Thoughts on “What Made Maddy Run”:

As an athletic trainer, as someone who has struggled with her mental health, and someone who has seen athletes mental health issues, reading this really hit me in the gut. But it was also so very well-written and powerful. I loved that it was written by someone who also had mental health issues/breakdowns while an athlete in college. Because then you knew it wasn’t just a journalist writing down facts and halfheartedly repeating a story, but by someone who tried incredibly hard to live through these moments with her, even though doing that took a toll on her at times. That was really powerful. That’s how you know how important mental health is.

I never had aspirations to be an athlete — but I wasn’t gifted there anyway. I never aspired to go to an amazing college and get top marks — I wasn’t gifted there either. I was average at everything, whether I worked hard (in water polo) or lazily did the bare minimum (school, at first). I had that perfectionist nature, and if I was stuck in a spot where if I couldn’t do anything perfectly, I just didn’t want to do it at all. The only way I would try is if I knew I was guaranteed progress. The reason I tried at practices was because I knew if I got just .01% better on my next attempt at a drill, that was progress. The book described the different ways Maddy reacted to changes and progress and failure and it just resonated so much with me. And as powerful as this book was for my personal life, this book showed me that I knew and still know many like her — and that’s what hurts the most. It’s not just about me anymore.

That high-achieving personality and lifestyle is something I’m familiar with seeing…but not fully in myself. I saw it in the way that my friends from childhood worked every single day for the best grades and the best colleges and how it tore them apart but they were still trying to hold it together. I saw so much of the heartbreak and pain just being on the outside. Now, multiply that by at least two with athletics. The pressure that Maddy was under was immense. She put so much pressure on herself, and in fact, more than others often put on her. And if 1 out of 4–5 people struggle with mental health issues (and I’d say it’s heightened in athletics)…that is a lot of people who are doing things like this. Think about the athletic department at a large D1 institution. There can be anywhere from 400–800 athletes at one school (this is a guess of sorts). That’s a lot.

Pressure comes from teammates, coaches, parents (and teammates’ parents) and the athletes themselves at every single level and definitely increases as you go up. These athletes are used to handling tons of things at once — school, sport, sleep, eat, study, that’s it. But when you jump to the college level, a lot of that ramps up — school gets harder and more time-consuming, the sport can become more intense and feel like a chore at times, and you get placed on a team with the best athletes from other schools + states. That competition can be great, but it also can be incredibly detrimental for those high-achieving perfectionists. But I truly don’t know what it was like, so I’ll just stop here. And this was something the author had to go through — even as she got into the depths of Maddy’s history by talking to every single person she knew and looking through her phone/computer…she could not fully be there in her head. I know I will never be fully in the head of my athletes, but I will help as much as I can.

Initially, I didn’t really want to read this book. I thought it would be too stereotypical to read a book that every single person loved — aren’t the best books the ones that are more controversial? I also have very specific tastes in books, I didn’t want this to be another book that told you what to do but didn’t talk about why, or the opposite — I needed both. Anyway, I had ordered it awhile ago for a book club the Women in Athletic Training group was holding but I just let it sit on my shelf. On a short day trip to a nearby lake, though, I grabbed it running out the door and I immediately latched on just a few pages in. I realized early on this was not “just another book”. At times I felt as if I was reading something Maddy herself wrote. And the author was unafraid to write about herself and her own past with mental health, which I think was perfectly and incredibly placed.

The story happened my freshman year as well (which I was very well aware of the entire time I was reading it —weird) — just across the state, in my hometown, Maddy attended a school that plenty of people I knew attended. But I never knew how it went for them, how difficult it was…or if it wasn’t. I thought they seemed happy. They didn’t have the added pressure of athletics, but…that doesn’t mean they weren’t struggling too, for example — the author discussed stats on mental illnesses of all college students, not just athletes. But that should tell you how easy it is to think you know someone or their level of joy based on the internet or what they’re telling you on the surface. That has got to change.

I cried when I got closer to the end of the book. I was reading at the pool, sunglasses on because of the sun, when I started tearing up — for me, when the tears well…the tears will fall. The most powerful thing about the book was knowing that I am not unique in the difficult, convoluted ways I process my emotions and my current situations. And it was even more horrifying as I slowly realized that thousands of collegiate athletes at all levels are struggling with their mental health but do not always know who to go to or what to do. This is no longer just a little problem we can have as an afterthought. This is something we — fans, parents, support staff, administration, every single person involved in athletics — need to think about when every athlete walks into our facilities.

Madison had always had the answer, because finding the right answer had never been tricky, had never been an enigma, but rather was simply a matter of hard work. She was good at showing up and chipping away. But solving this problem was nothing like that. This was slippery, painful, and the harder she tried to understand what was happening, the worse she felt.

I have always seen perfectionists as people who see their destinations and goals, and they see the path there as a straight line. Simple, black-and-white — you do the work, you get there, everything’s fine. But when that is not enough and the path becomes cloudy, suddenly they are stranded. They must either be able to ask for help with something they don’t know about — but how are you supposed to express that? Especially if you don’t want to try and express it, just in case it’s wrong. Sometimes you just don’t know what you don’t know, and that is one of the least comforting thoughts that has ever come to life.

Though the paragraph is simple, it expresses that approaching the unknown can be the most terrifying of all for some people. For others, it’s nearly exhilarating, almost fun to not have to worry about what comes next and just see what is waiting around the corner. But for a lot of people, not knowing the full future consequences of your decisions can make you hesitant and paralyze you with fear. And at that point you can get really, really stuck. And then I don’t really know what happens after, truth be told, because when you’re in the thick of a bad place, you don’t always know how you get out of it. But what I do know is that many athletes have this perfectionist, idealistic mindset and they need our help.

And here comes the “action plan”, because I often feel incomplete without one. We talk about mental health a lot as athletic trainers. We talk about knowing that it affects our athletes, but what are our action plans? What are we doing to make sure that our athletes don’t fall through the cracks and get the help they need? The hard part is that there isn’t one exact answer. One, because institutions are all unique in the way they handle these duties. Some schools are able to afford a psychologist specifically for athletes, some have allowances for clinical psychology PhD students and researchers to see athletes, some have other methods of referring to mental health specialists. It depends on what is best for that institution. So this is a really hard thing to answer.

Like the author said, it’s much easier to mandate that athletic trainers be at all practices to take care of the physical injuries that occur. But something needs to change when it comes to the mental illnesses of our athletes, and instead of feeling overwhelmed and worrying about changing the entire system…let’s take it slow. While overturning “the system” would probably make room for positive change just as much the small steps would, reality gives way to one of them. Everything starts small, but it starts with action. We have brought a lot of attention to these issues but I think it’s high time that we start asking each other what we can do to concretely improve situations. Athletic trainers, athletic directors, coaches, strength coaches, dietitians, physicians, academic advisors/guidance counselors, physical therapists…let’s do it!

1. The first thing you can do is look at your own department’s policy. It can be something as simple as implementing a mental health screening in a physical and outlining what to do with the information if an athlete checks the box that says “yes, I would like to speak to a mental health specialist”. Even if you do not have the resources directly in the athletic department, an on-campus presence may be the next option. And if that’s not an option…there is always something out there. What is the full process of referring an athlete? Who is “allowed” to know if an athlete is struggling? Assess where changes can be made. Look at other institutional policies for ideas, if they are accessible to public (if not, this is again where networking comes in handy. What do your friends and colleagues do?). At the very least, do you have a policy — and if not, can you propose one?
2. The second thing you can do is become more familiar with mental health issues. I have friends/colleagues who suggest taking a Mental Health First Aid course. I have not yet done it but after reading this book I am feeling really inspired to. It is for everyone to do! We (the list of people I made up there) all see athletes in different areas of their lives and if we can identify problems earlier on, let’s do it. If you are not yet able to attend one of those sessions, read articles, read books, learn about different mental health disorders (a simple google search of “mental health issues for athletes” gives you so much information!), and talk about it with different colleagues. Already I have learned so much about OCD, anxiety, depression, eating disorders and other things in this one group chat I’m in full of some of the brightest athletic trainers. There are even mental health issues specific to different sports!
3. As athletic trainers, we are often isolated at practice because…that’s how we see the injuries. But it allows us to see the little things, from how athletes respond to change, disappointment, and mistakes, and how the team is getting along — and how those change in context. We see them in the athletic training room, on bus rides home after losses, and we are often quite intuitive to what’s going on. We are responsible for the well-being of athletes — and more than just physical injuries. Plus, we know that physical injuries can cause mental health issues as well. We have to get to know our athletes because learning their histories, personality styles, and tendencies allows for the ultimate in patient-centered care. So the 3rd thing you can do is understand why it’s important to get to know your athletes (and it’s never too late to learn). When you genuinely care for them and will do anything to take care of them, building that “trust bridge” is key.
4. Take care of your own mental health. Understanding your own mental health allows you to understand more about what mental health + wellness is. I’m not saying you should apply your own strategies to your athletes because we are not so authorized to do that. But learning more about yourself allows you to provide better care for others — for example, if you know you’re a bad listener & you tend to think of answers while someone’s talking to prepare for all potential outcomes…then you should learn to listen even better. I’m not saying that you need to do this in order to be perfect for your athletes because you are human just as well, but this is another step we can take. Whether it’s making time in your schedule to go and see a therapist, or being more strict about your own free time — do something for yourself so that you may serve others even better. Easier said than done, but like I said — start small!
5. Check in on the mental health of your colleagues. Again, on that list of people I said up there. Get to know your coworkers and know that even the ones who take care of others can have mental health issues. You don’t have to be best buddies but this can help everything run more smoothly for everyone involved, even the athletes.
6. Network. One of the biggest things I learned from my director during graduate school was that networking, being present on campus, and making your face known to people is very helpful for these types of things. You may be able to connect with professors, researchers, or staff members who can help. At a smaller school that may not even have a specific student health center — you can make connections with people in the town/city/area who can help you. The only way we are going to tackle this mental health “epidemic” is by working together. I don’t quite know how it works at the high school level but I know plenty of ATs are friends with teachers, coaches, guidance counselors, nurses, etc. In the pros, psychologists often come in-house to speak with athletes, and at the D1 level…there are counseling services on campus, researchers and professors involved with clinical psychology, and plenty of other people to network with. See what is necessary at your institution and how you can use these connections for good!

This is a short list mainly because I’m not an expert. God, I hope I stop saying this soon because while I’m not an expert, I’m not a dummy. I just love action steps. I love thinking ahead, and not only looking back. By looking back and complaining, we do bring attention to the issues…but that isn’t how things change. When it comes to goal setting, there is a reason we have long-term and short-term goals. When you don’t know where to start with a huge problem like this, do something small because our actions speak louder than our words.

And I don’t mean to say “you need to do this” in an accusatory tone, but it feels a lot more action oriented than saying “we need to do this”. It’s a team effort, but individuals need to participate in order for things to change. And we, as well, can take some of the pressure off our ourselves to be perfect in these endeavors. We are not always the administrators who make the bigger decisions. We are not all-knowing. We are just all trying our best in our efforts to serve others. But I will say — I am seeing positive changes in some areas. Athletes are sharing their stories of mental health more, athletic departments are placing more information in the media about mental health, etc. These are all good things we can celebrate, but we can do more, and we have to.