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FIFA's new mental health research project is a race to save lives

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Lars Baron

FIFA's new research project, "Mental Health and Sport," has two main goals: to abolish the stigma that comes with mental health and to build a foundation for the development of treatment. The project will be headed by retired German professional footballer and sports psychologist Birgit Prinz, who is also a three-time FIFA World Player of the Year. She will join forces with another German former footballer, Edgar Schmitt, who will be the ambassador for the project.

The importance of the mental well-being of humans in general, and athletes specifically, is obvious. "Low on confidence" is everyone's favorite explanation of poor performance; coaches and managers speak all the time on players being "mentally ready" or that certain players will succeed due to their strong mentality. The language of mental health is embedded in our descriptions of the game, and yet the actual treatment of players goes largely ignored. Prinz describes the situation perfectly:

Mental fitness is equally important for the wellbeing and performance of professional football players on and off the ground, as is physical fitness and a well defined technique ... However, specific training for mental fitness is rare and players are often assumed to be mentally fit. From my experience and in my opinion it is important to see and to openly demonstrate that it is 'normal' for professional football players to experience mental stress and that this does not automatically result in failure of a professional career. But it can be prevented, treated and cured. We have to overcome the myth that professional football players are invulnerable.

The project will be done in stages. The first research effort will evaluate the highs and lows of a footballer's life during his career and after retirement. The second will focus on the risk factors for and prevention of the mental issues. The third will analyze the effects of sports on the mental health of recreational athletes. This initiative comes on the heels of and references the recent FIFPro study that found, amongst numerous other discoveries, that a quarter of the active 180 participants showed signs of depression and anxiety. The percentage is higher for the retired players for many reasons, including the loss of a sense of place in society and burnout.

Some other findings of the study:

  • Five to 42 percent of the former professional footballers reported to have some mental health problems.
  • Distress and burnout were reported by 15-20 percent of the former players. More than 30 percent of the former footballers reported to have some adverse alcohol behaviors, while 12 percent were smoking.
  • Nearly 20 percent of the current footballers reported to have some adverse alcohol behaviors, while only 7 percent were smoking.

The results, while a bit higher than the social average, do reflect the world at large. But in turn, they also show that footballers are more like normal people than the majority of observers allow:

About 450 million people suffer from mental disorders according to estimates of the World Health Organization (WHO 2010). One person in four will develop one or more mental or behavioural disorders during their lifetime", said Prof. Dr. Astrid Junge, Head of Research at the FIFA - Medical Assessment and Research Centre (F-MARC). "There is no evidence that football player are different - on the contrary, football players, especially at the top-level, experience high levels of stress not only due to the physical load of training and matches but also in relation to the high expectation on their performance and the potential competition/conflicts within the team. Stress is an important risk factor for the development of mental and behavioural disorders, and it has been shown that psychological factors contribute to the risk of sports injury and to a prolonged recovery from injury.

While the mental health of footballers in general is obviously an important and fascinating area of research, this study also has an emotional bearing on the Bundesliga specifically. The case of Robert Enke, a sufferer of depression, who took his life by jumping in front of a moving train on the night of Nov. 10, 2009, represented a tragic wake-up call for the German football world. Enke had been suffering from depression for over six years at the time and when he lost his daughter Lara, in 2006, he was unable to fight any longer.

The footballing world mourned his loss, with teams holding a minute of silence in his memory around the world. The German national team canceled friendlies, meetings and training sessions after his death. Five days after his death, the AWD Arena was filled with almost 40,000 people gathered as his coffin, covered in white roses, was carried by his teammates. A foundation that deals with the mental health of players was also founded on his name.

Over four years later, German football dealt with another high-profile death from mental illness: Andreas Biermann, a former Union Berlin, Tennis Borussia Berlin and FC St. Pauli defender, committed suicide in July after struggling with depression for several years. This time, the case was even more damning than Enke's -- Biermann had made his struggles with mental health known to his teammates and coaches in 2009; they were also aware that he had attempted to take his life on three separate occasions in 2012.

So how did the teams and his teammates handle the situation? As former teammate Torsten Mattuschka put it: "He has tried to do it a few times. It was believed that he would manage to handle his condition. Unfortunately he didn't succeed in doing so. It's a tragedy. How despondent does one have to be, to do such a thing as a father of two? It is hard to imagine."

Biermann's health problems were so apparently difficult to imagine that they went entirely untreated.

After revealing his condition and undergoing treatment, his contract with St. Pauli was not extended. No other teams looked to sign him either, forcing Andreas to retire at the age of 29. Frustrated and angry about being ostracized by professional football, he went public to state that if any footballers were suffering from depression, they should keep it to themselves -- a notion that is strongly enforced by the behaviors of the public regarding mentally ill individuals. He also lamented that after revealing his condition nobody from the team contacted him even to talk. Andreas died while the people who could have helped, those who should have known better, the ones who saw this situation play out a few years before, did nothing.

While the tragic ending is mercifully rare, the isolation aspect is more of a norm than an exception. The misconceived view that depression is nothing more than being sad and/or lonely is all too common, and unfortunately leads to the general public being ignorant of and unable to imagine the battles being waged in silence. American author David Foster Wallace, himself a victim of depression who ultimately committed suicide, described the experience very differently: "The so-called ‘psychotically depressed' person who tries to kill herself doesn't do so out of quote ‘hopelessness' or any abstract conviction that life's assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise."

FIFA, for all of its ills, has the opportunity here to save lives, not only from death but from the deep abyss of isolation and heartbreak which can engulf sufferers of everyday mental illness. The stigma, one of the main barriers of progress in mental health, needs to go; the eyes of people -- fans, coaches, managers, chairmen, owners -- need to be opened. These heroes of ours, both in sports and in everyday life (everyone is a hero to someone, after all) are at risk, and only full awareness and cooperation by all parties can prevent further damage. It took some time for Germany to learn; hopefully this project can encourage the rest of the world to stop repeating the same mistakes.