AFTER THE WHISTLE
How do elite athletes deal with the injuries nobody can see?
How do elite athletes deal with the injuries nobody can see?
A note about this article: This was first published by The Daily Maverick in 2018. This is an unaltered republication.
LIVING THE LIFE
It seems like such a glamorous life. Travelling the world and representing your country, all global events and plush hotels. Elite athletes must have it all.
But having it all means having the vulnerability of being human, as well as dealing with those vulnerabilities in an alien environment. It often means dealing with those vulnerabilities alone.
Sport mirrors life – and the mirror is in desperate need of a clean.
While there has been no rigorous, accurate study on the prevalence of depression or other mental illness in elite athletes, many estimate that, on average, 15 percent will suffer from depression in their lifetime.
In recent years, it has become more common for athletes to speak out; from Serena Williams discussing postpartum depression to Michael Phelps revealing his struggle with substance abuse and Missy Franklin sharing her battle with the so-called “invisible” illness.
Discussing the realities of mental health is slowly being normalised, but athletes still fear stigma and, as a result, often do not seek the help to get better.
In 2016, two studies in the USA and Australia showed that between 24 to 27 percent of elite athletes suffer from depression, a high statistic when the figure for the general population is believed to be around ten percent.
Research also suggests that athletes competing in individual sports are at higher risk compared to those within team sports.
Stigma is one thing but in many parts of the world, including South Africa, help is sometimes just not available. It’s frequently the team psychologist who gets the cut from the travelling party to save on costs, despite psychological health being paramount to high performance.
It’s not only elite athletes who struggle either. In junior academies, school set-ups, provincial sides and at universities, young people are affected by issues they often don’t have the maturity to understand.
But there are people slowly chipping away to try to change the landscape.
Across the world, federations and governments are slowly cottoning on. In 2018, the British government announced a new action plan to help protect the mental health of athletes, with provision for giving coaches and support staff extra training to spot the signs of poor mental health.
In South Africa, Varsity Sports launched their Speak Up campaign in 2018 – an awareness initiative running alongside all their sporting competitions.
When German international goalkeeper Enke took his own life, his widow was brutally honest about the fears he had over discussing his illness and what impact that might have on his career and personal life.
Speed, the ex-Everton and Newcastle midfielder and Welsh national team coach who also took his own life, battled the same demons.
His sister Lesley said in the documentary, Football’s Suicide Secret, back in 2013: “He hid it from us, because people who are suffering from depression are not only fighting the illness, but they are fighting the stigma that goes with it. It probably stopped him from asking for help from within his job.”
Despite it all, substantial and nuanced research into the mental health of athletes does not exist. In South Africa, the silence that surrounds the battles has been deafening. Until now.
Four brave, elite athletes have shared their stories in the hope of shedding the stigma, not just for those involved in sport but for anyone suffering in silence.
These stories give insight to the other side of elite sport. A reminder that behind the tough exterior, there are vulnerable humans who deserve more than inane abuse on social media – and who are defined by so much more than mere results.
Most important, they aim to shine a light on just how much more federations and unions need to do to live up to their duty of care in a high-performance environment. Never again can they say they did not know.
All Robbi Kempson ever wanted to be was a professional rugby player.
Selected as a schoolboy to play for his country and having joined the Sharks Academy straight after matric, he had to wait his turn. But, when it came, it was all worth it. He made almost 40 appearances for the Springboks and created memories that will last a lifetime.
“Fondest memory of playing for the Springboks… without a doubt singing the national anthem,” Kempson recalls.
“Be it Ellis Park, Kings Park… it didn’t matter. Having that opportunity to stand in front of 50,000 people and listen to them sing the anthem with you, it’s the most amazing experience.”
Like many professionals, his career spanned clubs and continents. And like many professionals, it came with its share of injury challenges, the most notable in 2003.
Not long before the World Cup, Kempson had to undergo routine surgery to fix a nerve in his hand. That process would reveal an underlying struggle he had never recognised.
As part of the procedure, patients who have operations where a limb might be immobilised, permanently or temporarily, are encouraged to see a psychologist. Kempson didn’t hesitate, saying: “I didn’t think much of it.”
At the time, he didn’t think there was anything wrong with him mentally. Whatever underlying issues were present, it was never considered as something requiring treatment.
He adds: “I just dealt with it on my own. I think I did lapse into depressive states but didn’t quite understand it.”
Still, he never thought he suffered from depression. Not until after his second visit to the psychologist, who referred him to a psychiatrist. The two had, as he put it, “a nice chat” and he left the consultation with a prescription.
“To see how it went,” says Kempson.
Short answer: not well.
Because medications used to treat mental health conditions can elicit vastly different responses, it often takes trial and error to find the right solution. For Kempson, his first effort resulted in him sleeping 16 hours a day – not ideal when trying to return to playing after surgery.
Fortunately, doctors who deal with the mind are receptive to change and understand the need to adapt if things aren’t working out for their patients.
“I went back and explained the difficulties to the psychiatrist. He changed it to something that helped me get back on my feet. But that was the limit of my understanding of the issue,” Kempson says.
Armed with new medicine and an openness to continue his recovery, Kempson carried on with his career. He went on to play for Ulster in Ireland and kept his condition mostly to himself, only disclosing it to his coach.
He reveals: “I didn’t even tell my mom. I didn’t feel like anyone needed to know.”
But Kempson continued treatment. After returning to South Africa, he decided he’d had enough and went cold turkey off the medication.
“Yes, idiot,” he says wryly.
“I didn’t realise you have to wean yourself off and I relapsed.”
Having been around the block, Kempson knew what he had to do: start from scratch. More than a decade on, he is well and no longer needs the medication.
But getting to this point was a long process, complicated further by the expectations and stigma that surround elite sport.
He explains: “It was a bit confusing because I felt that I was a very strong person and I do have some strong personality traits. But it was difficult for me to understand the process of what my body was going through and what I was going through at the time.”
And then there is the stigma of being a big, burly rugby playing bloke.
Kempson goes on: “I consider myself to be mentally strong because I’m a professional rugby player, why shouldn’t I be?
“You get to a place… it’s not a dark place, it’s a place of helplessness. You don’t know what to do. I didn’t understand why I could feel that I didn’t want to be in people’s company, that I’d prefer just to stay at home.
“I did go out at the time and I did try to enjoy my time with friends, but you just can’t manage to get yourself up to having a normal conversation or having a laugh about something.
“And the difficulty was that it’s not from a lack of trying. You were trying. But your body just wasn’t co-operating with what your mind was trying to achieve.”
The nuance of understanding matters of the mind isn’t just lost on those who suffer from it but those around them, too. Far too often, people in bouts of depression or anxiety are told to “pull themselves together”. These prevailing attitudes are often exaggerated when there is a perception that the person who is struggling doesn’t have anything to be “sad” about.
In some cases, conditions can be masked or remain dormant for years until an event triggers an avalanche of discontent. For elite athletes, it’s often a post-tournament or post-career battle.
For many athletes, retirement can be disastrous. Loss of structure and routines can cause serious issues. After retirement, professionals are at an increased risk of substance abuse, mental illness and suicide.
Kempson, though, considers himself lucky and never got to a place so dark where he thought “enough is enough”.
While his relapse came at that stage, he thinks this was incidental rather than correlated, but admits that the post-playing career is something many other elite athletes struggle with.
“I think for any professional sportsman that retires it’s difficult and you lose a major support base that you’ve had throughout your career,” he says.
Part of that is also learning to cope with real life.
He adds: “Throughout my life I’m doing my growing up. My emotional IQ wasn’t the strongest and rugby players don’t tend to have strong emotional IQs.
“Everything is done for you. You go from a school environment into a professional environment where you’re told what to do, how to do it and way to do it. From tours to everything.”
Kempson’s story is not unique, but he is unique in that he is willing to be a voice in a culture where these issues are brushed aside.
“You don’t want to get to that point where you know that one person unfortunately takes his life because they were too embarrassed to speak out about it and reach out. We need to give those people the opportunity to explain what is going on,” he urges.
Reaching that equilibrium of understanding, Kempson believes, will not only help athletes feel better and break the stigma, but will help sports people perform better.
He adds: “It’s about people feeling that they have enough of a sense of self-worth to be able to reach out and have a conversation about it.”
With the conversation floodgates opening come many challenges. Chiefly, the definition of mental health, especially in a sporting context where mental toughness is desirable.
But just because you have a mental illness does not mean you’re not mentally tough. Some will argue that overcoming a mental illness will make you even tougher.
Kempson sums it up: “I think there’s a small overlap. Mental toughness is how you approach what you’re doing. Mental health is about your well-being.
“How do you feel about yourself as a human being, how do you feel about yourself as being relevant? It’s an accumulation of things.”
Two Olympics, several World Cups and World Championships taking her all over the world, with her whole existence dedicated to her sport. For rower Lee-Ann Persse, this was the dream life.
“I started rowing by chance when I was 16. My friends reckoned that because I’m tall, I should give it a shot,” Persse says.
It didn’t take long for the Olympic dream to hatch. Early on, her coaches believed she could go far.
She explains: “I’m a very determined person so when I decide I am going to do something, I get on with it.”
Rowing earned her a scholarship at Boston University in America and, before she knew it, Persse was called up to the South African national team. At that juncture, she swapped her studies in America for a spot at the High Performance Centre at Tuks University in Pretoria.
Things changed quickly. From a career perspective, it was the best possible thing that could have happened. But on a personal level, the protective bubble that athletes immerse themselves in – and which loved ones often try not to burst – can be a lonely place.
“Once I stepped away from the sport, I realised how much I missed out on in terms of my family. And I realised they kind of kept things from me to protect me because they didn’t want to get me down. They might think, ‘she’s in a good place, let’s keep her there’,” Persse says.
Hours and hours in the water, in the gym, everywhere else – all with a single goal in mind. Eventually, exhaustion takes hold. Sometimes it’s more than just being tired.
Persse says: “That’s the hardest thing, you don’t really know what’s happening to you. When you eventually go see a doctor and they say it sounds like you might be a little depressed, you’re in denial.
“The first time someone says that to you, your response is: ‘That’s incorrect, I am definitely not depressed. I’m an athlete. What do I have to be depressed about? It can’t be true.’”
For Olympians especially, the so-called post-event slump often hits hard.
Take the Michigan-born US swimmer Allison Schmitt. After winning five medals – three of them gold – and setting a world record in the 2012 London Games, she battled a bout of depression which she could not reconcile with her success.
It wasn’t at all straightforward, because depression is not something athletes who believe they have it all associate with something that they cannot always see.
“I didn’t want to show my weakness,” she said in an interview with Channel 4 in Detroit.
“I didn’t want to ask for help, but in this situation, I found out… that I couldn’t keep fighting it by myself. There’s this thing that they call post-Olympic blues and I think I had a little bit of that and I kept isolating myself and isolating myself.”
Persse felt the same way after London and was prescribed anti-depressants, which she thought she could quit cold turkey.
“My doctor was very angry when she found out,” she recalls.
After that, Persse opted for a different route. She did not want to go back onto medication. She wanted to deal with what was causing some of her battles. At the top of her list was her looming retirement.
Through the process, her doctor always made sure to remind her the medication was there if she wanted it. But Persse refused, saying: “I wanted to deal with what was happening properly.”
Retirement finally came after the 2016 Olympics and it’s been a long road to recovery since then.
Legendary jockey AP McCoy, who spent two decades at the top of horse racing, put it perfectly when he said post-retirement: “I was living the dream, but now I’ve woken up from it.”
Scroll through the social media profiles of athletes and it’s easy to see why it’s natural to think professional sports people have it all.
“I think it’s a misconception. But I think athletes contribute to the misconception that we’re living the dream, because that’s what we say all the time,” Persse says.
“We think ‘this is awesome, all I have to do every day is get up and train’.
“We are fit, we are healthy and in shape. We are pushing our bodies to the limit. We are achieving some of the greatest things in the world.
“Being an Olympian… not everyone does that. I think we allow for that misconception to be made because we just talk about how great everything is all the time and we don’t talk about the bad times.”
But when the bad times come, far too many athletes feel that they are not adequately equipped to deal with it. Sports psychologists are playing an increasingly important role in high-performance structures. But in South Africa it’s often optional.
That was the case when Persse was at the High Performance Centre.
While forcing anyone to see a psychologist, especially with the stigma attached to so-called “head doctors”, is never wise, education around the subject is limited.
Often, tension builds and one simple question – how are you doing? – can trigger an avalanche of emotions. Sometimes, Persse says, she would rather bottle things up because she knew entering that discussion would set off a domino effect that would impact not only on her emotional state, but her training.
She adds: “I didn’t realise I was just ignoring all the things that were affecting me personally. I was thinking ‘how can I deal with this so that I can arrive at the next session 100 percent ready to go?’”
Obsession is a trait that both mars and defines professional sport. Hyper-focusing on one specific thing is something many consider to be perfectly normal.
Persse goes on: “I thought it was healthy. I thought once rowing was done, I’d go back and deal with all this other stuff.”
There is also an element of fear. Athletes are scared that any sort of niggle – mental or physical – will make them come across as weak.
“I wasn’t in a big team environment and when you’re struggling you will kind of not be seen as weak, but you were. It wasn’t a great place to be in,” says Persse.
“It was horrible actually to be in a place where if you weren’t performing, or if you were sick or if you were injured, you felt a little bit like you were on your own. But when you were strong you were fighting-fit and able to do all the sessions. And just crush all the sessions with fast times and just you just cruising along, then you are the best thing ever.”
Managing personal and professional expectations in a world where winning is increasingly valued above all else is a recipe for disaster.
“When things aren’t going well, you question yourself. You wonder if it’s your fault, if it’s acceptable for you to feel this way, like you’re not coping,” Persse says.
“We do need to speak about it more as athletes. I think we mustn’t feel afraid, especially to speak to each other about it and just tell our coaches about it.”
Persse has officially retired from rowing and while the future is still uncertain, she is optimistic. While she thought she might close that chapter of her life completely, she has started coaching rowing and hopes to empower other women in the sport.
She also hopes to make an impact on how federations and governing bodies deal with mental health at elite level.
Imagine being so crippled by a sense of panic that no matter how hard you try; your brain’s default function is to imagine the worst, even if you know these fears are entirely irrational.
For people who suffer from anxiety, this is routine. For athletes like South African national goalkeeper Phumelela Mbande, this is her lived reality.
Hockey might be a popular Olympic sport, but it remains largely amateur. That doesn’t mean the athletes who compete aren’t very good, it just means that, most of the time, they can’t only be athletes.
Mbande started playing hockey when she was 10. The sport has afforded her dream opportunities: travelling overseas, scholarships and, of course, the honour of wearing the green and gold.
She’s had to do all of that while balancing her work towards becoming an auditor – and suffering from crippling anxiety.
“It is quite hard to talk about it. I think it’s because you feel like you are the different one, the weird one, and you don’t know that everyone else or a lot more people feel the same way,” Mbande says.
Anxiety manifests differently for everyone. It mostly comes on without warning. Sometimes there are triggers, but the panic and fear that anxiety brings is an indescribably dark place.
It’s a hell of a thing for ordinary people. For athletes, especially those like Mbande who play at the highest level and, in her case, as the last line of defence as a goalkeeper, it can be paralysing.
Most recently, at the 2018 Commonwealth Games, Mbande conceded four goals in a warm-up game, something which left her traumatised.
She recalls: “When I got off the field Itold my team-mates, ‘I’m so traumatised, I don’t even know if I can play hockey again.’ The next two games after that, I’d shake and have to repeat affirmations in my head to calm down.”
There are many instances in professional sport where athletes go through a sudden bad spell without apparent rhyme or reason. Sometimes there are belatedly-revealed outside factors, like the concussion suffered by Liverpool goalkeeper Loris Karius in the 2018 UEFA Champions League final. Or a bad case of the “yips” often seen in golf and cricket.
Rarely though, are athletes brave enough to admit that it’s because they have a condition like anxiety. They fear they will be seen as a weak link, especially in a team environment where they are often dispensable.
The exceptionally high level of professionalism athletes set for themselves is often the reason they are so incredibly successful. The drive to be the best and do whatever it takes can be an unstoppable driving force.
But when those high standards are not achieved things can go downhill quickly, especially if an athlete believes their underlying struggles might affect their career.
“It’s easier when you’ve torn a hamstring because a doctor can come in and say: ‘hamstring torn.’ There’s nothing she can do, but when it hurts in your brain, not even a scan can show that this is a problem here,” Mbande says.
And when plans unravel, those on the outside looking in aren’t always aware of how many sacrifices have been made by the athlete.
“My darkest place was not being selected for the World Cup or the Commonwealth Games in 2014,” Mbande remembers.
Having put her studies on hold to try to get into the squad, the reality that she was going to have to redo the academic year hit hard.
“I wasn’t ready for what was coming,” she reflects.
For three weeks, she isolated herself in her bedroom. To avoid other people, she would study at night and sleep during the day.
Mbande goes on: “For three weeks, I barely took a shower, I hardly ate. I just lived in darkness.
“It felt like I’d almost wasted the last year-and-a-half. Even though a lot of people had said: ‘Focus on your studies, hockey isn’t always going to be there.’
“I think in that moment it felt like everyone was right and I’ve now screwed it up.”
But she didn’t screw up. Quite the opposite. Mbande is excelling, as an athlete and as a professional. Officially diagnosed with anxiety disorder and depression, she is proof that those who battle the invisible struggles sometimes see them manifest physically.
“Depression is horrible. You feel like it’s your own brain deceiving you. It’s very difficult to get out of something when the thing you need to get out of is almost the problem. So you say: ‘Come on, brain, work with me.’ But your brain’s what’s not coping,” she explains.
Sometimes her anxiety leaves her shaking and with stomach cramps. But her diagnosis brought her relief, even it is sometimes difficult.
She says: “It can be a horrible cycle. Sometimes the thought of being near hockey makes me want to cry. You want to train, but you don’t feel like it. You don’t train. You feel guilty about not training, so you want to train even more. And the cycle repeats itself.”
Everyone deals with this cycle differently and Mbande’s way is to share photos of her sessions on WhatsApp. Because so much of the training in the hockey environment is up to the athlete themselves, she knows there will always be somebody to hold her accountable if they don’t see that status of her being at the gym.
“It’s harder to let another person down than to let myself down. So, you slowly pull yourself out of the rut, finding little games to play with yourself and, before you know it, you’re in a good space and back in a proper routine,” she says.
For many athletes, Mbande included, sport is a safe space of sorts. A way out of the noise in their minds. Hardly surprising considering the scientific studies that reveal the positive effects of exercise on the brain.
She says: “When sport is your safe space, it makes everything else bearable. But it becomes very difficult when your safe space is no longer safe.”
Despite the challenges that come with her international sporting career, Mbande wouldn’t trade any of it for the world – with or without anxiety.
“Playing for the national team, it’s the best feeling in the world. Every time you’re in the green and gold, you can say to yourself: ‘I’m doing this.’ Even with the pressure, the stress, the panic,” she explains.
Mbande displays an infectiously positive demeanour, even when discussing something so difficult. And despite being open and honest about her condition, she also feels there is a widespread misconception around mental illness; not just in a sporting environment but in everyday life, where sometimes conditions are used as a throwaway line and the underlying issues aren’t addressed.
“I could be wrong, but sometimes it feels like people are just talking. It’s nice to talk about it, especially on social media. But going to see someone to talk about what you are going through is a different matter,” she says.
But she sees the value in speaking out about her struggles, adding: “If I can just do my bit for one person’s life to be different and maybe not have a route as tough as I’ve had, that would be good. If it’s more than one, great.
“But I think it’s important that people realise that athletes are also human and that athletes go through the same struggles as everyone else. We need to recognise that these things are here. They’re part of life.”
Who are athletes when they are no longer competing? Their names stay the same. Their achievements remain. But many say they feel like a part of them is lost. Some feel it creeping up slowly, others have a moment when reality hits.
Sanani Mangisa spent a decade of her life dedicated to the South African national hockey team. She retired in 2017 but continued to stay fit, using the same gym she had for years. Until, at the turnstile, her access card was declined. She tried again. Declined.
“The guy at the gym told me the membership had been cancelled. It was such a profound moment of rejection because something I had known for so long and taken for granted had been taken away,” Mangisa says.
The thought of paying for her own membership wasn’t an issue, she adds: “In that moment I knew hockey was over for me. A new batch of players had been put on contracts. My time was done.”
She spent the nine months after her retirement constantly questioning who she was and eventually ended up in a ball of tears in front of her therapist. Life after retirement is often what hits athletes the hardest. In her book, Waking From The Dream, Dr. Kirsten van Heerden spoke to 18 prominent South African athletes about life after sport.
The book is groundbreaking in South Africa, but the stories aren’t unfamiliar. Many of the themes around identity and trying to find new meaning are things Mangisa experienced, too.
“I went from this place where, when I walked into a room of hockey players, people knew who I was, to where people might not care that I went to the Olympics twice,” she says.
The balancing act was difficult. There’s one part that wants to hold on to identity as an Olympian and another that just wants to forge a new life in an unfamiliar space.
Initially, Mangisa asked people to drop the prefix when they introduced her.
She explains: “I needed to be Sanani Mangisa, the brand exhibitions manager. That’s what people know me for and my work must speak for myself in that environment.
“I didn’t want to get a free pass because they thought I had been to two Olympics. But that also means nothing in a workplace when you have deliverables; deadlines and learning new systems.
“It’s nice and warm and fuzzy; that’s what you achieved on the hockey field, but it doesn’t matter in the working world.”
All athletes know the day will come when they retire, by choice or by injury. Mangisa went to great lengths to prepare for the eventuality and always tried to have interests outside of sport. But the best-laid plans of mice, men and hockey goalkeepers often go awry.
“No matter how much prep you do, you can’t predict what is going to happen,” Mangisa says.
A lot of the research into elite athletes’ mental health has been done in the post-retirement sphere. The findings have been somewhat contradictory, but science can’t deny the lived experiences of those who have spoken out or, worse, taken their own lives.
Swimmer Ian Thorpe, ex-Glasgow Celtic soccer manager Neil Lennon, cricketer Andrew Flintoff and English soccer star Paul Gascoigne have all been open about their troubles. In his 1972 book, The Boys of Summer, Roger Kahn wrote that an athlete dies twice, first at retirement.
Legendary boxer Sugar Ray Leonard famously said: “Nothing could satisfy me outside the ring… there is nothing in life that can compare to becoming a world champion; having your hand raised in that moment of glory with thousands, millions of people cheering you on.”
Leonard’s battle with depression was acutely public and he tried to self-soothe by making repeated comebacks to the sport.
Central to the battle is the association with athletic identity. Loss of structure, routine and being alone. Suddenly only having to answer to yourself also causes problems. Many lapse into bouts of depression but Mangisa just felt a bit lost, adding: “I don’t know if I could call it depression. I just wanted somebody to tell me that what I am feeling was normal.
“But you don’t want to talk to anyone and let people in and let them know how you are feeling. Because I’m a national hockey player I’ve got to keep it together.”
Mangisa certainly kept it together. She is thriving in a new career and isn’t afraid to speak her mind on widespread issues. But she also knows that more needs to be done. She’s adamant that there is not enough support to help athletes through the process of retirement. Not in South Africa, not in the world.
Athletes often try to keep in touch with those who coached and mentored them to help ease the process but, for many, the reality is that their coaches simply do not have the time to keep the relationship alive.
Mangisa has ideas of her own to make it easier for athletes, particularly those who must enter a work environment. It’s often forgotten that athletes have approximately a decade at best to earn good money for playing sport. Many pay their own way to enter global events.
A very small percentage of athletes will be able to sustain themselves and their family with the money earned from a sporting career. If their retirement was forced through injury, that sum decreases substantially.
For many, getting a “real job” is a reality. But Mangisa wants to make this work in everyone’s favour. She suggests offering tax rebates to companies who employ athletes in the last two years of their careers, so that they can get a feel for the workplace.
More important, she wants athletes to speak out.
“If you can inspire one person to be able to come out of their shell and be able to say, ‘This is how I’m feeling,’ the dialogue becomes more open and it becomes a natural thing,” she says.
Mangisa hopes that the more athletes share their stories, the more governing bodies will be open to assistance, adding: “But we need to start before retirement. We need to start talking more and help others realise that the feeling of playing at the Olympics is not something you can ever replicate, but there will be other rewarding experiences.
“When we have conferences at World Cups, we need to dedicate a section to mental health. And we all need to listen to each other.”