Six years ago, Kevin Love, at the time a power forward for the Cleveland Cavaliers, published a now-famous essay in the Players’ Tribune titled “Everyone Is Going Through Something.” The piece describes an in-game panic attack that had blindsided Love earlier in the season, and his subsequent struggles to talk about what had happened. Love writes that he eventually started seeing a therapist, but that it hadn’t been easy to take this step. Since childhood, he’d subscribed to a notion that equated emotional vulnerability with weakness—an attitude which, Love argues, is pervasive in the cutthroat world of pro sports.

　　When it was published, Love’s essay was celebrated as an encouraging sign of the times; if even super macho pro ball players were opening up about their psychological struggles, it must signify a broader trend of acceptance. (Love has said that his essay was partially inspired by DeMar DeRozan, another NBA star, who had made comments on social media about dealing with depression the week before.) And, indeed, conversations around athlete mental health seem to have proliferated in recent years, with some of the biggest names in sports—Michael Phelps, Dak Prescott, Simone Biles, and Naomi Osaka, to name just a prominent few—publicly addressing the psychological toll of their profession.

　　This is undoubtedly a positive development. That said, one of the potential pitfalls of the sudden ubiquity of mental health discourse is a tendency to indiscriminately apply it to all forms of seemingly aberrant behavior. It may be true that “everyone is going through something,” just as it’s true that all of one’s actions are ultimately related to one’s mental health, but such totalizing language isn’t much help when it comes to the question of individual accountability. Late last year, there was a fevered, if esoteric, debate among NBA heads surrounding the suspension and league-mandated counseling for Draymond Green, after the Golden State Warriors forward  had multiple violent outbursts on the court. The question, in a nutshell, was whether Green was really experiencing a mental health crisis, or whether he was just being an asshole.

　　To help get some perspective on this issue, I recently spoke with author and journalist Julie Kliegman, whose new book Mind Game: An Inside Look at the Mental Health Playbook of Elite Athletes comes out this week. Kliegman, who has written extensively on athlete mental health for outlets like The Ringer and Sports Illustrated, chronicles some of the early history of the discipline, before examining more contemporary examples in both collegiate and professional sports. Although she spends a good deal of time with some of the high-profile cases mentioned above, one of the virtues of Mind Game is that we also get to hear about less well-known instances: The UFC champion who has a positive experience with psychedelics after traditional psychiatric medicine only exacerbates his depression. The National Women’s Hockey League retiree who faces an identity crisis after stepping away from the sport. The Major League pitcher whose debilitating bouts of anxiety eventually force him into early retirement.

　　OUTSIDE: At one point early on, you write that there’s no evidence to suggest that elite athletes experience mental illness at a rate higher than the general population. What was the impetus behind writing a book that focuses specifically on athlete mental health? Why is it useful to consider this as its own category?

　　KLIEGMAN: There’s certainly space for plenty of books to delve into different aspects of mental health. There will be many more, I hope. In terms of focusing on athletes, I thought it was relevant because athletes face all these incredible pressures, both some that we as a general public do as well and then some that we as a general public do not. Athletes are in a bit of a unique situation in that we pay so much attention to them. So I think it’s worth examining how we think about them, how we treat them, and how they treat themselves. And there’s a whole lot of stuff they face that we don’t necessarily automatically understand.

　　There are professional sports that seem like they would be very conducive to anxiety. You are performing in front of thousands of people, sometimes with millions of dollars on the line, and an entire industry of critics who will scrutinize everything that you do. Do you think it’s fair to suggest that being a pro athlete—at least in certain sports—puts someone at increased risk for mental health issues?

　　I think if you have a problem with mental illness it will certainly risk exacerbating it given that you have to perform on a certain stage. I don’t know that it will create an issue out of nowhere and I don’t think experts know that either, but it will certainly toy with the worst parts of you, or the parts of you that you’d like to quiet, if you’re not directly addressing it.

　　Mental health discourse has proliferated in recent years. There are many ways in which this is obviously a good thing, but a downside is that the term becomes so ubiquitous that its meaning gets diluted. In your book, you make a distinction between athletes who are concerned with the mental side of their sport from a performance perspective and those who are concerned with their mental health more generally. Can you elaborate on that distinction?

　　I think when we are talking about mental performance, a lot of the time what we are talking about, for instance, is the player whose throws to first base are just kind of off and he doesn’t know why. I think there’s a big difference between something like that and something like “I’m too depressed to go to the ballpark today.” Although one person could certainly have both of those issues. They can be related. But not everyone who sees a sport psychologist for performance reasons has a diagnosed mental illness. They could just be seeking to improve their performance. And, on the flipside, not everyone who has a mental illness necessarily has issues with their performance. It’s probably likely that they will at some point, but a lot of times athletes describe sports as their “zone.” So it is possible to not be having a great time in your personal life, but to still be able to switch it on and off at work. Just like the rest of us can at times.

　　Do you think that ability to be very functional, in public, is part of the reason why we can overlook mental illness in athletes? It reminds me a little bit of the Britney Spears saga. She’s not a professional athlete, but someone who was performing at a very high level for many years while dealing with a lot on the inside.

　　I think it’s definitely true. Not to focus too much on Britney, but I was reading her memoir and she talks about going out every day and going into an almost robotic state for her show in Vegas every night and doing it the same exact way every time and executing at that high level. And I do think there’s a similarity between that and what athletes do, where we look at them and are like, “Oh, but you won the game last night.” Or: “But you’re making so much money.” We don’t know what is going on beneath the surface, so it can be easy for us to overlook what’s really happening.

　　I think one of the virtues of your book is that you cite examples of athletes who have been outspoken mental health advocates while at the same time being flawed individuals. It’s helpful, I think, to remember that mental health ambassadors aren’t always these paragons of virtue. On that note, at one point in your book you write that “mental illness is no excuse for bad behavior.” So what are some ways that we can distinguish between an actual mental health episode, and when someone is just being a jerk? For instance, there are people who have argued that the NBA’s mental health framing around Draymond Green’s recent suspension was a little disingenuous.

　　I think that can be a very difficult thing to parse for a lot of people. Especially, as you said, as discourse around mental health becomes more prominent. It also becomes cheerleader-y in a way where everyone who is going through something needs to be put on this pedestal. And I don’t see that as particularly productive. So when you look at someone like Draymond—you and I don’t know what he is, or isn’t, going through, but it does feel a little cheap to attribute his situation to mental health without offering more information. One way to distinguish, and to your question, I think it’s important to remember that people who are mentally ill are more likely to be victims of violent crime than perpetrators of it. So, while there are mentally ill people who are violent, I don’t want that to become a one-to-one association. I think when the NBA, or the Warriors, say stuff like that about Draymond, I do think it risks re enforcing that stereotype.   

　　When Simone Biles got the twisties at the 2021 Olympics and withdrew from the team and individual competitions, there was this weirdly bifurcated reaction: On the political right, she was essentially accused of betraying her country and, on the left, she was celebrated as a hero. I found both of these reactions kind of absurd. It’s why one line in your book really struck a chord with me. You write that: “That area in between being exalted as superhuman for being tough and being exalted as superhuman for being vulnerable is going to take a massive cultural mindset shift to pinpoint.” What did you mean by that?

　　I think this dichotomy between “so-and-so is so brave” and “so-and-so is so tough,” it doesn’t have to be one or the other. Bravery and toughness and vulnerability, all those things can go together. It’s not an either/or scenario. I think, just as it’s bad to demonize athletes with mental illness, it’s almost equally harmful to put them on these pedestals and ascribing moral value to a decision that they just made for their personal health. There are a lot of great advocates for mental health among athletes, and at times they deserve praise for that, but that’s a little bit different than just making a personal decision that you have to make because of your health.

　　Right, because talking about mental health in this way almost mystifies it in a way that we would never do when an athlete talks about, say, needing knee surgery or something like that. I hate this word, but it’s about “normalizing” mental health talk.

　　I think that’s exactly right. And “normalize” is probably the best word available to us for that, even if it is kind of annoying. I think normalizing it is the thing that is going to make everyday people comfortable talking about their problems and seeking help.

　　A large part of your book focuses on the NCAA athlete experience and how the student-athlete’s sporting career can be all-consuming. You touch on this idea of identity foreclosure. To what extent do you think it’s fair to suggest that the quasi professionalization of college sports in this country has created its own mental health crisis?

　　I don’t know if it’s created a mental health crisis, but I do think the NCAA system has exacerbated it. I say that because you can look at college students who are not athletes and they are very often in crisis as well with their mental health, so we know that college is already a tough place to be and a tough time of your life. It’s incredibly expensive; it’s incredibly demanding; there’s so much expected of you—of your time and your emotions—while you’re still maturing. So adding sports to that equation, it’s no surprise to me that it’s igniting a fire if you are already predisposed to mental illness. There are a lot of positive things happening in college athletics; I would personally consider the transfer portal and NIL among those. And yet, even those positives, as I point out in the book, have stressors directly associated with them.

　　In terms of what can actually be done to improve mental health outcomes for athletes, we hear a lot about “increasing awareness” and “reducing stigma.” As you note in your book, these terms have become kind of cliché, which doesn’t necessarily mean that they aren’t true. In what ways can increased awareness have a tangible positive impact, and what are the limits of awareness, or the dangers of putting too much stock in it?

　　Well, I think awareness is clearly helpful in that, if you see someone on TV talking about mental illness, someone that you look up to or respect, you are more likely to get help or at least talk to someone. But I certainly think we can’t stop there, because stopping there ignores structural barriers that are in place. You can’t just always say “Get help,” without acknowledging that it’s harder for certain demographics to get help. We need to ask why that might be. And digging into and solving those problems often tie into big issues our country faces, like racism, or sexism, or economic class, or anti-LGBTQ sentiment—things like that keep people from getting help on a very real level. So I would encourage everyone to treat awareness like the good thing that it is, but also I would challenge everyone to not stop there.