I was first exposed to the world of high performance sport at the age of nineteen. I was a young and vulnerable girl who was trying to develop into adulthood. I was living away from home for the first time and within two months of me leaving home my mother was diagnosed with breast cancer. I was told to stay at university and continue with my studies. I’d given rowing a go during freshers’ week and as the year progressed I was doing well within the world of college rowing. At the end of my first academic year I won my first Novice cup and was spotted by the university and GB Development coach. I was approached by my college captain and asked if I wanted to go to trials. I was flattered and I went for it.
The next year I was thrust into what an onlooker, most likely, would have perceived to be an obsessive, masochistic and socially isolated world that, to your average rower, was par for the course. Of most concern was the day when I was invited to consider being a lightweight rower. It became commonplace to watch girls weighing themselves and training multiple times each day, missing meals, taking laxatives and slimming pills, sweat-running in bin bags, and sitting in scalding hot baths in hotel rooms throughout the night in an attempt to make the numbers on the scales correct the next morning. I lasted an academic year and after competing at Henley I returned home, soon to find myself in hospital with appendicitis. I recall waking the morning after emergency surgery and being spoken to in a rather stern way by the surgeon who said that if I had left it any longer my appendix would have burst and I would have succumbed to more significant complications. He told me I should not have ignored the pain, something my rowing training had educated me to do and expected me to do in order to perform. My get well soon card from my then boyfriend was brief and suggested that perhaps this might put an end to ‘all that silly dieting’. I returned to university for my final year and decided not to return to rowing.
My story is not extreme, far from it, but I share it with you as part of the journey that led me to writing this book. This was my first exposure to mental health difficulties in high performance athletes. Even at such a young age and with an untrained eye, I had a sense that something didn’t feel comfortable about what I was being exposed to. Almost fifteen years on, I now work as a clinical psychologist and psychodynamic psychotherapist with a wide variety of people who are struggling with their mental health, including elite athletes, albeit a small number, for various reasons that we will consider later in this book.
Of course, we must be careful not to assign blame to the world of elite sport or weight restricted sports. I often wonder if those with a pre-disposition or vulnerability to going on to develop eating difficulties are attracted to the world of weight restricted sport as it makes eating disordered behaviour socially acceptable. And, more generally, many individuals with certain personality traits or vulnerabilities may well be the very reason why they are attracted to their chosen sport. Perhaps sport maintains and perhaps even compounds an existing predisposition for some individuals that need an arena that makes their presentation socially acceptable. For the patient who visits the clinic for anger management classes this may be the pro boxer or MMA cage fighter. For the patient that visits the clinic for an eating disorder this may be the weight restricted sportsperson such as the jockey, the lightweight rower or ballerina.
This is where my book starts. In the first section, I seek to understand weight restricted sport by interviewing two men who have engaged with very different sports: Kieren Emery, an ex GB lightweight rower, and Mark Enright, a professional jockey. Both share with me their own stories and their relationships with weight restriction. Kieren talks with me about how he developed what he would call ‘functional vomiting’, literally translated as a means to an end in order to compete. Mark, whose journey included an inpatient stay whilst experiencing an episode of depression, talks with me about how when the horse is considered the athlete, very different weight management practices are engaged in. He tells me about how in horse racing the use of sweating and prescription and/ or non-prescription drugs is commonplace.
We live in a society today that breeds the idea that it is fashionable to have a sports psychologist but shaming to have a clinical psychologist yet it is this clinical help that so many of our top athletes need. I am often exposed to professional clubs employing mind coaches with little more than a day’s training in stress management or an alternative therapy to help these athletes through diagnosable clinical difficulties. It is important to understand how both society and the athlete wish to collude with the idea that this is all that is required in an attempt to normalise what they are experiencing rather than accepting and acknowledging the reality of their mental states. For many who rely on how they relate to themselves, their body and their sport to perform at such a high level in order to achieve, it may be incredibly difficult to visit a clinician. I am aware that some have met with me then avoided engaging any further for fear of what exploration and change may bring. Multiple conflicts are inherent in this process and I often feel that many coaches may also struggle to send an athlete to a clinician who may work with them on, for example, their obsessionality to help them move closer to a position of health when it is the very fact that they are so obsessive that makes them an incredible athlete. I have jested with coaches that they do not wish to send their athletes to me in case once they achieve a position of health they may no longer be motivated to achieve what they have done in the past. I joke but there is also a reality in this, I see it in so many patients. It is important that they themselves are ready before they meet with a clinician or a therapist. We all need our defence mechanisms and we possess them for good reason, because for a certain amount of time they work for us. It is at the point when the individual is able to recognise that this way of being is no longer working for them that I would encourage them to sit down with a clinician. The final chapter in the book seeks to explore how, if such a sporting culture has now been established whereby clinically diagnosable symptoms are now commonplace and socially acceptable within sport, how may we come to understand this and how might we start to elicit a cultural shift.
Finally, I want to acknowledge that I do not wish to suggest that all athletes present with mental health difficulties, far from it. The sporting population is similar to the general population in that it is heterogeneous in nature and consists of those that have physical health difficulties, mental health difficulties and those with no difficulties. Hence this is a reminder that just like the normal population it would be ludicrous to suggest that mental health difficulties do not exist within our sporting populations. If this book is successful in achieving one thing it is my aim to share with you the stories that have touched me and that I have been privileged to hear and to see. It is to increase understanding and awareness that even those that we idolise who are extremely successful in the sporting arena are just like you and I and have stories and histories and very present everyday struggles. I hope that you may understand, may empathise and may open your eyes that little bit wider.