Today, we’re talking about perhaps the toughest opponent in sports – the one in your head. In Germany, around 27.8% of the adult population is affected by a mental illness every year. That’s about 17.8 million people. The truth is, anyone with a mind can suffer from mental illness. So, that means all of us.
This includes athletes. Nils Petersen (most recently with SC Freiburg) ended his career after last season and talks about his mental health struggles in his book Bankgeheimnis – Selbstgespräche eines Fußballprofis ("Bench Secrets - Soliloquies of a Football Professional"). “We football players are always associated with having it good,” Petersen told SWR Sport. “White shoes, gelled hair. But everything isn’t always rosy.”
This was also the experience of professional football player and former national team member Carina Schlüter, as she shared in the ARD documentary Was uns wirklich bewegt: Mentale Gesundheit im Sport ("What Really Moves Us: Mental Health in Sport"). She says: “Depression is the worst injury I’ve ever had.” But she made it through! From the clinic to the Champions League.
(Credit: ARD Doku)
I, too, know the opponent in my head all too well. I have recurring depression. Low mood or emotional emptiness and lack of motivation are just two of the many symptoms. As an avid hobby athlete, one symptom that frustrates me the most is psychomotor inhibition.
During endurance training, there’s a paralyzing slowing down of my movements, like I’m dragging weights behind me. I have to think and force every step and every breath. It feels like the signals from my brain aren’t reaching my muscles, and my legs feel completely empty.
(Credit: Mateo @behindraw)
These training experiences are traumatic. They feel like losing control over my own body. Afterwards, I feel diffuse pain for days, as if my body is a corset of muscle soreness. Still, I try to maintain my sports activities as best as I can during depressive episodes, since sport is one of my main coping strategies. But on some days, even a slow walk is exhausting to the point of complete fatigue.
How do people whose job is sport manage to do it?
Former national team member and professional footballer Carina Schlüter knows depression all too well. For her, however, different symptoms were at the forefront. She suffered from sleep disturbances for months, sleeping only a maximum of three hours a night. At the time, the goalkeeper was under contract with FC Bayern Munich and was recovering from a knee injury.
(Credit: @sampics)
Recovery wasn’t an option for Carina Schlüter during rehab, as sleep disturbances were joined by endless cycles of overthinking. “Feelings of guilt that came out of nowhere, personal stress, the rehab process, and the fact that I couldn’t be with the team... So many things just overwhelmed me, and I didn’t know what to do with it,” Carina recalls. “And then there’s the typical mindset of a professional athlete: ‘I have to feel good! I can’t show this, I have to swallow it down somehow.’ I downplayed all the problems I had, saying other people had it much worse. Why should I be allowed to feel bad?”
Depression is neither imagined nor a "weakness" disease. It is a disorder of thinking, feeling, and behaviour and has a neurobiological basis. The transmission of information between brain cells happens through electrical impulses and neurotransmitters such as serotonin, dopamine, adrenaline, or noradrenaline. These affect our drive, behaviour, and emotional state. In mental illnesses, this neurotransmitter balance in the brain is disrupted.
As I described earlier, this also results in retardation as a symptom for me – meaning overall slowed movements and a slower gait. In those moments, the idea of "putting on running shoes and going for a run," or even interval training, is impossible. This is also accompanied by a reduced facial expression, slowed or frozen features, quiet and slow speech, or a hunched posture. It’s as if an invisible weight is pressing me down or holding me back. Hence the term “depression” – from the Latin “deprimere,” meaning “to press down.” This doesn’t just refer to mood but can also affect the entire body.
The opposite of retardation, or psychomotor inhibition, is agitation – psychomotor excitement. People move a lot more, but often uncontrollably, almost like a tiger in a cage. Psychomotor disturbances are common symptoms in people with depression. In the large STAR*D study, 60-70% of patients with depression had a psychomotor disturbance.
Die Bremse im Hirn
Prof. Dr. Sebastian Walther is the chief physician and deputy director of the University Hospital for Psychiatry and Psychotherapy in Bern. He researches what exactly happens in the brain of people with depression when normal motor functions are disrupted.
(Credit: www.neuroscience.unibe.ch/)
Prof. Sebastian Walther and his team measure the speed and amount of movement in people with depression using actimetry. These studies are combined with MRI scans to see what’s happening in the brain during these tests. “The motor system – the brain areas responsible for movement planning and execution – are generally altered in people with depression,” observes Prof. Walther. “In depressed patients who are slowed down, there’s a kind of overactivity in these areas. The brain is constantly busy planning actions, but the body doesn’t carry out the movements as planned.”
This is where the mind-muscle connection comes into play. Our brain and muscles are linked. For example, when you want to contract your biceps, the brain must send signals through the central nervous system to the muscle. These impulses cause the muscle to contract. The quality of this mind-muscle connection controls the intensity of the muscle work.
However, in people with psychomotor inhibition, this doesn’t seem to work as usual. The brain is revving up, but it’s as if the handbrake is on. These changes and processes can be visualized and measured, but their causes are still a mystery. One theory is that it’s a change in the dopamine or GABA (gamma-aminobutyric acid) system, which affects psychomotor function. However, research on this is still in its early stages.
An approach is offered by studies on people with catatonia. Catatonia is the most extreme form of psychomotor inhibition. It shows as a severe stiffness of the entire body. The human brain has a sort of emergency brake for dangerous situations. If we are moving towards a street and suddenly see a car speeding towards us, we need to stop our movement abruptly. This "emergency brake" in our neural connections – called the hyperdirect pathway – is the fastest way to stop all motor functions immediately. It’s a kind of shortcut. It’s believed that this function is disrupted in people with psychomotor inhibition, meaning the emergency brake is permanently on.
The Façade in Sport
Carina Schlüter (26) is now under contract with SKN St. Pölten in Austria. “It doesn’t matter what the triggers are. It doesn’t matter whether it’s because the hamster has a cold or because the house burned down. If you feel bad, you have the right to feel bad.”
(Credit: SKN St. Pölten)
Carina Schlüter held up a façade at her club despite her depression. As soon as she stepped onto the FC Bayern campus, she functioned. But when she left the grounds, she broke down. “Sometimes, I’d pull over in my car and just sit there, unable to keep driving.”
It was a very observant physiotherapist who realized that Carina was sick. “Physiotherapists are very close to the team. It’s a special relationship. On the treatment table, players share things that are really on their minds – sometimes personal issues or worries. My physiotherapist knew me well and noticed that I wasn’t coping anymore.” He referred her to a psychologist. At that moment, Carina felt very relieved because she realized she didn’t have to go through it alone.
She went to a psychosomatic clinic. In the club, Carina kept her illness a secret out of fear of stigma. Her biggest fear was that her depression would become public. “I made sure I didn’t wear an FC Bayern training shirt in the clinic or anything that could make a connection. Still, I was recognized several times and feared being judged. I was scared someone would say, ‘She’s crazy.’”
Along with the fear of stigma came existential fears. “What if the fans start chants like ‘Schlüter is unstable’ or something like that? What if I don’t get a new contract because employers think I’m not mentally fit as a goalkeeper? That’s why I tried to hide it all the time. I could never truly be myself.”
But the weeks in the clinic and the therapy helped Carina. Just like football. Even in the clinic, she always had a ball with her. Sometimes, she would disappear into the woods for hours, just juggling the ball.
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The Smartwatch as an Early Warning System?
Meanwhile, Prof. Sebastian Walther continues to focus his research on psychomotor function. It is possible to influence the motor system externally through the skull, for example with magnetic stimulation. However, this doesn’t work for all participants, and these methods are still far from clinical application. There is also hope that by observing movement changes, it may be possible to predict, for example, if a depressive episode is about to occur or if someone is at risk of relapse. Could psychomotor changes become a measurable biomarker and early warning signal?
The hope is that we’ll eventually have objective data. A smartwatch could, for instance, detect significant movement changes and alert the wearer. Something like: “Hey, you’re moving more slowly or not as much as usual!” The goal would be for affected individuals to seek treatment as early as possible – and to keep moving.
Because physical activity helps against depression!
But: Psychomotor inhibition can make exercise nearly impossible, which is frustrating and may even worsen the depression. A vicious cycle. Nevertheless, Prof. Dr. Sebastian Walther encourages his patients to stay as active as possible, even though overcoming the lack of motivation during depression requires an enormous amount of energy.
For professional athletes, it’s crucial that the pressure to perform doesn’t take away the joy. “You have to be put in a position where you can enjoy training again. That means careful consideration of how you train, with a more tailored approach – finding the right balance,” says Prof. Walther.
Yet, in professional sports, the balance between what you should do and what you want to do, between performance and fun, often falters. Carina Schlüter compares it to the number on your jersey. You’re just a number. “When you’re injured, the next player is there to take your spot. Football is a business. If you don’t perform the way you’re paid to, it’s natural that they’ll look for a replacement. It’s just a tough business.”
Games Can Be Won in Your Head
One positive development is that there are now more mental coaches and sports psychologists. A career path that also interests Louise Trapp. Louise plays in midfield for FC Viktoria Berlin while studying psychology in Dresden. She’s very focused. While her fellow students celebrate the end of term, she drives to Berlin for training in the evening.
Both psychology and football have been Louise’s passions for a long time. That’s why she’s considering specialising in sports psychology after her bachelor’s degree.
(Credit: Kai Heuser @heuserkampf)
“I feel like I’ve been doing this for as long as I can remember. I’ve been playing football for 16 years, including at a competitive level. I trained twice a day while in boarding school at Turbine Potsdam. After graduation, I spent a year in Chicago, where I also played football at college. In the U.S., mental health is a much bigger topic. That’s why I’ve spent a lot of time on personal development. I regularly check in with myself: Who am I? Who do I want to be? What are my values, my goals?”
For Louise, it’s clear: to perform at your best physically, you also need to be mentally fit. “Games can be won in your head. Mentality on the pitch can make a huge difference, even if you’re the supposedly weaker team.”
What Louise has learned is that she can trust in her strength, even when unpredictable situations arise on the pitch. But she also accepts when something is out of her control: “Getting upset about things you can’t change doesn’t help. I try to make the best of it. But mental health has many more facets. If you can’t handle setbacks or crises on your own, seeking professional help makes a lot of sense.”
And now our team at FC Viktoria Berlin will also receive support in this area. (More about our new trio for this in the next newsletter). Louise Trapp hopes that these three will be trusted contacts for issues that players might not want to discuss with the coach. Or someone to offer advice that helps both on and off the pitch, so players can feel better and improve.
Managing Your Own Energy Levels
Professional footballer Carina Schlüter, on the other hand, says, “Depression was the worst injury I’ve ever had.” Today, she’s doing well. She has become an expert in managing her illness and gives her own energy levels the same importance as her phone battery. She has made it from the clinic to the Champions League. Alongside her football career and medical studies, she has even started her own small health coaching business and created a six-week mindfulness training programme for athletes, which she sells on request.
Nonetheless, Carina believes that the topic of mental illness needs much more destigmatisation: “The more we talk about it, the more normal it becomes.”
After all, people talk about torn ligaments, too…
With that in mind: Take care of yourselves and each other. No one should feel ashamed of being ill.
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