As Seen in the New York Times

BackTalk; Outside the Norm: The Mind-Set of the Elite Athlete

By Robert Lipsyte

Michael Miletic had recently finished his psychiatric residency when he was called to the bedside of a young National Hockey League player, barely conscious in intensive care, who had swallowed an overdose of sleeping pills, painkillers and antidepressants. He was near death when his fiancee found him.

Miletic began treating him in the hospital. The player was eager to talk about his suicide attempt. Under pressure from fans, family, teammates, coaches and the news media, he said, he had lost the key to his game, a fearsome slap shot. He wanted a quick fix, the psychiatric equivalent of arthroscopic knee surgery, to get him back on the ice.

During a year of frequent face-to-face and telephone sessions with Miletic, the player was able to rejoin the team and block out enough negative emotions to reclaim some of his effectiveness. But it would be another year before the psychiatrist, also a former athlete ”raised in the culture of shame,” as Miletic puts it, was able to penetrate the hockey player’s ”closely guarded mind” and discover the underlying cause of the breakdown.

In a shrink’s version of ”Rocky,” once the young player’s pattern of repetitive childhood trauma and its repressed rage, guilt, shame and fear were revealed, he went on to become an All-Star.

The success of that therapy, a dozen years ago, began Miletic’s career as one of the few psychoanalysts currently treating active professional and elite amateur athletes.

Now 42 and in private practice in the Detroit suburb of Birmingham, Mich., Miletic has been a psychiatric consultant to the parents group of the National Football League Players Association, to several N.H.L. teams and to the Detroit Pistons. He is also developing, in papers and talks delivered at professional conferences, a psychological map of the jock mind, which he believes operates differently from the fan’s mind. He theorizes that the highly adaptive abilities of successful athletes were often formed to create a sense of invulnerability in the face of early physical and emotional hurdles. Thus, the seeds of success for some athletes — perhaps as well for some opera singers, police officers, test pilots, surgeons — are sown in trauma, often including physical abuse.

”Now don’t take this as a blanket statement,” said Miletic recently in his Birmingham office, ”but I have seen a significant proportion of high-achieving athletes who have come out of abusive homes. Their ability to block out pain and fear, to dissociate from their emotions, comes from their adaptive tactics to the trauma of their childhoods. It’s a form of compensation.

”The hockey player stopped being able to hit the net with a slap shot from the blue line, something he had done since he was a peewee, because an emotional event was occurring that he was no longer able to successfully dissociate. It was disguised and it wasn’t conscious.”

Although he was willing to talk about his first psychiatric case, so long as the hockey player’s name and team were not revealed, Miletic gingerly picked his way through the particulars of more recent patients, who include high school and college swimmers as well as pro hockey and basketball players.

Other than to say that the Pistons are ”a forward-looking organization” and that his loyalty is to the individual players that he treats, he will not discuss his relationship with the team.

Beyond routine confidentiality, he is concerned about ”appearing as a threat” to his clients’ near paranoia about allowing people into their minds and of becoming vulnerable to others. Like cops, doctors and soldiers, athletes tend to distrust those who have not shared their shames and anxieties. Miletic says he wins their trust by letting them know that he, too, has been in the dark corners of the locker room.

Early Knowledge Of Athlete’s Mind

The grandson of Croatian and Polish immigrants, Miletic grew up in Windsor, Ontario. At 14, he began serious strength training for his main love, ice hockey, and for high school football at a gym where Canadian weight-lifting champions also worked out. Miletic liked the explosiveness of weight lifting.

Eventually, at 6 feet 2 inches and 242 pounds, he became a member of the Canadian Olympic team. The same week in 1982 that he graduated from the University of Western Ontario medical school, he won a national title at 100 kilograms. After his internship, he moved with the national team to Montreal but injured his hip just before the 1984 Los Angeles Games. He was invited, he said, to go with the team as a physician, but the disappointment was too devastating. It was also time, he felt, to get on with his career.

While practicing family and emergency medicine, Miletic discovered he was more interested in his patients’ stories than in their physical diseases. He began a psychiatric residency at Wayne State University in Detroit, the hometown of his first wife. He trained at the Michigan Psychoanalytic Institute.

He had not considered sports psychiatry as a career path until he was called to the bedside of the suicidal hockey player. Another psychiatrist at the hospital had suggested to the player’s mother that Miletic, as a former athlete, might be able to reach her son.

The player’s willingness to be treated — he asked his family to leave the intensive care unit so he could talk to the young psychiatrist — and the superficiality of the insights he offered turned out to be typical of Miletic’s future athletic patients. So was the thoughtfulness and enthusiasm; the player approached his initial psychotherapy with the same work ethic he brought to physical training.

But he resisted the trip into his unconscious mind. The hockey player ascribed his suicide attempt to outside pressures; the fans and news media expected him to lead a subpar team racked by dressing-room dissent. Because of this pressure, he said, he had become so unsure of himself that he even suspected his fiancee of having an affair with a teammate.

It was not until the second year of therapy that the player was ready to deal with the repressed trauma that had led to his breakdown. He had become anxious because he was soon to be married and a father, and that had stirred old ghosts.

”Through a lot of work,” Miletic said, ”what we reconstructed was that the act of standing at the blue line with a puck and with a forward potentially charging at him brought back traumatic memories of when he was — he called it spanked; I would call it beaten — as a kid.

”He would remember someone approaching him with a stick or a belt to hit him, his father or uncle. There would be a sudden change in the way his body worked, he would experience acute anxiety and he stopped being able to hit the net.”

In recent years, Miletic has treated a number of athletes suddenly unable to complete a signature action, dunk a basketball, fire a combination of punches, throw a strike. Invariably, they came to him for some version of the cognitive-behavioral therapy offered these days by many specialists in performance enhancement. Frequently, they became analysands on a longer, scarier soul trek that might not solve all their athletic problems but would surely deal with their unconscious.

Because of managed care and drug therapy, psychoanalysis is no longer in vogue. It is even more rare in sports, where the emphasis is on short-term solutions to immediate crises. This has caused a conflict of interest among some mental-health professionals (including Miletic), be they evaluating prospects or counseling suspects. They are torn between their responsibility to the patient and their loyalty to the team. If Miletic’s ideas about athletes and early trauma ever lift from anecdote to data, it may help create a productive discussion of the ethics of sports psychologists and the responsibilities of teams and leagues.

Feeling of Power, Sense of Entitlement

Such disparate recent cases as those of Leon Smith, the 19-year-old former high school basketball star and first-round pro draft choice who attempted suicide; Bobby Phills, a veteran pro basketball player who killed himself and injured two strangers while drag-racing after practice; Ray Lewis, the Pro Bowl linebacker who was charged with murder Monday in the slaying of two people outside an Atlanta nightclub Sunday night; Rae Carruth, a pro football player accused of masterminding his girlfriend’s murder; and those self-destructors John Rocker, Lawrence Phillips, Pete Rose and Mike Tyson, have raised the issue of the mental-health needs of celebrity athletes.

Athletes’ sense of ”agency” — their power to make changes by their own actions — is a two-edged sword, Miletic says. Athletes have been conditioned to believe that if they do enough repetitions, shoot enough baskets, they can overcome anything, from poverty to injury. Yet a belief that serves them so well on the field can be translated, Miletic says, to a sense of entitlement in everyday life, a sense that they are above the law.

It is a feeling too often reinforced by how they are treated, as superior humans with extraordinary achievements. Rarely, until they get into serious trouble, do fans, the news media, coaches and management see them as fellow vulnerable humans with problems that need to be faced.

Miletic’s ideas are too new in sports to have been reviewed in context.

Several mental health professionals interviewed expressed interest but caution; the consensus was that Miletic’s sample was extremely narrow, and that most people are aware of their early traumas.

Miletic agrees, although he believes that most people are not aware of, or discount, the continuing impact of their childhood trauma. He says that he has a way to go to fully understand the process by which athletes adapt to their trauma, how their processes may be different from those of nonathletes or even why athletes are so driven.

”The upside of their drivenness is their orientation to their goal, their ability to focus,” he said. ”The downside is they are often emotionally constricted outside the white lines, with superficial marriages and friendships. The only place where real emotion can come out is on the playing field, where they can hug and kiss and cry. The only time they feel alive is when they are playing.

”There is a whole culture of the socialization of appearing invulnerable that’s put into play, almost automatically and unconsciously by coaches and parents. For example, they’ve been shamed, humiliated as wimps, if they show pain.”

End Zone Dance As Bonding Ritual

The end zone is one of the few places where athletes can feel free to unabashedly express themselves, Miletic says. Celebratory dances, demonstrations of affection, even throat-slashing gestures, he says, are necessary emotional releases and forms of bonding rituals.

Does this mean throat-slashing is healthy?

Miletic laughs. ”Healthy is a tough word,” he says. ”This is where the concept of dissociation comes in. There is an aliveness during the game. But to be in that state, you have to block everything else out of your mind. When you are performing, playing, attacking a defense, you are not thinking about your wife and kids at home, your parents, your investments, the crowd, even pain. You are only thinking about what you are doing. That is what I would call healthy dissociation.

”When the game is over, the most healthy athletes — from this armchair I would think of Wayne Gretzky and Joe Montana — dissociate themselves from the game and are able to shift back into being husband, father, son, daughter, friend. However, there has been a lot of pressure over a long period of time to be emotionally constricted. No wonder so many are in trouble when they get hurt or retire.”

Or when they get challenged off the field.