Sports psychiatry has evolved a lot in recent years. As elite sport turns to psychiatry for service, it is necessary to consolidate current psychiatric knowledge and offer guidance from experience gained in this field. Sport is important and should always be enjoyable and healthy for the practitioner in terms of mental and physical well-being. In addition, it is good for personal development and for building resilience; all of this is transferable to other areas of life.
For years I have lived in Amsterdam, Holland. He often visited the Rijksmuseum with its works by Jan Brueghel, Franz Hals, and Rembrandt – as well as the Van Gogh Museum. At first, he looked at the paintings from the artist’s perspective, that is, from the side of the canvas where the painter was. However, and with the passage of time, I decided to evaluate the paintings from a diametrically opposite perspective … that is, from the other side of the canvas …
I was wondering: how faithful is what I see on this side of the canvas to what is on the other side? Would you be able to recognize the authentic “Church of Auvers sur Oise;” the “Wheat Field with Crows;” or the “Starry Night?” What did van Gogh feel? And who can define and understand the mental disorder that kept him drunk and unhappy, and that would soon lead to suicide?
The artist van Gogh was capable of living in a world he made a personal interpretation of reality – but it was not the true reality. In fact, and like many others, the person of van Gogh was incapable of living in the harsh and unforgiving reality that lies on the other side of the canvas.
All of the above represents a disorder of adaptation to reality that frequently manifests itself in the psyche of athletes. In fact, anxiety, depression, and acute and chronic stress are painful, crippling, and often very embarrassing responses to sustained high pressure to perform at your best and win.
At such moments, rational volition and common sense are partially or completely lost, and a series of primitive and automatic brain structures take over. The serious anxiety disorders that have occurred in the elite of women’s sports gymnastics at the Tokyo Olympics (2021) are a faithful representation of this.
In short, high pressure, while capable of creating diamonds, also bursts pipes. Whoever they are, the athlete will always be a simple and fragile human being, and you have to know how to look at them and appreciate them from the other side of the canvas.
Anxiety disorders respond to pressure and are the most common mental disorder in sport. They are presented in two different groups: 1.- adaptation anxiety; and 2.- primary anxiety disorders. Although a certain degree of anxiety represents a normal and necessary part of training and competition, some athletes develop more generalized symptoms requiring a comprehensive evaluation and treatment by a psychologist or sports psychiatrist.
There can always be significant comorbid conditions, such as depressive disorders, substance abuse, stress disorder, and attention deficit hyperactivity disorder. In such cases the treatment consists of establishing a collaboration between the coach, the physiotherapists, the doctors, and the sports psychiatrist. Brief therapies, such as cognitive-behavioral therapy or motivational therapy, both occasionally supplemented with medication, tend to produce the best results. Natural social support groups that are part of the athlete’s environment are also used.
Sports psychiatry has evolved a lot in recent years. As elite sport turns to psychiatry for service, it is necessary to consolidate current psychiatric knowledge and offer guidance from experience gained in this field.
Sport is important and should always be enjoyable and healthy for the practitioner in terms of mental and physical well-being. In addition, it is good for personal development and for building resilience; all of this is transferable to other areas of life.
It is not usual for a sports club or team, or even a national body, to have its own psychiatrist, although it is becoming more and more frequent. When the patient is an athlete, the sport will form a large part of the context and an understanding of the sport will be essential for a complete and useful formulation of the problem it presents. For this to be successful, mental health specialists must understand and value the role of sport and sports organizations.
As in my assessment of Rembrandt and van Gogh’s paintings, athletes also need to be appreciated from both sides of the human canvas. Some of them, like van Gogh, will adapt better to the technical-competitive side of the canvas, while others will do better to the psychic-emotional side of the canvas… and vice versa.
Mental health is of the utmost importance in sport and, therefore, it is necessary that all professionals working in sport psychology and / or psychiatry have the knowledge and experience necessary to meet the needs of athletes.
William A. Laich de Koller
Doctor of medicine and surgery