This story originally appeared in the Fall 2018 edition of USA Triathlon Magazine.
The low point for Sarah True came last summer. A year removed from being forced to bow out early in the race at the 2016 Rio Games, True fell into a dark, deep, depressive state.
True is no stranger to depression — the two-time Olympic triathlete had been battling the disease since she was a teenager. But this was a hole more cavernous, more dark and more hopeless than she had ever fallen into.
She felt she was a failure. As an athlete. And as a wife, convinced she failed her husband Ben True, who missed qualification for the 2016 Olympic team. Triathlon wasn’t fun anymore. Life outside sport had no joy. Her training suffered. She couldn’t sleep. Suicidal thoughts ran through her mind.
“Maybe I’ll just swerve into oncoming traffic,” she thought during training rides near her home in Hanover, New Hampshire. One head-on collision with a truck could just end it all.
“Everything was a struggle. I was in a really, really dark place and I felt like it just wasn’t going to get better,” said True, 36.
You can’t “out tough” depression
A professional athlete, an Olympian, a competitor in IRONMAN, one of the most physically and mentally grueling endurance tests humans have created, and here is True contemplating her worth in this world.
But depression knows no boundaries.
According to the National Institute of Mental Health, in any given year, an estimated 16.2 million adults in the U.S. experience a major depressive episode. And an estimated 40 million adults live with anxiety disorders.
The incidence of those conditions, often linked, in the endurance sports population is probably similar, as a 2017 review of research published in the British Journal of Sports Medicine found no difference in depressive symptoms between what the researchers called “high-performance athletes” and nonathletes. Age-groupers or Olympic-caliber, all levels of athletes are affected. Michael Phelps, who has won more Olympic medals than anyone on this planet, has publicly spoken about his depression and thoughts of suicide.
Many of us experience bouts of sadness and worry, but there are distinctions between those feelings and clinical depression and anxiety. Dr. Mitchell Greene, a sport and clinical psychologist in Haverford, Pennsylvania, said therapists look for changes in a person’s emotions and behavior and they focus on symptoms such as feeling agitated or joyless, lethargic and apathetic.
These symptoms are what Carol Downing, 63, a massage therapist from Monkton, Maryland, experienced after the 2013 Boston Marathon when the horrific bombings injured two of her daughters, there at the finish line to watch her run her first Boston race. Erika was forced to have her left leg amputated, and Downing’s other daughter, Nicole, also suffered severe leg injuries.
“Most of the time I was consumed with guilt. My kids were up there to watch me do something that was big and important and they were all excited about it. Then they got injured and I didn’t,” said Downing, who began to see a therapist during this time. “I fell into a depression. I was angry. I didn’t have the energy or desire to exercise. I really just wasn’t interested in running any more. I forced myself to do it and it just didn’t feel good.”
Travis Liening, 28, from Seattle, said when he was a teenager he suffered from what he called a “low level of sadness and anxiety” growing up a smaller-than-average boy worried about his size, athletic ability and looks. These feelings of doubt, sadness, lack of confidence and anxiety simmered for years, but it wasn’t until a failed engagement did his depression fully develop, sapping his desire to exercise, affecting his work productivity and leaving him alone at home, unwilling to get out and socialize with friends.
“All I could think about was how I messed up or how I failed in some way, how my life was supposed to be going down this great path I had envisioned and how it’s not going that way,” said Liening, who works as a bank controller. “I didn’t want to do anything. I didn’t want to exercise. I wasn’t motivated. I was afraid to talk about it. I didn’t want people to know (what I was feeling).”
True said when you’re in the midst of a depressive episode, you feel powerless and weak.
“It’s the exact opposite of everything you try to aim for as an athlete. You no longer feel you have control of your mind,” she said.
Regaining that control over the mind is something Greene works through with his patients, many of whom are endurance athletes, both elites and age-groupers.
“You can’t out-think or out-tough your way out of depression or anxiety,” Greene said. “But we can set small, realistic goals, whether it's sports or life, to help achieve that feeling of taking action, taking control over those negative thoughts and accomplishing something.”
Greene also preaches the benefits of exercise as a form of therapy, known to boost powerful brain chemicals such as endorphins and neurotransmitters, which are linked to mood.
Though Downing hasn’t fallen back in love with running again — the sport can trigger her PTSD related to Boston — she has found a new mood booster in triathlon, her “drug of choice.” Same deal for Liening, a former soccer player who took up triathlon as a joke and surprisingly found a new passion and an outlet to work through his depression.
“One of the things I first noticed was how positive everyone is at a triathlon. You don’t have to know any of these people and they don’t have to know your struggles or what you’re going through. All they want to do is encourage you and push you and let you know that you’re doing great,” Liening said. “That alone has been a saving grace.”
“Depression is not a weakness”
Over time, True did crawl out of her dark hole. She sought professional help. She opened up to friends in ways she never had before, letting herself feel incredibly vulnerable. The dark cloud over her evaporated and she came out the other side of the depressive episode with a new lease on life. A new perspective, of gratitude, knowing she has the coping skills to get through a dark period, should it come again.
“If you think of it as something you can get better at — get better at coping and creating the professional support structure for when you go through the hard times — it can be a bit more empowering than feeling like this is something that happens to you and feeling like you don’t have control over your response,” True said. “When you can get out of it, you realize that we are capable of so much more than we thought.”
True emerged out of the depressive hole inspired and invigorated, not only for her new triathlon career jumping into the IRONMAN distance, but for also being an advocate for mental wellness awareness.
In 201 words spanning 10 successive tweets last September, True announced to the world that being an athlete with depression is OK. You can still be a mentally tough athlete. She offered tips for athletes dealing with depression, stressed that athletes aren’t alone in dealing with mental wellness issues and there’s no shame in seeking help.
“We tend to mythologize professional athletes a lot. Growing up, I just assumed that to be a professional athlete you had to be a certain way. That you can’t be flawed. But the truth is, we’re just human, we’re all flawed,” True said. “What I would have given as a young athlete to have come across a thread from a professional athlete, talking about mental health. It would have been massive for me.”
True is not alone in sharing her experience as a professional athlete dealing with mental illness. NBA players Kevin Love and DeMar DeRozan have been trailblazers in breaking down the stigma of mental illness among athletes, sharing their testimonies on social media and in first-person essays.
“I have so much respect for athletes like Sarah and all of these other players coming out and talking about mental health,” Greene said. “They’re talking about it unsolicited. They aren’t coming out because they had to ... or because they’re retired now and may feel safer talking about it. They’re willingly talking about this in the prime of their careers because they want to and think it’s important.”
Since her string of tweets, True has heard from athletes around the country, including many young women, thanking her for being so honest and for giving them the courage to continue their athletic careers.
Talking about mental wellness has been a “moving experience,” she said, and as she prepares for the IRONMAN World Championship in Kona, she’s enjoying the happiest and most fulfilled period of her life, grateful for her ability to compete.
“Everybody talks about how you’re going to go through these highs and lows during an IRONMAN, and, trust me, let’s be honest, sport highs and lows are really not that high and low compared to life,” True said. “I’ve come out of a dark time with so much gratitude for the sport. This is a way for us to celebrate what our minds and bodies are capable of. I think that’s something that’s so tremendously beautiful.”
Sarah True’s tips for dealing with depression as an athlete
Seek professional help: People who love you, they want to help, but they don’t have the skills to do so. That is too much pressure on my husband (professional runner Ben True). Talk to a therapist.
Back off the training: If you’re physically exhausted from overtraining, your capacity to absorb stressors is limited. Adjust your race and training schedule.
But, staying active is important: Because of the hormonal and chemical response to enhance your mood. Find that balance.
Communicate with your coach: A good coach will never judge you or use your mental health against you.
Reach out for help: I let people close to me know how bad my depression was. This was incredibly hard to verbalize, but once I did, talking about it started to help.
Give yourself time: I knew because I’d been through periods in the past, that it was just a matter of time. I knew that it would end. That with some help, I could get through it.
Contact USA Triathlon Content Manager Stephen Meyers at firstname.lastname@example.org.