The social construction of mental illness in sport

An increasing body of evidence suggests athletes experience mental illness at an alarming rate. Whilst evidence once suggested athletes were protected from mental illness due to traits such as mental toughness, studies in the last two decades have shown up to 68% of athletes experience a diagnosable mental disorder. The current consensus is that athletes experience mental illness at a comparable rate to the general population due to a multitude of sport-specific risk-factors such as injury, career transitions and type of sport. However, experiential insights from athletes are mostly absence from current understandings of mental illness in sport. Therefore, framed by interpretivism, the broad focus of this thesis was to explore constructions of mental illness in sport through a range of qualitative research methods. Through this approach it is possible to offer alternative insights to the field that complement the existing literature.

This thesis is comprised of four empirical studies. In study one (chapter three), a meta-study was employed to systematically appraise and synthesise qualitative research into athletes’ experiences of mental illness. Through a critical review of the literature, a dominance of postpositivist articles that conform to the medical model’s understandings of mental illness was noted.  Through meta-study conceptual and methodological gaps were identified such as explorations into identity which the following studies in the PhD sought to fill. Through a thematic synthesis of published data, four new themes were constructed: a) origins of certainty and ambiguity, b) gradual sense of decline, c) mental illness as a threat to identity, and d) constructing recovery stories. 

Study two (chapter four) built upon the interpretive insights gathered from study 1 to explore how illness identity is constructed by athletes diagnosed with a personality disorder. Specifically, I drew upon narrative theory to explore how athletes diagnosed with borderline personality disorder (BPD) constructed their illness identity and the various ways this impacted their experience. I used dialogical narrative analysis to interpretively analyse two powerlifters’—Samantha and Alex—life stories. The diagnostic label of BPD had significant but divergent influences on each athlete. Samantha accepted the BPD diagnosis, aligning to the dominant medical model of mental illness. She used this narrative resource to construct renewed understandings of the self. In contrast, Alex told a counternarrative to dominant medical discourses of mental illness, which was characterised by stories of activism and resistance. Instead, Alex sought an alternative diagnosis, autism spectrum disorder (ASD), which they perceived better validated experience. Both athletes found alignment to their respective narratives helpful, and also suggested sport was a safe space to disclose illness identities.

To explore disclosure further, study three (chapter five) explored athletes’ stories of mental illness disclosure within sport. This study explored how athletes came to disclose mental illness and its perceived impact on their psychosocial health. Data collection included participant writing whereby athletes were instructed to write a story about a disclosure experience within sport. The writing task was supplemented with a semi-structured one-to-one interview. Three themes represented athletes’ experiences of disclosure: a) the right time for disclosure; b) negotiating openness; and c) sport as a (un)safe space to disclose. Although some athletes received positive responses, most disclosure was met with unsupportive and dismissive responses, particularly from coaches. This impacted athlete’s relationships and intentions for future disclosure. Therefore, athlete accounts emphasised the urgent need for coach education about the complexities of mental illness and disclosure. 

Study four (chapter six) explored the power of narrative as an educational resource to educate coaches about disclosure. The educational resource used was an athlete’s written account of disclosing mental illness to their coach (collected from study three). After reading the disclosure story, 12 sports coaches were interviewed about their responses to an athlete disclosure story, as well as their understandings of athlete mental illness disclosure. Coach perceptions were represented using reflexive thematic analysis across three themes. The first theme, (Un)believable stories: Trusting athlete accounts, suggested that although narrative elicited emotive responses from coaches, many distrusted the athlete story. The second theme, the power of stories to prompt self-reflection, suggested that there was potential for narrative to become an effective educational tool and challenge current coach practices. However, the final theme, inability to infiltrate dominant narratives, implied that there were limits to narrative as an educational tool. Coaches valued their own personal and cultural narratives above the narrative presented to them, and therefore questioned the athlete story. 

I have chosen to explore mental illness beyond dominant postpositivist ways of understanding mental illness in favour of more interpretive ways of knowing. As such, I have produced insights into how mental illness is socially constructed. Athletes and coaches provided powerful, subjective accounts which allowed insight into mental illness through a alternative lens that shined light on experiences that were complex and deeply personal. As such, it is imperative that athlete voices lead the way in informing how mental illness is understood within sport. In light of the conceptual and methodological insights highlighted within this thesis, scholars should strive to embrace the complexities of mental illness through the adoption of an appropriate methodological lens. It is important that experiential knowledge is valued within sporting and therapeutic settings, to provide athletes with a voice and appropriate mental health care.