The Stigma and the Game

In May 2018, William D. Parham was named the inaugural director of the National Basketball Players Association Mental Health and Wellness Program. Parham is a professor in the counseling program of the School of Education and interim associate dean of faculty. A licensed and board-certified psychologist, he has worked extensively with athletes in organizations ranging from the National Basketball Association, National Football League, Major League Baseball and the U.S. Olympic Committee as well as those who play intercollegiate sports. We spoke to him about mental health issues in the world of professional sports. Parham was interviewed in person and through email by Editor Joseph Wakelee-Lynch.

When Kevin Love, of the NBA Cleveland Cavaliers and DeMar DeRozan, now with the San Antonio Spurs, spoke openly earlier this year about mental health issues they’ve faced, they heightened awareness of the issue in the public. How extensive is the problem of NBA athletes experiencing mental health struggles?
It’s hard to estimate the extent of the problem in professional sports because, first, data regarding mental health and wellness aren’t kept, and, second, keeping those data raises questions, such as confidentiality, record-keeping, to name a few, and could have real consequences for player’s careers. If, on the other hand, you frame the question in relation to what we know about mental health and wellness struggles within the general population, there’s every reason to believe that the demographics of the U.S. population, are mirrored within and across professional athletic communities. When viewed within multiple contexts including, but not limited to culture, race, ethnicity, social class, gender and other markers of personal identity, the possibility of hidden or masked mental health and wellness struggles with and across professional athletic communities becomes even more striking.

What led the National Basketball Players Association to decide they must act?
I believe there are at least two variables that came together and triggered the NBPA to act. First, players spoke out, risking vulnerability, to share their stories of the emotional burdens they no longer wanted to carry in silence. Related, many of the players who came forward knew that their brothers in the basketball fraternity also were carrying around personal baggage that was weighing them down and impacting their on-court performance and the quality of their off-court lives. NBPA heard the voices of the players and decided to support players in tangible and concrete ways.

A second variable, though not often articulated, that I suspect had some influence on players coming forth when they did to share their stories is the current environment in which women and African-Americans, to name a few communities, are reclaiming personal identities and self-respect, and deciding to no longer remain silent about the injustices to which they have been subjected. Movements including #MeToo and Black Lives Matter, and the courageous stance taken by Colin Kaepernik, to cite a few examples, are offered for consideration. Importantly, protesting and stimulating difficult dialogues are not new activities enacted within professional athletics. This past October 16th marked the 50th anniversary of the silent protest on the podium during the award ceremony at the 1968 Olympics in Mexico City. Tommie Smith, John Carlos and Peter Norman (Australia) decided to use their forum as Olympic medalists as a way to focus the lens of social, political, legal, educational, health care and other injustices perpetrated in America against marginalized communities.

How has the NBA responded to the emergence of this issue in the public?
The NBPA and NBA have responded positively! The mental health and wellness of players is important, and everyone is on board. Within larger athletic arenas and in the general public, however, there’s still a cautious embrace of the issues framing mental health and wellness conversations. Mental illness, specifically, is viewed within the contexts of stigma and shame, which leads persons struggling to manage their lives with these challenges to remain silent and not get the support that could make a turn-around difference in their lives. One of the goals my colleague Keyon Dooling, player wellness counselor with the program, and I seek to achieve, buoyed by ongoing player disclosure of their struggles and successes with managing their mental health, is to jumpstart a shift in the narrative about mental health and wellness by engaging in national and global conversations on the topic.

How did you come to be asked to be the first director of the program?
I am inclined to respond initially to this question by saying that I was in the right place at the right time. With that being said, I have consulted with several professional sports organizations, including the NBPA and NBA for several years, and in the various roles I was asked to serve, I always advocated for the need for each organization to understand and appreciate the mental health and wellness of players. The courage of players coming forward to share their stories, the willingness of the NBPA to step up and be counted among those making a tangible difference in the lives of players and whatever reputational capital I may have accumulated over the years relative to my commitment to serving athletes honestly represent the forces that came together to achieve a common goal.

What are the sources of anxiety and depression, and other mental health issues, among professional athletes?
There are basically four categories. First, the challenge of being a professional athlete: travel, physical demands on the body, issues of nutrition, circadian clock disruption, significant amount of downtime and the possibility of being traded. Second, life stressors: relationships with family and friends, management of money and concern for retirement, for example. We can label these situations as daily hassles. These daily hassles can be exacerbated by larger environmental realities. For example, athletes who come from impoverished backgrounds and communities that have been marginalized traditionally, evidenced by factors such as poor schooling, poor health care and high crime, find added complexity relative to their abilities to manage daily hassles. A third category includes history of mental health and wellness struggles, which increases personal vulnerability to future struggles. A fourth category is a history of trauma, experiences you can’t un-see, un-feel or un-remember. Traumatic experiences, akin to the ink used by tattoo artists, are the indelibly etched lived experiences, frequently experienced initially during childhood, that exhaust intrapersonal resources used to manage emotionally overwhelming circumstances. I call them invisible tattoos. They cannot be seen by the untrained eye, but they are nonetheless present and influence players’ attitudes, moods, dispositions, decision-making, demeanor and overall approach to performance on and off the court.

Speaking of invisible tattoos, you’ve spoken of the need for better understanding of players who appear to have a chip on their shoulder. What do you mean by that?
I invite players, their coaches and those in their circles of influence to see players perceived to have a chip on their shoulder as individuals who have discovered a means of self-protection. On the surface, to the untrained eye the chip-on-the-shoulder behavior looks very aggressive, disruptive, perhaps disheartening and like the player doesn’t really care about what others thinks about how he behaves. On the surface that’s exactly what observers see. At a deeper level, however, what an observer is actually witnessing is a player’s vow, a childhood pact, that grew out of a personal declaration that he will never return to or be subjected to the traumatic, hurtful, humiliating, frightening and sometimes unforgiving experiences of early life. Remembering what life used to be like fuels the drive and succeed-at-all-cost mentality that helps a player to survive the predictable up and downs of life he is likely to experience as he grows into adulthood. A player who while growing up and before the age of 10 has experienced poverty or witnessed gun violence or sexual assault, promises himself, “I will never, ever face this again!”, “I will never subject my future family to this horror!”; “I’m not going back to that dark place!” These promises represent promissory notes to self to keep their eyes on a bigger prize of future financial, relational and other successes. The chip, in short, is the byproduct of a calculated, intentional and purpose-driven design for achieving future success, thus positioning the player to see hope for better days ahead. The chip is a double-edged sword in that it helps players navigate life hurdles and at the same time covers up childhood issues that ultimately need to be addressed.

You’re building something new, something that has not existed prior to this, at least under NBPA auspices. Where do you start?
Because I’ve been thinking about this for the past 10 years, I’ve imagined what this kind of program would look like. So, when the opportunity to serve in this inaugural role, I was already locked, loaded and ready to go! In essence, my beginning started years ago. Fast forward to the present, Keyon Dooling and I have a five-part plan to get the program up and running. Our goal is to populate each of the 29 cities that host NBA teams with a directory of five to 10 licensed mental health practitioners who agree to work with players. Second, we are in conversation regarding the development of a 24/7 crisis hotline in anticipation of crisis situations. Third, we will be launching our website that will be uniquely available to the players and will have information and links about the project, mental health literacy, organizations that address mental health and wellness and up-to-date information regarding medication, concussions, alcohol and substance abuse, leisure time pursuits, career transition and much more. Fourth, throughout the season, we will have touch points with each active player in the league. Fifth, we will work with various media to help us spread the word.

What does success look like down the road?
Players with mental health and wellness challenges walk around, often, with a layer of invisibility. They don’t feel comfortable sharing their story and journey — it’s a way for them to emotionally self-protect. Success, then, will be measured, in part, when we see more visibility relative to players talking more and deeply about the challenges they are facing. Everyone has baggage. So, there are only two questions ever on the proverbial table: How many pieces of luggage are you carrying? And, what’s packed inside the baggage? In the long term, I’d like to see the conversation about mental health become normalized so that it’s seen as part of a conversation about overall fitness, just like matters of nutrition, sleep and rest and strength conditioning. When mental health and wellness is viewed as a part of the human experience and when coaches, executive leadership, family, friends and fans begin to see the athlete as the person behind the performer, then we will have made some progress.