SPECIAL REPORT: Experts warn of addiction, eating disorders and depression in isolation

‘I wonder if some of these guys don’t fancy the ultimate test,’ said Ian Botham, as uncertainty around the Ashes drags on.

If only England’s players were worried about the cricket.

Instead, the tour remains in doubt because of Covid restrictions Down Under – notably, the spectre of more biosecure bubbles. The England team have been in and out of bubbles for 15 months. Some are reluctant to enter another set of them across Australia, Ashes or not.

Adam Peaty enjoyed success at the Tokyo Olympic Games but vowed to take an extended break

Both Ben Stokes (left) and Adam Peaty (right) have stepped away to focus on their wellbeing

‘Every single player as a kid wants to go to Australia, they want to win the Ashes,’ said captain Joe Root. ‘It’s just at what cost?’

For society, normality beckons. For elite athletes, the grind goes on. Ben Stokes, Naomi Osaka, Simone Biles and Adam Peaty are among those to step away to protect their wellbeing. Many others are suffering in silence as sport’s relationship with mental health reaches a tipping point.

Sportsmail has spoken to a number of experts across sport tasked with treating athletes’ mental health. They warn:

  • More bubbles will lead to more players suffering with depression
  • Isolation has sparked addiction and eating disorder issues
  • Psychological damage caused by bubbles could linger forever
  • Players have considered ‘breaking out’ of bubbles during the night to escape turmoil
  • ‘There’s never been a situation like this that is so threatening to players’ mental wellbeing,’ leading mind coach Don Macpherson tells us. ‘It is out of control and threatens to be more out of control.’ 
Joe Root (centre) and the England team are pondering whether to commit to an Ashes bubble

 Joe Root (centre) and the England team are pondering whether to commit to an Ashes bubble

The Women’s Tennis Association’s mental health and wellness team are ‘tentative’ about using the word bubble. It can be ‘misleading’, claims vice president Becky Ahlgren Bedics. They prefer ‘Covid-testing environments’.

The principle remains the same: competitors are housed in tightly controlled environments to minimise risk of infection. And no shift in semantics comforts those suffering behind closed doors.

‘You get stuck in this never-ending nightmare,’ Australian cricketer Glenn Maxwell has said.

US tennis star Reilly Opelka claims life ‘can get dark’ and ‘scary’. South Africa’s rugby union team have ruled out another bubble, saying: ‘It will break the players.’

The downsides are obvious: weeks without loved ones or the freedom to explore. Only isolation and the slog of competition – often in empty arenas.

‘When you have too much time on your hands, you are a sitting target for anxiety and depression,’ says Macpherson, author of How to Master Your Monkey Mind.

‘Bubbles cause higher levels of intensity, intensity produces anxiety, anxiety can produce depression, that’s the slippery path. Sadly, I’ve seen a huge increase in depression in young sports people, especially aged between 16 to 24.’

One of the most high profile cases of athlete wellbeing this year was Team USA's Simone Biles

One of the most high profile cases of athlete wellbeing this year was Team USA’s Simone Biles

During the pandemic, athletes are contacting Macpherson ‘almost on a daily basis’.

‘I’ve spoken to England rugby players, England football players, tennis players at Wimbledon, snooker players,’ he says. ‘They feel restless, trapped, claustrophobic, flat emotionally. They are anxious and don’t know why, and have no idea what to do or where to go.

‘Nottingham (tennis event) got very controlled and upset a lot of players. I was getting calls from players threatening to break out during the night, past the guards. It’s almost like Colditz – this vision of tunnelling out of the hotel.’

Sporting Minds, a mental health charity started by former Worcestershire academy cricketer Callum Lea, has seen a huge increase in referrals over the past 15 months.

The charity has supported more than 900 players from across sport since 2020 – 119 in June 2021 alone. Increased stress and anxiety is a familiar complaint.

‘It’s been brilliant that athletes have had the strength and courage to take themselves away from that environment,’ the 21-year-old says. ‘You have to deal with your mental wellbeing first because if you don’t, you’re not going to have a long and sustainable career.’

One problem? Our tendency to overestimate athletes’ resolve. ‘They appear so physically strong and flawless and there is this inappropriate assumption that it’s the same on the inside,’ says Claudia Reardon, a sports psychiatrist who works with, among others, the International Olympic Committee.

There is, in fact, evidence to suggest that elite athletes are more susceptible to mental illness. ‘They don’t normally endure normal daily stresses that you and I do,’ explains Macpherson.

US tennis star Reilly Opelka claims life 'can get dark' and 'scary' for athletes stuck in bubbles

US tennis star Reilly Opelka claims life ‘can get dark’ and ‘scary’ for athletes stuck in bubbles

Reardon looked into this with the IOC. ‘We found for most mental health disorders, elite athletes are just as vulnerable as non-athletes,’ she says. ‘Then there are certain ones where they’re actually disproportionately more likely to suffer.

‘Those of us working clinically with high-level athletes have been painfully busy during the pandemic. Athletes are coming in with symptoms that were directly precipitated by pandemic factors.’

Many can have roots in prolonged confinement: social avenues are closed off, rigid routines are knocked off kilter.

‘If that is controlled by somebody else, you can end up going on a pitch feeling unprepared,’ says Macpherson. ‘It does affect performance negatively for the vast majority of players in bubbles.’

Disruption to sleep patterns can ‘seriously accelerate mental issues’. So can an inability to shift focus. Restricted to that mind-numbing schedule (sleep-compete-room-repeat) many athletes suffer when they ‘place their whole identity around their sport,’ says Lea. ‘If their cricket or football isn’t going well, it’s almost like their whole life isn’t going well.’

Put more bluntly by Macpherson, bubble life ‘unbalances brain chemicals’. The result? He has seen addictions — to phones, gambling and social media — spiral, as well as worsening phobias and OCD. ‘You’ve got time on your hands. This is when mental issues can flourish,’ he says.

Among those causing most alarm to Reardon are eating disorders. ‘Huge,’ she says. ‘Either triggered or worsened in the pandemic.’

Reardon explains: ‘Part of the athlete identity for a lot of people is being very fit, strong and feeling proud of their bodies.’

Naomi Osaka has been vocal in needing a break from tennis to protect her mental health

Naomi Osaka has been vocal in needing a break from tennis to protect her mental health

So when training is disrupted by isolation, some athletes become ‘very afraid that they’re going to lose fitness (or) gain weight and they get unduly obsessed with food, eating and end up restricting’.

Is it any wonder problems can snowball when the world grinds to a halt? After all, ‘exercise itself is a powerful anti-depressant and anti-anxiety intervention,’ explains Reardon. ‘If you’re suddenly stopping exercise or decreasing your ‘dose’ of it by 50 per cent, that’s like suddenly cutting your anti-depressant dose in half.’

Not only are athletes at more risk of some problems, treating them with typical medication can be more complicated too. ‘A side-effect that may not be a big deal to a non-athlete can be a huge deal,’ explains Reardon. ‘If it slows down their 100m time by one hundredth of a second, that’s the difference between a gold medal or not.’

Other medicines may not be safe for sportspeople – who push themselves to extreme limits – while WADA often ban stimulants used to treat some disorders.

There are, fortunately, other ways to help. At this year’s US Open, Reardon helped launch a new six-part Mental Health Initiative. Following Osaka’s struggles with media obligations, they offered more press ‘flexibility’ to players who might be suffering. They are now keen to talk to other Grand Slams and the IOC with a view to potentially developing common standards across tennis.

Elsewhere, though? ‘What mental tools were offered to the Lions players before they went on tour? I’ll tell you. None,’ says Macpherson, whose list of clients includes wing Anthony Watson.

‘I don’t see much action from teams, and I can’t be the only mind coach getting calls from people inside bubbles.’

Mind coach Don Macpherson counts England's Anthony Watson (middle) among his clients

Mind coach Don Macpherson counts England’s Anthony Watson (middle) among his clients

For some athletes, the worst could be yet to come. ‘It’s completely unsustainable. If bubbles go on for the next 18 months, then Sporting Minds is going to see a huge spike in referrals,’ insists Lea. Macpherson agrees. ‘There will be more Ben Stokes cases… he recognised, if they’d have gone on one more tour, they would not have been able to cope with the emotional traumas.’

The hope, of course, is that problems will diminish as normality returns. Unfortunately, the brain cannot switch illness on and off. Issues brought on by bubbles will not disappear even when they burst.

‘There are people who assume athletes can suck it up and live in this bubble because it’s temporary and then they’ll move on,’ Reardon says. ‘It’s not a temporary thing. We’re definitely not anywhere near out of the woods.’

That does not bode well. Last April, it was revealed that the number of footballers reporting symptoms of depression had doubled since the shutdown, while anxiety symptoms also rose.

So when will this damage be reversed? ‘I wouldn’t put a deadline on it. I don’t think there is an end,’ says Reardon. Certain stressors ‘can be forever life-changing’, she adds.

If there is a silver lining, Reardon believes ‘we are in the early phases of the golden age’ as, ‘especially over the last year, people are really grasping the importance of mental health’. Osaka and Co have helped. ‘After an athlete like that comes forward, the next week in clinic I’m busier,’ she says.

Progress cannot be squandered post-pandemic. But as Macpherson points out: ‘It’s not enough to just talk about the importance of mental health… we’ve got to do something about it.’ 

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