Sports Psychiatry: Strategies for Life Balance and Peak Performance
It seems not unreasonable to assume that many psychiatrists are participant in the American obsession with sports at all levels, especially professional and collegiate. Increasingly frequent psychological ramifications make the topic all the more tantalizing, eg, dramatic confessions of lying about use of illegal performance-enhancing drugs, tragic connections between repetitive head trauma (concussion) and subsequent depression and suicide, domestic abuse, problems associated with retirement. But most clinicians have actually treated only a few athletes as individuals, and very few indeed have been formally affiliated with teams. One wishes for an insightful, clinically oriented discussion of the sports culture. David R. McDuff, MD, the longtime team psychiatrist for the Baltimore Ravens and Baltimore Orioles and countless other athletic teams, has provided just such a clinical guide.
Eight core concepts and the breadth of approach can best be summarized by the 10 chapter titles that compose the work: "Scope of Practice"; "Mental Preparation"; "Stress Recognition and Control"; "Energy Regulation"; "Substance Use and Abuse"; "Injury Recovery and Pain Control"; "Common Mental Disorders"; "Teams, Medical Staff, and Sports Leadership"; "Developmental and Cultural Competence"; and "Evidence Base and Future Directions."
There is much to recommend this book to virtually every practicing mental health professional. It is highly readable and tightly organized. Each lecture follows a logic that is evident in such a way that one is never lost, and each ends with a substantive conclusion, a summary of key clinical points, and a brief list of references. Such features make the book an easy reference guide when seeking help with a particular problem, patient, or team. A wealth of case studies accompanies various situations described, thereby illustrating the clinical applicability of different interventions. Note should be made of the fact that the text overall is quite eclectic in that it references use of behavioral, psychodynamic, interpersonal, group, community-based, pharmacologic, and other approaches.
Yet another quite consistent feature of this book is its practicality. It is unspoiled by highly theoretical speculation and dogma. On the contrary, it is filled with quite specific suggestions of what to do in various situations and how to do it. In that regard, it offers assistance to therapists who may see a great variety of problems, both sports-related and otherwise, but with a common clinical symptomatic presentation such as anxiety. For example, one may be in the habit of advising that the patient pause and "take a few deep breaths." But how many therapists are prepared to teach patients the "how" of deep breathing? McDuff distinguishes 3 different specialized breathing techniques (patterned relaxation breathing, nasal hyperventilation, and clearing breath), when each is preferable, and how to perform each technique. Thus, with reference to relaxation breathing, one reads "breathe in through the nose quietly and evenly for 4 counts, hold for 7 counts, and then breathe out through the mouth evenly for 8 counts" (p 34). Such practical and specific guidance will help most patients, whether athlete or nonathlete.
But, apart from its general applicability, the book is specifically about the "world of sports." To the great benefit of most psychiatrists who are not intimately involved in that world, the book is filled with insights unknown to the casual observer. For example, one learns of the distinctly different patterns of substance abuse between athletes and nonathletes; the different causes of insomnia in football versus baseball players; and that, whereas in general over 3 times the number of injuries occur in games than in practices, most injuries in noncontact sports occur in practice sessions. The description of the sports psychiatrist as an integral member of a group (orthopedic and other physicians, psychologists, coaches, trainers, players, owners, etc) can serve as a model for the recent rediscovery of medical practice as a team endeavor. Some of the more intriguing insights involve difficult cultural issues such as gender discrimination, homophobia, and nationality and culture of origin. Child and adolescent psychiatrists will especially welcome a developmental, age-appropriate approach to participation in sports.
Clearly, the scope of this work is highly inclusive, albeit not encyclopedic. One might wish, for example, that Dr McDuff would have expanded on a topic of high current interest, namely, the role of money in both professional and collegiate athletics and its psychological impact on players. But a book that leaves the reader wanting even more constitutes high praise. It is a work that describes many successful strategies for life balance and deserves a place on the shelf of every child, adolescent, and general adult psychiatrist.
Author affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.
Potential conflicts of interest: None reported.
J Clin Psychiatry 2013;74(4):e342 (doi:10.4088/JCP.13bk08392).
© Copyright 2013 Physicians Postgraduate Press, Inc.
