Austin Kayser, a 4^th year medical student at the University of Wisconsin-Madison School of Medicine and Public Health had the opportunity to sit down and talk with NFL linebacker AJ Klein of the Buffalo Bills. They talked about mental health in the NFL, stigma, recent high-profile cases of athletes sitting out for mental health reasons, and the value of therapy, among other topics.

Talking about mental health can be challenging for athletes and non-athletes alike. What made you want to sit down and talk about this?

There are these recent current events of high-profile athletes stepping away or being open about mental health struggles – Michael Phelps’ documentary The Weight of Gold, Simone Byles, Naomi Osaka and Hayden Hurst sharing his story. People are starting to realize that athletes are humans too and that we have some of the same struggles that everyone has.

In the NFL you see the tragedies of mental health. Every year there are incidents that maybe wouldn’t have happened if guys felt comfortable talking about their emotions and feelings. Guys are getting assault charges. There’s DUIs and addiction. How much of that stems from mental health and how much of it is just mistakes, I don’t know. But I think much of it stems from things they are going through that no one really knows about.

Do you have any fears or reservations talking about mental health as an NFL player who is in the public light?

No, not really. This past year was hell for me. And not only this past year; I’ve been through traumatic events since I’ve been in the NFL that have affected not only who I am as a person but also my play on the field. I don’t have any reservations, though, because if anything positive can be taken from my story that’s great. I lose nothing by being open and want to be someone who can share my experiences.

The NFL has said that they are committed to prioritizing and destigmatizing mental health. What stigma do you think still exists in the league and how is that changing?

The hardest part is that stigma that we always have these “big tough, manly men.” For as long as I have been playing the game it’s been, “Toughen up. Don’t cry. Get up and dust yourself off.”  Struggling with mental health can be perceived by some as a sign of weakness. You worry that people might wonder, “Can this guy still perform on gamedays?”

With all of this stigma we internalize an idea that we shouldn’t care about our mental health. We don’t address things but rather just continually stick them in our back pockets. The next thing you know, you’re carrying a bag of bricks in your back pocket that is dragging you down. Whether it’s personal challenges, relationship issues or prior trauma, we put all that on the backburner because we’re more worried about doing our job than we are about our own well-being.

There is nothing wrong with being vulnerable. I think it is more manly to show your emotions instead of always trying to be stoic. It shows realness and authenticity. It shows courage and strength. It shows that you are human.

What about the perception from the public?

That can be hard too. Even some of the negative responses we saw to Simone Biles pulling out of the Olympics were disappointing. I get that the Olympics mean a lot to people but at the end of the day she is human.

Some fans often don’t see us that way. They see us as performers who only have entertainment value and are just commodities that might mess up their fantasy football teams. Even if fans knew some of the personal struggles that are discussed in house or with our sports psychiatrists, I still think there would be some in the public who would react negatively. They say things like, “Oh that guy is a wuss. How could he possibly have that much money and still be sad? I guess that’s why he’s been dropping so many balls lately.” People still react much differently if you sit out a game because of a mental health injury compared to if it were a leg injury.

It’s interesting the way we often divide the body and mind as if they are separate things. We tend to view physical injuries as being worthy of rehabilitation and attention while mental health injuries are thought to be a person’s moral failure and own responsibility to ‘get themselves together.”

Exactly. A mental health injury doesn’t show up on a CAT scan or MRI. There is no cast for depression or wheelchair for anxiety.

Talk about your own experiences with mental health during your time in the NFL.

One of my biggest challenges was during the offseason after we lost the Super Bowl in 2015 with the Carolina Panthers. The highs of that season were met with some of the most devastating lows that I’ve ever experienced. The loss was bad enough, but I was also having some significant relationship struggles. On top of that my dad was diagnosed with cancer and I felt like I was too far away from family to know how he was doing with treatment.

My body hurt. I felt depressed as all hell and sunk into a really dark place. My thoughts were off, and I was irritable and angry. I wasn’t a fun person to be around. I’m not sure I quite got to thinking about suicide but there was definitely a time when I was thinking “What am I even worth anymore? Why do I play football?”. But I didn’t talk about these things with anyone, I just kept stuffing them in my back pocket. It was hard because at times I felt like I was being selfish thinking about how I was doing while my dad was going through cancer treatment. But at the same time, I didn’t feel like I had anyone checking in with me about how I was doing.

This past year was also tough for me. I showed up to camp at a weight that I hadn’t been at since high school because I hadn’t been eating or sleeping. My body was physically reacting to all of the stress and anxiety I was experiencing.

I’m curious about this idea of putting things in our back pockets until they get too big. In a high-intensity career like professional sports, does that sometimes function as a double-edge sword – distracting from the struggles in a good way but also meaning things might not get addressed?

For sure. I used football as a distraction. There were times during that Super Bowl run that were awesome and so in many ways it worked as a distraction. But distracting myself completely from my mental health wasn’t what I needed.

How were you able to cope with these situations?

It’s tough because we’re used to overcoming physical adversity. We play through pain. When I had surgeries on my groin and shoulder I was always on a path to rehabilitation and getting better. With mental health there is this sense that “I should just get over this myself.”

After the Super Bowl loss, I don’t remember anything specifically I did to get myself out of feeling like that. I didn’t have football as a distraction. I just kind of hit this rock bottom and waited until I could start training again for the upcoming season. I’ve realized now that if I’m not actively working on something I don’t function well. I need a goal set in front of me.

When I was in my darkest spots it was mostly trying to be around friends. Not the kind of people who when you go home only want to talk about football. But those friends who know there is more to me as a human being than the fact that I play football for a living. Those friends who know that’s not what defines me as an individual.

This past year, only my linebackers coach, head coach and general manager knew what I was going through. It was scary to break down in tears in front of them about how things were affecting me emotionally and physically. Fortunately, they reacted in a way where they told me to take care of myself and my family and that they were there for there for me in whatever way I needed. I am very grateful for that because I’m not so sure other places around the league would have reacted the same way.

What role has therapy played in your life?

I spent more time on the phone with my therapist than I probably ever will again this last year. It helped to de-clutter and calm my mind. I have supportive friends and family, but sometimes it really helps to hear things from a professional who is this objective, third-party who doesn’t have any skin in the game other than helping me. I was getting bombarded with football expectations, relationship problems and other stress. My therapist helped me realize how much I was holding in that I just needed to get out. And once I got those things out, not only did I feel a release mentally but even physically. I always slept the best after talking with my therapist.

What resources are available to NFL players regarding mental health?

Recently the NFL made changes to require a licensed mental health professional on every team. Through the NFL Players Association, we have mental health counseling that players and their family can use. There’s also this app we have that has a whole section on mental health; tools for improving mental health, stories from guys around the league, and information on things like diet, sleep, and stress.

What resources or support do you think would be helpful for NFL players?

I recently listened to former NFL player Brandon Marshall’s podcast, ‘I am Athlete’. There’s an episode about the importance of checking in with teammates to make sure they are alright. You’d like to see more of things like that. Small groups where we could sit down for 15 minutes and talk about this stuff. You don’t always know what’s going on in your teammates lives and being able to get that off our chests and address those things would be great.

The hard part would be getting buy-in from the players for something like that. The moment something is mandatory in an NFL locker room, nobody cares about it. It would have to be an unforced, safe environment for guys to be able to share like that.

What are your hopes for the conversation around mental health in the NFL moving forward?

The league’s reaction but even more so the players’ reaction to Hayden Hurst’s story was really encouraging. I hope that sets a good trend moving forward. Exactly like Hayden did, this conversation must be player driven. We can’t wait for the NFL to take the lead on mental health because they aren’t going to unless we push for it.

Moving forward I hope we can rally around and support guys who share their stories about what it’s like to struggle with mental health as NFL players. That vulnerability and courage, like we talked about earlier, creates an environment where more guys can come forward.

Other NFL players know we are human. We know that. But we want fans to know that too. Sharing our stories helps them see us in that vulnerable light where they can recognize that we are humans struggling and overcoming the same mental health challenges that we all face.

By Austin Kayser,
4^th year medical student,
University of Wisconsin-Madison School of Medicine and Public Health

Reviewed by Claudia L. Reardon, M.D.,
Associate Professor, Department of Psychiatry,
University of Wisconsin School of Medicine and Public Health