By Jason Sahlani, Sweat Magazine, Winter 2008

NFL legend Terry Bradshaw had anxiety attacks after games. MLB player Steve Sax developed a 'tic' that made it impossible for him to throw from second to first base. And NFL-er Terrell Owens' mental health issues were so severe, he attempted suicide. The relationship between mental health and sports isn't new; but it isn't just pro athletes who should heed the warning signs of mental illness.

The stoic tone of Kari Ala-Leppilampi's voice doesn't waver when he talks about his past. Unlike many who struggle with mental illness or addiction, he speaks openly about what he’s been through, including the moment he contemplated suicide.

His undergraduate career was filled with heavy drinking and drug use, mixed with cross-country running as a crutch to maintain some form of balance in his life. What he didn't realize at the time was that boozing and drugs were only symptoms of a more pressing issue.

His life at that time was emblematic of the difficulties that varsity athletes continue to face. He was holding down a full course-load, training for and competing in varsity crosscountry and working a part-time job. Sleep deprivation and exhaustion were the norm for Ala-Leppilampi and the stresses that were placed on him – stresses college athletes face every day – had an impact on his mental health.

"Things began to fall apart. And even in that early stage in my undergrad, there were underlying mental health issues in play,” says the University of Toronto Health and Behavioural Sciences PhD candidate, who is working with the Canadian Mental Health Association's Minding Our Bodies program. "I was a huge drinker and didn't realize I had a lot of anxiety and depression issues."

Jump to the present day – he's running along the beaches on the east side of Toronto, not worrying about keeping up with his dog Sneakers. "It runs like the wind," he says. "If I'm running about 30 km, it's . . . probably running 40 to 45 km without even trying."

He's training for the 2010 World Championship Ironman competition in Kona, Hawaii, an event he’s participated in before, but this time he’s making sure not to repeat the mistakes of his past.

Immersing himself in the Ironman label during his first competition gave Ala-Leppilampi a sense of self-assurance, but it came at a price. "I was so tied in to [the label] that a lot of other things fell by the wayside – my socializing with friends, my passion for school. And so, I went [to Hawaii] and had a good race by any other person's account, but I just felt that I didn't have the perfect race I should've."

According to Helen Jefferson Lenskyj, a professor of the sociology of sport and Olympic studies at the University of Toronto, there is a tendency for college athletes to set unrealistic goals, leading to a setback that can adversely affect an athlete's psyche if goals are not achieved.

"Setting goals in athletics is good, but when those goals are near unreachable, the training process is no longer a commitment but a sacrifice," she says. "They focus only on training, blocking out what they should be doing in their formative years, and the balance of their lives gets way skewed."

Ala-Leppilampi had set such a high bar for himself during his first Ironman competition that even though he had a great race, his disappointment was so severe that his thoughts turned to suicide.

"I was there for a week after the race in the most beautiful place in the world, but for me – I was in a living hell," he says. "I remember thinking to myself, 'I want to throw myself into the volcano.'"

Eventually, Ala-Leppilampi began to examine his issues with anxiety and depression, forcing himself to rethink what had led to the emotional depths he had reached. Exercise would soon shift from the crutch it once was to a tool for stabilizing his life.

"I've realized it's about trying to do it with balance, always realizing that it's the activity itself I enjoy," he says. He's also aware of the consequences if he steps back over the line: "I'm going to drink myself into a state where I’ll just be an alcoholic and die in a dark room somewhere."

He adds that many athletes are unable to simply enjoy their sport due to the need to perpetually maintain a façade of strength and that this mind-set exists across the athletic board.

"Athletes are in a culture where they repeatedly need to push through physical pain and not show any weakness ... and that idea can be shifted to mental pain," says Ala-Leppilampi. "In both [academics and athletics], performance is everything, and not showing any weakness is something that's promoted in both – making the grade, making the shot. So, both realms synergistically reinforce the idea of dealing with it and not seeking help."

He says that by the time they reach college, many athletes have failed to establish the professional and social skills needed to build a well-balanced life. Without these skills, they are unable to cope when the pressures of academics collide with sports.

"It also could be that an athlete has an underlying mental health issue that existed before. But rather than dealing with it, instead of talking about it and seeking treatment, they shift it over to their sport."

An unwillingness or inability for athletes to discuss mental health issues is problematic for college sports, but it is by no means limited to that realm.

"[There was once] this image of a man ranting at the sky ... as being indicative of mental illness," says Lisa Brown, executive director of the Rendezvous with Madness film festival from her poster-plastered office. “But people still face an enormous amount of stigma when they admit to their own mental health problems."

She says one in five people will have a mental illness, and one in four will also have an addiction. "Two-thirds of that population will never seek treatment because of the stigma attached."

The silence that surrounds mental illnesses will at times keep Dr. Christine Courbasson up at night. Lying in bed, she'll think about the number of athletes "closing their eyes" to their eating disorders and body image issues because their focus is solely on performance.

"There's a lot of shame associated with eating disorder behaviour. And so; most will not talk about it, will deny it if it's brought up and, in most cases, won't seek treatment," says Courbasson, the head of the Eating Disorders and Addiction Clinic at Toronto's Centre for Addiction and Mental Health. "They feel if they talk about it, even with their coaches ... their lives will fall apart. So, they stay silent."

She says that while the focus tends to be on women, both sexes are vulnerable to eating disorders or body image issues. Neither is likely to seek treatment.

Ala-Leppilampi notes that in the context of athletics, the performance anxiety that results from the pressures of making that free-throw or performing well in the game can actually lead to misdiagnoses. "People may suggest or assume that it's just related to the sport itself, whereas it may really be reflective of a more generalized anxiety disorder."

Complicating matters is the fact that many of the drugs used to help cope with mental illness are banned in college athletics, he says, making it more difficult to get help.

Despite the difficulties there are preventative measures that colleges can implement.

Monique Haan, the athletics academic advisor at Humber, spearheaded a new initiative to help athletes balance their personal, academic and athletic responsibilities to maintain the stability crucial to mental health.

"This program isn't about the mental health of our athletes per se, but it's definitely here to help them build strong academic skills and learn to manage their time effectively," Haan says from Humber's new Varsity Academic Centre. She says by providing academic services "we're trying to . . . eliminate some of the stressors in their lives."

Minimizing the mental health risks associated with varsity sports is easier said than done. One way to do this is to get athletes talking about these issues. But Ala-Leppilampi says in some cases that means going against years of conditioning wherein an athlete's health, both mental and physical, takes a back seat to performance.

For Ala-Leppilampi, the task now is changing the lexicon dealing with mental health in sports.

"I read an article recently where schools . . . are trying to change the phrasing around 'mental illness' to 'mental performance' so athletes feel more comfortable discussing it openly," he says. "But no matter the terminology, the athletes themselves need to recognize when they're going through something, be honest with themselves about it and talk to someone before it's too late."

Here are some signs of mental stress athletes should watch for and some questions to ask themselves.

Ask yourself:

• Do you still enjoy your sport?
• Do you find yourself irritable or distracted for no apparent reason?
• Do you find yourself binge-eating then feeling guilty?
• Are you constantly upset about a perceived inability to stay on a diet?
• Are you training through an injury?
• Do you find yourself sliding from emotional highs to lows, both during and after your games?
• Are you exaggerating minor setbacks or undervaluing successes?

Keep an eye open for:

• People who talk a lot about food but are rarely seen eating.
• People who use food to cope with stress (e.g. binge eating).
• Athletes who drink to excess or use drugs to self-medicate.
• People who eat fast then disappear.
• Athletes with scars on their hands (tooth abrasions caused by self-induced vomiting).

All of these are signs that you may be in need of some help, and while being an athlete doesn't mean you're more likely to develop a mental health issue or addiction, it may be harder to ask for help.