StarTalk Radio - #ICYMI - Mental Health in Sports, with Royce White

Episode Date: November 1, 2018

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. Subscribe to SiriusXM Podcasts+ on Apple Podcasts to listen to new episodes ad-free and a whole week early.

I'm Gary O'Reilly and I'm Chuck Nice 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 realize 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. 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. 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. Former NBA first round draft pick. So you know what? Coming out of college, that's going to be someone special. That's right. 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.

That's right. 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. So, Royce, welcome to the show, sir. Thanks for being here. Thanks for having me, guys. Appreciate it.

Oh, you're welcome. 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. 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. But in a more proximal and 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 is extremely, the excitement around Anthony Davis and his extreme talent and attributes was the mystery of where I would be drafted 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, et cetera, 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 the people inside the league are the only ones involved in that conversation besides what makes its way out onto the Internet for the public 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 GMs were saying in regards to how they felt anxiety was a risk and how mental health was, you know, more so unknown. 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, time to start the season, I went to my team and I asked, what's the mental health policy? What's the program? 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 Hopkins High School here in Minnesota, which both were very progressive environments in terms of the way that they viewed mental health. And again, as a rookie, I had no clue really what the answer

was going to be. I mean, I'm fresh out of water, so to speak, and coming into an entirely new corporation that has a 50 plus year history 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, which is something that blossomed from here in Minnesota from the late Senator Paul Wellstone, which which creates parity, which which demanded that the insurance companies view mental health in the same way that they do physical injury and insuring people. And Senator Wellstone was the champion of that of that legislation.

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

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 in an environment that had totally dismissed the validity of mental health as a field and as a science. Had they dismissed it or had they not even considered it to be an issue? Well, 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 through the claim of ignorance. Yeah.

You know, and I think most of, I won't say most of, I'd say a considerable amount of the ignorance is willful. Yes. 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, however, let me just say that, you know, you have two advocates here in me and Gary. I mean, it's I have to say, 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. movement, things didn't probably work out for you as well as they could have, because whenever you're the first, you normally suffer. Is that kind of how it went down? Well, so I'll tell you.

So again, just to tail off the end of the first part of my story. So we asked for there to be a parity between physical health and mental health. And they said no to that. So now we were left in a place where we had no language in our collective bargain agreement, our uniform player contract that related to mental health at all. 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. Wow. And, 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. Right. Was that they were worried that players would be able to fake it. Yep. I know it.

Let me tell you something. That's pretty consistent throughout most of corporate America. It's just such a pseudoscientific approach. It's ridiculous. You know, because 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 how it works when it becomes more of a business you know via 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, 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 is going to tell you to go run a sprint. And when you get done, they're going to ask you how does it feel how do you feel at that point you have no more of a chance to fake mental to fake a physical injury then you you would have no more of a chance to fake a mental illness than you would a physical injury at that point right 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 we'll disagree or agree. I never once met a player who would fake a mental illness 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. I completely agree with you, and'm depressed, I can't play today. That's, no, I don't feel it.

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 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 more so than that, I thought it was just absolutely reprehensible that there would even be a suggestion or connotation that the best athletes in the world would, when they get a chance to, find a way to coward 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 myself have questioned teammates and the validity of their injury and probably in an ignorant fashion. But ultimately, 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 under supported, then the potentiality or the risk of them faking the illness. Yeah. So let's say a guy fakes anxiety. OK, 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? Right. Or are we versus him sit in the game because he, you know, and he exaggerated the anxiety symptoms. I think right now, first of all, everything you said is absolutely correct. There's another dynamic at play here too. Um, and let me just say full disclosure. Um, I suffer from a form of anxiety. Uh, did not even know I had it until recently. I am currently in therapy.

It's difficult. And I didn't understand what was happening to me, to be honest, because I've gone my whole life. And I didn't realize that there was something wrong with me. didn't realize that there was something wrong with me. I honestly felt like this is just something that... This is what people do. This is what people deal with. This is what people deal with. That's how I felt.

I'm no different to anyone else. This is what other guys are going through. And so the idea of, and I grew up in a time where, get over it. All right? Man up. All right? a time where get over it yeah all right man up all right uh buck up right yep 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 a there's a main reason why you never see a player fake mental illness and 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, 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. That doesn't need it.

That doesn't need it. That doesn't need it. That doesn't need it. Nobody's doing that. So, you know. So, go ahead. The thing is, Royce. It's an absurd. It was an absurd claim that was made haphazardly out of reaction of the fear of the change of the system that was going to ensue if they acknowledge this issue. Wow. ensue if they acknowledge this issue. And to move the story further along,

the mental health issue in the NBA was never really about the way that they viewed this issue. They've hidden behind the stigma that the entire world faces around regarding the mental health issue. 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 through 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 that get help. Meanwhile, Commissioner Adam Silver is admitting that there is a stigma that he can't guarantee won't factor into their free agency. See, that's a fundamental incentive to actually be open and honest about anxiety or mental health struggles. I mean, if we look at other players that have followed you,

likes a 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? you feel about the way they were treated as opposed to the way you were treated you know we're we're in two totally different echelons or categories of player we share a common struggle as does the entire human species um in terms of our our struggle in the way that it was presented to the NBA is two totally different situations you know two players that had uh you know veteran career status um had had all-star uh level accomplishments and accolades um had some security there had some you could say individual leverage there yeah um and and versus myself a player who came in immediately saw the issue and and said that the the urgency of the issue was long overdue and that it

couldn't wait another nine years. You know, so, you know, DeMar DeRozan has 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, after the need, after the need. Yeah, interesting. Well, you know, and with that being said, I mean... See, I don't believe in better late than never. I don't believe in that. I, you know, I've been reading Heidegger's Being in Time lately, whether that's a peaceful world, whether that's a world where people are adequately cared for. world whether that's a world where people are are adequately cared for um 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 who's the who's the giants wide receiver brash brandon

marshall uh brandon marshall's a running back uh new york giants n player. He said mental health issues will be the human rights movement of now, of today. 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. You would physically screen an elite athlete that was at the beginning, 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? 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.

Okay. You know, so I think that it's important to, I think it's important to broaden the scope of mental health to a place where we don't understand it as anxiety or depression or PTSD, where we understand it as the way that people think, feel, and interact. And it's another word, another term for the human condition. 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. Absolutely. 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. Exactly. You're placing them in great peril because what you're doing is you're arming owners with ammunition to use against them. Which is why I asked the question. And this goes back to what you were doing, 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, 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. Well, and you guys will appreciate this because it's not even so much that we're going to make the choice not to look at you 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.

Yes, Yes. Yeah. So it's not just it's not just you're not going to decide 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. 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, you know, hire a lawn guy to do it that had no electrician training. You know what you just did? Not only is it not only is he not going to do the job right, he's going to it's dangerous.

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 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 our airwaves. And as I said, you are extremely thoughtful and terribly conscientious.

And it's been a pleasure to talk to you, man. Thank you, guys. I appreciate you giving me the time to share my story. That's Royce White. Time to take a break. And thank you once again to Royce White there for his thoughts, his ideas, and his thinking. therefore his thoughts, his ideas, and his thinking. Welcome back to Playing With Science.

This show, of course, is our mental health show. 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 Icahn School of Medicine at Mount Sinai. Doctor, how are you? Good, how are you? Oh, doing well, doing well, thanks. And we're always happy to have you on because we learn so much about the brain and the wonder therein. So 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? Right. As opposed to just a condition that people experience and then move on with their lives. 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 or the, um, anxiety provoking stimuli. Um, and it causes these like avoidance behaviors as well. 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. It interferes with your personal life, your work, your daily activities, your relationships. That's when we consider it a disorder. Interesting you say that. It's been there are a couple of high profile athletes, one a 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 are there other factors involved? You know, I think that there's, we know, yeah, anxiety disorders in general, like that whole category of disorders, about, yeah, 18 to 20% of the US population. It's the most common 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 the 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 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. So 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? 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? Right. I would say, I mean, I'm not, I don't know what the actual statistics are on this, but I would resume that the prevalence rate is probably going to be about equal, whether they're playing high school sports or professional sports.

What I find with a lot of, so I do some neurocognitive testing of athletes, high performance athletes, people in the NFL and the NHL. And what's interesting is I find that they perform really well on cognitive tasks, like way better than the average person. So they're above average in many things. But we also know that 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 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 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 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? Right. So there's this general fight or flight response.

So basically what's called a sympathetic nervous system that arouses you when there's a stressor, which is a normal, again, adaptive body response. And so basically what happens is there's a trigger. Let's say, you know, evolution speaking, there's like you see an animal a tiger it's threatening then the brain releases the signals in the amygdala and into the hypothalamus that releases these hormones um from the pituitary gland like acth which is an abbreviation for a 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 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. 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 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? 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, um, with depression. So there's huge, as again, I keep using this word comorbidity, 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 a lot of underlying, what we call etiology or causes. So for instance, SSRIs or 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 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. Gotcha. Gotcha. Wow. 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 so what i would say is that in most cases having a full-blown medical like you know psychiatric condition is probably not going to be helpful most of the time it's a hindrance um 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 before you're about to go over in 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. So, and also like having, you know, like obsessive type traits or attention to detail, um, 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 imagine an athlete had not a far end of the spectrum ocd but had an element of, 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. And better yet, better yet, it's to further upon Gary's point, which I've never thought about. It's brilliant. Does that mean if there's a spectrum for all of these disorders? Exactly. I mean, they're actually, it's kind of a misnomer, but 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 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 dimensional, it's a dimension. And, and you can have, 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 got to think the type of people that are attracted to these fields, or, you know, disciplines, however you want to call it, are going to have certain traits that attract them to the sports or to become these, these elite athletes. And those traits might involve things like obsessive attention to detail. 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. Wow. We are already out of time here. But I just want to ask you one last thing from a scientific standpoint. Royce brought this up, talked about the stigma attached to mental illness and why the stigma was somewhat silly because of the science involved. Can you give us an education behind why and how we look at this medically, clinically, scientifically, as opposed to the way people quote unquote feel about mental illness. 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 get an infection or, you know, you're going to take an antibiotic to treat it it's a physical problem

with the physical solution you break a leg you're going to get the treatment you need to fix it if you have you know stomach cancer you're going to 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, and because they're subjective in a sense, because a person can only tell you how they're feeling or what they're thinking, and you can't objectively see it, it gets this stigma as if, oh, that can't, 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 others' 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, we really have to understand it's, you know, suck it up and be happy. I mean, when we really 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. Wow. Well said. Thank you for explaining that. We're sorry to say we're out of time. We've got to get to the break. 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 center 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. 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 Slingeland, co-founder of Canada's first Centre for Mental Health and Sport, researcher in mental health and sports. Krista, welcome to the show. Hi, guys. Thanks for having me. show. Hi guys, thanks for having me. Oh, absolutely. Well, you know, I'm interested to basically know, you were an athlete yourself, right? Yeah, I played basketball in university.

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 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? Yeah, sure. Well, I think it's really all of that. My own experience as a varsity athlete, struggling with mental illness was not well received. I don't think sport or at least the team that I played with was really ready to support somebody like that and certainly the culture wasn't optimal and sport culture in general can be detrimental

to athletes mental health. 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 that it's become the focus of my my life and work and both work and personally so I went on to to do a master's and now at the PhD level 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 Dr. Duran Bush. See that that's so interesting Chuck because from an athlete's point of view I'm 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 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? I don't want to say suffer, but have a condition that might be detrimental. Suffering is probably the perfect word because 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 not knowing what kind of reception you're going to receive when you come forward and ask for help.

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. 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 going to pass and it'll probably come around again. 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? high-level athletes? 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 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 going to have a wrestling with weight classes. Those are going to have a higher incidence 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 social support system that 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 center is, especially in the Canadian context, create more research in this area. 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 are we here

in the 21st century looking at just the number two? 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. So when you say, it's funny because when you say, what do you mean athletes and mental illness. So it hasn't quite sunk in yet for everyone. 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, 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? Yeah, certainly we see a lot more early sports specialization from our young children.

And a lot of that's due to parents wanting to 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. it certainly sport creates a stressful environment and 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. It's interesting, Krista, that you say that because with young athletes that go into elite organizations, be it an NFL or a soccer or basketball or baseball, they will have physical screening to assess anything that might present later on in their career or whatever. how 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 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 recognized universally that an athlete's well-being 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. Wow. So speaking of that, because we've got about two minutes left, and God, we could talk to you all day on this. We could, by the way. 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 ourself 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 the best way to encourage, direct, or steer that person towards the help that they need? Well, a few things. First, 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. 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. In a youth sport 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 loved one. So speak to them first and sort of ask permission.

If it is a child, then you may want to get a parent involved. If it's an adult, I would just 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 know, I was just going to say that you'll, you'll regret not asking. Yeah. That's a great question. It's so simple. Like you don't even think about it, you know, hey, are you doing okay? Not because here's what we do. And we're so used to this. Hey,

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 want to talk to me? Are you, is everything all right? Are you doing okay? That's a, that's so simple that I can't believe it's so simple. And adding those specific behaviors will make it easier for the person to talk about it because like, are you doing okay? It's such a broad blanket question, but if you name specific things, then they can address those in their response to you. Right. Exactly. Right. Yeah. Yeah. No, 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 freaking simple that is. 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 Slingeland, 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 Slingeland. Hopefully, it has been thought-provoking. 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.