The world of sports is littered with motivational anecdotes and psychological references. Athletes are taught to “push through,” and when they fail to do so, pundits declare that they lack mental fortitude.
We now know through the public revelations by athletes such as Steve Smith Sr., Imani Boyette and Brandon Marshall that this mentality makes it difficult to address mental health challenges during one’s playing career, and even later in life.
It’s no surprise that the culture of sports contributes to the mental health stigma that exists today. Mental health complications contradict the gladiator narrative that captivates millions every day, but the fact remains that one in five American adults — or 43.8 million people — experience a mental health issue each year.
Mental illness does not discriminate based on circumstance, which means that athletes are just as susceptible as anyone else.
In February 2016, Larry Sanders, then 26, checked himself in to Rogers Memorial Hospital in Oconomowoc, Wisconsin, a choice he made to protect his own psyche and to mitigate the damage he had caused to his friends and family.
“We were struggling for some years in Milwaukee, and it was taking a toll on me. The problems compound and I saw it in the damage that took place in my relationships. That’s when the depression set in. It happened fast,” Sanders, who played for the Milwaukee Bucks, told NBC News.
Sanders, who is now 29, felt the need to get away from the distractions of the league, an environment characterized by regular invasions of privacy and endless media obligations. In the process, he left $27 million on the table.
“When you’re a professional athlete, you’re put on a pedestal, y’know, like you have some superpower … so there’s just no time to focus on your mental health,” he said.
The toxic dynamic between Sanders’ mother and father triggered severe anxiety attacks early in his life. Sanders’ mom was a “runner,” moving from one women’s shelter to the next.
“One day, my uncle gave us a car. We were so happy, and that same day we were kicked out of the shelter,” Sanders recounted. “We went to live with my grandmother, and there were already 10 people there. When my mother would leave the house, I would have panic attacks and cry myself to sleep. I felt like her life was in jeopardy, so I felt like my life was in jeopardy.”
Mental health resources were not readily available to Sanders, so he never received the professional help he needed. As his stress mounted, he turned to marijuana — a quick coping mechanism that fit his hectic NBA schedule.
He would eventually be suspended for five games for a third violation of the league’s substance abuse policy during the 2013-14 season — a measure Sanders still believes was punitive as opposed to solution-based. The league mandated drug counseling, but the National Basketball Players Association and Sanders’ representatives pushed for mental health therapy to get at the root of the problem.
When my mother would leave the house, I would have panic attacks and cry myself to sleep. I felt like her life was in jeopardy, so my life was in jeopardy.
“One stigmatized belief is that mental health struggle is a sign of weakness,” said Shainna Ali, a mental health advocate with a doctorate, and owner of Integrated Counseling Solutions in central Florida. “This conflicts with the idea of an athlete as an example of someone who is in optimal health. This distortion demonstrates the misunderstood concept of health and the common habit of valuing physical health over mental health.”
Some 1,200 miles away, there was Royce White, the 16th overall pick in the 2012 draft out of Iowa State. White, 27, who grew up in a single-parent household in Minneapolis, Minnesota, had a diverse subset of people in his life, including his grandmother and several positive male figures.
White experienced anxiety throughout his life.
“I’m a perceptive cat, so I think my anxiety was a result of a disposition. Anxiety doesn’t just come out of nowhere. As a child, I was always on the defense, so I guess you can say that I was always anxious. But did I have an anxiety disorder my entire life? No. Angst is emergent … it’s a symptom and a diagnosis,” White told NBC News.
Like Sanders, Royce White cited early traumas in his life that exacerbated his anxiety, but quickly noted that everyone is susceptible to it.
“We don’t know what we haven’t experienced; we don’t know what we can’t frame from experience. Humans are different in that we can abstract an idea. I can recall traumatic events in my life like 9/11. I wasn’t in New York. I just saw images. It was an abstraction, but it was traumatic,” White said.
White entered the league with a clinical diagnosis of anxiety disorder. He asked for help, but his requests were ignored. White never played a game for the Houston Rockets and played just three games during the 2013-14 regular season for the Sacramento Kings.
Headlines surfaced referencing the anxiety White experienced on planes as the reason for his lack of a sustained run in the NBA. White says those reports were blown out of proportion and were misleading.
“It was a misdirection. My overall message was to call for a more prudent mental health policy and better understanding,” said White, who flew 20 times while at Iowa State and now flies with his team in Canada.
“Guys deserve to get the treatment they need. When I played, I requested an independent doctor who wasn't employed by the team so there would be no conflict of interest, but the NBA told me this accommodation would set the precedent for future player accommodations.”
The league never provided White with an independent doctor, but he and Sanders started a national conversation that is still going on today.
Fans have taken to social media to discuss their own bouts of mental illness. This has sparked conversations about a lack of information and understanding about mental health, especially in the black community; barriers in access to adequate health care; and how judgmental responses from family and friends make it harder to seek help.
Last year, Kevin Love wrote in the The Players' Tribune about suffering a panic attack during a game.
Prior to that, Demar DeRozan spoke with Doug Smith of the Toronto Star about suffering from depression and anxiety.
Mental health in sports is a difficult issue to speak about openly. Team doctors and psychologists are bound by HIPAA codes of confidentiality that make it almost impossible to share stories of players’ struggles or successes. Players are reluctant to talk about mental health for fear of being seen as broken, uncoachable or a strain on locker-room chemistry. And many owners run a factory-like operation where players who enter the workplace with “baggage” are deemed disposable or easily replaceable.
When you’re a professional athlete you’re put on a pedestal, y’know, like you have some superpower… so there’s just no time to focus on your mental health.
Some owners of professional sports teams, who have invested millions of dollars in their players, believe they should have the right to access the medical files of their athletes, including their mental health reports, in lieu of taking a more holistic approach to player evaluation. But this breach of confidentiality compromises players’ privacy, especially that of those who may have a condition that does not affect their performance.
This makes the reincorporation of former players such as Sanders and White vitally important. They can connect with players and serve as a bridge to the resources current players desperately need.
And Sanders believes there is no better time than now for players to turn words into actions.
“We’re in a mental health renaissance. We can speak about mental health without fear that our culture will turn its back on us. It’s a beautiful place to be; we’re pioneers, and this will be different when we leave.”
Dr. Shamard Charles is a physician-journalist for NBC News and Today, reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.