Leonard Zwelling

         There is a compelling new sports documentary on HBO called “The Weight of Gold.” It is narrated by super-Olympian Michael Phelps who is also an executive producer. It was directed by Brett Rapkin. Its story is a simple one and a horrible one all at once. It is that the mental health support afforded Olympic athletes, especially after their competitive days have ended, is woefully inadequate. The pressure that comes from dedicating one’s life to what may be 40 seconds before the world leaves even the winners spent and depressed. Many have committed suicide and the message of the film is summed up in the New York Times headline on July 31—“I Can’t See Any More Suicides.”

         Having watched the film, I found the connection between what we in medicine (and I suspect other professions) go through is similar although protracted. Olympians may have careers lasting no longer than one four-year cycle. We doctors tend to last longer, but we surely experience very high highs (passing the boards) and very low lows (losing a patient) that can play on us like winning and losing plays upon the greatest of Olympians which Phelps is.

         Those athletes have been training since childhood for those 40 seconds. Many of us in medicine were training since being told we were smart in kindergarten for what? For the next gold star—college, medical school, internship, fellowship, assistant professorship or private practice. What are we all chasing? We are chasing ourselves and the faster we run the more likely it is that the sport or the MD itself will define who we are and if that should vanish (the athlete retires or the doctor burns out) who is left to pick up the pieces.

         There is no doubt that the Olympic athlete is a special case. Most Olympians don’t win a medal let alone a gold. Many are living on handouts from the USOPC. Many have to take second jobs so that they can afford to eat while they train. Such is usually not the case for physicians. But many docs have sacrificed much that normal people (what my pathologist father-in-law called ‘civilians’) did not give up. Time with loved ones and vacations and sleep.

         To medicine’s credit, many institutions have recognized the scourge of mental illness among health professionals with employee assistance programs and counseling of all sorts. Drug abuse, alcohol use and other mental illnesses plague physicians just as they plague Olympians. In many ways, the effects of mental illness on physicians is even more worrisome as depression and other ailments can impair doctors who keep trying to care for patients.

         The Phelps documentary is deeply disturbing. Many members of our Olympic team have suffered mightily for their art and their sport. Many have not won and have been ostracized for not performing better because that’s what they all deem it to be, a performance.

         I agree. As someone who was on the medical merry-go-round for years collecting gold stars to the point of an addiction that undermined my well-being, I understand what the Olympians describe as their confusion and loss of purpose let alone focus and will to live. At least I did not have to retire at 25. Some of them do after years of doing nothing but train for those 40 seconds. As the documentary points out, the US Olympic and Para-Olympic Committee must increase the support for its athletes in the mental health arena as much as it already does for their ankles. We in medicine need to do better as well, but at least we are on the way. When I had my moment during my internship at Duke, I could not admit I needed help. I muscled through it. I am not at all sure that was wise but that’s what I thought my option was.

         Athletes, doctors, lawyers and all professionals may have moments, our Dark Night of the Soul. We need to be able to reach out for help and help must be readily apparent. It’s better in medicine. As this documentary shows, athletes need more help than they currently are getting if Michael Phelps is not to see any more suicides among his teammates.

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