#ICYMI - Mental Health in Sports, with Royce White

In case you missed this episode on the Playing with Science channel… Hosts Chuck Nice and Gary O’Reilly explore the state of mental health in sports, with former NBA player and mental health advocate Royce White, neuroscientist Heather Berlin, and the co-founder of Canada’s first Centre for Mental Health and Sport, Krista Van Slingerland. Photo Credit: GoIowaState dotcom (flickr user GoIowaState) [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:11Gary O'Reilly?

  I'm Gary O'Reilly.

• 0:12Chuck Nice?

  And I'm Chuck Nice.

• 0:13Gary O'Reilly?

  And this is Playing with Science. In a recent show, we addressed the topic of gender in sport. Today, we explore another contentious issue, that of mental health. If you realise that about one in five adults in the USA suffer from mental illness, it's no surprise this serious issue is present in the world of sport.

• 0:34Chuck Nice?

  Yes, and some of sport's major stars have opened up about their battles with mental illness, like Michael Phelps, the most decorated Olympian of all time for one. Another athlete to make his stand is former NBA player Royce White, who will be our first guest.

• 0:50Gary O'Reilly?

  And following Royce White will be neuroscientist Heather Berlin, as well as Krista Van Slingerland, a researcher at the University of Ottawa and co-founder of Canada's first centre for mental health and sport. But first, as Chuck said, let's get to our interview with Royce White.

• 1:08Gary O'Reilly?

  Former NBA first-round draft pick, so you know what? Coming out of college, that's going to be someone special.

• 1:14Chuck Nice?

  That's right.

• 1:15Gary O'Reilly?

  Last played for the London Lightning of the National Basketball League of Canada, but it doesn't stop there. He led his team to the Canadian championship whilst being voted MVP of that same season.

• 1:28Chuck Nice?

  That's right.

• 1:29Gary O'Reilly?

  Been an interesting road so far, but there are all sorts of things to unlock, unpack and discuss. And as the title of the show will tell you, mental health has played a large part in Royce White's basketball history.

• 1:47Chuck Nice?

  Yeah.

• 1:48Gary O'Reilly?

  So, Royce, welcome to the show, sir.

• 1:50Chuck Nice?

  Thanks for being here.

• 1:51Speaker 02

  Thanks for having me, guys. Appreciate it.

• 1:52Gary O'Reilly?

  Oh, you're welcome.

• 1:53Chuck Nice?

  You know, before we even do anything, I think it's important to have you tell your own story in your own words, because there's a lot that has been written about you. I've watched quite a few little interviews of people talking about you. I've read other things that people, other players have quoted, speaking about you. But now that we have you here, instead of moving forward, let's just have you tell your story, and then we can go from there.

• 2:29Speaker 02

  Yeah, well, I'll say, you know, overall, I'm a person that believes in himself and I believe in humanity greatly. And I'd say, you know, the central theme of my story, it's about five years ago, I had a theory. And my theory was that the mental health dynamic was at work in the NBA in large part the same way it was in a greater society. And that anxiety and depression and trauma and stress and addiction and ultimately stigma was having a very pervasive effect in the underbelly of the league. And, you know, that was, that was the intuition that I had.

• 3:14Speaker 02

  But in a, in a more proximal, in a more proximal sense, I'm a person who was diagnosed with anxiety disorder in high school at the age of 16. I was very public about my anxiety disorder in college upon entering the draft, the conversation about the 2012 draft beyond Anthony Davis's extremely, the excitement around Anthony Davis and his extreme talent and attributes was the mystery of, of where I would be drafted. And, and not because I lacked the skill or I lacked the passion or the intensity or the feel for the game. It was because there was a conversation happening within the NBA with GMs, scouts,

• 3:56Speaker 02

  et cetera, and, and all of the draft prospect experts, the mock draft board guys, that was really questioning how the NBA viewed mental health. And this is before I was ever drafted. Right. So I was hearing that chatter because the players and, and the people within inside the league are the only ones involved in that conversation besides what makes it its way out onto the internet for the public to, to interact with. And even when it does, it's very, very minimal, you know, information that the public is given access to. But I was given access to all the things that the GM were saying in regards to how they felt anxiety was a risk and how mental health was, you know, more so unknown.

• 4:37Speaker 02

  And upon my arrival in the league, when it came close to time to start the season, I went to my team and I asked. What what's the mental health policy? You know, what's the program? What what are we going to do to create the same type of environments that I've had success with in the past, be it at Iowa State or be it in high school at at in Hopkins High School here in Minnesota, which both were very progressive, progressive environments in terms of the way that they viewed mental health.

• 5:07Chuck Nice?

  Uh huh.

• 5:08Speaker 02

  Um, and and again, as a rookie, I had no clue really what the answer was gonna be. I I mean, I'm fresh out of fresh out of water, so to speak, and and coming into an entirely new corporation that has, you know, a fifty plus year history and and is a huge global apparatus. And I asked what the mental health policy was. We found out that there was no actual policy. So my next initiative was to go to the Wellstone Act, the Wellstone Parity Act, which is something that blossomed from here in Minnesota, from the late Senator Paul Wellstone.

• 5:44Chuck Nice?

  Okay.

• 5:44Speaker 02

  Which which creates parity, which which demanded that the insurance companies view mental uh health in the same way that they do physical injury in insuring people. Um, and Senator Wellstone was the champion of that of that legislation. So my next strategy was to say, okay, you guys don't have a mental health policy. Let's use whatever you have for physical injury as the template for mental health. It's already has a federal precedent in terms of of being the the standard of the way mental health should be looked at from a legislative standpoint. Let's do that. They didn't want to do that.

• 6:18Chuck Nice?

  Oh, my God, you so you the first of all, let me just say that for uh any uh right now, uh, anybody who's listening has got to be thinking, if you know anything about the business of the NBA and all sport, all professional sports. What I just heard you say, I'm thinking to myself, dude, what is wrong with you?

• 6:45Chuck Nice?

  Like, man, you got some balls on you. Like, you are challenging the entire system with questions such as that. I mean, did you realize that's what you were doing at that time?

• 7:01Speaker 02

  Um, I didn't, I didn't understand the gravity of it at the time. No, I actually, I actually am just a, a person who suffers from anxiety disorder. And I was more so feeling like, um, I was, I was coming into an organization and an environment that had totally dismissed the validity of mental health as a field and as a science.

• 7:24Chuck Nice?

  Absolutely.

• 7:25Gary O'Reilly?

  Had they dismissed it or had they not even considered it to be?

• 7:29Speaker 02

  Well, I, I think it's important that we get into that because, you know, I think what we see in society is a lot of shadows that people can hide in.

• 7:35Chuck Nice?

  Yes.

• 7:35Speaker 02

  Uh, it, through the claim of ignorance.

• 7:38Chuck Nice?

  Hmm, yeah.

• 7:39Speaker 02

  You know, and, and I think most of, not, I won't say most of, I'd say a considerable amount of the ignorance is willful.

• 7:47Chuck Nice?

  Uh huh. Yes, and, and, and of course it is because it, once you're enlightened, you have to take action. Otherwise, otherwise you are accountable. And so, you know, um, however, let, let me just say that, uh, you know, you have two advocates here, uh, in me and Gary. I mean, um, it's, I, I, I have to say, I'm, you know, we'll get more into your story because I'd love to hear the progression. I have a feeling though, that you being kind of the progenitor of a movement, things didn't probably work out for you as well as they could have because whenever you're the first, you, you, you normally suffer. Is that, is that kind of how it went down?

• 8:32Speaker 02

  Well, so, so I'll tell you, so again, just to, just to tail off the end of the, the first part of my, my story, um, so we asked for there to be a parity between physical health and, and, and mental health.

• 8:44Chuck Nice?

  Uh huh.

• 8:45Speaker 02

  And they said no to that.

• 8:46Chuck Nice?

  Uh huh.

• 8:46Speaker 02

  So now we were left in a place where we had no language in our collective bargain agreement or our uniform player contract that related to mental health at all.

• 8:57Speaker 02

  So my next request is that we create a policy. That we create a policy from, from scratch. And they said, no, we can't do that. We won't, we won't create a policy.

• 9:07Chuck Nice?

  Wow.

• 9:07Speaker 02

  And, um, you know, not the, the, the biggest apprehension that was communicated to me from my team, from the people that I was talking to in the union, the, the NBA office. And, you know, vis a vis the owners.

• 9:23Chuck Nice?

  Right.

• 9:23Speaker 02

  Uh, was that they were worried that players would be able to.

• 9:26Chuck Nice?

  Fake it.

• 9:27Speaker 02

  Fake it.

• 9:28Chuck Nice?

  Yep. I, I, I, I know it. I know. Let me tell you something. That's pretty consistent. Uh, throughout most of, uh, corporate America.

• 9:37Speaker 02

  It's, it's just, it's just such a pseudo scientific.

• 9:40Chuck Nice?

  It's ridiculous.

• 9:41Speaker 02

  Approach.

• 9:42Chuck Nice?

  It's ridiculous.

• 9:43Speaker 02

  You know, cause here's the thing, and, and this is what I meant by the shadows and willful ignorance. As a fan, you probably wouldn't know this unless you have been an athlete at some point in time, which most of us have, but at a high level and you understand.

• 9:55Chuck Nice?

  Mm hmm.

• 9:55Speaker 02

  How it works when it becomes more of a business, you know, be a, the, via the, the high level, high school, um, college or professional. What, what we know as athletes is this, if you have a physical injury,

• 10:09Speaker 02

  it always comes down to a verbal test. If I broke my ankle, I healed it, I did the rehab, I'm now getting ready to come back. At the end of the day, somebody's going to tell you to go run a sprint. And when you get done, they're going to ask you, how does it feel?

• 10:23Chuck Nice?

  How do you feel?

• 10:24Speaker 02

  Yeah. At that point, you have no more of a chance to fake mental, to fake a physical injury. Then you, you, you would have no more of a chance to fake a mental illness than you would a physical injury at that point.

• 10:34Chuck Nice?

  Right.

• 10:35Gary O'Reilly?

  See, the thing is, Royce, I spent 14 years as a professional soccer player in the UK. And if you have the same thought, then if, or disagree or agree. I never once met a player who would fake a mental illness.

• 10:50Chuck Nice?

  Because you know what? The reason we get out of bed is to do our thing. And you take our thing away from us, you hurt us. And I can't imagine anybody who would say, "I'm depressed, I can't play today." That's, no, I don't feel it.

• 11:06Speaker 02

  I completely agree with you. And I thought, you know, going into this, I was more so trying to, I was more curious and I was more, you know, concerned about the way that I, my career would go in an environment that hadn't really acknowledged mental health as being the primary aspect of health that it is. But, but more so than that, I thought it was just absolutely reprehensible that there would even be a suggestion or connotation that the, the best athletes in the world would, when they get a chance to, find a way to, to cowerd out of competition. Now, am I saying that people don't fake injuries or things like that? No, I won't say that because I, I myself have questioned teammates and the validity of their injury and probably in an ignorant fashion. But, but ultimately,

• 11:52Speaker 02

  what I came from was two environments that erred on the side of the person's mental health is way more important, way more dynamic and way more fatal if miss, if miss, if, if undersupervised, than the potentiality or the risk of them faking the illness.

• 12:09Chuck Nice?

  Yeah.

• 12:10Speaker 02

  So let's say a guy fakes anxiety. Okay, i- is it better to, to support the guy and make sure that he doesn't become an addict? Or make sure that he doesn't commit suicide?

• 12:20Chuck Nice?

  Right.

• 12:20Speaker 02

  Or are we go, versus him sitting the game because he, you know, and, and he exaggerated the anxiety symptoms?

• 12:27Chuck Nice?

  I think right now.

• 12:28Speaker 02

  Just a no brainer.

• 12:29Chuck Nice?

  I think right now, first of all, what you, everything you said is absolutely correct. There's another dynamic at play here too. And let me just say, full disclosure,

• 12:38Chuck Nice?

  I suffer from a form of anxiety. Did not even know I had it until recently. I, I am currently in therapy.

• 12:49Chuck Nice?

  It's, it's difficult. And I didn't understand what was happening to me, to be honest.

• 12:56Chuck Nice?

  Because I've gone my whole life. And I didn't realize that this was, that there was something wrong with me. I, I honestly felt like, uh, this is just something that.

• 13:09Gary O'Reilly?

  This is what people.

• 13:10Chuck Nice?

  This is what people deal with. This is what people deal with. That's how I felt.

• 13:13Gary O'Reilly?

  I'm no different to anyone else. This is what other guys are going through.

• 13:16Chuck Nice?

  And so the idea of, and this, I grew up in a time where, get over it.

• 13:23Gary O'Reilly?

  Yeah.

• 13:23Chuck Nice?

  All right. Man up.

• 13:25Gary O'Reilly?

  Mm hmm.

• 13:26Chuck Nice?

  All right. Uh, buck up, right?

• 13:30Gary O'Reilly?

  Yep.

• 13:30Chuck Nice?

  Those, I mean, this was, I, I grew up in the put some ice on the air. All right. That's all I can tell you. There's, there's a main reason why you, you never see a player fake mental illness. And that is, even as the kind of efforts that you have taken and strides you have taken to bring this out into sunlight and sunlight is the best disinfectant, um, it is very difficult for people to come forward. And nobody wants to have that stigma attached to them for the purposes of faking anything.

• 14:03Speaker 02

  That doesn't need it.

• 14:04Chuck Nice?

  That, that doesn't need it. Nobody's doing that. So, you know, so go ahead.

• 14:07Gary O'Reilly?

  The thing is.

• 14:08Speaker 02

  It's absurd. It's, it's, it's, it was, it was an absurd, an absurd claim that was made haphazardly out of reaction of, of the fear of the change of the system that was gonna ensue if they acknowledged this issue.

• 14:22Gary O'Reilly?

  Wow.

• 14:22Speaker 02

  And, and so, and so, and, and to, to move the story further along, um, this, the, the mental health issue in the NBA was never really about the way that they viewed this issue. They've hidden behind the, the stigma that the entire world faces around regarding the mental health issue.

• 14:39Chuck Nice?

  Right.

• 14:40Speaker 02

  That was, that was a hiding place for them. The mental health topic in the NBA isn't about whether the players can receive care or not to their team. That's what they're trying to make it be about now and saying that we're providing programs and services for players to get help. Meanwhile, Commissioner Adam Silver is admitting that, uh, there is a stigma that he can't guarantee won't factor into their free agency. See, that's a fundamental de-incentive to actually be open and honest about anxiety or mental health struggles.

• 15:07Gary O'Reilly?

  I mean, if we look at other players that have followed you, like so Kevin Love, DeMar Roseanne, have publicly declared their issues. How do you feel about the way they were treated as opposed to the way you were treated?

• 15:25Speaker 02

  You know, we're in two totally different echelons or categories of player. We share a common struggle, as does the entire human species, in terms of our, our struggle and the way that it was presented to the NBA is two totally different situations. You know, two players that had, you know, veteran career status, had, had all-star level accomplishments and accolades, had some security there, had some, you could say, individual leverage there.

• 15:56Chuck Nice?

  Yeah.

• 15:57Speaker 02

  And, and versus myself, a player who came in immediately, saw the issue and, and said that the urgency of the issue was long overdue, and that it couldn't wait another nine years. You know, so, you know, Demar DeRozan's been in the league probably seven, eight years, nine years maybe, and in his ninth year, he brought the discussion forward. And in many ways, his own journey is, is a microcosm of the trajectory of the mental health conversation as a whole, is that it's always come after the fact.

• 16:30Chuck Nice?

  Hmm hmm.

• 16:31Speaker 02

  After the need, after the need.

• 16:34Chuck Nice?

  Yeah, interesting. Well, you know, and, and with that being said, I mean-

• 16:37Speaker 02

  See, I don't, I don't believe in better late than never. I don't believe in that. I, I, you know, I've, I've been reading Heidegger's Being in Time lately, and it's obvious that man's existence has a very fundamental relationship with time. And we have, in a, on a number of fronts, decided that the convenience of our lifestyle, the convenience of our thought, the convenience of our entire being, will take precedence over the, the much-needed work, or at least what we, what we purport our aspirations to be, whether that's a free America, whether that's freedom of individual expression, whether that's a peaceful world,

• 17:20Speaker 02

  whether that's a world where people are adequately cared for. Our convenience has, has become a roadblock for that, and this mental health conversation is the example. It's the microcosm of that, of that, uh, character.

• 17:32Chuck Nice?

  Who's the, who's the Giants wide receiver, Brandon Marshall?

• 17:37Chuck Nice?

  Brandon Marshall's a running back.

• 17:39Gary O'Reilly?

  Uh, New York Giants, NFL player. He said mental health issues will be the human rights movement of now, of today. I think, I think you've echoed those comments, but let me go back to the point you're saying how time is, I want to say of the essence here. Um, you would physically screen an elite athlete that was at the beginning, uh, you know, in a draft or the rest of it. Would you advocate the same with mental screening for the identification of an issue with a younger athlete so as they don't have to address it and go through a career suffering?

• 18:16Speaker 02

  Well, I'd only advocate for that if the owners or the decision makers were willing to be properly educated on what it was, what mental health is.

• 18:23Gary O'Reilly?

  Okay.

• 18:23Speaker 02

  You know, so I, I think that it's important to, I think it's important to, to broaden the scope of mental health to a place where we don't understand it as anxiety or depression or, or PTSD where we understand it as the way that people think, feel and react. And it's another word, another term for the human condition. And when we broaden that scope to that place, you see that the entire human species falls nicely onto a spectrum.

• 18:51Gary O'Reilly?

  Absolutely.

• 18:52Speaker 02

  You know, so when you understand it that way, then I'd be open to them screening players for mental health. But if you, if you screen players for mental health in a place in time where all of the decision makers are just going to use folklore and pseudoscience to then cast judgment, then you're actually putting the players in danger.

• 19:08Chuck Nice?

  Exactly. You're, you're placing them in great peril because what you're doing is you're arming owners with ammunition to use against them. Uh, the, and, and

• 19:16Gary O'Reilly?

  Which is why I asked the question.

• 19:17Chuck Nice?

  Yeah. And this was, goes back to what you were doing, um, uh, uh, whether it was consciously or not, but as a rookie coming into the league and asking for actual mechanisms that would allow you the freedom of treatment without being stigmatized, that's what you were doing. You were actually giving people the freedom to be able to go forward and come forward and be diagnosed and get help. And that can only happen when you have safeguards in place that say, hey, uh, we're not going to look at you as a liability and get rid of you now because we found out that you have this particular health issue.

• 20:00Speaker 02

  Well, and you guys will, you guys will appreciate this because it's, it's not even so much that That we're gonna make the choice not to look at you in this in this way, in this judgment way, it's that the mental health field is a scientific field that has brought us to a place where we can have some faith in the validity of the work that's been done.

• 20:20Chuck Nice?

  Yes, yes.

• 20:21Speaker 02

  Yeah, so it's not just, it's not just, you're not gonna decide or or make this snap time judgment about who I am, it's you have to surrender your own ignorance to the field of mental health. I made the point when I first came into the league, uh, how is it at all reasonable that general managers, coaches, owners would be in charge of or lead the way in making mental health decisions? It'd be like me going to have my electricity fixed in my house and and and, you know, hire a lawn guy to do it that had no electrician training.

• 20:56Chuck Nice?

  You know what you just did?

• 20:57Speaker 02

  Not only is it, not only is he not gonna do the job right, he's gonna, it's dangerous.

• 21:02Chuck Nice?

  Yeah, I know. I'm speaking from experience. You just told me the problem with my electrical uh, issue in my house. Now I know what I did wrong. Now I know what I did wrong. I shouldn't have never let that landscaper do that. There you go. Well, listen, man, we wish you all the best in that endeavor and um, and and every future endeavor. And hopefully, as we continue to explore this subject, we can get you back on the uh, on our airwaves. And as I said, you are extremely thoughtful and terribly conscientious. And it's been a pleasure to talk to you, man.

• 21:30Speaker 02

  Thank you, guys. I appreciate you giving me the time to share my story.

• 21:34Gary O'Reilly?

  That's Royce White. Time to take a break.

• 21:36Chuck Nice?

  Yeah.

• 21:37Gary O'Reilly?

  And thank you once again to Royce White there for his thoughts, his ideas and his thinking. Welcome back to Playing with Science. Uh, this show, of course, is our mental health show. Um, and we need some experts and we have two. The first is one you're probably familiar with, neuroscientist Heather Berlin, Assistant Professor of Psychiatry at the ICAN School of Medicine at Mount Sinai.

• 22:09Chuck Nice?

  Doctor, how are you? Good. How are you? Oh, doing well, doing well. Thanks. And we're always happy to have you. You on because we learned so much about the brain and the wonder therein. So here's, here's what I'm interested in. We all suffer from anxiety. We all suffer a certain amount of panic at times. We all suffer from phobias. What is it that causes this to be categorized as an illness?

• 22:44Heather Berlin?

  Right.

• 22:45Chuck Nice?

  As opposed, as opposed to just a condition that people experience and then move on with their lives.

• 22:53Heather Berlin?

  Right. So anxiety in general is a normal emotion to have and it's adaptive, right? You know, we've evolved to have this fight or flight response, which is if you see something threatening, you know, it arouses a lot of hormones and neurochemicals and it causes your body to respond and to either freeze or run and avoid that, that harmful stimuli. But when it gets to become a disorder, basically it's when it's the anxiety or the stress or the fear you experience either to a specific stimuli or in general is excessive. It's persistent. It lasts for a very long time. It's out of proportion with the actual trigger or the fear of the anxiety provoking stimuli. And it causes these like avoidance behaviors as well.

• 23:37Heather Berlin?

  So, you know, for example, if you have a fear of flying, it might make sense to have a little bit of anxiety. But if it's so much that you can't even get on a plane or it's out of proportion with the actual risks of flying, you know, that's when it becomes a problem and it interferes with your personal life, your work, your daily activities, your relationships. That's when we consider it a disorder.

• 23:57Gary O'Reilly?

  Interesting you say that. It's been, there are a couple of high profile athletes, one soccer player who did have a fear of flying. And he's based in Europe, in the UK, and they had to drive him to games. If they played in Italy or Germany or Spain, otherwise big, big problem. I'm just wondering now, doctor, we are talking about this condition and it's prevalent throughout possibly 20% of adults in the USA. Can sport exasperate these conditions or is, are there other factors involved?

• 24:34Heather Berlin?

  You know, I think that there's, um, we know, yeah, anxiety disorders in general, like that whole category of disorders, about, yeah, eighteen to twenty percent of the US population, it's the most common, um, form of mental illness. And we know that there's genetic factors involved as well. So basically, you know, we have what's called the stress diathesis model of psychiatric illness, which means you're born in a predisposition, but it will express itself depending on the stressors that you are exposed to. So whether it's high-performance sports, or a really highly demanding job, I don't know, in corporate America, the stress is going to interact with your vulnerability and probably cause a lot of the anxiety disorders to emerge, or the symptoms to emerge. So I don't think

• 25:18Heather Berlin?

  it's particular that the sports itself will bring on an anxiety disorder, I just think those who are vulnerable or predisposed to anxiety, any kind of major stressor is probably going to exacerbate the symptoms.

• 25:32Gary O'Reilly?

  So would you, would you expect it to be more prevalent in an elite athlete, say an NFL quarterback, a defensive lineman, or just, I don't want to say average, but a high school athlete? Or is it all the personal way that you cope or don't cope?

• 25:50Heather Berlin?

  Right. I would say, I mean, I'm not, I don't know what the actual statistics are on this, but I would, um, presume that the prevalence rate is probably going to be about equal, whether they're playing high school sports or professional sports.

• 26:05Gary O'Reilly?

  Right.

• 26:06Heather Berlin?

  What I find with a lot of, um, so I do some neurocognitive testing of, of athletes, high-performance athletes, people in the NFL and the NHL. And what's interesting is I find that they, they perform really well on cognitive tasks, like way better than the average person. So they're, they're above average in many things, but we also know that there, there is sometimes a high comorbidity between, or a co-occurrence between people of high intelligence and anxiety disorders. And these guys, like these football players, I mean, they can do memory tasks like you wouldn't believe, and it makes sense, because they have to remember all the different plays and what they're supposed to do, and it's actually really cognitively demanding. But, so a lot of highly intelligent people tend

• 26:49Heather Berlin?

  to, there tends to be a higher rate of anxiety disorders amongst that population. So with that in mind, it could be that these, um, athletes have a higher prevalence of anxiety disorder than general population.

• 27:00Chuck Nice?

  Hmm. So can you tell us what is going on in the brain? Have we been able to localize or map exactly what the reaction to the brain is? Is it, is it chemical? What exactly is happening in the brain? Is it signaling? What is happening that makes the person become debilitated by something as simple as, "Oh, my God, I cannot go outside," or, "Oh, my God, I can't get on this plane," or something that everybody else finds so simple to do?

• 27:31Heather Berlin?

  Right. So there's, as I said, this general fight or flight response. So basically, what's called the sympathetic nervous system that arouses you when there's a stressor, uh, which is a normal, again, adaptive body response. And so basically, what happens is there's a trigger. Um, let's say, you know, evolutionary speaking, there's like, you see an animal, a tiger, it's threatening. Then the brain releases signals in the amygdala and to the hypothalamus that releases these hormones from the pituitary gland, like ACTH, which is an abbreviation for hormone, that then causes a cortisol response, that then causes increased heart rate, you know, um, shortness of breath, um, all these kind of physiologic reactions.

• 28:13Heather Berlin?

  So that system, that kind of fight or flight response, we really do understand the physiology very well. What happens with anxiety disorders is this response gets triggered to things that are maybe even benign, you know, or randomly triggered. And then they start learning these responses to avoid it. So let's say they randomly had a panic attack and they happen to have been in a mall. Now they're going to start associating fear with going to the mall. And then it leads to these more cognitive, um, kind of associations that in therapy, you have to try to start to break down so that the stress response isn't so easily triggered by normally benign stimuli.

• 28:52Chuck Nice?

  Interesting. So when you say triggers now, I want to phrase this carefully because I don't want to confuse the issue. I'm not speaking of triggers as in the sympathetic nervous system or visual being visually exposed to something or even experiencing. But can these disorders be brought on by other mental health issues such as depression or maybe substance abuse? Or perhaps if you're talking about sports players, the abuse of maybe steroids or what I'm saying is can there be another stimulus other than just your brain itself?

• 29:38Heather Berlin?

  Right. So either, you know, there's genetic predisposition, there's learned behaviors over time and associations. But then there are, there's something actually called substance or medication induced anxiety disorder. Where, yeah, and it's actually a diagnosis where it's anxiety that's due to a substance intoxication or to withdrawal or to a medical treatment. So sometimes these either medications or drugs can trigger an anxiety response. And so as a clinician, you have to be able to differentiate, is it just a person who has an anxiety disorder or is it being triggered by a substance? So that's, that's one issue. Another is with depression. So there's huge, as again, I keep using this word coagulability,

• 30:22Heather Berlin?

  a co-occurrence of depression and anxiety. About 60% of people who have depression also have anxiety and vice versa. And I don't think it's so much that one is triggering the other. I think they have some, they have a lot of underlying, what we call etiology or causes. So for instance, SSRIs or serotonin selective serotonin reuptake inhibitors can treat both depression and anxiety. So when you have something that can treat both, you start to understand the mechanisms related are similar. And that being said, depression can exacerbate anxiety and vice versa. So they don't help each other. But I don't, I don't know that it's that someone who has depression, it triggers the anxiety. I think they just tend to co-occur because they have similar underlying mechanisms.

• 31:06Chuck Nice?

  Gotcha, gotcha. Wow.

• 31:08Gary O'Reilly?

  Okay, it's interesting, doctor. We're talking here about mental conditions in a negative state. And it's obvious that they present and do affect people negatively. Are there some, and I've got one in my mind. Are there any mental health conditions that could actually be beneficial to an athlete or say a coach?

• 31:29Heather Berlin?

  Mm hmm. So what I would say is that in most cases, having a full-blown medical, like psychiatric condition is probably not going to be helpful. Most of the time it's a hindrance. However, there's variation in terms of the severity of the symptoms. So there's something called the Yerkes-Dodson curve, which basically says that in terms of arousal level or anxiety, there's an optimal level of arousal. So you want to have a little bit, let's say about, before you're about to go on the field or something, a little bit of arousal, a little bit of anxiety, because that helps your performance. But it gets like a curve and you hit the optimal point. And then when it's too much, it starts to become a negative.

• 32:12Heather Berlin?

  So, and also like having, you know, like obsessive type traits or attention to detail can be a positive thing, both in like academia, you know, where I'm in, or, or in sports, when you really are focused and determined and motivated and want to get it right and don't like to either get it wrong or be defeated. To an extent, it's the same kind of curve. You're going to have an optimal level of these traits, but once they become too much, they become detrimental.

• 32:37Gary O'Reilly?

  Imagine an athlete had not a far end of the spectrum OCD, but had an element of that. Could that be used as an advantageous part of their abilities? And then say for a coach, because if you've got OCD, attention to detail is your thing and coaches love that.

• 32:56Chuck Nice?

  Uh, better yet, better yet, it's to, to, to further upon Gary's point, which I've never thought about, it's brilliant. It, does that mean if there's a spectrum for all of these disorders?

• 33:09Heather Berlin?

  Mm hmm. Exactly. I mean, they're actually. Um, it's kind of a misnomer, but they're they're called like OCD spectrum disorders. That's the new category of these disorders. But they more mean it's a spectrum of OCD type symptoms, like there's tics and Tourette's and OCD and they're all related. But I would say it's like a dimension, it's a dimension and and you can have, um, let's say obsessive like traits as a personality trait. You can have obsessive personality traits and and a little bit might be helpful for you. Again, anything when it becomes too much, it can become interfere. But you know, you gotta think the type of people that are attracted to these um, fields or or you know, disciplines,

• 33:50Heather Berlin?

  however you wanna call it, are are gonna have certain traits that um, attract them to the sports or to become these these elite athletes. And those traits might involve things like obsessive attention to detail. Um, but again, I don't think that having the disorder is necessarily an advantage. Just having like, being slightly higher on certain traits might be.

• 34:11Chuck Nice?

  Wow, we are already out of time here. Um, but I just wanna ask you one last thing from a scientific standpoint. Royce brought this up, uh, talked about um, the stigma attached to mental illness and why the stigma was um, somewhat silly because of the science involved. Can you give us an education uh, behind like, why and how we look at this medically, clinically, scientifically, as opposed to the way people quote unquote feel about mental illness?

• 34:50Heather Berlin?

  Right, you know, it's important to understand that the brain is an organ like any other, right? So, and I often use this analogy, it's like, if you if you if you get an infection or you know, you're gonna take an antibiotic to treat it. It's a physical problem with a physical solution. You break a leg, you're gonna get the treatment, you need to fix it. If you have, you know, stomach cancer, you're gonna get treatment to fix it. So it's the same thing when the brain is ill, you get a neurochemical imbalance, you have damage, you have problems in the neurocircuitry, it's just another physical problem. But it manifests itself, its symptoms are mental. And because you can't, and because they're subjective in a sense, cuz a person can only tell you how they're feeling or what they're thinking and and you can't objectively see it, um, it gets this stigma as if, oh, that can't,

• 35:35Heather Berlin?

  maybe it's not real, or you know, maybe you're making it up, just like. Physical pain, you can never really know how much pain a person is in. They have to tell you what they're feeling, right? And we have to either believe them or not believe them. But if we can see the blood streaming out of the leg, we'll say, okay, I believe you're in pain. But you can't see, you know, most people can't see inside other's brains. And so it's just what the person is saying. And we see it as a weakness somehow. Like, you know, you should just be able to, you know, buck up and like, oh, you're depressed, just, you know, suck it up and be happy. I mean, when we really understand, have to understand it's the medical condition that needs to be treated that way. And people should not be stigmatized for having a medical condition.

• 36:13Chuck Nice?

  Wow. Well said.

• 36:15Gary O'Reilly?

  Thank you for explaining that. Um, we're sorry to say we're out of time. We've got to get to the break. Um, thank you to Dr. Heather Berlin, Assistant Professor at the ICANN School of Medicine at Mount Sinai. Um, yeah, when we take this break, we're going to come back with Krista Van Slingerland. Now she is the co-founder of Canada's first Centre for Mental Health and Sport, a PhD candidate and researcher in mental health and sports, an athlete herself with no doubt an incredibly interesting point of view. She will be with us when we come back after this break.

• 36:55Gary O'Reilly?

  Welcome back to Playing with Science and our show today, as you are already aware, is a mental health show. We've heard from the athlete's point of view. Now let's speak to the experts, Krista Van Slingerland, co-founder of Canada's first Centre for Mental Health and Sport, researcher in mental health and sports. Krista, welcome to the show.

• 37:20Speaker 04

  Hi guys, thanks for having me.

• 37:22Chuck Nice?

  Well, absolutely. Well, you know, I'm interested to basically know, you were an athlete yourself, right?

• 37:31Speaker 04

  Yeah, I played basketball in university.

• 37:34Chuck Nice?

  Okay. And so how did, what is it that inspired you to make this a concentration? Is it something personal? And if it is too personal, then forgive me. But if, or, or is it just personal experience that you were able to make from an observational standpoint that said, hey, something has to be done. This is an area that needs some attention. Can you give us some insight?

• 37:57Speaker 04

  Yeah, sure. Well, I think it's, it's really all of that. My own experience as a varsity athlete, struggling with mental illness was not well received. Um, I don't think sport or uh at least the team that I played with was really ready to support somebody like that. Um, and certainly the culture wasn't optimal and and sport culture in general can be um detrimental to athletes' mental health. Uh, so I really struggled and I saw a lot of gaps in the care that was available to me as an athlete and in the understanding of coaches, teammates, and just the general public. So I felt really strongly that I needed to speak out and tell my story and since doing

• 38:36Speaker 04

  that, it's become uh the focus of my my life and work and both work and personally. Uh, so I went on to to do a masters and now at the PhD level, uh, I've continued to study this this topic and that's led to the the co-founding of the Canadian Centre for Mental Health and Sport with uh Dr Durand Bush.

• 38:56Gary O'Reilly?

  See, that that's so interesting, Chuck, because from an athlete's point of view, I'm not happy I can't find an environment I'm working in. I will speak out and make people aware. Krista has now gone to the next and possibly the level above that by creating an environment where athletes don't just have to make a point of saying, I have this, please help me. There is somewhere to go. So so Krista, can you explain how you go about or how you went about structuring an environment and what were the key components to ensure there is a nurturing and good environment for athletes?

• 39:38Gary O'Reilly?

  I don't want to say suffer, but have a condition that might be detrimental.

• 39:44Chuck Nice?

  Suffering is probably the perfect word because for a for a lot of people, you're dealing with it on your own. You're dealing with it in isolation. You're dealing with it in fear of being stigmatized. You're dealing with it um not knowing what kind of reception you're going to receive when you come forward and ask for help. And all of these things actually contribute to an environment of suffering. And so when you say someone suffers with mental health issues, I think suffering is the perfect word.

• 40:18Speaker 04

  Yeah, I always tell people that mental illness is more like diabetes than a cold and that you don't really ever get back to your normal state of functioning, but you're in a recovery period. So your life has changed and you live differently, but it doesn't mean you can't optimally function or you'll never be happy. For me, my own depression still kind of cycles and I think of it like a train, that the train comes through and it's gonna pass and it'll probably come around again.

• 40:43Chuck Nice?

  Right, right. What are the percentages, if it is known, I'm not sure if it is, what are the percentages as opposed to the general population of mental health issues with sports and more importantly, high-level athletes?

• 41:02Speaker 04

  So, in general, what we're seeing from limited research is that athletes are experiencing mental health challenges, mental illness more specifically, at at least the same rate as the general population. And in certain sports with certain illnesses, that'll be a bit higher. So, eating disorders are by far the most studied mental illness in the sport context. And that can, that has reached in some studies up to 70% of athlete populations. Now, there is a very big range. And aesthetically-based sports like diving, swimming, ice, figure skating, those are gonna have, or wrestling with weight classes, those are gonna have a higher incidence

• 41:43Speaker 04

  of, of an eating disorder as opposed to something like basketball. We also know that individual sport athletes tend to be, are more likely to be depressed than a team sport athlete, likely due to the, the social support system that a, a team provides. Interestingly, though, the team context also creates a very difficult landscape to navigate when you're the athlete who's suffering from mental illness. So, research, there isn't a ton, and that's one of the things we want to do at the centre, is especially in the Canadian context, create more research in this area.

• 42:19Gary O'Reilly?

  How do you feel that you are only one, I believe, correct me if I'm wrong, you are only one of two centres in the world, the UK and Canada, you being Canada, that have a facility like yours? Why, why are we here in the 21st century looking at just the number two?

• 42:38Speaker 04

  It's a great question. I mean, it's a massive undertaking, especially in the Canadian context because of the way that our healthcare system works. The first is actually in Sweden, and because they have a national healthcare system, it was much easier to set up. We are running into a lot of barriers around provincial regulations and billing, who can see province inter-jurisdictionally, or who can see patients inter-jurisdictionally and things like that. In addition to that, I don't think sport has been ready to address this issue, certainly even in the last five years. So although it's sort of a no-brainer to a lot of us, there are still a lot of other people who are like, "What do you mean, athletes and mental illness?" So it hasn't quite sunk in yet for everyone.

• 43:23Chuck Nice?

  So when you say, it's funny because when you say, "What do you mean, athletes and mental illness?", as I was, you know, kind of studying up on what you guys do, it dawned on me to ask, is it possible that the high level of competition and the fact that children start competing so much younger in a structured competitive environment, is it possible that the sport itself is engendering and promoting mental illness amongst the athletes?

• 44:00Speaker 04

  Yeah, certainly we see a lot more early sports specialization from our, like, young children, and a lot of that's due to parents wanting to be, have the next Olympian or the next NHL player, so they're putting their kids in sports really early. But research shows that early sports specialization has a lot of negative effects, including on mental and psychological health and on the development of youth, their physical literacy and their skills. So early sports specialization definitely has played a role in maybe an increase, I can't say that for sure, but an increase in the mental health challenges we're seeing in athletes.

• 44:43Speaker 04

  Certainly, sport creates a stressful environment. It adds a whole layer of stress that you don't have as a non-athlete. And so if you have a genetic predisposition to have a mental illness, that stressful environment can be a trigger for a psychological concern or will exacerbate something that's already there.

• 45:03Gary O'Reilly?

  It's interesting, Krista, that you say that because with young athletes that go into elite organisations, be it an NFL or soccer or basketball or baseball, they will have physical screening to assess anything that might present later on in their career or whatever. But how far are we away from addressing the mental issue about being able to identify, seeing, as you say, they might be predisposed by their own genealogy to have some kind of condition? How far do you think we're away from seeing that become an integral part?

• 45:42Speaker 04

  I mean, certainly, we have the tools now to screen for mental health challenges as athletes are coming into programs or institutions. It's just not recognised universally that an athlete's wellbeing and performance is not only linked to their physical health, but also to their mental health. So people could implement these procedures tomorrow. Whether they're going to or not has a lot to do about mental health literacy and awareness that we just haven't reached yet in the sport community.

• 46:12Chuck Nice?

  Wow. So, speaking of that, because we've got about two minutes left, and God, we could talk to you all day on this.

• 46:18Gary O'Reilly?

  We could, by the way, yes.

• 46:19Chuck Nice?

  It's amazing how expansive this topic is and how esoteric it is because there's so many people that really need to be educated about mental health. And it really is health. It's about mental health. It's, you know, at some point, we have to divorce ourselves from the conversation of just like, you know, "Oh, that dude is crazy." Or, you know, that whole thing, like, you know. But, you know, what I want to ask is if you know that you see someone that may need help, is someone who's exhibiting some signs that says, "Hey, red flag of any sort," what is

• 47:00Chuck Nice?

  the best way to encourage, direct, or steer that person towards the help that they need?

• 47:10Speaker 04

  Uh, well, a few things. First, I'd, I'd want people to know that what they're looking for is significant changes in the way that people are functioning, whether it be weight loss or changes in their behavior. Over about a two-week period or sustained over a two-week period. And then it really depends if the person is a minor or an adult. Um, in a youth sports setting, say you're the coach. I would first always speak to the athlete because there are things that are, mental health is very private for some people. They may not be ready to disclose that to a parent or um, loved one. So speak to them first and, and sort of ask permission. Um, if it is a child, then you may want to get a parent involved. Uh, if it's an adult, uh, I would just

• 47:54Speaker 04

  can not confront the person, but have an honest conversation and say, these are the things that I've noticed about you lately. Are you doing okay? And just be bold enough to ask that question. Are you doing all right? Because you, no, I was just gonna say that you'll, you'll regret not asking.

• 48:11Chuck Nice?

  Yeah, that's a great question. It's so simple. Like, uh, you don't even think about it. You know, hey, are you doing okay? Not, cause here's what we do and we're so used to this. Hey, how you doing? Oh, I'm good. And that's it. You know, we say it as a greeting, not as an actual question. And so you're saying, take that greeting and turn it into an actual question. Hey, are you doing okay? Like, you know, you, you want to talk to me? Are you, is everything all right? Are you doing okay? That's a, that's so simple that I, that I can't believe. It's so simple.

• 48:50Speaker 04

  And adding those specific behaviors will make it easier for the person to talk about it because like, are you doing okay is such a broad blanket question, but if you name specific things, then they can address those in their response to you.

• 49:03Chuck Nice?

  Right, exactly, right. Yeah, yeah, no, that that makes perfect sense. It's like you're identifying the change in behavior, you're identifying what seems to be problematic in the person's life, and then you're addressing that while expressing concern and saying, "Hey, are you doing okay?" I mean, I can't believe how fricking simple that is.

• 49:26Gary O'Reilly?

  Keep it simple, stupid. Oh, yeah, the KISS method. Absolutely. Sometimes it is the best way of dealing with things. Krista Van Slingerland, thank you so much for your time and for opening Chuck's mind to the simplicity of life. Krista Van Slingerland, the co-founder of Canada's first centre for mental health and sport. Thank you so much. Well, that's it, Chuck. That's our mental health show. Thank you to Royce White, professional basketball player and a man who looks like he's going into mixed martial arts, and of course, the Dr. Heather Berlin, and of course, Krista Van Slingerland. Hopefully, it has been thought-provoking.

• 50:07Gary O'Reilly?

  Hopefully, we have been able to open your mind to aspects of mental health that you weren't quite aware of. I think I'm in that last part, most definitely. From Chuck and I, this has been Playing with Science. Thank you so much for listening. We look forward to your company very, very soon.