The NHL landscape has been marred by tragedy this offseason with the recent deaths of Derek Boogaard, Rick Rypien and now Wade Belak. It’s possible that their passing in such close proximity is entirely coincidental and a mere artifact of chance alone. Sometimes unlikely occurrences don’t necessarily carry graver implications.

The fact that each guy wasn’t merely a hockey player but an enforcer is highly suggestive, however, especially given the growing awareness around brain trauma and chronic traumatic encephalopathy (CTE). In May, I wrote an article on the potential risks associated with CTE and how enforcers may be putting their future physical and psychological health on the line for a role whose benefits were, at best, unclear.

The growing battle over fighting in the sport seems to revolve around the degree to which concussions and/or physical maladies may or may not influence health of current enforcers, particularly in light of the recent tragic passing of men who were perhaps too young to have succumbed to a long-term, chronic issue like CTE. However, the relationships between health, depression, suicide and substance abuse is far more complex than drawing a single, causal line between concussions/chemical misbalance and premature death. The life of an enforcer is replete with stress, anxiety, pain and isolation which, when mixed with certain idiosyncratic factors, may give rise to psychological pathologies, even in the absence of degenerative brain damage.

Many ex-enforcers have gone on record to express the extreme levels of stress they go through in anticipation of a fight. Former tough guy Brantt Myhres’ career was ended by a George Laraque punch which broke his eye socket. In discussing the fight years later Myrhes,

said his stomach was churning before that Oilers game. He knew he’d have to fight Laraque.

“I was in bed, sick in the afternoon.

I didn’t even eat a pre-game meal. I knew I was over the edge.”

Enforcers are often portrayed as the prototypical warrior on the ice: a man who fearlessly gives no quarter. Truth is, however, even tough guys have a lot to fear when it comes to dropping the gloves. Outside of the potential for physical pain and injury is the possibility of  losing the fight and being humiliated in front of thousands of fans as well as their team mates. In addition, since enforcers are often at the fringes of the roster, each guy is always a bad fight away from losing his place on the team. Each tussle isn’t merely about trying to avoid getting hurt: it’s about saving face and trying to keep a job.

Such acute, variable bouts of stress can have deleterious effects on psychological and physical health. In fact, an increased risk of coronary heart disease has been linked with job strain; that is, occupations which rate low on decision control but high on psychological demand. Waiters/waitresses and nurses are examples of jobs that rank high in terms of job strain – the demands on their time/abilities is large, but their ability to influence decisions or control their environment is relatively low. It’s no stretch to suggest “NHL enforcer” is another occupation that would rank high in terms of job strain.

Chronic stress and anxiety issues are also highly co-morbid (co-occuring) with clinical depression. In fact, the onset of depression is often incited by a highly negative or stressful life event, as in the sudden death of Rick Rypien’s girlfriend earlier in his life. Depression has also been induced in lab animals by way of a “stress test”. Martin Seligman developed his learned helplessness theory of depression by exposing rats to mild shocks they could not control or via the forced swim test. The analog to human depression was theorized to be a “depressogenic” cognitive style which interprets negative events to be stable, internal factors of the subject in question. Meaning, depressed people tend to think bad things that happen to them are consistently due to their own weaknesses or flaws and eventually become helpless/hopeless in the face of what seems to be intractable failings. In addition, another cognitive distortion common to sufferers of depression is the idea of an external locus of control. That is, depression arises and is maintained in those who consider their fates to be in hands of some external agent, outside of his or her power to control.

High job strain, chronic stress, depression and the resultant cognition distortions can also be augmented or complicating by physical pain, pain medication and substance abuse. The potential for enforcers to self medicate physical injuries is high given the demands of the role and the need to be always “on call” so as not to lose a spot in the line-up. In addition, the culture surrounding hockey is explicitly “macho” and shows particular antipathy towards expressing pain and injury. Players are invariably expected to “suck it up and play through it” as much as humanly possible, or face a loss of respect.

Of course, players may also use pain killers and other drugs (alcohol, narcotics) to self medicate the psychological pain of stress, anxiety or depression. Substance dependance can result, leading to a pattern of self-administration, tolerance, withdrawal, etc. The initiation into the world of substance abuse may be physical injury for the typical enforcer, but it’s maintenance and augmentation to full blown dependence may be to dull anxiety and stress or escape the depression that comes with the territory.

Now a substance abuse councillor, Brant Myhres has previously gone on record about the issue of drugs and enforcers in hockey:

“A lot of people really don’t hear the dark side of it. I played with seven different NHL teams, 17 pro teams to be exact, and I had a first hand glance at the abuse that went on.

“A lot of these guys don’t want to say anything to anybody because their careers are at stake and that’s where I could come in. They could confide in me because I’m speaking the same language. There’s no threat to them, like they’re going to a coach, a general manager or an agent.

“They’re going to an ex-player who’s been there, done that several times.”

….

“I think I was the only player to get suspended four times by the league and then get reinstated,” he said. “I played one game with the Flames, a pre-season game (in 2005), got my orbital bone smashed by Georges Laraque (Edmonton Oilers) in a fight and after that my spirits were down and I ended up relapsing again.

Myhres drew his first suspension for alcohol abuse when he was just a 17-year-old member of the Lethbridge Hurricanes. He paid his first visit to rehab when he was a 24-year-old member of the Philadelphia Flyers during the 1997-98 campaign.

“They say insanity is doing the same thing over and over and expecting a different result,” he said. “I looked at it as doing the same thing over and over and expecting the same result. You know what you’re getting into.

“For me I couldn’t seem to function without being medicated and I think fighting definitely took a major toll on me. I started fighting at age 16.”

Unfortunately, drug dependence can inevitably deepen the issues faced by enforcers potentially suffering from mood disorders since substance abuse tends to strain social connections and make sufferers feel they lack the ability to control themselves and their behavior. Drug abuse also tends to threaten relationships and positions of value in the sufferers life, thereby increasing stress, depressive symptoms and, in response, the compulsion to continue to use drugs. Drug addiction, like depression, is often a miasma of co-mingling factors, both physical (chemical addiction, withdrawal) and psychological (escapism) that can become self-perpetuating.

None of this is to suggest that NHL enforcers will necessarily be victims of any of the problems discussed here. As mentioned at the onset of the article, because of the complexity of the interrelated factors, the most we can say it is theoretically plausible that being an enforcer in hockey raises the risk of eventually suffering from one or more of the pathologies described, for the reasons outlined. Other potential factors include personal histories and proclivities of the person in question, including familial and genetic tendencies towards depression, anxiety, etc. Twin studies have found strong concordance rates of mood disorders in monozygotic (identical) twins. However, the fact that rates have never reached 100% concordance also indicates that environmental factors play a role in mediating depression/mood disorder vulnerability.

The plural for anecdote is not data, so although the idea that NHL enforcers face significant short-term psychological risks (on top of potential long-term brain damage) seems increasingly convincing with each new tragedy, the important next step in this issue would be to objectively determine if the incidence of depression/psychological disorders is indeed higher amongst fighters versus other NHLers, professional athletes and the population in general. After all, hockey players are also people and it should be assumed they will suffer from certain pathologies as a matter of chance. So although increased prevalence of mood disorders in enforcers seems intuitive given the events of this summer and what we know about stress, concussions, depression, pain and substance abuse, this doesn’t necessarily mean it’s a reality.

What we have now is, at best, warning signs that enforcers are a population at risk which bear further investigation. Calls for a stringent anti-fighting stance based on recent tragedies is probably putting the cart before the horse. However, the counter assertion that this summer’s events are merely coincidental and not indicative of any causal relationship between fighting for a living in the NHL and psychological pathology strikes me as callous and myopic as well. Nothing is certain at this time, but the heart-wrenching casualties of the 2011 off-season demand we take the issue seriously going forward.

Comments (6)

  1. This is so well written. Thanks very much.

  2. Excellent article Kent.

  3. Great insight into an important issue

  4. Fantastic article.

  5. Well done Kent. There may or may not ever be developed, conclusive proof that fighting causes any of the multitude of issues that have caused unexpected deaths in fighters or former fighters in recent years. Regardless, it seems to me that the nearly negligible value to game play or entertainment value represented by this spectacle means it needs to be curtailed.

    Is there one person out there saying they will watch less hockey of there are fewer staged goon fights?

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