On Enforcers, Depression and Risk Factors

(This article was originally published at the Score’s Backhand Shelf blog in 2011. I have re-published it here in the spirit of #BellLetsTalk, which aims to grow awareness of mental health issues.)

The NHL landscape has been marred by tragedy this offseason with
the recent deaths of Derek Boogaard, Rick Rypien and now Wade Belak. It’s
possible that their passing in such close proximity is entirely coincidental
and a mere artifact of chance alone. Sometimes unlikely occurrences don’t
necessarily carry graver implications.

The fact that each guy wasn’t merely a hockey player but an
enforcer is highly suggestive, however, especially given the growing awareness
around brain trauma and chronic
traumatic encephalopathy
(CTE). In May, I wrote an article
on the potential risks associated with CTE and how enforcers may be putting
their future physical and psychological health on the line for a role whose
benefits were, at best, unclear.

The growing battle over fighting in the sport seems to revolve
around the degree to which concussions and/or physical maladies may or may not
influence health of current enforcers, particularly in light of the recent
tragic passing of men who were perhaps too young to have succumbed to a
long-term, chronic issue like CTE. However, the relationships between health,
depression, suicide and substance abuse is far more complex than drawing a single,
causal line between concussions/chemical misbalance and premature death. The
life of an enforcer is replete with stress, anxiety, pain and isolation which,
when mixed with certain idiosyncratic factors, may give rise to psychological
pathologies, even in the absence of degenerative brain damage.

Many ex-enforcers have gone on record to express the extreme
levels of stress they go through in anticipation of a fight. Former tough guy
Brantt Myhres’ career was ended by a George Laraque punch which broke his eye
socket. In discussing
the fight years later
Myrhes,

said his stomach was churning before that Oilers game. He knew
he’d have to fight Laraque.

“I was in bed, sick in the afternoon.

I didn’t even eat a pre-game meal. I knew I was over the edge.”

Enforcers are often portrayed as the prototypical warrior on the
ice: a man who fearlessly gives no quarter. Truth is, however, even tough guys
have a lot to fear when it comes to dropping the gloves. Outside of the
potential for physical pain and injury is the possibility of  losing the
fight and being humiliated in front of thousands of fans as well as their team
mates. In addition, since enforcers are often at the fringes of the roster,
each guy is always a bad fight away from losing his place on the team. Each
tussle isn’t merely about trying to avoid getting hurt: it’s about saving face
and trying to keep a job.

Such acute, variable bouts of stress can have deleterious
effects on psychological and physical health. In fact, an increased risk of coronary heart
disease has been linked with job strain
; that is, occupations which
rate low on decision control but high on psychological demand.
Waiters/waitresses and nurses are examples of jobs that rank high in terms of
job strain – the demands on their time/abilities is large, but their ability to
influence decisions or control their environment is relatively low. It’s no
stretch to suggest “NHL enforcer” is another occupation that would rank high in
terms of job strain.

Chronic stress and anxiety issues are also highly co-morbid
(co-occuring) with clinical depression. In fact, the onset of depression is
often incited by a highly negative or stressful life event, as in the sudden
death of Rick Rypien’s girlfriend earlier in his life. Depression has also been
induced in lab animals by way of a “stress test”. Martin Seligman
developed his learned helplessness theory of depression by exposing rats to
mild shocks they could not control or via the forced swim
test
. The analog to human depression was theorized to be a
“depressogenic” cognitive style which interprets negative events to be stable,
internal factors of the subject in question. Meaning, depressed people tend to
think bad things that happen to them are consistently due to their own
weaknesses or flaws and eventually become helpless/hopeless in the face of what
seems to be intractable failings. In addition, another cognitive distortion
common to sufferers of depression is the idea of an external locus of control.
That is, depression arises and is maintained in those who consider their fates
to be in hands of some external agent, outside of his or her power to control.

High job strain, chronic stress, depression and the resultant
cognition distortions can also be augmented or complicating by physical pain,
pain medication and substance abuse. The potential for enforcers to self
medicate physical injuries is high given the demands of the role and the need
to be always “on call” so as not to lose a spot in the line-up. In addition,
the culture surrounding hockey is explicitly “macho” and shows particular
antipathy towards expressing pain and injury. Players are invariably expected
to “suck it up and play through it” as much as humanly possible, or face a loss
of respect.

 Of course, players may also use pain killers and other drugs
(alcohol, narcotics) to self medicate the psychological pain of stress, anxiety
or depression. Substance dependance can result, leading to a pattern of
self-administration, tolerance, withdrawal, etc. The initiation into the world
of substance abuse may be physical injury for the typical enforcer, but it’s
maintenance and augmentation to full blown dependence may be to dull anxiety
and stress or escape the depression that comes with the territory.

Now a substance abuse councillor, Brant Myhres has previously gone on record
about the issue of drugs and enforcers in hockey:

“A lot of people really don’t hear the dark side of it. I played
with seven different NHL teams, 17 pro teams to be exact, and I had a first
hand glance at the abuse that went on.

“A lot of these guys don’t want to say anything to anybody
because their careers are at stake and that’s where I could come in. They could
confide in me because I’m speaking the same language. There’s no threat to
them, like they’re going to a coach, a general manager or an agent.

“They’re going to an ex-player who’s been there, done that
several times.”

….

“I think I was the only player to get suspended four times by
the league and then get reinstated,” he said. “I played one game with the
Flames, a pre-season game (in 2005), got my orbital bone smashed by Georges
Laraque (Edmonton Oilers) in a fight and after that my spirits were down and I
ended up relapsing again.

Myhres drew his first suspension for alcohol abuse when he was
just a 17-year-old member of the Lethbridge Hurricanes. He paid his first visit
to rehab when he was a 24-year-old member of the Philadelphia Flyers during the
1997-98 campaign.

“They say insanity is doing the same thing over and over and
expecting a different result,” he said. “I looked at it as doing the same thing
over and over and expecting the same result. You know what you’re getting into.

“For me I couldn’t seem to function without being medicated and
I think fighting definitely took a major toll on me. I started fighting at age
16.”

Unfortunately, drug dependence can inevitably deepen the issues
faced by enforcers potentially suffering from mood disorders since substance
abuse tends to strain social connections and make sufferers feel they lack the
ability to control themselves and their behavior. Drug abuse also tends to
threaten relationships and positions of value in the sufferers life, thereby
increasing stress, depressive symptoms and, in response, the compulsion to
continue to use drugs. Drug addiction, like depression, is often a miasma of
co-mingling factors, both physical (chemical addiction, withdrawal) and
psychological (escapism) that can become self-perpetuating.

None of this is to suggest that NHL enforcers will necessarily
be victims of any of the problems discussed here. As mentioned at the onset of
the article, because of the complexity of the interrelated factors, the most we
can say it is theoretically plausible that being an enforcer in hockey
raises the risk of eventually suffering from one or more of the pathologies
described, for the reasons outlined. Other potential factors include personal
histories and proclivities of the person in question, including familial and
genetic tendencies towards depression, anxiety, etc. Twin studies have found strong
concordance rates
of mood disorders in monozygotic (identical)
twins. However, the fact that rates have never reached 100% concordance also
indicates that environmental factors play a role in mediating depression/mood
disorder vulnerability.

The plural for anecdote is not data, so although the idea that
NHL enforcers face significant short-term psychological risks (on top of
potential long-term brain damage) seems increasingly convincing with each new
tragedy, the important next step in this issue would be to objectively
determine if the incidence of depression/psychological disorders is indeed
higher amongst fighters versus other NHLers, professional athletes and the
population in general. After all, hockey players are also people and it should
be assumed they will suffer from certain pathologies as a matter of chance. So
although increased prevalence of mood disorders in enforcers seems intuitive
given the events of this summer and what we know about stress, concussions,
depression, pain and substance abuse, this doesn’t necessarily mean it’s a
reality.

What we have now is,
at best, warning signs that enforcers are a population at risk which bear
further investigation. Calls for a stringent anti-fighting stance based on
recent tragedies is probably putting the cart before the horse. However, the
counter assertion that this summer’s events are merely coincidental and not
indicative of any causal relationship between fighting for a living in the NHL
and psychological pathology strikes me as callous and myopic as well. Nothing
is certain at this time, but the heart-wrenching casualties of the 2011
off-season demand we take the issue seriously going forward.

  • beloch

    As Flames fans, we’re pretty accustomed to seeing enforcers on the ice. The idleness of Brian McGrattan this season and his eventual reassignment to Adirondack heralds the end of the pure enforcer in Calgary, for now at least. For the first time in as long as I can remember, it is a rare occurrence to see two enforcers drop the gloves a scant two seconds after the opening puck drop.

    However, we still see plenty of fights. Brandon Bollig and Derek Engelland are pretty close to being pure enforcers and players like them are still abundant in the league. According to hockeyfights.com, the Flames are currently ranked #21 in the league for fighting majors (The Flames played the #1 team last night). Bollig and, on occasion, even Engelland have been healthy scratches, suggesting that, some nights at least, Hartley wants to beat the other team at hockey, not merely beat them up!

    Even better news is that the number of fights per game in the NHL has been on a steady decline over the last decade. In between 2000 and 2004 there were an average of 0.596 fights per game in the NHL. The first two seasons following the lockout saw a marked reduction in fights, which unfortunately rebounded to pre-lockout levels by 2007-2008. Since then there has been a steady decline in fighting. This year there has been an average of 0.34 fights per game in the NHL, which is just over half of what it was a decade ago. This is progress.

    I doubt the NHL will ever outright ban fighting. A fight between stars in a close match is a visceral, exciting and consequential part of the game. However, the days of every fourth line being a goon squad are probably gone for good. I’m going to miss the absurdity of games like the one last season in Vancouver where Hartley threw the Flames’ entire goon squad out for the opening face-off and Torts, in one of his finer moments of madness, matched them goon for goon. The results were made even more hilarious by Torts lapse into dressing-room-storming insanity, followed by his suspension and a season derailing slump for the Canucks. That was glorious but, perhaps, the sort of thing the NHL should leave behind.

    I would like to see a complete ban on fighting in junior and amateur leagues however. It’s pretty sickening to go to a Hitmen game and see multiple fights per game between teenagers who don’t know what they’re doing, all egged on by management, which thoughtfully provides a light-show and heavy metal music to help wash the violence down. It would probably be smart to ban or, at least, severely restrict fighting in second-tier pro-leagues as well, if only to prevent the influx of out-of-work enforcers from causing excessive harm to the NHL’s up and coming stars.

    The NHL has made progress. The incidence of fighting has been halved over the last decade without significant impact to the entertainment value of the game. Here’s hoping that continues.

    • mk

      +1 for the comment about junior & amateur leagues. Especially for young players. I’ve heard many argue that they need to fight in junior in order to ‘be prepared’ for fights in the NHL, but the set-piece fights that we often see are not something most players will contend with (a la enforcer vs. enforcer). Even players that play dirty and deserve to take a few punches can skate away, possibly even drawing a penalty in the process.

      Plus, as much as we all enjoy the ridiculosity (it’s a new word, just go with it) of events like the VAN-CGY game last year, I could definitely bear to see 4th lines that can skate better. Watching some 4th lines play hockey is only slightly more interesting than watching paint dry. * Shuffle shuffle, weak pass, dump in, grind grind grind, turnover, grind grind, loose puck, weak shot from 8 miles away and then change*.

  • I am of the mind that fighting should be allowed but only in the “heat of the moment” type fights where you have two actual hockey players that are really into the game, get heated and want to mutually blow off some steam. I am against the staged enforcer type justice that seems to be less and less these days.

    I am not sure if that means more cheap shots at some of the better players without some kind of punitive justice from an enforcer. It seems like you can do away with those whose job it pretty much solely to fight and not have a huge impact on the team.

    • beloch

      I would love for those heat of the moment fights. But the NHL is seeminly trying to cut those out too. A decade Jarome Iginla go into possibly one of the most exciting fights ever against Vincent Lacavalier in the SCF. Now, he was going to go at it with Dion Phaneuf and the refs stepped in.

  • RedMan

    the staged violence is, in my opinion, disgusting. That these people suffer life altering injuries, both physical and mental, for the entertainment of the crowd, is as sad commentary on society. And no, i do not want to take an level of physical play out of hockey – the aggressive in your face hockey is the best kind. But how can a crowd cheer and smile when people are hurting each other and potentially damaging one another for life, with no purpose other then to provide the blood sport to go with your beer and nachos, that’s entertainment???

    The argument that you hear is that these guys need to police the game. hogwash, that’s the ref’s job. The scary thing is that, as bad as the nightly cheap-shotting is, it has actually gotten a lot better. Watching hockey from the 80’s and 90’s, i am surprised at the intentional, regular elbows to the face and headfirst boarding. i remember when Mat Lombardi had his head taken off by, i think darian hatcher, in the 04 playoffs, and Mat was never the same hockey player afterwards. Yay, lets cheer! that was fun! hurt someone else for life! weeee!

  • icedawg_42

    I read this again after your tweet yesterday. Excellent writing, and apropos for the timing yesterday. Personally, I’ve never enjoyed hockey more than I am now, with the staged goonery all but a thing of the past.

    A rerun of the 2004 cup finals game 6 Cgy/Tampa was playing the other night and watching, all I could think of was “this is ugly hockey” – not goonery per se, but the clutching/grabbing etc. Hockey looks so pure now.