Mental health in the NBA
Our five-part series on mental health issues in the NBA:
• The state of mental health in the NBA
• Mental health in the NBA's black community
• To medicate or not? A difficult decision
• Behind the anxiety and anger of an NBA ref
• The future of mental health in the NBA
http://www.espn.com/nba/story/...te-mental-health-nba
ACE's HIGHLIGHT
Parham, a psychologist and director of Loyola Marymount's School of Education's Counseling program, says mental health is "a human issue, not a basketball issue."
His goal is to not only destigmatize mental health issues but also to identify their origins. Too often, Parham says, patients are treated for their symptoms, either with medication or coping mechanisms, not the actual causes of their mental health struggles. Parham illustrates it this way: If the smoke detector goes off in your home, you don't grab a stool, pull down the detector and take it to get fixed. You locate the source of the fire and address that.
"That shrill noise doesn't suggest that it's not working," Parham explains. "It actually suggests that it is. Anxiety, depression, panic attacks are all human smoke detectors indicating that something else is going on."
"Too many of these guys don't realize how badly they need help until it's too late."Celtics GM Danny Ainge
In 2001, the Centers for Disease Control (CDC) and Kaiser Permanente studied more than 17,000 patients to determine the effects of adverse childhood experiences (ACE), including physical, emotional and sexual abuse, physical and emotional neglect, domestic violence, parental substance abuse, parental separation or divorce, household mental illness, suicide or death, and crime or an imprisoned family member.
"An adverse childhood experience can be anything from seeing your parents bickering to witnessing a drive-by shooting," Parham says. "The findings were that two-thirds of the American public had anywhere from one to four adverse experiences before the age of 10."
That baggage, if left unchecked, is lugged through the teenage years into adulthood, accumulating symptoms along the way. According to the pyramid established by the study, adverse childhood experiences can lead to disrupted neurodevelopment, which can lead to social, emotional and cognitive impairment, which can lead to adoption of health-risk behavior (such as drugs and alcohol), which can lead to disease, disability and social problems. The final layer of the pyramid for untreated mental health concerns is death.
"I can tell you much of what I'm dealing with is deep-seated," Love confirms. "It goes way back."
Love says shortly after The Players' Tribune article came out, he visited his brother in Portland. "I didn't know if he'd want to talk about it," Love says. "He told me, 'I remember when you were young, and you'd either have these rage fits, or we'd lose you for a couple of weeks and I'd just leave you alone."' During those stretches, which Love calls his "dark times," he'd stay locked in his room, shades drawn, and speak to no one.
Through more than 20 interviews with current and former NBA players, a recurring theme that emerged was the false public perception that because professional athletes are famous and wealthy, their lives are idyllic.
"You think when you come from a difficult environment that if you get out and you make it to the NBA, all that bad stuff is supposed to be wiped clean," DeRozan says. "But then this whole new dynamic loaded with stress comes your way.
"People say, 'What are you depressed about? You can buy anything you want.' I wish everyone in the world was rich so they would realize money isn't everything."
Parham says those worries are punctuated by the fact that elite athletes, particularly men, are reared in society to "keep it tight, pack it in, don't share emotions."
"When you add a layer of celebrity," says Parham, "now you have a double whammy. If an elite player starts talking about 'stuff,' he feels in danger of being traded or not being re-signed or losing endorsements. So the conclusion becomes, 'Better to stay quiet.'"
FULL ARTICLE:
The courageous fight to fix the NBA's mental health problem
LOS ANGELES -- I WAS JOSTLING for position with a gaggle of journalists and losing ground, sandwiched four-deep in a sea of bodies during media availability at the 2018 NBA All-Star Game in Los Angeles.
It was hardly an ideal environment to broach such a sensitive, personal topic as mental health, but Cavaliers forward Kevin Love had hinted three weeks earlier in Cleveland that he might be ready to share. At that time, I was interviewing Channing Frye in the Cavs' locker room regarding his depression following the deaths of his parents, while Love, sitting at the adjacent locker, listened intently to our conversation.
"We all go through something," Love said, cryptically, as I stood up to leave.
Now Love was perched on a dais in a ballroom at Staples Center in front of a long, flowing black curtain, fielding innocuous questions regarding his workout regimen. I navigated my way to the front of the pack and lofted Love a couple of warm-up questions regarding Frye. Once Love acknowledged that Frye's candor was "an important step" toward putting a face on mental health, I had my opening.
"Have you ever," I shouted above the din of the All-Star media day madness, "sought professional counseling?"
Suddenly, silence. The incessant chatter at surrounding podiums persisted, but in the vacuum of Kevin Love's space, everyone stopped, turned ... and waited. Love fixed his eyes on me, hesitated ever so slightly, then straightened his broad shoulders and leaned into the microphone.
Mental health in the NBA
Our five-part series on mental health issues in the NBA:
• The state of mental health in the NBA
• Mental health in the NBA's black community
• To medicate or not? A difficult decision
• Behind the anxiety and anger of an NBA ref
• The future of mental health in the NBA
"Yes," he answered firmly.
So began Love's public journey as the NBA's unofficial (and eloquent) spokesman on mental health. The willingness of Love and DeMar DeRozan to step out of the shadows and reveal their struggles has set the NBA on an important path of self-discovery. It has prompted the National Basketball Players Association to hire Dr. William Parham as its first director of mental health and wellness, and it has convinced commissioner Adam Silver and union head Michele Roberts that hammering out a comprehensive mental health policy needs to be a priority.
Yet there remain many obstacles to confront, chief among them the stigma attached to mental health that prompts many players to suffer in silence. The union also insists that mental health treatment be confidential, but some NBA owners, who in some cases are paying their players hundreds of millions of dollars, want access to the files of their "investments." That is not, however, the league's position. "The NBA fully supports protecting the confidentiality of players' mental health information and, accordingly, committed to the players association that any mental health program we undertake would do so," NBA spokesman Mike Bass says.
Confidentiality, says Love, has to be non-negotiable. Without it, he says, he never would have become comfortable enough to announce from that All-Star dais that he was seeking treatment.
Within seconds of Love's declaration that day, I frantically gestured to NBA senior vice president of communications Tim Frank and Cleveland Cavalierscommunications director BJ Evans to arrange a private moment with the Cavs forward. That private moment turned into 25 minutes of earnest discussion behind the curtain (literally) of one of the most accomplished players in the game.
While LeBron James, Kevin Durant and James Harden fielded queries on the most delectable wine, the coolest dunks and the best cities for sushi, Love and I sat in the players' sanctum directly behind them, unpacking one of the most prevalent issues facing the NBA -- and society as a whole. While Love explained that most of his social anxiety occurred off the basketball court, newly minted Hall of Famer Steve Nash, happily oblivious to the weighty topic we were addressing, playfully launched soccer kicks the length of the ballroom.
"I have anxiety, but I also come from a family with a history of depression," Love told me on that February afternoon. "It's difficult to talk about. It's difficult to confront. I finally had to say to myself, 'Your whole life these things will affect you, so how are you going to manage it?'"
Love's struggles were one of the worst-kept secrets in sports. Three months earlier, he had experienced a panic attack during a game against the Atlanta Hawks and had to abruptly leave the court. He also left the team in January following a game against Oklahoma City, prompting then-teammates Dwyane Wade and Isaiah Thomas to confront him regarding his mysterious illness. Love, however, says he did not have a panic attack during the Thunder game.
Both incidents provided excellent fodder for gossipy NBA wives -- and their husbands -- who eagerly dished on Love's mental health during the endless stream of All-Star cocktail soirees. While the outpouring of support was heartening once Love publicly announced that he was suffering from anxiety and depression, behind the scenes, mild derision and skepticism lingered. A small number of Love's teammates weren't buying the mental health excuse for his bailing on the team in the middle of a game. The withering criticism was piercing -- and proof that the stigma of mental health remains alive and well behind closed doors of NBA locker rooms.
Love is acutely aware of that stigma. The topic of mental health was never discussed among his family members, despite a history of depression that he believes has been passed down from generation to generation. Love says anything but "just sucking it up and dealing with it" was perceived as weakness.
"The last thing this should be is taboo, but that's what it is," Love told me during All-Star Weekend. "I think about my dad [former NBA player Stan Love], coming from that generation. You don't talk about anything. You hold everything in."
How, I asked him, did his father react to Love's revelation that he struggles with anxiety?
"We'll see," Love said with a shrug. "I haven't told him yet." (Turns out, Love doesn't speak with his father all that much.)
Love's candor was both striking and surprising, but when I brought up the November panic attack in the game against Atlanta, his demeanor changed. His answers became clipped and evasive, his jawline tightened, and his eyes darted around the room, as if hoping to navigate a hasty exit. It became clear that this was too much, too soon for Kevin Love. We agreed to revisit the subject later, when he was more comfortable.
"Yes, thanks," he said, visibly relieved. "I think that's a good idea."
Three weeks later, a text message from Love popped up on my phone. He had decided to reveal his struggles on The Players' Tribune. "I felt," he later explained to me, "I needed to address this in my own words." In the piece, Love detailed the panic attack during the Hawks game, which he said "came out of nowhere." He acknowledged that he was dealing with family issues, having trouble sleeping and feeling the weight of expectations regarding Cleveland's season. That, he said, became a "perfect storm" of issues that left him with his heart racing, unable to catch his breath. Love wrote that when he left the court, he was "running from room to room looking for something I couldn't find."
Love revealed that he was seeing a therapist and benefiting greatly from that decision.
In a subsequent interview with ESPN this past Wednesday in Los Angeles, Love provided more details about that panic attack. After he ran from room to room in a total panic, he says, he finally collapsed on the floor of the locker room.
"My heart was jumping out of my chest," Love says. "I couldn't get any air to my lungs. I was trying to clear my throat by sticking my hand down my throat.
"It was terrifying. I thought I was having a heart attack. I was very scared. I really felt like I was going to die in that moment."
Love says Cavs trainer Steve Spiro came in and found him splayed on the floor. "He was trying to calm me down, but he didn't know what to do," Love says. "He asked me, 'What can I do to get you some air?'"
The team transported Love to the hospital. All his vital signs checked out. His heart was fine. His teammates were confused, and angry. "They had no idea what was going on," Love says.
EDITOR'S PICKS
DeRozan on depression fight: 'We're all human'
Toronto Raptors star DeMar DeRozan opens up about his bouts with depression, saying they can often become overwhelming.
Love calls support of message 'overwhelming'
As of Wednesday morning, Kevin Love had received more than 4,000 emails in response to his first-person essay that shared details of a panic attack he suffered earlier this season. He says the response has been amazing and has him looking to the future.
And Love wasn't quite ready to tell them, just as he balked when the two of us sat behind the curtain in Los Angeles.
"I was really bothered why I couldn't finish our conversation during All-Star," Love told me after the The Players' Tribune article. "I went back home and asked myself, 'Why am I still hiding this? Why can't I come clean?'"
Kevin Love is hardly alone. Houston Rockets assistant coach John Lucas, a retired NBA player who has struggled with addiction and now runs a wellness aftercare program for athletes, estimates that more than 40 percent of NBA players have mental health issues, yet less than 5 percent of them are seeking help. (Asked if he thought Lucas was overstating the problem, Parham, the players association's director of mental health and wellness, answered, "Not in the least.")
Those issues, Lucas says, can directly lead to alcohol and drug abuse.
"It's an epidemic in our league," he says. "I'm talking about everything from ADHD to bipolar to anxiety and depression."
After canvassing dozens of coaches, owners and general managers, it's clear that mental health issues have touched every NBA franchise. It is also clear that far too many players either choose to ignore their symptoms or fail to treat their mental health issues with the same diligence they would a broken wrist or a knee injury.
"I've got three guys on my team -- two on medication," one Eastern Conference coach told me. "Some days they're fine. Some days they aren't. I'm trying to be as sensitive as I can, but I'm not a doctor or a psychiatrist, and sometimes I'm asked to be."
Perhaps the thorniest problem facing NBA teams is not identifying who needs help. It's convincing those players they need help. "We can offer all the services in the world," explains Boston Celtics GM Danny Ainge, "but if they won't use them, we can't help them. Too many of these guys don't realize how badly they need help until it's too late."
The public revelations of Love, Frye and DeRozan are a positive development, and so are the dozens of anonymous players who have chosen to get help without going public. Yet the multiple-time All-Star who intermittently abandons his bipolar medication because he hates the way it makes him feel still hasn't come to grips with the severity of his current mental state. Nor has the veteran guard who insists that his "anger management" problems do not constitute a mental health issue.
"People carry it differently," Love explains. "Everyone has to come to their own conclusions when to address it. One of my favorite [TV shows] of all time is 'The Sopranos.' I'm sitting there watching it, and James Gandolfini is going to see a therapist. He's telling her, 'F--- this, I don't need this,' and by the end, he's like, 'I can't get enough of this.'
"That's a little bit how I feel right now."
KEVIN LOVE'S COURAGEOUS decision to share his story -- "If you don't think that takes courage, then you don't know the NBA mentality," points out Hall of Famer Charles Barkley -- has spawned a new layer of awareness and acceptance. Yet the enormous encumbrance of managing a professional career remains. The pitfalls include teenagers suddenly coming into millions of dollars with friends, family and strangers angling for a cut. There's unrelenting scrutiny and pressure to perform. Then there's the expectation to exude an aura of toughness and invincibility.
The curious case of the Sixers' Markelle Fultz, the No. 1 pick in the 2017 NBA draft, left many scratching their heads. A prolific scorer at Washington, Fultz suffered a shoulder injury, developed a mysterious hitch in his shot and missed most of his rookie season. Was it physical? Mental? A combination of both? Fultz's mindset became clearer after he posted this on Instagram in July: "Depression, anxiety and panic attacks are not a sign of weakness. They are signs of having tried to remain strong for so long. 1 in 3 of us go through depression, anxiety or panic attacks at least once in our lifetime. Would you share this on your wall for at least one day? Most people won't. To those who do -- thanks for sharing the support. Let those who struggle know they are not alone."
Parham, a psychologist and director of Loyola Marymount's School of Education's Counseling program, says mental health is "a human issue, not a basketball issue."
His goal is to not only destigmatize mental health issues but also to identify their origins. Too often, Parham says, patients are treated for their symptoms, either with medication or coping mechanisms, not the actual causes of their mental health struggles. Parham illustrates it this way: If the smoke detector goes off in your home, you don't grab a stool, pull down the detector and take it to get fixed. You locate the source of the fire and address that.
"That shrill noise doesn't suggest that it's not working," Parham explains. "It actually suggests that it is. Anxiety, depression, panic attacks are all human smoke detectors indicating that something else is going on."
"Too many of these guys don't realize how badly they need help until it's too late."Celtics GM Danny Ainge
In 2001, the Centers for Disease Control (CDC) and Kaiser Permanente studied more than 17,000 patients to determine the effects of adverse childhood experiences (ACE), including physical, emotional and sexual abuse, physical and emotional neglect, domestic violence, parental substance abuse, parental separation or divorce, household mental illness, suicide or death, and crime or an imprisoned family member.
"An adverse childhood experience can be anything from seeing your parents bickering to witnessing a drive-by shooting," Parham says. "The findings were that two-thirds of the American public had anywhere from one to four adverse experiences before the age of 10."
That baggage, if left unchecked, is lugged through the teenage years into adulthood, accumulating symptoms along the way. According to the pyramid established by the study, adverse childhood experiences can lead to disrupted neurodevelopment, which can lead to social, emotional and cognitive impairment, which can lead to adoption of health-risk behavior (such as drugs and alcohol), which can lead to disease, disability and social problems. The final layer of the pyramid for untreated mental health concerns is death.
"I can tell you much of what I'm dealing with is deep-seated," Love confirms. "It goes way back."
Love says shortly after The Players' Tribune article came out, he visited his brother in Portland. "I didn't know if he'd want to talk about it," Love says. "He told me, 'I remember when you were young, and you'd either have these rage fits, or we'd lose you for a couple of weeks and I'd just leave you alone."' During those stretches, which Love calls his "dark times," he'd stay locked in his room, shades drawn, and speak to no one.
Through more than 20 interviews with current and former NBA players, a recurring theme that emerged was the false public perception that because professional athletes are famous and wealthy, their lives are idyllic.
"You think when you come from a difficult environment that if you get out and you make it to the NBA, all that bad stuff is supposed to be wiped clean," DeRozan says. "But then this whole new dynamic loaded with stress comes your way.
"People say, 'What are you depressed about? You can buy anything you want.' I wish everyone in the world was rich so they would realize money isn't everything."
Parham says those worries are punctuated by the fact that elite athletes, particularly men, are reared in society to "keep it tight, pack it in, don't share emotions."
"When you add a layer of celebrity," says Parham, "now you have a double whammy. If an elite player starts talking about 'stuff,' he feels in danger of being traded or not being re-signed or losing endorsements. So the conclusion becomes, 'Better to stay quiet.'"
ON SEPT. 25, 2000, Paul Pierce was stabbed multiple times at the Buzz Club in Boston. One of the knife wounds was seven inches deep, just inches from his heart. Pierce underwent emergency surgery for a collapsed lung and later contended that the thickness of his leather jacket saved his life.
The face of the Celtics franchise stunned everyone by recovering in time to play all 82 games that season. As everyone marveled at his speedy physical recovery, Pierce privately grappled with the mental scars of the incident, which took years to heal.
For the first time, Pierce discusses the debilitating bout of depression that left him so unglued that he ordered a 24-hour-a-day police detail outside his home in Lincoln, Massachusetts.
"I was stabbed 11 times," Pierce tells ESPN. "I felt like I was trapped in a box. I couldn't go nowhere.
"I battled depression for a year. The only thing that saved me was basketball."
Long after he was released from the hospital, Pierce remained nervous, jittery, anxious. He couldn't sleep. The Celtics urged him to seek counseling, but he waved them off. "I thought, 'I can do this myself,'" Pierce recalls. "I didn't want anybody else in my business."
But as the weeks dragged on, moving around in public spaces became almost unbearable for Pierce. The trauma of the event had stripped him of his confidence. His anxiety spiked while dining at Morton's restaurant in Boston just a few months after the stabbing, when the manager approached him with a house phone and said a friend was insistent on speaking with Pierce. He picked up the receiver, and a menacing voice sneered, "I'm going to kill you."
"So now I'm really paranoid," Pierce says. "I don't want to go anywhere. The police sat in the front of my house for months. I was a mess.
"I think that's the reason I got back on the court so fast. Me sitting at home thinking about [the stabbing] didn't work. I went to every practice, sat on the sideline for hours, because that's where I felt safe. I didn't want those practices to end because then I had to go back out there in this world that really scared me."
"I would tell everyone to get the help they need. My depression was bad -- really bad. I never want to feel that way again."Former Celtics All-Star Paul Pierce
Incredibly, Pierce managed to average 25.3 points and 6.4 rebounds during the 2000-01 season. It was a tumultuous season for the Celtics, who won only 36 games and whose coach, Rick Pitino, quit midseason. Pierce didn't care. Basketball was his sanctuary.
"I couldn't be near crowds," he says. "If I got in a crowded place, I'd start shaking inside. It took me years to get over that. If I was walking and someone bumped into me or rubbed against me, I'd freak out."
Before the 2000 season opener, the Celtics ran a promotion in which they stationed players at the entrances of the arena to greet fans as they filed through the turnstiles. Pierce agreed to be part of it, but when it came time to participate, his heart rate spiked, his palms began sweating, and he started to experience shortness of breath. He was having a full-blown panic attack.
"I told the Celtics, 'I can't do this,"' Pierce says. "[The second year] I thought I was better, but I lasted about two minutes, and then that panicky feeling started up again. I was sure something bad was going to happen to me."
In retrospect, Pierce says, he wishes he had listened to the Celtics and talked with a mental health expert. His decision to deal with his post-traumatic stress on his own heightened his depression and isolated him from friends, family and teammates.
"I should have opened up earlier than I did," Pierce admits. "It was eating me alive. Once I finally started talking to a family member, it helped me.
"I realized, 'I should have done this sooner.' I would tell everyone to get the help they need. My depression was bad -- really bad. I never want to feel that way again."
KEVIN LOVE SPENT years trying to ignore, then reconcile, his behavior. When he was young, he says, he was prone to "rage fits" that he couldn't understand.
"I'm a type of guy who has a very long fuse," Love says. "I try to be as nonconfrontational as I can, but when that fuse breaks, I explode. Those type of people can be really destructive, and I'm one of these people.
"When I was a kid, I was like that. I was so competitive. As I got older, I started holding a lot of that stuff in. My girlfriend, Kate, saw me going down a little bit of a destructive path, and she told me, 'I love you so much. I really think you need to talk to someone.'
"But I kept telling myself, 'I don't need any help. I'm successful. I've gotten this far. I've got the best friends in the world.' But the truth was, there was still a lot that made me unhappy."
Some of the best players in the league are the most vulnerable because of the inordinate amount of pressure heaped on them to not only perform but also raise their franchises' level of play.
Former 11-time All-Star Chris Bosh can relate. He recalls the euphoria he felt during the 2006-07 season, when the Toronto Raptors began flourishing with him as their star and won 47 games.
"We finally got to the point where we're successful, we've got an Atlantic Division title, we're the No. 3 seed in the East, and we're right where I always hoped we'd be," Bosh tells ESPN. "But then, all of a sudden, I wake up in the morning, and I look at my hands, and they're shaking. I'm just nervous all day, and I'm saying to myself, 'What the hell is going on? What's wrong with me?'"
The Raptors brought in a sports psychologist, who implemented relaxation techniques, including meditation. But, Bosh says, all it did was cause him to nod off.
"He didn't really help me at all," Bosh says.
That spring, the Raptors were upset in the first round by a veteran New Jersey Nets team led by Jason Kidd, Richard Jefferson and Vince Carter.
"It's an epidemic in our league. I'm talking about everything from ADHD to bipolar to anxiety and depression."Rockets assistant coach John Lucas
Bosh's anxiety heightened again, he says, when he signed a ballyhooed free-agent deal with the Miami Heat to join LeBron James and Dwyane Wade in 2010.
"I was coming from Toronto, a benign situation," Bosh says. "I figured, 'All right, people are going to understand why I went, and they are going to like me.' That's all I cared about -- that people liked me.
"I go there, and I'm smiling, and everyone is scowling at me. The whole LeBron 'Decision' had everybody so mad. I don't know why, but I caught so many stray bullets being around it. Then we lost [in the 2011 NBA Finals to Dallas], and people were dogging me. I started to get pretty bitter."
The enduring image of Game 6, the clinching win for the underdog Mavericks, was a distraught Bosh stumbling to the locker room in tears. Videos of him crying went viral, and he was summarily vilified for being "soft."
"All those people who made fun of me for breaking down, they didn't understand," Bosh says. "I put my life into this. I was getting it from all sides, and then we lose. I expressed my feelings, and then they made fun of me for that. I was too honest. I just couldn't win."
Social media often serves as a searing spotlight on the shortcomings of players. They are dissected for everything from a botched basketball play to an evening of nightclub revelry. Nothing is sacred -- and the vitriol spewed upon them often comes from anonymous trolls.
"Social media is a major challenge for athletes," Parham says. "It has really begun to take hold of what people say, when they say it, if they say it. You never know what motives people have or who they really are.
"You can counsel players to tune it out, but for many of them, social media is a major way in which they communicate."
For some athletes, the criticism is so visceral and unrelenting that they have eliminated social media from their lives.
"Poor Kevin Love," Barkley notes. "Every time the Cavs lost, social media blamed him. You couldn't watch TV without someone saying, 'The Cavs suck, and it's Kevin Love's fault.'"
Love says the public criticism only compounded questions he already had about himself. "I'm a perfectionist, so I'm hard on myself," he says. "I don't pass the mirror test."
For Love and DeRozan, the journey to mental wellness is evolving and ongoing. For NBA players who resist getting help, the journey remains difficult, lonely, uncertain. Parham insists that confronting their issues will unlock potential they don't even realize they have.
"With an investment in player wellness, these athletes can perform at an even higher level than they are now," Parham says. "But they have to be willing. Otherwise, nobody can help them."
Coming Tuesday: Part 2 in our five-part series on mental health in the NBA.
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