Slater's bipolar disorder

[sydunisportsmed]

Good courage of Michael Slater to come out and talk about manic-depressive illness/bipolar disorder. A lot more athletes have this syndrome than is probably recognised. Also, credit for the way he has conceded that his behaviour was inappropriate and tried to offer explanation rather than excuse. Much more mature approach than the alternative rant of "it wasn't me/I didn't do anything wrong/even if I did I have ADHD so it's not my fault".

[injuryupdate]

Steve Waugh lends his support:

Waugh in to bat for his mate
By Robert Craddock
March 16, 2005

STEVE Waugh has praised Michael Slater or speaking out about his psychological problems and admitted he was concerned about his teammate's state of mind during the final year of his Test career.

Waugh has said the dramatic termination of Slater's Test career on the 2001 Ashes tour was the catalyst behind a change in policy in which the captain was relieved of selection duties on tour.

Slater admitted on Andrew Denton's Enough Rope he had been diagnosed as having a form of bipolar disorder which he felt may have been a trigger for his erratic behaviour during the last year of his Test career when he split with his wife Stephanie, got four tattoos, behaved impulsively and had a stream of panic attacks.

"I had my concerns which I raised to the selectors and the CEO [of Cricket Australia, Malcolm Speed]," Waugh said of Slater's health and behaviour.

"There were a few things going on behind the scenes. That's all part of being in the team. You have got to be aware of teammates' needs.

"Parts of it [the interview] were a learning experience, parts of it I knew and parts were untold as well. He showed a lot of courage to be as open as he was."

[injuryupdate]

Good editorial from Cricinfo:

Slater shows importance of mind over batter

Peter English

March 17, 2005


Mental strength is such an important characteristic, but a calf injury will get a player more sympathy than a sick mind. Steve Waugh's most enviable trait was not run-scoring or baggy-green pride, it was the grey matter his cap protected. Unforgiving, unflinching, almost all-conquering, Waugh's brain was the model for long-term success.

Waugh grew to understand the power of the mind and set about dismantling those of the opposition with his mental disintegration. Michael Slater was a successful and senior member during the early years of Waugh's captaincy, but while his team-mates were looking for flaws in their rivals, Slater was experiencing problems with a pattern that was last year diagnosed as bipolar disorder. His behaviour started taking noticeable turns in 2000 and over the next year his actions created much publicity but received little help. Team-mates turned from him, and professional assistance was too far away.

Slater this week revealed he suffered from the manic depressive disease, which causes large mood swings, and was worried about how his announcement would be received. The threat of admitting weakness has lasted much longer than his playing days. Society says injury-induced retirees are glorified; those with sick minds are signed off as nutcases.

"Are people going to think I'm a fruit loop," he asked Enough Rope's Andrew Denton as he shared his secret. Twenty percent of Australians experience some sort of mental illness, yet an opening batsman who thrilled and spilled in a Test career of 71 Tests, scoring 5312 runs at 42.83, was more cautious – scared even – than facing Ambrose and Walsh at their fastest.

The sad case of Slater, who believes the disorder was a by-product of the spinal disease Ankylosing Spondylitis afflicting him since he was at the Cricket Academy, highlights a disturbing cricketing anomaly. The mind is a player's greatest weapon but maintenance and repairs are generally left to the individual.

Why don't teams tour with psychologists? A usual support-staff contingent includes a coach, manager, physiotherapist, masseuse and sometimes an assistant coach, bio-mechanist, yoga instructor and chef. Bodies are temples, but minds are like mini-bar bills and are the user's responsibility. For help it's usually necessary to make an international phone call or have a chat with a senior figure behind the nets.

The problem with the in-dressing-room solution, compared to the confidentiality of a professional, is the trusted player or coach has a team duty to pass on information about the sufferer's mindset. Forget the personal damage, what could it do to the side? Waugh, who praised his former team-mate for talking publicly about the illness, made the selectors and Malcolm Speed, the then Cricket Australia chief executive, aware of Slater's slide in 2001 and he was dumped, never to return, for the final Test of the Ashes tour.

While losing the one-day series 5-0 to Australia, John Bracewell said his batsmen were offered the use of Gilbert Enoka, the team's psychologist, and the reaction was the stereotypical "send them to couch" humour. At his next public outing Bracewell effectively told the doubters to grow up. Psychologists were part of professional sport.

Slater will forever wonder whether things could have been different. It now seems absurd that Waugh's golden calf injury sustained at Trent Bridge in 2001 was a national concern and the state of Slater's seriously worsening state of mind was mockingly dismissed. Waugh recovered to play at The Oval and scored a gutsy 157 not out; Slater's combined problems – panic attacks that rushed him to hospital, reactive arthritis that folded him into a wheelchair – forced him to retire at 34. Leaping, helmet-kissing celebrations like his Lord's 152 were old, fanciful dreams.

The first signs of Slater's bipolar disorder came in 2000 with his television commentary debut in England, and grew to become as common as a couple a day. Panic attacks are worse than any hamstring strain or bone-spur operation. The health problems were compounded and contributed to by the separation from his wife Stephanie, the accusation that he was addicted to cocaine and the awful, false rumour that he was the father of Adam Gilchrist's child.


During this time Slater gave regular signs of his trouble. Glass of wine in-hand, he jumped on stage to sing with Jimmy Barnes at the 2001 Allan Border Medal, then there was the Rahul Dravid outburst, the buying of his long-saved-for Ferrari and four tattoos when one would have done. "This might clear up for a few people why my behaviour appeared erratic," he explained of his decision to go public.

Why it wasn't dealt with, and why he wasn't properly helped as it was happening remains a mystery. The talk on that Ashes tour was Slater was running quickly off the rails, but he was left on his own. Slater said he felt isolated as his friends turned their backs.

Now a commentator who talks like he batted – fresh, mostly relaxed and highly entertaining – Slater's eye-sparkle remains but his body looks worn out for a 35-year-old. He hopes for a long career but worries the "fruit loop" reaction could hinder his prospects. If his bipolar revelation has that effect it would be a greater injustice than the lack of support he received as he careered out of international cricket.

"I wish I'd been stronger," Slater said. "I was too sensitive and wore my heart on my sleeve." Perhaps he was just right: there were far more highs than lows. Perhaps the people around him should have worried more about their caring than the cracking up. Mental injuries must be treated more seriously than any grade-one muscle tear.

[hhh]

Would the sympathy for Slater be as great if the diagnosis was ADHD? In all seriousness the diagnostic characterisitcs between ADHD and bipolar disorder can be very similar and at the end of the day diagnosis is a grey area requiring a clinical decision. Mason copped a pounding when his diagnosis was made public (and still is). If his diagnosis was different would the reaction be different?

[injuryupdate]

Agree completely that bipolar and ADHD have huge overlap. My cynicism regarding ADHD compared with bipolar disorder is that the drugs for bipolar disorder (Lithium, Tegretol etc) are generally ones that calm you down, whereas Ritalin (for ADHD) is an 'upper'.

No one is ever going to fake bipolar disorder in order to get Lithium, because it isn't banned in the first place. Any number of athletes might want to try a stimulant if it wasn't banned (i.e. that they had an exemption due to ADHD).

I agree that this is completely different to the public cynicism, which is based on the premise of not accepting responsibility for one's actions.

[hhh]

Reading the latest WIllie Mason Article you published, it is not the players that will be faking ADHD it is the team medical staff!! Hugh Hazard copped a public pounding from Mason (something I'm tipping brought a smile to your face) with regards to the diagnosis of ADHD and perscription of Ritalin. This opens the door for the team Dr to over diagnose ADHD so all the players get ritalin 'legally'.

What I find funny is Hazard's stand on local anaesthetic inections where he refuses to do it, but when it comes to Ritalin its a different matter altogether! It's a bit like the saying 'the pot calling the kettle black'

Agree completely that bipolar and ADHD have huge overlap. My cynicism regarding ADHD compared with bipolar disorder is that the drugs for bipolar disorder (Lithium, Tegretol etc) are generally ones that calm you down, whereas Ritalin (for ADHD) is an 'upper'.

No one is ever going to fake bipolar disorder in order to get Lithium, because it isn't banned in the first place. Any number of athletes might want to try a stimulant if it wasn't banned (i.e. that they had an exemption due to ADHD).

I agree that this is completely different to the public cynicism, which is based on the premise of not accepting responsibility for one's actions.

[sydunisportsmed]

It is pretty obvious even from what is being relayed second hand in the media that the Bulldogs club (including medical staff) honestly believe that Willie Mason does have ADHD and that they sent him to a specialist who suggested Ritalin and therefore the club thought he should take it.

I don't think for one minute that the diagnosis (in the Mason case) was suggested out of thin air in order to get access to a banned drug. Some of his behaviour does seem compatible with this diagnosis.

I'm amazed though at how 'easy' it appears it would be to rort this system, if someone wanted to rort it to get access to a banned stimulant like Ritalin. (1) Behave like a madman (2) Go to a doctor and then to a psychiatrist and complain of problems concentrating, along with other people complaining about your behaviour (3) Get a diagnosis of ADHD and a suggestion to take Ritalin (4) Get the drugs panel to approve it.

I realise this sounds like a lot of effort and far fetched, but it is an absolute breeze compared to the effort of getting HGH, say, on the black market from a gym. Plenty of athletes appear to be willing to do this, so why wouldn't they be willing to 'fake' ADHD symptoms to get a clean stimulant?

My take on the Mason case (and I'm glad it has been debated in the general press due to the details being openly disclosed) is that it will lead to a positive in that more solid guidelines will have to be written for Ritalin.

My recommended guidelines would be:
(1) No new diagnoses of ADHD be granted Ritalin exemption (i.e. if you have survived up until playing professional sport without Ritalin, then you can't start - try something else like Lithium that isn't banned)
(2) Evidence of having had the diagnosis made before the age of 14 and having needed Ritalin continuously since that time, in order to get an exemption.