Sports Psychiatry: Strategies for Life Balance and Peak Performance

It would not surprise anyone to realize that sports are an important part of a national glue holding American life and culture together. After all, competitive sports have evolved from battles and wars among countries and tribes to battles among teams representing localities and groups (1). As such, from children’s sports to professional sports, their impact is at an all-time high because of rising participation rates, expanded professional and recreational opportunities for women and seniors, and the huge popularity of the business of college- and professional-level sports.

What is surprising is that although teams at all levels “spare no expense” to medically prepare and treat the body with a crew of trainers, masseurs, internists, and orthopedists, there is still very little attention paid to the brain and what we used to call the “mind”; that is, what we view as the “psychiatric aspects” of individual and team sports (2, 3). Yes, there have always been psychologists, trainers, and coaches, who have focused mostly on “mental preparation,” mostly for performance enhancement. But until now, there has not been a text to help a psychiatrist/sports physician working with competitive athletes and their teams.

David McDuff is the salaried frontline, 24/7 psychiatrist working with the 2013 National Football League champion Baltimore Ravens team and the Baltimore Orioles baseball team. He has pulled off the difficult task of successfully helping both the players, as individuals, and their teams.

This book provides a detailed “road map for mental health providers, athletic trainers, and sports medicine practitioners involved in the care of athletes (as both competitors and people).” (p. x). Dr. McDuff covers 1) the scope of his practice; 2) mental preparation; 3) stress recognition and control; 4) energy regulation; 5) substance abuse (which is a big problem); 6) injury recovery and pain control; 7) common career-related mental disorders; 8) how to work with the team, including medical staff; 9) developmental and cultural competence; and 10) the evidence base and future directions. The text is heavy with case examples, backed up by the growing and relevant psychiatric literature. The book is very helpful in its use of tables and graphs highlighting important issues, such as banned substances and data on concussions in different sports. It is also practical, providing detailed information on the above topics.

Why do we need this book? First, teams need to transition into the 21st century and provide the same (if not better) psychiatric and behavioral care as medical care. Second, individuals who play need help to achieve peak performance, as well as emotional stability and success, in sports and life. Third, to cope with the issue of stigma about psychiatric illness, players and coaches simply find it easier not to seek help or to receive treatment for psychiatric illness or symptoms of “bad behavior.” To see a psychiatrist is still viewed as being “crazy” or “weak,” and worse still, athletes may be told that “they can’t play” because of their untreated problems. Pick up any newspaper and see the daily athletic litany of substance abuse, doping, violence, suicides, domestic abuse, etc. Finally, parents, spouses/significant others, and families can be guided on how to provide better support during the ups and downs of an athletic career.

In short, we highly recommend this text. By way of competition, related texts include one on sports psychiatry (2), published in 2000, and one on clinics in sports medicine, published in 2005 and issue focused on the interface between sports psychiatry and sports medicine (4). (Each of us has a chapter in the latter text.)

There is a long-standing organization of sports psychiatrist pioneers called the International Society for Sports Psychiatry, whose scientific sessions have been helpful in developing the field. In addition to attending the annual meetings of this organization, we highly recommend Dr. McDuff’s book to psychiatrists, psychologists, and other mental health professionals. Finally, we recommend this text as a valuable resource to owners, athletic directors, coaches, managers, general managers, agents, and even commissioners of professional leagues, as well as to the National Collegiate Athletic Association and their staff.