What Baseball Still Doesn’t Get About Injury and Mental Health

Ryan Freel’s 2012 suicide shed light on the rarely mentioned issue of mental health in baseball. Dirk Hayhurst’s new book goes even further, chronicling his own struggles in the majors, and the culture that tries to keep those kinds of discussions quiet.

Stacey May Fowles is a novelist, essayist, and reviewer. She is the author of the novels Be...

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“Sports, and the fame around sports, tells us a lot about our value system. It’s this really ironic, hypocritical value system that we act on and react to, but we never want to acknowledge, because it might incriminate us.”
- Dirk Hayhurst

In 2009, while playing for the Baltimore Orioles, Ryan Freel was on second base when Boston Red Sox pitcher Justin Masterson hit him in the head with a pickoff throw. It wasn’t the first time Freel had sustained a head injury on the field: two years earlier, he’d collided with then-Cincinnati Reds teammate Norris Hooper, resulting in pain and headaches that prolonged his rehabilitation by weeks. By the time he played his final game in August of 2009, Freel, then 33, had personally reported nine or ten concussions over the course of his eight-year career in Major League Baseball.

Three years later, Freel was found dead in Jacksonville, Florida, from a self-inflicted shotgun wound.

His family, looking for answers, donated Freel’s brain tissue to researchers studying chronic traumatic encephalopathy, a degenerative neurological condition that can only be diagnosed postmortem. The disease is typically found in people who have suffered multiple concussions and other head injuries (it was initially discovered in boxers), with symptoms including depression, apathy, anxiety, impaired cognition, and aggression. In December 2013, a year after his death, the examination by the Center for the Study of Traumatic Encephalopathy revealed Freel had been suffering from Stage II CTE. He became the first MLB player to be diagnosed with the disease.

“It’s a closure for the girls who loved their dad so much and they knew how much their dad loved them,” Freel’s mother told the media when the findings were released. “It could help them understand why he did what he did. Maybe not now, but one day they will.” The news brought some relief to the family, but also helped initiate a desperately needed dialogue about the relationship between injury and mental health in a culture of insidious silence. During his life, Freel seemed like a wildcard: he’d been diagnosed with bipolar disorder, ADD, and depression, and was an alcoholic with anger and impulse-control issues. Now that we know the cause of his death, his story symbolizes the need to remove the stigma of mental illness in professional sports.

Mental health deterioration is epidemic in professional sports, and fans, by way of their willful blindness in the pursuit of personal enjoyment, are complicit.

Though Freel’s was the first official diagnosis in baseball, he joined a long, daunting list of professional athletes in other sports who have grappled with severe mental health issues as a result of injuries sustained in play. In a concussion-related lawsuit finalized in the summer of 2013, the NFL reached a settlement of $765 million with a group of more than 4,000 former players who claimed the league had not disclosed the dangers of head injuries to players. Last November, more than 200 former hockey players sued the NHL over claims that the league had not done enough to protect them from brain trauma. These lists of current and retired players seeking compensation are only getting bigger, with new lawsuits being launched, and more and more names being added to existing claims.

In last year’s League of Denial, Mark Fainaru-Wada and Steve Fainaru’s sweeping indictment of the NFL’s health and safety policies, the list of players who engaged in erratic, violent behavior, or suffered from confusion, depression, anxiety, and suicidal thoughts, is staggering. The authors share stories of players losing their fortunes, shutting out or abusing their families, and ending their lives in a number of disturbing ways, from overdosing on painkillers to shooting themselves in the chest to drinking antifreeze. For obvious reasons, the leagues do their best to play these off as isolated events. Presented in such a concentrated fashion, though, as Fainaru-Wada and Fainaru have done, their point becomes clear, and it’s hard to ignore: mental health deterioration is epidemic in professional sports, and fans, by way of their willful blindness in the pursuit of personal enjoyment, are complicit.


Throwing-related injuries are the main cause of injury in Major League Baseball, though players also suffered a surprising 21 head injuries throughout the 2013 season. While the number is lower than football’s 96—87 of which were concussions—it’s high enough to warrant a closer look at the effect these injuries are having on players’ long-term mental health. In an unexpected but welcome move, Major League Baseball has decided to prohibit “egregious“ home plate collisions for the 2014 season, due in large part to Freel’s death and the diagnosis that followed. The rule change, as was probably to be expected, has received mixed reactions from players past and present. “The hitters wear more armor than the Humvees in Afghanistan,” 72-year-old Pete Rose dismissively told The Associated Press. “Now you’re not allowed to be safe at home plate? What’s the game coming to? Evidently the guys making all these rules never played the game of baseball.”

Blue Jays third baseman Brett Lawrie tweeted, “I understand it’s for the safety of the game but there’s some things that I think should be left alone.” Similarly, former catcher and current Detroit Tigers manager Brad Ausmus told the New York Times, “I am a little bit old school in the sense that I don’t want to turn home plate into just another tag play. This is a run. This is the difference between possibly making the playoffs and not making the playoffs. It should matter a little bit more.” This is the status quo talking: when we’re content to be “old school,” it’s easy to shrug off violence against players’ bodies as integral to the game, even if it ultimately destroys their minds. To put it another way, the play comes to matter more than the player. Is it any wonder, then, why it’s so difficult—so controversial—to advocate for the psychological health of those involved?

“There’s an expectation [from] the fan base that says, ‘I don’t want to hear that you feel sad, because you make millions,’” Dirk Hayhurst says. I recently spoke with Hayhurst, a former major league pitcher and now the author of four books about baseball, about this deep reluctance—from the leagues, the fans, and the athletes themselves—to discuss the mental health of active players.

“You would be amazed at how fast these guys… suddenly don’t give a fuck about you because you’re not healthy enough to help them win. You’re dead. I thought we were family, we were brothers, and now all of a sudden I’m banished to some hole-in-the-wall training room. I don’t hear from anybody. I might as well be dead.”

“The perception is that, if you are very successful at a prestige job that we [associate with] fame, we perceive you as better and stronger than us. Even though we’ll say we’re all equal, we still perceive famous people as better and superior, and better and superior people who have been compensated should never feel sad.” He goes on: “They should be totally inoculated against any of life’s hardships. If we accept that [players] feel bad, we accept that a lot of things we hold dear are hollow.”

Hayhurst’s was among the voices that did speak out against plate collisions. “Take off the ‘baseball players are commodities’ glasses for a second and understand that they are people,” he wrote in a piece for Sportsnet. “They’re well compensated for playing a game that makes us think irrationally about how they should behave, but they’re people all the same who will have life after baseball.” In February of this year, Hayhurst released his fourth book, Bigger Than The Game, a memoir that not only documents his struggles with injury, addiction, and mental illness, but the punishment he felt he received for daring to speak candidly from the interior of baseball life.

This assertion that players are people, vulnerable like anyone else, is a tough one for sports culture to accept. Yet mental health is as much a part of an athlete’s ability to perform as any other aspect of their well being. And while these leaguesare, of late, making clearer attempts to protect players from injuries that have a direct link to the function of their minds—the MLB’s approval of pitchers’ protective caps; NFL rules preventing helmet-first hits to the head and neck; the NHL outlawing head-aimed body checks—they continue to fall short when it comes to addressing the more nuanced relationships between performance, injury, and mental health.

“[Some players] get so popular they have a legacy to protect, or an image. It’s like this gilded front,” says Hayhurst. “They’re so-and-so the product or so-and-so the superhero in uniform, and they’re always thought of that way. There’s a double-edged sword effect. On one side, these guys are bigger than normal humans, [so] they’re thought of as above and beyond. But on the other, in order to keep up that façade, you can’t express broken things that make you look human.”

In Bigger Than The Game, Hayhurst documents a shoulder injury that put him out of commission for the 2010 season, his subsequent descent into an abyss of crippling anxiety, his abuse of painkillers and sleeping pills, and a perceived lack of support from teammates and management. He felt as if his injury left him deserted. “You would be amazed at how fast these guys… suddenly don’t give a fuck about you because you’re not healthy enough to help them win,” he says. “You’re dead. I thought we were family, we were brothers, and now all of a sudden I’m banished to some hole-in-the-wall training room. I don’t hear from anybody. I might as well be dead.”

Saddled with loneliness, self-loathing, violent mood swings, and “emotional freak-outs,” Hayhurst represents a distinct variation on the common connection between injury and the athlete’s mental state—one that is so rarely discussed. “You’ve internalized and made your identity out of [sports], and then injury just says you’re gone,” he says. “All of it. You may never come back to this. Everything will change. It doesn’t only strip it away, it also isolates you in the process. And then you sit there on a training table, and you’re like, there’s no one patting me on the butt, there are no fans cheering for me, I have no value, I can’t help my team.” In the sad reality he describes, athletes punish their bodies because it is asked of them—they are literally paid to do so—and are then neglected or disposed of when the punishment becomes too intense to continue.

“This book talks about addiction.” Hayhurst tells me. “The strongest addiction any athlete will ever face is their addiction to identity and adulation they get from being physically fit and doing their job.”

“You can talk to your teammates about a lot of things. That you’re angry, that you want to get drunk until you can’t see straight, that you need them to keep a secret about cheating on your girlfriend. But you just don’t talk about your emotions… Baseball players don’t do that.”

The Toronto Blue Jays did not respond to my request for more insight into the psychological resources available to players, but Hayhurst, (who played in the major leagues in 2008 and 2009) paints a grim picture of a poisonous culture that denies and avoids the issue. Organizational efforts to assist players with mental health maintenance seem Kafkaesque in his depiction: the first time a player has “the mental health conversation” with a professional, he’ll be in uniform, cleats on, glove in one hand, and a Gatorade or dip cup in the other. He’ll be sitting outside on the grass, or maybe in the locker room, and a doctor will frame the conversation by telling him that, by following his advice, he’ll perform better on field. “He has to talk this way because he’ll get tuned out by the players if he doesn’t, and he’ll also get fired by the organization,” Hayhurst suggests. “The organization doesn’t genuinely care about your mental health, unless you’re really rich and they spend a lot of money on you. They care about performance on-field. Everything in this realm has to be tweaked so it comes back to that one thing that baseball can quantify, which is production.”

A poor or misguided level of care isn’t the only issue; compounding it is a fundamental misunderstanding of what help is necessary in particular situations, and the cultural barriers to seeking it. “If injury isn’t death, it’s certainly a near-death experience,” says Hayhurst. “It is a total life changer. Athletes always say injury is the hardest thing, don’t ever get injured. And I thought, yeah, it probably sucks—it’s painful, surgery, a lot of question marks—but I had no idea the psychological duress.” And even if the appropriate level of care were available, the clubhouse climate makes seeking help nearly impossible. “You can talk to your teammates about a lot of things,” Hayhurst writes in Bigger Than The Game. “That you’re angry, that you want to get drunk until you can’t see straight, that you need them to keep a secret about cheating on your girlfriend. But you just don’t talk about your emotions… Baseball players don’t do that.”

In fact, according to the book, players tend to steer clear of the team psychologist as if he were a threatening presence, someone who hangs around to weed out those not mentally strong enough for the sport. “Most of the players avoided him, especially in public,” Hayhurst writes. “They called him a brain fuck, a blanket for the mentally weak, or a wet nurse for guys who can’t handle the stress of baseball life. They’d beat their chests and say, ‘If you can’t handle the grind of the game, you don’t belong in it.’” When I raise this passage with Hayhurst, he elaborates: “There are some resources. The problem is, if I turn to a mental resource, there’s a stigma to me needing mental help, and that gets reported back to the organization.” And a player runs the risk of such a report following him throughout his entire career.

As this environment makes pursuing treatment for mental health issues difficult, it also, according to Hayhurst, discourages players from—and punishes them for—speaking out about said environment. In Jason Turnbow’s The Baseball Codes, outspoken pitcher-turned-psychologist Tom House seems to back this claim. “There are many things baseball manages to keep quiet about,” he says. “In fact, players who are foolish enough to discuss what went on in a closed clubhouse meeting… often turn up on other teams the next year.” Add to this a lack of real leadership—managers and coaches are not necessarily trained in successful management techniques; often, the main qualification is that you played the game, and, ideally, were good at it—and genuine, transparent conversations about how players are feeling become increasingly unlikely, if not impossible.

Many of us who love sports uncomfortably understand we’re making a choice to ignore certain things in order to enjoy ourselves. Racism, homophobia, sexism, DUIs, domestic abuse, physical violence, rape, gambling, drugs—it’s a toxic culture, cloaked in large part by our fandom.

“If you are a head case—and there have been a lot of head cases in this sport—but you’re a really successful head case, if becomes part of your character,” says Hayhurst. “Everyone’s okay with it. If you’re a fringe character, a fringe talent, you don’t get that right. You get branded as weak or not able to hack it, or too much of an issue to worry about. So a lot of guys, instead of getting help, they choose to stay quiet.” Instead, he tells me, players cope in accepted fashions—namely, prescription drug use and abuse. Pills and booze become a popular way to self-medicate and avoid the stigma that comes with seeking real help. The upshot is a vicious cycle: a lack of professional support for those suffering from mental illness, and no safe way to speak out about it.


During a spring training game last week, Cincinnati Reds closer Aroldis Chapman was hit in the face by a line drive off the bat of Kansas City catcher Salvador Perez. The initial pitch was clocked at 99 MPH, and the sound the ball made colliding with Chapman’s face was audible throughout the park. The stadium fell silent as he lay face down on the ground for several minutes, officials surrounding him, his legs twitching, his cleats digging into the dirt of the pitcher’s mound, in what appeared to be excruciating pain. The entire scene was a jarring reminder of the fallibility of the spectacle, and the vulnerability of its players.

Many of us who love sports uncomfortably understand we’re making a choice to ignore certain things in order to enjoy ourselves. Racism, homophobia, sexism, DUIs, domestic abuse, physical violence, rape, gambling, drugs—it’s a toxic culture, cloaked in large part by our fandom. This isn’t lost on Hayhurst: “Everything is basically justified by how well you play on the field. If you’re fantastic on the ball field, you can be a guy who beats your wife, has rage issues, has used performance-enhancing drugs. It has always been the case that performance covers over a multitude of sins. Baseball is full of horrible examples, but they were good enough at the right time in their career for us to forget how horrible they were.”

Doling out criticism of this culture from the inside is rarely a popular move. The rare ones who speak up face disdain not just from players and management, but also from fans—the “old school” ones, the ones who have bought into a mythical notion of “respecting the game,” the ones who would rather things be left alone. Hayhurst may have betrayed a long-standing code by speaking out about his personal experiences, but his book reveals the danger of concealing them, and his decision to use his experience as a launching point is an admirable one. “I had to write [the book],” he says, “because I had to figure out how to go on with the rest of my life. I needed this therapy. And I felt like if I needed it, other people probably needed it too.”

A few days after taking that line drive to the face, Chapman posted a disturbing photo to his Instagram account: him in his hospital bed, with a crown of dozens of staples keeping his head closed shut post-surgery. Optimistic media reports have been relaying that Chapman suffered only a mild concussion and will return to throwing in a few weeks. Looking at that picture, though, it’s hard not to think of a guy like Ryan Freel, hard not to wonder what lies ahead for Chapman through his recovery and into the future, and hard not to hope he’ll be able to ask for the help he might some day realize he needs.

We can’t say conclusively, of course, whether Freel or any other professional athlete’s life could have been saved if they’d felt more comfortable seeking help for injury-related mental deterioration. Therapy doesn’t deal in those sorts of absolutes. But as more players go through experiences like Freel’s, it seems near criminal to not at least start the conversation. If we invest in the game as fans, we likewise have a responsibility to invest in the long-term health and safety of its players. We’re well past the point where the ease and comfort of willful blindness can be considered any sort of excuse.