Psychiatry

This month’s issue, guest edited by Antonia L Baum, MD, covers the relationships between sports and mental health. It’s a timely issue because of the growing buzz over the long-term effects of head injuries sustained by professional football players, and their much publicized lawsuits against the National Football League (NFL).

In fact, the journal Neurology recently published data indicating that there is a link between repeated head injuries and Alzheimer’s and Parkinson’s diseases, particularly among NFL linemen.¹

Dr. Baum and colleagues thoughtfully review a number of areas spanning the overlap of psychiatry, psychology, and neurology. We begin with a case from Dr. Baum that offers us a glimpse at how competition can be harmful rather than helpful (see page 361), particularly in a young athlete.

Then, Jeff Victoroff, MD, and David Baron, DO, explore traumatic brain injury (TBI) as a delayed onset, polythetic syndrome with varying signs and symptoms. This should offer some pause for thought.

Gen Kanayama, MD, PhD, and Harrison G. Pope Jr., MD, have collected data on the still largely unknown effects of anabolic steroid use. While much is still to be understood about these drugs, Pope and Kanayama do us a great service by dispelling common misconceptions about their use.

David Conant-Norville, MD, offers a discussion of attention-deficit/hyperactivity disorder (ADHD) in youth through adulthood and its interactions with athletics. It’s a counterpoint to Dr. Baum’s case, detailing how a young man’s affliction with ADHD was greatly relieved by competitive cycling.

We round out the issue with three short cases from Thomas Newmark, MD, who uses hypnotic rehearsal in his practice to help elite athletes deal with performance anxiety. Altogether, this month’s Psychiatric Annals covers a wide and clinically relevant spectrum.

Given the risks addressed in this series, one might ask: Is participation in competitive athletics worth the risk? For a professional athlete, the answer may come down to a financial reward vs. risk calculation.

But for you, me, and our children, are the risks, such as from drugs, anxiety, or chronic brain ailments, worth the gain?

What is hard to measure is the emotional and learning value of participating in competitive athletics. Personally, despite the pain, and lifelong considerable cost of having lost a front tooth in a tough game, I believe that had I not played high school football, I would not have developed the confidence that allowed me to go to medical school, which was the gateway to a life-long career of excitement and meaning in psychiatry.

I know of people with great athletic talent who were prevented by well-meaning parents from the physical risks of high school football who then developed a serious drug problem instead of fulfilling their respective athletic potentials.

In life, every decision is a risk offset by a potential benefit. In medicine, we get to see many of the negative outcomes of taking that risk. Like most decisions, we weigh the risks and the potential benefits without knowing what the law of probability will decree. Living life entails risk.

How many of us who participated in competitive athletics would do it all over again? I would — would you?