Feet issues
There are various taboos within the sports world, such as homosexuality, eating disorders, and doping. The latter because it is against the rules; eating disorders because it means you are not completely ‘in control’ of your body, but that you have a disease; and homosexuality – well, why is that actually a taboo? But there is yet another taboo, and that is depression. We often only see the glorious side of (elite) sports and not the harsh reality that it also is. But even athletes who experience glory can be depressed. And that is something they won’t easily tell their colleagues or the public.
In the meantime, it’s a serious problem. Athletes are less depressed than our non-sporting compatriots, yet (elite) athletes more often suffer from depression than one would probably think, women more so than men. A French study shows that female athletes have had a depressive disorder almost twice as often in their lifetime as male athletes, namely 16.3% versus 8.7%. Of the athletes studied, nearly 5% of women had had a depressive disorder in the last six months, while that was 2.6% for men. These are high figures – for both female and male athletes.
Understanding depression is not easy. If you have never suffered from depression or don’t have a depressive predisposition, then you can’t really imagine how overwhelming and hopeless depression can be for the person suffering from it. It’s not just a feeling of being a bit gloomy, but it’s much deeper and is a real disease. From the outside, it’s not always clear where being a bit sad ends and a real depression begins, and partly because of this, there’s not always understanding for this disease. However, there is a clear change in the brain visible once someone is depressed.
Chemical Background
Sports physiotherapist Erik van Putten and psychologist Jefke Vink have delved into and trained in psycho-neuro-endocrino-immunology (PNEI). This deals with the chemical operation in the brain and what (im)balance therein can cause in the rest of the body. Because although depression is often seen as purely a psychological problem, this is only a small part of it. Internal biochemical changes have at least as much a share and are often forgotten, even in the treatment of depression. Biochemically, there remains a disbalance in the neurotransmitters (the ‘messenger’ substances of the nervous system). Neurotransmitters normally ensure that there is good communication and stimulus transfer between all systems in the body.
Without making this an overly technical article, there is another underlying mechanism in the brain that needs to be explained to understand depression, and that’s about the consequences of stress. When someone experiences stress, the hormonal stress axis is activated, which regulates the production of a number of hormones. Exercising is also stress, substances that are released in this context include adrenaline, cortisol, and endorphin. Normally, the hormonal stress axis returns to balance after exercising.
However, this stress axis can also be activated by various other causes, such as psychological stress (high work pressure, pressure to perform, keeping a family going, perfectionism), chemical stress (toxins in our food, air pollution), or physical stress (too much sports, heavy work). Because this is not a case of ‘normal’ exercising, there will then be a continuous production of stress hormones (adrenaline and cortisol) and a decreased production of endorphins. This eventually leads to exhaustion of the neurotransmitters and that goes at the expense of the production of dopamine and serotonin. This can lead to various complaints, including depression and performance anxiety. Restoring the neurotransmitter level is therefore necessary to function optimally again. Only by regaining balance can symptoms be permanently reduced. For an athlete, this is essential, because only then can training efforts and sports performances increase again.
Overtraining can also cause depressive feelings. But in people who do not have a predisposition for depression, the depressive feelings disappear once they have rested and the overtraining is over. Some depressions, however, last longer – for various reasons – and the chemical process behind it shows that it is not actually a psychological, but rather a ‘physical’ disease. Simply getting over it is not just possible.
Depressed as an Elite Athlete
In that chemical background of depression often lies the problem when it comes to depression among elite athletes. Where an (elite) athlete is assisted by his trainer in the physical aspect and the coach helps him to perform best in his sport, sports psychologists are designated to help someone mentally if needed. And since depression is also ‘in your head’, people often turn to a sports psychologist once depression is mentioned. But with a treatment that is purely focused on talking, changing thoughts and behavior, or psychomotor therapy (PMT), you won’t get there.
A sports psychologist, simply put, does not always have the knowledge and skills to help athletes with a serious (predisposition for) depression. On the other hand, psychologists and other therapists who could help with the depression are not enough aware of the sports world and the conditions within it to effectively help an elite athlete. This causes (elite) athletes with such problems to often fall between the cracks. As a result, they may never be able to deliver the sports performance they could with the right guidance. And not because they can’t physically or mentally, but because the depression gets in the way. And that’s a huge waste.
Depression and Female Cyclists
What doesn’t help is the taboo that still rests on depressions. Coming out as having (had) a depression is a big step that not many athletes dare to take. We now know that the Dutch skater Stefan Groothuis has a depressive predisposition and also the Australian swimmer Ian Thorpe has recently been open about it. Thorpe also had to deal with that other taboo, namely homosexuality.
Only a few female cyclists dare to address the subject and speak out about this disease. A rider who now admits to being regularly depressed (a so-called chronic depression) is Ina Yoko Teutenberg (team manager Lidl-Trek. Ed). It was not until she fell hard in the Dutch race Acht van Dwingeloo in 2013, a fall that ultimately ended her career, that she was first open about it. It was a life-changing event that made her realize that it couldn’t go on like this. You wouldn’t expect there to be a depression behind the always smiling, friendly German rider. Exactly that and the fear of shocking people when she talks about it is the reason she always kept it silent until that time.
Another rider who calls for attention to depressions and all other mental illnesses is Clara Hughes. The Canadian cyclist and skater became depressed in the late nineties. Last year, after ending her professional career, she came up with an action to break the stigma around mental illnesses. In ‘Clara’s Big Ride’, she cycled around Canada in 110 days, visiting all provinces to support local initiatives around the treatment or prevention of mental illnesses. Clara’s own depression was initially caused by overtraining, but slowly she fell into a deeper depression, which lasted for a long time. She did not recognize the signs herself, but had to be pointed out by the Canadian team doctor to seek treatment for it. That’s how overwhelming depression can be, that you yourself don’t realize you have a (treatable) disease.
Leontien van Moorsel also suffered from depression due to her eating disorder, but the problem of her underweight and later overweight overshadowed the other elements that came with her illness. No other Dutch female cyclist has yet come forward as having (had) a depression. Hopefully, that’s because none of our Dutch female cyclists has ever actually had a problem with it.
Complex Matter
Of course, one article does not provide enough space to explain the full cause of depression in detail, or to write an exposition in which all views on depressions are sufficiently highlighted. Let alone explain how you can possibly treat a depression and how someone can become healthy again. However, we hope to achieve several things with this:
Firstly, to provide information about where to go if you want to know more about depressions or think you have a depression yourself (see the boxes). Secondly, to make it clear that depressions and other mental illnesses – just like in the ‘real’ world – are part of the sports world and therefore deserve just as much a place in a magazine about women’s cycling as the beautiful and glorious stories. Finally, we want to emphasize that depression is not something to be ashamed of and also not a matter of just getting over it. The only way to make more people realize this is by being open about it and talking about it. Ina Yoko Teutenberg and Clara Hughes have led the way. Hopefully, more and more athletes will dare to do this and one of the taboos within the sports world will eventually be broken.
Help with Depression
If you have been feeling gloomy for a long time without an identifiable reason, think you are suffering from depression, or are afraid that a friend has depression, seek help! You can contact various organizations.