymnast who's now in her twenties and is doing okay. But nobody knows the systematic follow-up of those who you don't hear about. So it's certainly a real concern.
Medscape: In high-profile settings such as the Olympics, what beneficial interventions might sports psychologists or psychiatrists offer?
Dr. Glick: It would be useful to have a psychiatrist there to at least do supportive, brief therapy as problems come up in the course of competition. In terms of the future, what's the future going to hold for these athletes? It would help them to have some counseling or psychotherapy available as part and parcel of the Olympic experience, rather than have it be seen as a sign of weakness.
Medscape:You mentioned how athletes looked at going to a psychiatrist or psychologist as a means of gaining a performance edge, as opposed to as a way to cope. How do you think we change that perception to one about learning how to deal with the internal challenges that athletes might be struggling with?
Dr. Glick: I think the media can help by pointing out that seeking mental health is an old stigma (if you went, there was something wrong with you) and that teams have adapted from that. Second, it can be emphasized that working with a psychologist might help athletic performance. But that's a relatively recent phenomenon. And again, there's very little science behind it. It's all pop psychology. There are techniques like imaging and straight psychotherapy, but it's hard to know whether they really increase performance. There's never been a controlled study of, say, taking 100 wrestlers and giving 50 of them the pop psychology intervention and 50 of them no intervention to see which group does better. That's what would be needed. There's no question that if you're sick, going to a doctor usually helps rather than harms; at the very least, it doesn't hurt you. We want to instill the same thing in athletes about mental health: Just as having a physician available to treat your cold or bronchitis or sprained knee is helpful, so, too, is having a psychiatrist available to help you deal with the stress of having to succeed.
Medscape:What are the biggest risks that athletes run in regard to long-term mental health? What are the most potentially damaging issues that athletes face once their playing days are over?
Dr. Glick: One thing is that not everybody succeeds -- almost everybody fails. I was reading this book called The Art of Fielding -- a great book. One of the concepts in it is that what separates those who are successful from those who are not is the ability to cope with failure. Almost everybody in the Olympics is going to fail, so the ability to cope is number one. Number two is having to cope with physical injuries. And number three is being out of the spotlight; you have to have developed the balance to go on to the next part of your life. That is really the biggest issue: staying balanced. Sports are a means to a happy, successful life, but they're not the end.
A Coach, a Trainer, and...a Psychiatrist
Medscape:Can you elaborate on the mental health systems in place for young athletes? What improvements are needed to improve mental health outcomes in this population?
Dr. Glick: I think there's a lot of improvement needed. Everybody I've spoken to, the athletes and other sports psychiatrists, say that youth athletic programs are slowly bringing mental health into the picture. But it's a very slow process and it's very difficult to get psychiatrists and psychologists involved, especially psychiatrists. Psychologists seem more socially acceptable because they're there presumably not because there's something wrong with the athletes but because they're helping them to do better in their sport. And some of the pro leagues, like the NBA, have very extensive programs for helping athletes. They work with the rookies. They have people in their office that they bring in to talk to them about life, relationships, and working with coaches. But they're really the exception. So, it's slowly changing, but very slowly. And what we're advocating is much greater use of professionals in both youth and adult programs -- the same way it would be unheard of now to have a program without a trainer or an internist or a general or family physician.
Medscape:Olympic athletes can compete at as young as 15 years of age. Does the fact that such a person is still developing, yet competing at the elite Olympic level, change the management approach?
Dr. Glick: They have incredible physical attributes, but mentally they're just kids and their brains are just developing. Their personalities are developing. And again, nobody is following this. Nobody has done a long-term, follow-up study to know for sure the science of this. Obviously, the media speculates that there might be longer-term problems with them. You can argue that these are people with terrific personalities; they're able to use their personality to become good at a sport. Or you can say that there are terrific stresses here. And a lot of these kids are going to end up with long-term problems. All you read about are those who have done well. Once a year there's a story on a gymnast who's now in her twenties and is doing okay. But nobody knows the systematic follow-up of those who you don't hear about. So it's certainly a real concern.
Medscape: In high-profile settings such as the Olympics, what beneficial interventions might sports psychologists or psychiatrists offer?
Dr. Glick: It would be useful to have a psychiatrist there to at least do supportive, brief therapy as problems come up in the course of competition. In terms of the future, what's the future going to hold for these athletes? It would help them to have some counseling or psychotherapy available as part and parcel of the Olympic experience, rather than have it be seen as a sign of weakness.
Medscape:You mentioned how athletes looked at going to a psychiatrist or psychologist as a means of gaining a performance edge, as opposed to as a way to cope. How do you think we change that perception to one about learning how to deal with the internal challenges that athletes might be struggling with?
Dr. Glick: I think the media can help by pointing out that seeking mental health is an old stigma (if you went, there was something wrong with you) and that teams have adapted from that. Second, it can be emphasized that working with a psychologist might help athletic performance. But that's a relatively recent phenomenon. And again, there's very little science behind it. It's all pop psychology. There are techniques like imaging and straight psychotherapy, but it's hard to know whether they really increase performance. There's never been a controlled study of, say, taking 100 wrestlers and giving 50 of them the pop psychology intervention and 50 of them no intervention to see which group does better. That's what would be needed. There's no question that if you're sick, going to a doctor usually helps rather than harms; at the very least, it doesn't hurt you. We want to instill the same thing in athletes about mental health: Just as having a physician available to treat your cold or bronchitis or sprained knee is helpful, so, too, is having a psychiatrist available to help you deal with the stress of having to succeed.
Medscape:What are the biggest risks that athletes run in regard to long-term mental health? What are the most potentially damaging issues that athletes face once their playing days are over?
Dr. Glick: One thing is that not everybody succeeds -- almost everybody fails. I was reading this book called The Art of Fielding -- a great book. One of the concepts in it is that what separates those who are successful from those who are not is the ability to cope with failure. Almost everybody in the Olympics is going to fail, so the ability to cope is number one. Number two is having to cope with physical injuries. And number three is being out of the spotlight; you have to have developed the balance to go on to the next part of your life. That is really the biggest issue: staying balanced. Sports are a means to a happy, successful life, but they're not the end.