In 18 years as the Mets' team psychiatrist, Dr. Allan Lans witnessed player insecurities, depressions and griefs "all the time." But this recent wave of major-leaguers becoming so stressed that they have been assigned to the disabled list has moved Lans, now a professor of psychiatry at Columbia University, to call social anxiety disorder "the swine flu of baseball; it's crazy."
Before the All-Star break, three players -- one of them on two different occasions -- officially had been put on the DL by the anxiety diagnosis. Just as Kansas City pitcher Zack Greinke was sidelined three years ago, Detroit pitcher Dontrelle Willis, St. Louis shortstop Khalil Greene and Cincinnati first baseman Joey Votto have missed playing time this season for non-physical issues.
Greene made a second trip to the DL on June 30 after falling into another unsettling batting slump.
Experts remind that debilitating strains of performing in the world of elite competitive sports hardly are new. Local baseball historians recall some paralyzing doubts, after their first taste of the big leagues, expressed by no less than Hall of Famers Willie Mays and Mickey Mantle a half-century ago.
But it hardly is clear whether anxiety disorder is spreading, is more widely reported, or is possibly overdiagnosed lately.
"Many, many athletes I see are suffering from anxiety and it's always been there," said Dr. Tom Ferraro, a Nassau County, Long Island-based sports psychologist who has worked with athletes and celebrities for more than 20 years. "The pressure, being on stage and under scrutiny, this is not easy. To get a baseball player or a general manager to put a high-level athlete on the disabled list, rest assured, it's not a mild tension."
Lans agreed that "anxiety disorders are very real," and cautioned -- as did Ferraro -- that cases must be judged individually and with thorough knowledge of the player's personal history. There are multiple sources for feeling sad and low _ from Votto citing his father's death last August to Greene's admission of "internalizing" poor performance -- but Lans noted that "feeling depressed is not depression" and that, in many situations involving young ballplayers, "they're suffering from adolescence, and that's not an illness."
Anxiety, after all, "is normally part of any performance," Lans said -- the oft-mentioned "butterflies." "It's a regulatory thing, like getting up in front of the class and giving a talk. You need a certain edge to perform at your highest level, the thing you see with pitchers -- like bullfighters _ going though a ritual. You learn to control it and, once you start performing, it goes away."
Furthermore, baseball players build up a sort of immunity -- as they advance from school teams to minor leagues to the big time -- to the growing crowds and media and competition. "To suddenly develop anxiety disorders (in the majors), it's an unlikely setting for that to evolve," Lans said.
Ferraro argued there "are many issues related to depression in athletes. Physical injuries create major depression, or personal loss. It's an abnormal environment. They're traded, they're benched, or, like Chuck Knoblauch, they can't throw."
Lans and Ferraro agreed that a relationship of trust with a trained psychiatrist or psychologist is crucial for proper diagnosis and treatment. And that anti-anxiety drugs are, at best, a last resort. "A professional psychologist does one thing and one thing only," Ferraro said, "and that is give them time to talk. Listen. On a regular basis. Let them ventilate."
To Lans, putting a player on the disabled list "makes no sense at all. In the general public, when you see a very depressed person, you don't put him in the hospital; that makes it worse, because then he'll think he's crazy. At all costs, the guy should be kept at work.
"Baseball is a wonderful thing because, when the game starts, the only thing in the world is the game itself. It's a treatment. Why do any of us go to games? Turn off the cell phone and everything else goes away."
When Mays, 1-for-his-first-26 major league at bats, despondently asked manager Leo Durocher, "Mr. Leo, send me back (to the minors)," Durocher told Mays not to worry, that he would be the New York Giants' centerfielder as long as Durocher was manager, and the healing began.
In a game in which dealing with failure is paramount, Lans said, there must be that understanding that "kids need something more than at-bats."