Each year, consciousness about ballplayers' psychological well-being is raised as more Major Leaguers seek help, publicized or otherwise, to ease their mental state. Giants first baseman Aubrey Huff, who went on the 15-day disabled list last Wednesday with an anxiety disorder, is the latest player to take this journey.
The route is never easy.
"I have to focus completely on getting well," Huff said in a statement. "Sometimes you have to pull back and work on things in private."
Major League clubs understand this. Organizations have Employee Assistance Programs for players who realize they need professional help. Maybe it's a Joey Votto, the 2010 National League Most Valuable Player Award winner with Cincinnati, whose depression and anxiety attacks a few years ago were prompted by the death of his father. Maybe it's a Zack Greinke, the 2009 American League Cy Young Award winner, now with Milwaukee, who was diagnosed with social anxiety disorder early in his career. Maybe it's a Justin Duchscherer, a two-time AL All-Star with Oakland who struggled with clinical depression.
"I do think the game has changed a little bit, with the fishbowl that these players are in now, dealing with the ups and downs of playing in the Major Leagues and how much they're scrutinized," Giants manager Bruce Bochy said. "I do think you have to be a little more sensitive about these guys [being] under a lot of pressure, regardless of how much money they're making. We're all different. We all handle it different. But I think in society as a whole, there's a lot more attention now to something like anxiety."
With San Diego, Bochy managed Khalil Greene, a marvelously talented shortstop who went on the DL with social anxiety disorder as a member of the St. Louis Cardinals in 2009. Bochy knows that nothing in the imaginary manager's handbook prepares him for the shock of a player acknowledging his human frailty.
"You just have to realize that everybody's different and people deal with adversity differently," Bochy said. "Life has gotten a lot more complicated than it was 20 or 30 years ago."
And baseball remains the near-daily grind that it was in Horton's day, with its 162-game regular-season schedule, excluding Spring Training and the postseason. Players speak incessantly of not worrying about factors they can't control, and mostly they appear to succeed. But that equilibrium can be easily upset, particularly when events in a player's personal life -- a failing marriage, an ailing child, financial concerns -- weigh heavily upon him.
"We actually perform best when we have that moderate anxiety that helps get our focus and concentration," said Charles F. Brady, Ph.D., who directs the Cincinnati-based Lindner Center of HOPE's Obsessive Compulsive Disorder and Anxiety treatment program and oversees the Supported Employment program. "The problem is when you're in a high-stress profession like that where the challenges are so great, moderate anxiety can sometimes erupt into an anxiety disorder."
And for athletes who are accustomed to performing with bodies that don't fail them, anxiety can be particularly debilitating.
"Anxiety has two parts of it. It has a psychological part, but it'll change the breathing rate, heart rate and muscle tension, and so it will have a real physical impact on the person," Brady said. "One thing we know about anxiety, it's not a matter of intelligence or courage or willpower. When anxiety hits, until you understand what's going on your body, no matter who it is, that person's going to feel like their body's falling apart. They're going to feel like they're dying. They're going to feel like they're losing their mind."
Fortunately for players, the presence of sports psychologists has become the rule rather than the exception. The late Harvey Dorfman became the exemplar of this group, counseling top pitchers such as Roy Halladay, Greg Maddux and Brad Lidge. Though a psychologist's job is rarely simple, it doesn't have to take much for a player to regain his mental balance.
"Usually with the combination of medication and psychotherapy, we can get things turned around to where the person can function like he did before," Brady said.
That can be a challenge in cases where players suddenly lose the ability to execute basic skills. This phenomenon usually involves throwing, whether it's within the strike zone or to first base. Steve Blass, Mark Wohlers and Rick Ankiel were among the pitchers who endured the former malady; Steve Sax and Chuck Knoblauch were infielders afflicted with the latter problem.
"When we start losing trust in our ability, we start to think too much," Brady said. "Then we start using a part of the brain which is in charge of thinking, which is not a part of the brain that's in charge of physical things, like throwing or swinging the bat. They tend to cause a little bit of a traffic jam, which tends to foul things up.
"Ask a golfer when his game goes wrong what's going on inside his head, and he'll say, 'Too much.' "
In a sport where maintaining a poker-faced exterior is a valued trait, many players might think that it's too much to speak up for themselves. But as others continue to seek help in dealing with mental issues, perhaps those who might ordinarily remain in the background will step forward.
"Many people are afraid to seek treatment because they're afraid that people might think that they're a coward or can't handle things," Brady said. "Unfortunately there still is that stigma out there that if you have anxiety, somehow that's a sign of weakness, a sign that you can't cut it or you're not tough enough.
"Unfortunately that's exactly the type of thing that tends to keep people out of treatment and actually makes them even more afraid of their anxiety, which can make the condition even worse, because once you learn not to be afraid of anxiety, that's a key part of the recovery process."