Players, teams learning to treat anxiety

Players, teams learning to treat anxiety

Mel Didier is as old-school baseball as they come.

The 83-year-old has been around the game for 58 years as a Minor League player, big league scout and executive and has seen and learned a lot.

It was Didier, for example, who told Kirk Gibson that Dennis Eckersley would throw a back-door slider with a full count and first base open and then watched one of the most famous home runs in World Series history leave Dodger Stadium.

In other words, not a lot surprises Didier, even though he has seen established Major Leaguers such as pitchers Zack Greinke and Steve Blass, catcher Mackey Sasser and infielders Chuck Knoblauch and Steve Sax suffer from diagnosed and undiagnosed psychological maladies that affected their play in strange and sometimes career-threatening ways.

He's also watched this year as talented and successful big leaguers Dontrelle Willis, Khalil Greene and Joey Votto have been put on the disabled list because of similar problems, now known by the collective phrase of "social anxiety disorder."

"I'm sure it has happened in baseball forever, but back in my day, players probably played through it because there was somebody below them that was hankering to get to the big leagues and was capable," Didier says.

Didier is not alone in those thoughts, as these disorders aren't well known and are not easily diagnosed. While these types of disabling conditions might not have been recognized or treated in the past, there no doubt were individuals affected by the symptoms players have discussed more publicly than ever before this season.

Psychologists and doctors contend very real problems exist, and it's logical that they are made that much more evident by the 24-hour news cycle and the pressures of playing up to lucrative contracts, among other factors.

And the reality is mental roadblocks have stalled the seasons of Willis, Greene and Votto, and their teams are looking for 21st-century answers to getting these talented players through it.

More than a just a slump

Willis, the affable left-hander with the cap turned slightly sideways and the huge smile, is a two-time All-Star who won 22 games in 2005 and finished second in the National League Cy Young Award voting that season as a member of the Florida Marlins. He was traded to Detroit before the 2008 season and hasn't shown any command of the strike zone since.

During Spring Training, the team diagnosed him with an anxiety disorder, citing blood tests that raised concerns. He missed the first two months of the season, returned in May, continued to pitch poorly, and was put on the disabled list once again last week.

"I'm not crazy," Willis said. "My teammates might think I'm crazy, but this is not something like that. This is something totally different that I'm concerned about. This is something in my blood."

Greene has been quietly dealing with a different type of anxiety, one that has manifested itself not only in subpar results on the field -- he hit .213 while with the Padres last year and was batting .200 for St. Louis this year before being placed on the DL on May 29 -- but in erratic verbal and physical outbursts. He missed the last two months of the 2008 season after breaking his left hand punching a storage chest.

Greene's trip to the disabled list was followed by a short Minor League rehab stint, and when he returned to the big leagues last Thursday, he hit three homers in his first four games back with the Cardinals. A shortstop for his Major League career, Greene shifted to third base upon his return from the DL.

Greene, 29, described his condition to the St. Louis Post-Dispatch as anxiety caused by fear of failure, something that he has experienced since childhood but has intensified over the last couple of seasons.

"It's difficult for me to manage that [anxiety]," he told the paper in May. "I don't know how many people can relate to it. It's so strong. It's a very intense feeling and it's very unpleasant. It's not life-threatening. I'm not putting myself at risk. But at the same time, those responses are there automatically. I really have to concentrate to slow down, focus and stay in the game."

Votto, meanwhile, had been bothered by dizziness brought on by an inner ear infection along with the flu, and the 25-year-old slugger exited three games this year with those symptoms.

On May 21, tests revealed the inner ear infection, but there was enough wrong outside of the physical problem to warrant a team meeting.

On Tuesday, Votto finally opened up to the media, saying he had battled depression and anxiety related to the sudden death of his 52-year-old father, Joseph, last August.

"He was in my thoughts and I was dealing with it on a daily basis, but as powerful a moment that was to lose your father so young, in a way, I did suppress it," Votto said.

"From the beginning of the offseason until Spring Training, I was pretty severely depressed and dealing with the anxieties of grief, sadness and fear and every single emotion you can imagine everyone goes through. I had a really difficult time with it."

Help on the way

More and more, clubs are turning to sports psychologists to make these situations less difficult, and according to a prominent doctor in the Pacific Northwest, it's good to see anxiety disorders now being considered legitimately DL-worthy.

"It's a highly stressful situation with players these days," says Dr. Donald Smith, the director of the clinical psychology program at the University of Washington and a former roving Minor League psychology instructor for the Houston Astros (1985-96) and team counselor for the Seattle Mariners (1990).

"Anxiety is a mind and body phenomenon, and muscle tension interferes with the smooth, athletic movements we normally associate with Major League players. We tackle it by teaching stress management coping skills."

Smith says he has helped conduct studies that have shown that anxiety is much more likely to affect pitchers than position players and that even moderate muscle tension by a batter can "make an 85-mph fastball turn into 95 mph."

And for any team that has any doubts that psychological treatment can help players riddled with anxiety, Smith says clubs can go ahead and avoid it -- at their own risk.

"I met an old-school pitching coach who told me, 'I'm not here to coddle mental weaklings. It's a game of survival.'

"Well, survival is exactly what I'm talking about here, because a Major League team can't really afford to chalk these problems up to a guy not being 'tough enough' and letting him drop by the wayside. You need depth up and down that roster. You want as many players as possible being as healthy as they can be."

To that end, clubs are taking anxiety problems seriously before they even draft players.

Charlie Kerfeld, a former big league reliever and longtime scout who now serves as a special assistant to Philadelphia Phillies general manager Ruben Amaro Jr., says this approach is a no-brainer nowadays.

"Oh, absolutely, you have to dig for all that stuff," Kerfeld says. "By the time guys become Major Leaguers, most of that stuff has been out there by then. If they have problems they've been through in the past, in high school and in college or even before then, you better know about it already."

A different approach

And that's where Dr. David Grand's unique methods come into play.

Grand, a sports psychologist based in a suburb of New York City, helped cure Sasser, the former promising Major League catcher who, after suffering a collision in 1990, had trouble throwing the ball back to the pitcher. Grand did it with a procedure that he and his Massachusetts-based associate Dr. Alan Goldberg refer to as "brainspotting."

"Traditional sports psychology looks at performance problems in baseball such as those of Sasser or Knoblauch on a purely conscious level," Goldberg says.

"It says that if a player can control negative thoughts, he can concentrate better. But the problem is that these issues are not caused by conscious control. They reside in the athlete's body. Trauma doesn't get processed, it gets stuck. And the pressure of the big leagues triggers it."

Goldberg said more often than not, these traumas are rooted in physical injuries the athletes suffered years before, sometimes even in childhood.

"With past injuries, the brain doesn't process them," Goldberg says. "The physically and emotionally taxing experience is stored, and long after the experience happened, the body maintains the memory of it."

Grand's methods involve a bilateral stimulation of the brain in which music plays in alternating ears while the patient is asked to look from left to right and identify where they are looking when their anxiety intensifies.

"Where you look shows how you feel," Goldberg says. "They can open up and tell us what experiences they've had in the past that might have caused these problems."

Sasser swears by it, saying Grand helped him identify scarring experiences from boyhood. A college catcher patient of Goldberg's found that the numbness in his hand when he threw the baseball was related to a broken wrist suffered while being hit in a football game in seventh grade.

But no matter how a baseball player is treated for anxiety, Goldberg says the important thing is to recognize that it truly is a debilitating condition and not one to be ridiculed.

"We have to remember that these are human beings," he says. "They have emotions and frailties and feelings."

From darkness to light

Happy endings do exist for players stricken with anxiety disorders. Just ask 25-year-old Royals righty Greinke, a big-time prospect who left Spring Training in 2006 because of anxiety and missed most of that season.

"It wasn't as much pitching lows, it was more just dealing with stuff like this, where it used to bother me a bunch," Greinke said earlier this year while surrounded by about 15 media members.

"I hated being around attention and stuff in the clubhouse, and I just hated being around that. I just really didn't like anything to do with being around people, for the most part."

With the help of doctors who diagnosed his disorder, Greinke has come all the way back, with an 9-3 record, a 1.90 ERA, 111 strikeouts in 109 innings and a good chance at starting the upcoming All-Star Game for the American League.

"What players and teams have to understand is that there is light at the end of the tunnel," Smith says.

"With the proper treatment, these problems can be taken care of. The player can return to the performance that everyone knows he's capable of."

Doug Miller is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.