There exists a stigma even today for people who struggle with any sort of mental health or substance abuse issue. People will feel ashamed of “not being strong enough” or “being broken” when they are dealing with a mental health issue. The reality is that is simply not the case. What someone is dealing with is no different than heart disease, pneumonia, or asthma. Mental health and substance abuse may require medical intervention and should not be stigmatized just because it isn’t understood.
So, in an effort to make some of the more common mental health matters more widely understood for people who have no prior lived or shared experiences, it may be beneficial to discuss the most common diagnoses and some of the signs and symptoms of each. This can serve as a resource for coaches who may have an athlete who has a history of struggling with depression, or to help an athlete recognize something a friend is dealing with may require professional intervention. It is worth noting that you may recognize some of the signs and symptoms of any diagnosis in yourself. There are distinctions a trained clinician is aware of when they are evaluating a person that will not be discussed in depth here. This is intended to help alleviate stigma, as well as provide a tool for people to consult allowing them to determine if they need to enlist a professional to assist a friend, themselves, or a client.
Depression may be the most discussed of all mental health diagnoses and is one of the most common mental illnesses. There are a number of signs and symptoms associated with depression that can be explained away by other things going on in an individual’s life, and often they may do so because of the stigma associated with being depressed. Someone who is dealing with depression may be fatigued all the time with a lower energy level than normal. Obviously, within the world of powerlifting we may chalk that up to training being hard and recovery not being sufficient. A deload may be called for, or an increase to caloric intake. This is exactly why we need to look at the big picture when we suspect there may be something more going on. Someone who is struggling with depression may also have problems concentrating and making decisions when they normally do not. Changes in sleep and/or appetite (sleeping/eating more or less than normal) are common and can include unexplained weight loss. Someone who is depressed may be irritable and restless and may be avoiding activities that they love to do. Being depressed may lead to feelings of hopelessness, worthlessness and overall pessimistic thoughts. Depression can also manifest with somatic complaints as well such as stomach pains, an upset stomach, or other assorted aches and pains. Being depressed may also yield persistent sad, anxious and empty feelings and at its worst, depression can lead to suicidal thoughts, behaviors and even attempts. We will discuss suicide more in depth later in this article, as it deserves careful attention.
Bipolar was formerly referred to as manic depressive disorder simply because the two “poles” in this case are moods on opposing ends. Depression is obviously the low end and mania is on the opposite pole at the high end. Mania can be a challenge to recognize, because being manic can be an enjoyable experience. Having boundless energy, feeling euphoric, and believing you are capable of anything while not needing to sleep much can certainly sound appealing. Imagine, as a lifter feeling all this energy and not having to sleep as much as you normally would. Feeling unstoppable and walking into training every day feeling like a million bucks, having the confidence to lift anything, and not having to slow down for a second. While some people may just normally be like this, you want to be mindful if the way someone is behaving is a sudden change from their normal appearance, as this may be cause for concern, especially if it persists. Along with the increase to energy and euphoric feelings comes racing thoughts, rapid speech, and very poor judgment which may include an unusual sex drive and provocative behavior. Someone in a manic state may be in denial about anything being wrong and may resort to using drugs and alcohol trying to balance out with cocaine, sleeping pills and alcohol. With these highs, there is destined to be a crash because by definition Bipolar will present with at least one episode each of depression and mania.
Schizophrenia is characterized by issues with thoughts or perceptions and is often characterized with psychosis. Someone who is experiencing psychosis will often experience hallucinations; seeing, hearing, smelling and on occasion tasting things that are not there. Someone who is psychotic may be observed talking to themselves at length. In addition, delusions may be present where the person truly believes something to be true that is not reality. The individual may also be dealing with paranoia. They may feel they are being followed, or that people are out to get them, or someone is stealing from them. Unfortunately, the degree to which these delusions and hallucinations are experienced by the individual will lead to an extreme level of difficulty in deciphering what is reality and what is a symptom of the illness. Someone with schizophrenia may have rambling speech patterns, and potentially nonsensical speech. Because of the severity of the symptoms of schizophrenia, it is not likely going to mask itself as something else within a training environment that would have a coach alter programming.
Substance abuse is harder to distinguish as it can often be co-occurring (happening in conjunction with) some of the other mood diagnoses. Substance abuse is going to be characterized with a regular using pattern, a growing tolerance, and withdrawal symptoms are likely if the individual suddenly stops using the substance they have been abusing. It goes deeper than that, though. An individual may decide they want to quit or cut back, but find they are unable to do so. They continue to fail at quitting. Additionally, the person with a substance abuse disorder will continue to use even though there are consequences associated with their use. These consequences can be loss of job, loss of family, or legal problems. In powerlifting, substance abuse can often be overlooked because drinking is not uncommon in the community with whiskey being almost synonymous with deadlifts and beers post meet being a regular occurrence. In the same vein, painkillers may not be unheard of either with people dealing with a variety of injuries and pain meds being prescribed as part of the process to heal from those injuries. Some substances may require a medically supervised process to ensure the individual can safely stop using the substance they have been abusing, as certain drugs and alcohol have life threatening withdrawal symptoms.
Suicidal Thoughts, Behaviors, and Attempts
Suicidality is possible when dealing with any of the aforementioned diagnoses. Someone who is suicidal may not always disclose they are feeling suicidal, but they may make other comments that can clue you in that something is amiss. If someone is talking about feeling like they are a burden on other people or feeling hopeless and having no reason to live and stating they feel trapped and in significant pain, these are all big red flags to pay attention to. When someone starts giving away their prized possessions, often that can be an indication that they may have decided they no longer want to live. Sudden changes in someone’s life may also lead to these feelings and thoughts. Losing a relationship or losing a job or even receiving distressing news, such as a major illness can all lead to suicidal thoughts. Someone who has a family history of suicide, has attempted themselves previously, or has been exposed to suicide (in person or even online) can have a heightened risk for attempting suicide.
There are a variety of resources available to those who are impacted by mental illness. The resources available will vary city to city and state to state and will be impacted by factors such as having insurance, fitting into a certain demographic, or even something as simple as transportation issues. Since the resources available at a local level are so specific, the best course is to examine those resources that exist at a national level.
NAMI, the National Alliance on Mental Illness is a grass roots organization that came about as a result of families who got together to advocate for their loved ones. NAMI educates the public, advocates on a national level, and offers support to those impacted by mental illness. They can be located at www.nami.org
Alcoholics Anonymous is one of the best known of the 12 step programs and is in fact the originator of the 12-step process. AA is a support group with a vast network spanning across multiple countries. More information can be located at www.aa.org
Similar to AA, is NA, or Narcotics Anonymous. Narcotics Anonymous focuses on addiction in general, and can be accessed at www.na.org
Another excellent resource is the National Suicide Prevention Lifeline. This hotline is available 24/7 and has ties to local crisis centers as well as working to find the correct resource for someone based on their experiences. The hotline can be accessed by calling 1-800-273-8255 and more information is available at http://suicidepreventionlifeline.org
The U.S Department of Health and Human Services have a website devoted to mental health, recognizing signs and symptoms of mental illness, how to obtain help, as well as tips on how to discuss mental health and mental illness. To explore more simply go to www.mentalhealth.gov