A sporting chance with depression

MEDICAL MATTERS:Professional athletes are no different from the rest of us when it comes to mental illness

THE DEATH of 32-year-old German international goalkeeper Robert Enke, who took his own life recently, has led to extensive discussion about depression and the pressures faced by high-profile sports stars. Initially, much of the speculation about why he had taken his own life centred on the pressure to perform that is part and parcel of professional soccer. If you don’t perform over a couple of games, managers are quick to drop you. With millions of euro resting on qualification and success in European competition, coaches are themselves under huge pressure; they no longer have time for the arm around the shoulder and the coaxing back to confidence practised by managers of yesteryear.

First treated in 2003, Enke’s illness was never public knowledge, driven by a fear that his adopted daughter would be removed from the care of his wife and himself if his depression became known. In a suicide note, he apologised for hiding his illness. And another indication that the pressures of being a professional player with Hannover 96 were not the only stresses in his life, Enke had also struggled to overcome the death of his biological daughter, Lara, at the age of two in 2006 of a rare heart condition.

His widow, Teresa Enke, said: “He didn’t want it to come out because of fear . . . It is the fear of what people will think when you have a child and the father suffers from depression.”

Further evidence that professional athletes are no different from the rest of us when it comes to psychological illness came from last week's BBC TV series Inside Sport. In a programme titled Mind Games: Depression in Sport, presenter Gabby Logan spoke to sports stars including boxer Frank Bruno and rugby legend John Kirwan about how depression had affected them. This was great television, with the subjects describing in some detail what it feels like when the illness strikes.

“It just comes on you, your heart races, you panic” was former New Zealand rugby player Kirwan’s description. Glasgow Celtic soccer star Neil Lennon said “you could be in a roomful of people and yet feel like the loneliest guy in the world”. And England cricketer Marcus Trescothick noted: “If you’ve got a broken leg you’ve got a cast on your leg, people can see you’ve got a problem, but when you’ve got mental problems, there is nothing evident to people to show you need help.”

Trescothick was first affected by his illness on England’s tour of India in 2005-06, though he said he had experienced anxiety attacks since he was 10. We saw clips of him while on a club tour to India in October, the first time he had been back to the country.

It was a brave move and even though he had to return home after two matches, you could see how important it was for him to go back and perform well on a cricket field. Somerset has even appointed him club captain for next season, a ringing endorsement that meant a lot to the visibly relaxed cricketer. Importantly, it sent a strong message to viewers that, contrary to the fears so deeply felt by Robert Enke, being open about depression can be both liberating and career-enhancing.

Of course, performance stress may contribute to depression in professional athletes. It has been suggested that cricketers are twice as likely to take their own lives as the average English male.

Sport can be all-consuming in a nerve-shattering way, which is enjoyable while it lasts, but then there is a massive drop in intensity when the game is over. But it is over-simplistic to think that this alone could trigger psychological illness. It is more likely that, in some people, the same traits of tenacity and perfection- seeking, necessary for success, go hand in glove with a genetic susceptibility to depression.

Would Robert Enke still be alive if the stigma surrounding mental illness was a thing of the past? It’s hard to be certain, because during times of deep depression, paranoid thinking takes hold and with it the most irrational thoughts assume an illogical certainty. But his wife and family will always wonder whether, if there was a visible plaster cast of the mind for those with depression, the goalkeeper would have found it easier to live openly with his illness.

• mhouston@irishtimes.com