Brave New World: The Emotional and Psychological Response to Injuries in Youth Athletes in a Changing Environment
Kameron Reichert was a young, lifelong football player who dreamed of playing college ball and making it to the big leagues. Although he kept it a secret, Kameron suffered from depression and a recent knee injury pushed him over the edge:
On December 10th, 2008, he committed suicide.
Under the guise of an all-American, high-powered athlete, his family and coaches missed the warning signs and Kameron did the unimaginable. Today, youth athletes are experiencing a new playing field; they are at the helm of an unfamiliar sports arena where competition is cutthroat and physical limits are pushed without boundaries. This [new] culture glorifies heroism, strength, speed, and courage. It emphasizes such adages as 'no pain, no gain,' 'hurt is temporary, pride is forever,' and 'you can't make the club while sitting in the tub.' Accompanying these maxims are the unspoken rules of the game: injury is not allowed, pain is ignored and unacceptable..." (Shuer)
How does this new competitiveness affect the psyche of a youth athlete when they are suddenly injured?
I will answer this question by exploring their emotional responses to injury and the methods in which they cope. Engaging in this topic is important because it gives athletes a better understanding of their situation and allows them as well as bystanders to participate in the recovery process.
Shockingly, situations similar to Kameron are common but the blame doesn’t solely lie on family members and mentors. As a collective society, we have created this norm where we push our youths to perform extraordinarily. There is a growing competitive mindset that pits the children in my generation against each other. In high school my classmates were fiercely fighting for AP scores and honor courses, while my sister and her fellow college graduates still struggle to find a job in the cut-throat job market. On the pitch, athletes are also ruthless for their name on a roster or a shot at the state championship. Although this drive for success is admirable and great athletes have emerged, the psychological impact of today's athletic commitments can be detrimental. According to the U.S. Centers for Disease Control (CDC), 70% of kids drop out of youth sports by the age of 16. Their top three reasons: adults, coaches and parents. Their fourth reason: injuries (Weisenberger).
A few years after Kameron, I fractured vertebrae in my neck during an important soccer training. It was at an international clinic with many important coaches and recruiters attending and I was arguably playing the best soccer of my life. When you're in form, you are on top of the world. Nothing else matters because you are playing your best and you build on that confidence like a loose train gaining momentum. That was me today. I was in a wonderful fairytale, dancing in my fantasies of playing in the big leagues one day. After all, only I control my destiny - or so I thought…
The intensity of this new sport culture is clearly taking a toll on the human body with the soaring number of youth hospitalizations, doctor visits and injury-related healthcare costs (Herring). When I stuck my head out for the ball, I remember thinking "I'm putting myself in a vulnerable position to get hurt, but it would be worth an injury if I could get to the ball". Obviously, I would take it back if I could, but my mentality is pervasive among many other competitive athletes. Because of this increasing competitive nature, we can assume that the number of injuries is only going to rise. Consequently, the question shifts from "What can we do to prevent injuries?" to "How can we best treat injuries?"
In order to answer this question, we must seriously analyze the universal stages of the grief cycle: initial shock and denial, anger, depression and loss of identity, and finally acceptance (Walker).
Although the grieving process is unanimously agreed upon by experts as a useful tool for organizing different responses, it is not perfect. Athletes - like myself - may skip a stage entirely or pass through one more quickly than others. According to Dr. Julie Waumsley, senior lecturer in the Division of Psychology at the University of Northampton, "The precursor to athletic injuries…for example, high life-stress levels, extraversion, anxiety, and personality traits are proposed to not only increase the risk of actual injury, but also amplify post-injury mood disturbance" (Russell).
Everybody's life is different....
which means their response to an injury is somewhat subjective based on what is currently going on in their lives. Parents going through a divorce or failing grades at school are factors that can influence how a young athlete will react. In a way, these externalities act as the smoking gun - the injury can simply be the final straw that pulls the trigger. Basically, recognizing the limitations of the grief circle, we have to additionally take into account the situation of the pre-injured athlete: his emotional state, relationships and personality.
Gauging your recovery
Did your experience correspond with any stages of the Grief Cycle?
Stage 1: Shock and Denial
Treating the first stage of shock and denial is important because all other stages build upon it. Recent studies indicate that athletes suffering from severe injuries have stress levels on par with victims of natural disasters or experiencing the death of a loved one (Shuer). At first glance, this may seem exaggerated; however after a second look, the unexpectedness, suddenness, and lack of a person's control over a natural disaster are similar to an unforeseen injury - contributing to shock. I believed that I had the sole control over my destiny, but when I collided with that player it was over in a second. I had no say whatsoever and I didn't know how to react to that fact. It is a common misconception that an educated athlete will deny their injury when really an athlete is more inclined to deny its severity and needed rehabilitation (Walker). Aside from the pain, it never crossed my mind that I was severely injured; I thought it would pass just like a sprained ankle would. This is not an unfair judgment since major injuries in soccer are relatively rare. When I was carried off the field, I honestly believed that I would be sleeping in my own bed that night. There was no thought of me spending the next weeks in the hospital, but when it did happen I was confused and scared.
In the present-day world, injured athletes are expendable and need to be replaced. Therefore, a lifelong athlete whose self-worth is measured by his sport - just like Kameron and I - might be pressured to overlook their injury and continue playing. In my case, since it was clear that I couldn't physically continue, I did what most other athletes in my position do: I immediately dramatized the situation and make it seem worse than it really was. I thought that if I ever got back to playing soccer, I would never be good enough to play again (unfortunately, in reality, that was ultimately the case with me and many others too). As youth athletes, we have been so conditioned to giving all our time and energy towards our sport that if it is suddenly taken away, we are lost. This mentality can give us a glimpse as to why someone like Kameron could be blinded into seeing no other alternatives but to take his life.
To console these confusing yet inevitable emotions, bystanders are more important than ever; friends, coaches and family members provide the emotional support and security in a situation where the injured are unable to react rationally. Many athletes find it difficult to talk to their parents or coaches about their thoughts and feelings which are why friends can sometimes be more effective in helping them move forward. Although it is important to focus on the, to solve the problem we have to face this new sports culture that we have adopted. Coaches must coach responsibly and assess the mental state of their players before letting them back into the sport. Parents must parent appropriately: instead of pressuring their children, they should allow their children to discover passion, accept defeat, and most importantly relinquish stress instead of adding to it. The goal in moving through this stage is to keep positive, set realistic goals and most importantly set a timeline for recovery.
Stage 2: Anger
The second stage of the grief process, anger, is the most common emotion felt by injured athletes (Walker).
I heaved my powdered eggs and dye-colored Jell-o towards the hospital door, I ripped off my IVs and I chucked my medication all over the floor. I spewed out enough swear words to make a sailor cringe and yet amid my screaming tantrum, the surrounding nurses completely ignored me as if I didn't even exist. Defused by the lack of attention I was receiving, I quieted down and sulked back into my bed. A few minutes later, the nurses came into my room and cautiously cleaned up my mess and re-inserted my IVs. I cried out my apologies and told them I didn't know what got into me. A nurse kneeled down next to me and whispered, "It's OK, we see it every day. It's normal, you're normal. These kinds of things happen."
Anger is a type of coping mechanism that provokes typical questions like, "Why is this happening to me?" which is a tell-tale sign of frustration (Herring). Athletes typically get frustrated early on with the realization that the rest of the world will continue without them. Their teammates will play, their coaches will coach, and a sense of uselessness is unleashed (Russell). As athletes, we are used to being in control of our destiny - we are taught that if we can better ourselves through discipline and practice. A sudden injury makes us lose control of our dreams and aspirations - and that scares us. As a method of reducing stress our first instinct is to get frustrated and react impulsively.
Friends and family members - and sometimes even nurses - are usually at the wrong end of these unforeseen outbursts of anger and irregular mood swings. Confined to the safety of my room, I became a frustrated, unpleasant person - on top of being a typical, rebellious teenager. I threw away "Get Well Soon" cards and had uncontrollable fits of anger over petty matters like crumbs on the kitchen counter or someone using my bathroom. I frustratingly broke the showerhead when I slipped in the shower once. The silverware clinked and scattered across the kitchen tiles when I threw it across the room. I wasn't acting myself but I also couldn't choose differently.
When confronted with this behavior, bystanders should put themselves "in the shoes" of their injured companion: this frustration is a method of coping. My family honestly believed that I was just being a typical teenager and would only reprimand me, not out of ignorance but for lack of knowledge. I acted angry, but I was really crying out for help inside in the only way I could. Research has shown that athletes can feel insecure or weak if they admit to having psychological issues, especially males. It can be seen as an admittance of "weakness" which is why many athletes remain frustrated and angry instead of progressing. I spent years angry at myself and others and although coping is good - this was clearly not healthy in the long run. This is why a support network should continually push the individual towards the "recognition of the inevitability of injury" and motivate them press on (Russell).
Stage 3: Sadness
Anger acts as a highway to depression as it causes a spiral of negative and interfering thoughts and actions. This is because an extended time in this stage leaves the athlete vulnerable to losing crucial support, friends, optimism and confidence. My support network stayed with me, but over a few months they carried on with their lives and I just became a nuisance. The longer one spends time coping with anger, the more likely they are to become depressed which carries many more serious implications.
If an injury is severe enough or an athlete becomes significantly overwhelmed, depression is not uncommon. The head of Vanderbilt's Sport Medicine Center, Dr. Gerald Kaforey states that "I'd say one out of every four or five of the injured athletes who come to our center suffer from depression'' (Tarkan). Furthermore, "those who do get depressed may stay that way for several weeks after being injured, their mood lifting only as their injuries begin to heal. Some athletes, especially those with longer recovery periods, may stay depressed for months. And in rare instances, injured athletes have attempted or committed suicide." (Tarkan) The main cause of depression in athletes is their loss of self identity; like an artist without a paintbrush, an athlete without his sport is a fish out of water. The longer the recovery, the more susceptible an athlete is to losing his skill, determination and optimism. Depression acts like a runaway train: it takes friends and family away while dragging grades, relationships and life goals along with them.
Depression is subjective to the individual which makes it difficult to diagnose. Additionally, depression is especially alarming because it magnifies other emotional responses and impacts recovery from injury. By being able to identify possible stressors and psychological distress - whether they be related to the injury or not - friends, family and coaches can help facilitate the rehabilitation process (Russell). For example, around the time of my injury, I had a lot of external issues that I was dealing with: money was incredibly tight, my parents were splitting, and I was moving away from my childhood home. The injury alone was probably not enough to cause depression, but with all these stressors combined it hit me like a freight train. My motivation was gone, the light at the end of the tunnel vanished and I woke up every day "just going through the motions".
There is no single right answer, but those with depression will agree that it takes time and continual support from family, friends, and even doctors. Finding alternative interests is one of the biggest motivators to help steer away negative thoughts and keep morale high. Within months of breaking my vertebrae, I took up fishing (my friends joke that it was the only activity I could do) and it relaxed me enormously. It is important to funnel the negative energy away from being sad and angry, whether it means playing video games or staying up to date with the news. Similar to a broken bone, the entire healing process takes plenty of time and outside support.
Final Stage: Acceptance
The final stage in the grief cycle for an injured athlete is the acceptance of their injury. Although an athlete may accept his or her injury, "acceptance" in this stage implies that there are no emotional or psychological factors obstructing the rehabilitation process. The mental barriers obstructing rehabilitation: anger, sadness, confusion, loss of confidence should all disappear or become minor roadblocks. This is the start of the Acceptance Stage which normally comes with time and as the athlete approaches the final stretch of recovery (Russell). This stage of acceptance is extremely crucial because a return to sports may cause a catastrophic re-injury. Additionally, persistent psychological problems such as insomnia or anxiety should diminish as these are tell-tale signs that an athlete isn't fully healthy. I personally continue to suffer from insomnia years after my incident and cannot sleep more than a couple of hours a night. I have found other means of coping with this - through acupuncture, therapy and medication. There are certain persistent issues that might not be cured, but the ultimate goal is to strive towards a normal, healthy lifestyle. That is enough for most of us, and we should all have access to effective mental health treatment.
Finally, an injured athlete should have a genuine desire to return to their sport, a final confirmation of their acceptance. An injury is capable of significantly altering established lifestyles but it also gives athletes a chance to sit back and reflect on their true desires. Sometimes, athletes realize that adults or other factors are forcing their hand and they refuse to continue their sport. The main point of focus is being physically fit as well mentally capable of slowly returning to your sport and re-gaining a rhythm - no matter how long it takes.
Did depression play a role in your recovery process?
Fighting an Injury is Like Battling an Unseen Enemy
In my studies, I spend a large portion of my time analyzing the various conflicts across the globe, which today is predominantly guerrilla warfare. Small groups of individuals are waging war against large powerful states and winning in some cases. When I study guerrilla warfare, I subtly draw a resemblance between it and the war against my injury. At first, I enjoyed success against my enemy: I got through surgery, I raced about in my wheelchair and I made do with the neck brace. But watching my friends run around got dull and being immobilized became a hassle. The little white painkillers came to symbolize my degradation; Netflix was a used commodity. I thought I could stay positive, but slowly the injury drained my mind dry. The enemy was winning. Like a guerrilla war, the insurgents continually strike until the giant gives up or the insurgency loses momentum.
- You're not alone
- Recovery is a process - it will take time
- Accept your predicament
- Find peace with the gifts God has given you
A big enough injury will never leave the mind of an athlete. Especially if you've suffered from depression, an injury will always be there fighting an unseen guerrilla war with your emotions and self-identity. However, in a broad sense, learning to cope with an injury is just a part of surviving life. Realistically, it is just another roadblock and it should be confronted that way - logically and with care. Injuries in athletics are an inevitable result of high intensity trainings and matches. Today's culture of sports is different than before: young athletes are pushing themselves and being pushed by adults to their limits. Injured athletes - especially elite competitive athletes - have trouble with coming to terms with their injury and often struggle during the rehabilitation process. Albeit the grief cycle is useful in identifying emotional patterns during recovery, many externalities exist such as current life-stressors, past tendencies and personality traits. There are many athletes that, like Kameron Reichert, have treatable injuries but lack access to the proper rehabilitation tools: medical help, support from family and friends, a conscious environment and set timeline for recovery.
Personally, I wish I could say I overcame my struggles and I'm a better person today because of it, but I can't. I can't change what happened but I wish I had more support when I was going through the rehabilitation process. Even today I am slave to my insomnia and I am reminded of how lucky I am to have made it - alive. Although one day I hope to be back physically to where I was before the accident, I strongly believe my emotional personality has permanently changed. This is an aspect that is too often overlooked; Dr. Chris Carr, the team psychologist for the Indiana Pacers sums up perfectly this obstacle in our society:
"Certainly we’re not naïve enough to think that our student athletes are immune to a torn knee ligament or other physical injury on the playing field or in training. But we are naïve if we think these same kids are immune to struggles with depression, anxiety and thoughts of suicide. When—not if—the expected mental health crisis arises, kids need the very best support, referrals, and understanding of coach and teammates we can deliver" (Brent).
Awesome interview with Dr. Brian kern from the Orthopaedic Institute of West Kentucky.
Visit http://www.stopsportsinjuries.org/ for more information.
Brent, David. "Sudden Death." Well Aware Sp. Well Aware Wyoming, n.d. Web. 7 Nov 2013. <http://www.wellawaresp.org/bulletins/ATHLETES AND SUICIDE/Well-Aware-Bulletin-Fall- 2012.pdf>.
Herring, Stanley. "Psychological issues related to injuries in Athletes." Sports Med. N.p.. Web. 7 Nov 2013. <sportsmed.org>.
Shuer, Marjorie. "Psychological Effects of Injuries in Elite Athletes." Europe MC. West Med. Web. 7 Nov 2013. <http://www.europemc.org/pdf>
Russell, Paul. "The Psychological Impact of Sports Injuries." . The Fifth Space, n.d. Web. 7 Nov 2013. <http://www.thefifthspace.com/pdfs/psychologyofinjury.pdf>.
Tarkan, Laurie. "Athletes' Injuries go beyond the Physical."NYtimes.com. New York Times. Web. 7 Nov 2013. <http://www.nytimes.com/2000/09/26/health/athletes-injuries-go-beyond-the- physical.html>.
Walker, Natalie. "Psychological responses to injury in competitive sport: a critical review." Proquest.com. N.p., n.d. Web. 7 Nov 2013. <http://search.proquest.com/docview/231076088>.
Weisenberger, Lisa. "Youth Sport Injuries in Youth." Stop Sports Injuries. N.p.. Web. 7 Nov 2013. <stopsportsinjuries.org>.