LED BY PLAYERS SUCH AS IAN SNELL, BASEBALL IS TAKING THE LEAD IN PRO SPORTS IN ADDRESSING DEPRESSION, ANXIETY AND OTHER MENTAL HEALTH PROBLEMS
This is an article from the June 21, 2010 issue
Do it, he thought. Just do it already, and be at peace. As the clock struck midnight on April 30, 2009, Ian Snell, the onetime ace of the Pirates, was still brooding in the shower of his apartment outside Pittsburgh. Hours had passed since he'd arrived home from an afternoon game in Milwaukee, an agonizing 1--0 loss in which he'd thrown 131 pitches in seven innings, a career high, but yielded the game-winning home run to opposing starter Yovani Gallardo. Now, standing beneath the spray of hot water—his body exhausted but his pulse racing—the 27-year-old Snell wanted to end his life.
Kill yourself, he thought. Get it over with, and you won't have to deal with this anymore.
This, of course, had been building for far longer than one afternoon. For months Snell had been reliving the anger he'd struggled with since his senior year at Caesar Rodney High just outside of Dover, Del., when he was always "ready to flip at little, stupid things," he says, "ready to fight whoever said something" about him; the frustration of making dumb mistakes in the majors as he tried to compensate for missing out on the college social experience by partying at bars (a couple of times the married Snell had wound up on sports blogs, photographed posing with girls); and the stress of difficulties in his relationship with his wife, Angelica. "I was not respecting other people," Snell admits. "My family, friends, parents."
Worst of all, Snell could not forget what he kept hearing and reading in Pittsburgh: the boos from the stands and the cruel insults online going back to the previous season, when he went 7--12 with a 5.42 ERA. Once the Pirates' minor league pitcher of the year, Snell was now a figure of ridicule. You can find out where these guys live, he would think in a fury, even if they just have some secret name on the Internet.
The loss to the Brewers was a match flickering near all this tinder. Snell felt unbearably alone. Should I just do it? he thought again.
"It was a juggling back and forth, like the angel versus the demon," Snell says. "I felt like I was going to have a heart attack." So he turned the shower dial from hot to cold, trying to cool off, trying to douse a million burning questions: If a player messes up, why does everyone automatically think he's a bad person? Do parents even want me to say hi to their kids and give them high fives? Why am I always being singled out?
And: Is the world better without me?
Snell had no answers, but he did have strength enough to drag himself out of the bathroom and find distractions: He flicked on the TV, paged through a stack of magazines, opened the Bible. Having grown up without his biological father, whose surname he stopped using as a minor leaguer, Snell thought about what it would mean to leave behind his five-year-old son, Ethan. Finally he reached for his phone. "I had to explain to my family, my friends, 'This is what I was going to do.'"
One of his first calls was to a Marine named Mike Crump, Snell's lifelong best friend, back in Delaware. Crump, all too familiar with the military's struggle with mental health issues, "knew where I was coming from," Snell says. "I told him I was having these anxiety attacks and depressed moments, that nobody was there for me." Crump told him, "Your family loves you and is always here for you. If you need me there, I'll be there." And he reminded Snell of an essential truth: "Baseball is just a job."
As intensely personal as Snell's anguish was, he was not, as he feared, alone. Not even at work. Major league baseball, the country's oldest professional team sport and a longtime fortress against psychiatry, has recently taken giant steps to openly acknowledge players with emotional problems and give them the time and resources to deal with those issues. The NFL, NBA and NHL each have had notable cases—from the social anxiety of Dolphins tailback Ricky Williams to the clinical depression of Cavaliers guard Delonte West and former Canadiens winger Stéphane Richer—but baseball has led the way in supporting a growing number of players who have been brave enough to seek assistance for such problems and speak out about them. "Baseball's older generations like to say, 'Guys these days just aren't as tough,'" says Ray Karesky, a licensed psychologist who has directed the Oakland A's Employee Assistance Program (EAP) since 1984. "But what's different is just that guys have come out and actually admitted their problems."
Such men vary in star power, from Snell, who now pitches for the Mariners; to reigning American League Cy Young winner Zack Greinke of the Royals, who has admitted to suffering from social anxiety disorder and clinical depression; to Mariners outfielder Milton Bradley, who asked Seattle manager Don Wakamatsu and general manager Jack Zduriencik for help with his emotional problems on May 5. The day before, Bradley had abruptly left Safeco Field during a game against the Rays after he had an emotional flare-up following a strikeout and was benched by Wakamatsu. "He's going through some very personal and very emotional things in his life right now," Zduriencik told reporters. "But the fact that he has stood up and asked for us to help him is an extremely important step for him."
Bradley, who subsequently spent two weeks on the restricted list as he underwent counseling for what he has called "stressors, unpleasant thoughts and feelings I've been having," was following a precedent set last year, when five major leaguers were placed on the disabled list for emotional disorders—the first "mental DLs" since Greinke missed most of the '06 season. It was the largest total for any single season in baseball history and one more than the number for all other seasons in this decade combined. The players were then Tigers pitcher Dontrelle Willis (anxiety disorder); Oakland starter Justin Duchscherer (clinical depression); then Cardinals shortstop Khalil Greene (social anxiety disorder); then Diamondbacks reliever Scott Schoeneweis (clinical depression); and Reds first baseman Joey Votto ("stress-related issues" later revealed to be severe depression and anxiety attacks, which twice led to hospitalization last summer). "I really hadn't acknowledged how important it is to express the things I'd been dealing with on the inside," Votto said last June. "[The Reds] surprised me with how supportive they are."
This number isn't anywhere close to those reported for the general population—the National Institute of Mental Health estimates that 26.2% of Americans ages 18 and older suffer from a diagnosable mental disorder in any given year—but for baseball it represents a sea change: Between 1972 and '91 the grand total of mental DLs in the major leagues was zero. "The simple fact is, the macho world of professional baseball refused to recognize emotional weakness," Marvin Miller, the former executive director of the players' association, wrote in his 1991 autobiography, A Whole Different Ball Game. "Not only were baseball executives prejudiced against players with emotional problems, they pretended this didn't exist."
And it wasn't only players with obvious emotional problems—such as Red Sox outfielder Jimmy Piersall, whose battle with bipolar disorder was immortalized in the 1957 film Fear Strikes Out—who were obliged to suffer in silence. "If [any] guy had a mental issue before, you'd just say, 'Get him out of here, the guy's nuts,'" says Stan Conte, the Dodgers' head trainer and director of medical services. "Now we try to look at it more objectively. We don't just throw him away."
A new protocol had been affirmed on April 1, 2009, three days after Willis gave reporters a rambling disquisition on his anxiety-disorder diagnosis. ("This is not depression, this is something totally different. ... I'm not crazy, though my teammates might think that I'm crazy.") Daniel R. Halem, baseball's senior VP and general counsel for labor, sent a confidential memo to each of the 30 teams spelling out disabled-list regulations. The letter, a copy of which has been obtained by SI, stated that for players to be put on the DL for emotional disorders, they "must be evaluated and diagnosed by a qualified mental health professional as suffering from a mental disability that prevents a player from rendering services."
Detroit again placed Willis on the DL with an anxiety disorder that June, and every other mental DL in 2009 occurred after the rules were reinforced by Halem, which further suggests a cultural shift in the nation's pastime. "After the whole Willis situation I'd figured that players would be pretty fearful about coming out, and that there wouldn't be so many publicized diagnoses," says one team official who had seen the memo in April. "But there were."
Perhaps the official shouldn't have been surprised. Baseball, after all, might be the team sport that puts the most mental stress on players. As Brewers pitching coach Rick Peterson puts it, "How many apples had to fall off the tree before someone said, 'That's gravity'?"
The apple first landed on Mark Shapiro about 15 years ago. While working in Cleveland's player-development system in the mid-'90s, Shapiro, now the executive vice president and general manager of the Indians, saw something curious: Outside the elite of the elite, 90% to 95% of players at the Double A level had comparable physical skills. The better players' competitive advantage came mostly from something intangible. "At least in baseball," Shapiro says, "the mental side is what allows you to bridge the gap between potential and performance." It turns out that Yogi Berra, who once calculated that "90 percent of the game is half mental," had something of a point.
While every human being reacts differently to mental and emotional obstacles—and every profession brings its own difficulties—a potent bundle of stressors threaten a major leaguer's mind:
• Rate of failure. Start with the sheer difficulty of trying to connect with a spheroid less than three inches in diameter that's moving at 95 mph. Now add tens of thousands of people watching. "The greatest pure athletes on the face of the earth are in basketball and soccer, but the single most difficult skill in sports is hitting a baseball," says Tom House, a Ph.D. in psychology who coaches pitchers at USC and once did the same for the Rangers, Astros and Padres. The game is less about exertion than precision, and a great success rate for a hitter involves failing at his job seven times out of ten. Similarly, the difference between a mediocre and a great pitcher is a matter of mere inches, as became painfully clear when former Pirates All-Star Steve Blass inexplicably lost his ability to throw strikes. Blass had a 9.85 ERA in the 1973 season, one year after he finished second in the Cy Young race, without a trace of injury or fatigue.
• Time to think. Pitchers and hitters alike have an enormous amount of time to sit and stew in their mistakes. For many—such as Snell—the stretches of idleness can be torturous. "God wanted to give males something to do to keep them occupied and make them crazy, other than war, [and] he came up with baseball," says Karesky, who has counseled Vietnam vets and firemen, is EAP director for the Blue Jays and the Padres, and works with the Diamondbacks. "So much time to think is likely to produce problems, especially if you're a perfectionist." Indeed, studies by University of Chicago psychology professor Sian L. Beilock suggest a correlation between increased conscious thought and choking under pressure—something that has long been obvious to major leaguers. (As Giants pitcher Barry Zito sums it up, "Sometimes it's better just to go out there and be ignorant.")
• Solitude. Baseball players have 81 away games in a season; travel-weary NBA players have 82 games, period. Thus baseball players' personal support structures—whether friends or relatives or a church group—aren't nearby for at least half of the most stressful time of year. "Most people get stability from the families they go home to every night," says Karesky. "That's not the world of baseball." Because teams are away so much, a player on injury rehab, a fertile time for depression in any occupation, is isolated even from his teammates. Duchscherer, whom Karesky treated, felt his depression surge while recovering from arthroscopic surgery on his elbow. "[Players are] cut off from the team, worrying about their careers, scared of losing their positions," says professor Ronald Smith, director of the University of Washington's clinical psychology training program and a former counselor for the Astros and the Mariners.
But the specific provenance of a disorder, whether it's on the field (a drawn-out slump, say) or off it (an unexpected death, like that of Votto's father, Joe, in 2008), may not even matter. Emotions tend to spill over into every area of a player's life. "It's one tank," says David R. McDuff, professor of psychiatry at Maryland's medical school and team psychiatrist for the Orioles and the Ravens. "We can artificially break it down, but there's no actual partitioning in the mind." A player's skills are at the mercy of his emotional condition, but as Bradley discovered, the reverse can also be true. "An athlete's self concept is so anchored to his ability to do these wonderful things on a field," says Smith. "I've seen problems develop in well-functioning people with no prior issues. Then they have to deal with constant questions, booing. It's a pressure cooker."
Asking for help has never been easy, either. In the mid-'90s Bill Pulsipher, then a top pitching prospect for the Mets, tried to convince team management that his loss of control—a recurring baseball mystery known by names such as the Creature and White Line Fever and, yes, Steve Blass Disease—had metastasized into a larger, all-encompassing illness, only to have the conversation keep returning to his mechanics. "They showed me my delivery in a 30-picture sequence," says Pulsipher, who would eventually be diagnosed with general anxiety disorder and clinical depression. "I'm going, 'You guys aren't listening to what I'm saying.'"
Blass, now 68, believes he suffered from undiagnosed performance anxiety. "I can say anxiety now," he says. "Back in the day there was a stigma. There were a lot of issues that guys never revealed." He relates his own stories of emotional torture: nights like the one following a terrible relief appearance on the road against Atlanta when he walked the streets for hours, as aimless as one of his sliders. "I was devastated," says Blass. "I had begun feeling very, very alone."
In the late 1980s a researcher at the University of Southern Maine named Loren Coleman studied the suicide patterns of MLB players—77 current or former big leaguers had taken their own lives, more than half of them between their late 20s and late 40s—and called for an improved counseling program for retirees. The recommendation resonated loudly on July 18, 1989, when Angels reliever Donnie Moore, 35, shot his wife (who survived) and killed himself at their home. Moore, a former All-Star who had been released from Triple A the previous month, had given up a series-turning homer to the Red Sox' Dave Henderson in the top of the ninth inning in Game 5 of the 1986 ALCS. Friends say that Moore was forever haunted by that one pitch.
More than a year after his bout with suicidal thoughts, and more than two decades after Moore took his own life, Snell has yet to seek professional counseling or therapy. But after a team win last June, he tried something that was brave in its own right. Snell, whose ERA had jumped from 3.72 to 5.36 in the eight weeks since that heartbreaking loss in Milwaukee, asked Pirates G.M. Neal Huntington to send him down to Triple A for the good of "this team, my career, and me, so I don't harm myself or do anything stupid." Huntington obliged. Fans seemed skeptical or baffled. In his first start for the Indianapolis Indians, the pitcher struck out 17 Toledo Mud Hens, including 13 in a row. "It was a big weight off my shoulders," says Snell, who would welcome being traded to the Mariners that July. "I could finally enjoy the game."
One day three years ago at the Royals' spring training facility in Surprise, Ariz., Mike Sweeney was hanging around the weight room when Kansas City G.M. Dayton Moore quietly approached with a question. "There was a deal on the table for a high-profile shortstop that another team wanted to trade, straight up, for Zack Greinke," Sweeney says. The shortstop may not have been a future Hall of Famer, but he had, in Sweeney's words, a "huge upside." So Moore asked his veteran first baseman, "Would you do it?"
The facts: Greinke, then 23, was a prized prospect whose ERA had been trending in the wrong direction (3.97 in '04, 5.80 in '05). He had thrown only 61/3 major league innings in '06, in relief. And—most troubling—Greinke had spent months on the DL that year with a mental illness.
Sweeney's answer: "Heck, no," he recalls with a chuckle.
As vital as Greinke would become to Kansas City, his success had a more profound effect on baseball culture. "I hate to make this comparison, but Zack was like Jackie Robinson," says Sweeney, now a teammate and friend of both Snell and Bradley in Seattle. "Whether he likes it or not, he's the guy who really paved the way for the modern player to come out about these types of issues."
The introverted Greinke, who credits therapy sessions and antidepressants for his recovery, proved that emotional disorders are treatable injuries. And in confirming that therapy patients can increase in market value, Greinke helped push players' attitudes about mental health closer to the increasingly open-minded views of the rest of the country. Before his treatment Greinke was so consumed by nervousness and anger that he punished himself by overtraining; he would work out, by his estimation, 90% of his waking hours. "The medicine is unbelievable," Greinke said this spring. "I'm still the same person, but my attitude about everything is different."
"Zack Greinke is the perfect example for players today," Pulsipher says. "I mean, if you can talk to someone about your issue, and that fixes you? Or take a pill once a day for 10 years? Why wouldn't you do that?"
Old-timers like Blass consider that rhetorical question even today. "If I was playing now," Blass says, "I'd haul my butt up to Harvard Medical School and just say, 'Here I am. Fix me.'"
But if Blass were to go to a research university for extensive brain imaging, he'd find that emotional disorders are not entirely biological or chemical: Everything from genetics to social pressures can act as triggers, and in unclear ways. "We don't have reliable diagnostic, objective tests for any emotional disorder at this point," says Franklin Schneier, a professor of psychiatry at Columbia and a leading researcher into anxiety. "There's no doubt that there's something different going on in the brain—the fMRIs of those with social anxiety disorder can reveal differences in the activation of fear circuitry—but even if you cut a head open, you couldn't definitively tell. There's not one smoking gun."
Indeed, the 886-page fourth edition of the Diagnostic and Statistical Manual of Mental Disorders is premised on the reporting of symptoms and observation of the distress they cause. Many illnesses date back to childhood (such as Khalil Greene's), but others come to the fore only in adulthood (such as Scott Schoeneweis's depression, which was set off by the sudden death of his wife, Gabrielle, in May 2009). "We would love to have hard and fast rules," says professor Stefan G. Hofmann, director of the Psychotherapy and Emotion Research Laboratory at BU, "but such disorders really can happen at any time." Making matters still more complicated, there is no blood test or X-ray that a player can produce to verify his suffering.
The background of one man in particular hints at the difficulty of bridging the gap between the clinic and the clubhouse. Harvey Dorfman, the godfather of mental coaching and the co-author, with Karl Kuehl, of The Mental Game of Baseball (1989), remembers being asked not to stay in the same hotels as the major leaguers he was summoned to counsel. But for all the deserved plaudits he has received for his work in baseball—All-Stars such as Alex Rodriguez and Roy Halladay say he helped save their careers—Dorfman isn't a trained clinical psychologist. He has a master's degree in education and took some courses in psychology, but he was a high school teacher and a freelance journalist for 27 years before he began seeing players with the A's in the '80s. "When I started, there were no graduate courses in sports psychology," says Dorfman, who has also worked for the Marlins and the Rays and is now employed by agent Scott Boras. "I laugh at the guys who are wannabes—people who may get the degree but don't know the game or how to talk to athletes."
The question, then, has been how to elevate the field professionally—and get rid of some of the game's oldest rituals, such as the shot (or two) of vodka that former Mets team psychiatrist Allan Lans often saw players take to deal with stress—without alienating potential patients. "I'm a big believer in credentials," says Conte, who estimates that he receives a résumé from a non-Ph.D. claiming psychological expertise every two weeks during the season. "It does comfort me that there are now more true psychologists and psychiatrists out there."
The biggest step toward striking the right balance was the establishment of the EAP regime by the commissioner's office in 1981. Every team must have a program to deal with the personal issues of players, either directly or through referrals to outside experts. At first the program primarily addressed problems of substance abuse—that's why Karesky was plucked from St. Luke's Hospital in Phoenix by then Oakland executives Sandy Alderson and Kuehl—but now EAP reps from each major league franchise meet twice a year to discuss a greater range of issues, including mental health.
Best practices have emerged. As the Orioles' McDuff noted in a 2005 article for the journal Clinics in Sports Medicine, "dramatically [increasing]" EAP usage rates depended on the regular presence of an EAP staffer at the ballpark, as well as collaboration with the team's physicians, strength and conditioning staff and—crucially—trainers. In Baltimore the EAP usage rate among players had risen from 10% in 1996 to an average of nearly 40% from 1999 to 2004, the early years of the current cultural shift.
"I go into a clubhouse two or three times a home stand, arriving at 3 p.m. for a 7 p.m. game," says McDuff, a doctor who served 28 years in the military, in the gulf war, Syria, Pakistan and Egypt. At the request of the majority of his players, McDuff, whose offices are a two-block walk from Camden Yards, has sensitive conversations with them right in the clubhouse. "That was a surprise," he says, "but there's a convenience and comfort there for them. I won't suggest they lie down on the couch.
"In the Army we called it 'care by walking around,'" says McDuff, whose players call him Doc. "Patients first need to experience you as a communicator with common sense and practical experience—not as overly psychological or mystical."
Adds Karesky, "You need to be able to just shoot the s---. Even players who really don't like having psychologists around—and there are more than a few guys like that—will wind up calling you." One off-season Karesky even took to counseling by text message in order to reach one player who said he felt uncomfortable talking over the phone. "It was very odd," Karesky says, "and it worked."
There is another engine of change: money. As players have become more and more valuable commodities—Bradley, with his eighth team in 11 seasons, is making $11 million this year—protecting those investments has become paramount. Team psychologists like to joke that they are insurance policies. Says House, "If a guy making $12 million has the Creature now, you're going to try and fix him." The underlying hope is that the mind becomes the next major frontier in players' health, as legitimate as strength and conditioning, and that teams cover not only treatment but also prevention, identifying potential emotional problems early enough to avoid the DL.
But EAPs are still maturing, and according to one team official's estimates, there is a bottom third of clubs that lag behind in resources and management support. There are constant questions to consider, such as how to better build trust across cultural and linguistic barriers with Latin American players. "So many of those players arrive young, poor, homesick and with no formal education," says McDuff.
Nevertheless, momentum in the field is growing. "This could be like it was with Tommy John surgery," Conte says. "Psychological issues aren't as scary anymore. They've been taken out of the closet."
Says Pulsipher, "I just wish I had played 15 years later."
When Bradley's problems exploded in the media in May, Snell gave his teammate a simple message. "I just told him that we love him, we care about him, we need him," the pitcher says. "Everybody thinks he's a bad guy. He's not. He just has problems, like a normal person. And if you're afraid to ask for help...."
It's a humid spring afternoon in Baltimore, and a grinning Snell remembers how he was received in Seattle. Last July the Mariners "welcomed me, arms open," he says. The first to greet him when he arrived was Wakamatsu, who—in Sweeney's words—has since become a father, brother, counselor and psychologist to Bradley, who in late May confessed to thoughts of suicide himself. When Snell was introduced to his manager and to pitching coach Rick Adair, he says, "They asked me, 'How are you doing? Is everything O.K.?' They ask you that every day. They're players' coaches: They talk to you instead of waiting for you to talk to them." Right in the clubhouse on that first day, Snell decided to open up about his past to Sweeney, who has since been one of Bradley's biggest advocates too.
Seattle did not expect Snell and Bradley to be successes on the order of Greinke—let alone another Mariner, the recently retired Ken Griffey Jr., who was hospitalized as an 18-year-old after swallowing 277 aspirin in a suicide attempt. ("It seemed like everyone was yelling at me in baseball, then I came home and everyone was yelling at me there," Griffey told The Seattle Times in 1992. "I got depressed. I got angry. I didn't want to live.") In fact, these days Snell is coping with another baseball low: Last Wednesday he was shelled by the Rangers, giving up seven earned runs in only 12/3 innings of a 12--2 loss. "I sucked ... out there, and nobody can blame this on the team," he calmly told reporters afterward. "I just have to keep my head held high and keep going after it." To psychologists and psychiatrists, though, the first priority is simply recovery, which is neither easy nor guaranteed. As Sweeney explained to Snell and Bradley in separate, tearful conversations, the hope is for each of them "to be the man [he's] always dreamt. To be on the field without all that extra weight. To be a better husband, father, teammate, friend." In Kansas City, Sweeney had told Greinke the same thing.
Snell, who was moved to the Mariners' bullpen over the weekend, openly aspires to that much. He remains uncomfortable with the idea of taking medication and has thus far preferred the help of his pastor, an approach duly acknowledged by a science that most values positive outcomes for patients. He began studying the Bible, attended nondenominational services and went on religious retreats. He says, "My family said something important to me: Life is short. Enjoy it. Do everything possible to make it better for other people. Just try to laugh, have fun and don't let anything negative bother you."
It's yet another sign of a shift that didn't happen in one afternoon. "The equation has forever been changed," Karesky says. "The major league guys stepped up and gave young players and minor leaguers cover to come forward. And they gave men cover in general."
Duchscherer has said that strangers have thanked him for going public with his depression and helping them come to terms with their own issues. The Reds report that they've been deluged by compassionate letters addressed to Votto. And for every anonymous sneer on the Internet, there have been anonymous confessions: Fans praise players for coming clean about their problems when the fans themselves have not. Says Antonia L. Baum, vice president of the International Society for Sport Psychiatry, "These athletes have helped people realize that these things happen to all of us."
And so, in the humidity at Camden Yards, Ian Snell is trying his best in one more tough season. He hugs Orioles coaches, laughs during batting practice and high-fives teammates and the Japanese reporters who perpetually trail Ichiro Suzuki. As he awaits the arrival of Mike Crump, who will cheer his best friend from the stands, Snell offers the journalists a warm "Konichiwa!" and pretends to wipe their camera lenses clean with his sleeve.
Snell, now 28, still hears the boos and jeers, of course. He's still vulnerable to frustration and flashes of negativity. As a pitcher with a 5.89 ERA and an uncertain future on a struggling team, how could he not be? But there has been a tangible improvement in an ostensibly intangible problem. "I can finally breathe," Snell says. "I think people need to push their pride aside, just say what's in their hearts and what's on their minds. Get those issues out." He pauses for a moment. "And if people think you're crazy?" The question hangs in the thick air before he answers, "Well, that's just their opinion." Knowing that is itself a kind of peace.