On Enforcers, Depression and Risk Factors
By Kent Wilson
9 years ago(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 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.
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.
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,
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.
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.
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.
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.
(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.
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.
(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:
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.
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.
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.”
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.
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.
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.
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.”
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.
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.
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.
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.
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.
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