The tragic suicide of Germany's best goalgetter - How can we change the public image of mental disorders?

maybe have a mental health week where the public at large is invited to make an appointment to see a shrink.

Not sure. We can discuss it publicly and try to make it not so taboo, but it isn’t something easily done. In my experience people often don’t want to admit even to themselves that they have a problem, and if they do many times lie about it. We are not supposed to be in anguish, but stable and happy, and what is not seen on the outside is easily overlooked.

I am sure his wife is crushed, and believe she failed him, but I believe he died because he didn’t talk about it but instead hid his pain. It is understandable though. This pain goes to the very core of who you are, and is a deeply personal. The fear of disclosing that pain to the world is terrifying, as it shows how weak you are.

I feel that given time living like that, you loose respect for yourself and in the end you despise and disgust yourself. One of the biggest fears is to see the people you love look at you the way you look at yourself. Closing yourself into a place where there is only you and the pain, makes you a very lonely person. I think it’s this loneliness that finally breaks you.

I think that when the pointlessness of killing yourself becomes less than the meaninglessness of your life, your decision will not be if, but when and how to end your own life.

There is always, always a solution to this, and that is to talk about it. What if the world collapses? We only get one life, and we can live it in any way we choose. We have the right to chose to end it as well, but it shouldn’t be for the stupid reason of not looking yourself in the mirror and let other people look as well.

@oratio – You’re making very good points. Actually, the way I understand the case, Enke was in fact talking about it a lot both with his wife and his psychotherapist. He had regular sessions for many years. He just wanted no one else to know. I’m not sure whether the psychotherapist also recommended medication. Ideally a good psychotherapist should also be a doctor to be able to decide whether therapy alone, therapy and medication or (strong) medication alone is the best approach. Some psychotherapists reject drugs.

The puzzling part is that since the onset of this major depression 6 years ago Enke made it to the top. He was a hero in Portugal. Then he went to Barcelona, one of the best soccer clubs in the whole world. He had to compete with another goalgetter there. No big deal if you are only number 2. What happened in Istanbul was a disgrace. There was only one game, the team lost and fans threw stuff at Enke. He left immediately. Back in Germany his career went back on track. And he became number 1.

@mattbrowne Top athletes are under a lot of psychological pressure, and I guess there were extraordinary conditions which were especially challenging for him and everyone around him.

I guess every case is a bit different and there is no one way to handle things. I think that when one feels backed into a corner one has to break the walls down. Whatever it is that make you feel you can’t take it anymore, is something you have to come clean about.

As often, people present solutions after it is needed and think they know why things happen. I don’t know why he killed himself. Maybe only he did.

Even though the psychological state of athletes is already seen as important, I suspect that premier league teams will take it even more seriously now.

My son, who has bi-polar is very dedicated to “stigma busting..” He is a musician and has made mental health awareness his platform. If more people would, “come out,” it would do a lot to show the world that this disease hits anyone and it is not a “weakness.”
It is so sad that a National hero chose this route. Did he also forgo medication out of fear that it would effect his game?
The best thing that can be done is what you’re doing here. Bring it up in discussions and talk about it. Public opinion is changed in conversation and at kitchen tables. It’s a long road, but it’s possible.

@Judi – I totally agree. The medication part is still unclear. Only regular psychotherapeutic sessions for a period of 6 years have been confirmed. Plus that recently the condition worsened and he was asked to check into a clinic which he refused.

There is and has been such a stigma attached to mental health issues! I too feel that the answer to your original question, @mattbrowne, is to discuss the issue openly. There seems to be a good, supportive image of mental health issues here on Fluther. As you mentioned, the anonymity that makes Fluther different from real life also encourages those with such issues to admit them, possibly giving them the outlet that is not available in “real life”. But there is a need for discussion, public and private, about the stigma surrounding these issues. This stigma can and does prevent many from finding the treatment that is really necessary.

@Yetanotheruser – Are there successful strategies for ‘stigma busting’? Should depression patients follow the example of gays for example and come out of the closet? Should someone found an organization raising money for public campaigns?

Nami.org is trying to do that.

This is a very tough battle and I’m not sure how to go about changing the public’s perception of mental illness.

I’m guilty of it myself; many years ago, I made fun of a message board poster for being bi-polar. That guy was a jerk, but that was just wrong of me. Having gone through therapy for anxiety myself, I realize just how wrong I was.

Here is the NAMI page dedicated to stigma busting

@mattbrowne I think that is the answer, for patients, loved ones, caregivers, and advocates to follow the example of gays, to name one group. I think the NAMI stigma busting initiative is a great place to start.

We could have a “crazy pride” movement, but people with mental illnesses are too busy fighting for their health for many of them to get involved in a political fight or in an awareness campaign.

Also, not all believe they are “ill.”

Sometimes big celebrities make a show of their mental illness, but it never seems to gain much traction. I don’t think people really care, and I don’t think they are going to care. Who is going to take pride in being depressed? How do depressed people advocate for themselves when they are shy, don’t believe anything will change, and are often unable to do anything?

If it takes mentally ill people to do it, it won’t get done.

Good question. I think we first need to get away from this idea of “blaming the victim” that so many modern societies are hung up on. That it is somehow the fault of the person suffering the disorder.

I also think we need some general education. People seem to have severe stereotypes associated with each label: depression, antisocial, etc…

In all honesty I would like to get rid of the labeling system altogether. There has been some good research that suggests that it is more harmful than helpful.

I also think that allowing treatment to occur more in the community would help normalize the issue. In counseling the therapists are taught to control their boundaries. They aren’t typically allowed out in the community with their clients. However being out in the community with them has shown to be very effective. And there are some very effective treatment strategies that involve being with one’s client outside of the therapeutic setting.

These are just some initial ideas. I have many more.

I do believe it is better in the United States than it used to be and that folks are more open about getting psychological and psychiatric treatment. In part this is due to celebrities going to rehab.

However, public figures still have a problem with admitting a mental illness. For example, Thomas F. Eagleton, a former senator, was removed as the Democratic vice presidential candidate in 1972 after revelations of mental illness. That was thirty years ago and today I think there is a better acceptance of some illnesses such as depression.

OTOH, unless folks live with someone who has a mental illness they really don’t understand how it affects someone. Way too many people honestly believe that my son could do just fine if he would just try a little harder. Thus, I suspect that any time Enke didn’t make a goal his illness would have been blamed and folks would suggest he be let go.

I do think part of his unwillingness to let the public know about his depression was itself a symptom of his illness. But part of it, too, was a fear of no longer being the great sports hero once it was discovered that he had feet of clay. In any case, it is a very sad thing that he felt he had to take his life.

@daloon how about a “crazy pride parade”
The looks on peoples faces would be priceless seeing 10’000 crazy people wandering down the street lol

In the public eye

Crazy = scary

Society is ingrained with prejudice toward mental illness, and sufferers are often widely perceived to be dangerous or unpredictable. Reinforcement of these popular myths through the PsychoMedia can perpetuate the stigma surrounding mental illness, precipitating shame, self-blame, and secrecy, all of which discourage affected individuals from seeking treatment. Efforts aimed at countering stigma in mental illness are faced with the challenge of centuries of discrimination and must, therefore, replace existing stereotypes with coverage of positive outcomes, as a first step in achieving the daunting task of overcoming these negative stereotypes.
here
Eg: here here here here and so on, and so on
then there is the movies about mental illness eg: here

then my fav: HALLOWEEN

about a million different Psycho costumes, props, stories,

Ref here
It’s trick or treat time again. We don’t mind ghosts and goblins, but when “haunted house” attractions become “insane asylums,” featuring “mental patients” as murderous ghouls

Cell Block Psycho
StigmaBusters report that Walmart stores are selling a “Cell Block Psycho” adult costume that is also sold online by other companies. The site also offers “psycho” costumes that include straitjackets and shackles.

few (if any) of the above has shown Mental Illnesses in a positive light

so ya…. we are screwed… and alot of work ahead of us
we should be close to our goal when we have a neo-nazi gay black pope(that has a Mohawk and a Hitler mustache)

@tyrantxseries I think maybe you’d get me to join the crazy pride parade. Of course, what I’d want to do is to play into people’s stereotypes, but that would probably defeat the purpose. What I really want is to show that craziness is useful and helpful, and all we need is to manage the really bad parts, but we can channel the less scary parts to productive use. Crazy people, so the story goes, are more imaginative. So that’s got to be useful—well, some people are afraid of imagination, but still.

I had a person with ADD working for me, and it was great. In fact, I generally seem to work very well with people with ADD. Our strengths mesh. I am great with the overall picture, but I hate attending to details. Folks with ADD really enjoy getting lost in details, so they need help staying focused. It’s a beautiful thing to work together like that.

But in general—even before I got sick—I believed we treated crazy people wrong. I believe that we are crazy because there are times when our talents are needed. We wouldn’t stay in the gene pool if that weren’t true. The trick, I think, is to really work at making adaptations so crazy people can work. We do it for the disabled. Why not crazies?

Sometime we could do some brainstorming about what the ideal job would be for each mental difference. Maybe OCD folks could do something that requires much repetition with careful attention to detail. ADD people are good at going out to work in isolated places where they need to pay attention to detail, yet observe everything. They are good scouts. Bipolars can manage things. They can see the big picture, and set other people to making it happen.

These are just examples, and they are probably not the right examples. But those are details. If we know where we’re headed, we can fill that all in as we go along.

I don’t know if this helps deal with stigma, and to be honest, I don’t really care about stigma. I’ll deal with it if I have to. When you are proud of your craziness, you have confidence. When you have confidence, you can do anything.

Perhaps some of these “illnesses” are really only differences. Author/researcher/ talk show host Thom Hartmann has published several books on ADD/ADHD.His best-known theory has to do with the “symptoms” or personality traits of ADD/ADHD individuals being the exact same traits that would serve a hunter/gatherer well. It is when we evolved into an agricultural society, and later into an industrial and post-industrial society that thee traits became to be seen as “abnormal” or a “disorder”. Perhaps there are other conditions that modern medicine sees as illness which are really only differences.

Well, to me a major clinical depression is a real and serious illness. I’m fine if we consider very mild forms of depression or anxiety to be only a “difference”. And they are certainly not “abnormal”. Consider this: Is type 1 diabetes an illness? Well, some view it merely as a condition. Diabetes 1 is a manageable “disease”, so if a doctor asks a diabetic whether he or she is ill (e.g. before a vaccination or during a medical checkup), the reply would be, no, I’m fine right now. No fever, no limb pains, nothing. Still diabetics without insulin would die within days or weeks. So it is in fact somewhat unclear what a illness or disorder really is. The gray area seems huge.

However, in the case of Robert Enke, I would say it was a major disorder. It was in a way quite “abnormal”, yet most of the time over the past 6 years he did not have major depressive episodes. Otherwise he would have missed all the regular training/exercises and the games. He only had those episodes from time to time, but when he did -as far as I understand – it was very dramatic. For example after his daughter died. The psychotherapist and his wife knew about those major episodes. But no one else. Not his coach or anyone else at his club. No one else in Germany or elsewhere. He was the perfect hero he wanted to be.

@mattbrowne There was a big story about this in the New York Times yesterday. It is a very sad story and itis to be hoped, as you suggest, it will highlight issues about depresssion and treatment in Germany. One can be proud of one’s difference or not, make useful contributions or not, but if depression is making your life miserable, it needs to be dealt with IMHO.

There is a theory that mental illness is in part a reflection of society. The prevalence of particular disorders varies in place and time. According to the theory, those who become mentally ill are those who are particularly sensitive to the stresses of society. The specific form that their mental illness takes is an indicator of problems faced by everyone. So maybe people might have more respect for the mentally ill if they looked upon them as mirrors of society. Since depression has become the most common mental disorder in industrial nations, it might be well to wonder why this should be and what it indicates about our current way of doing things.

@janbb – Thanks for mentioning this to me. I searched the online version of the New York Times. A very good article indeed. It contains a lot of new aspects I wasn’t aware of. Here it is:

Depression Haunted Goalkeeper Killed by Train

The official Web site of the Hannover 96 soccer club was blacked out Wednesday except for a simple statement: “Wir trauern um Robert Enke.” We mourn for Robert Enke. He was the club’s goalkeeper, its captain, its most likely player to make Germany’s World Cup team next year. On Tuesday evening, Enke was hit and killed by a train at a level crossing near his home.

Almost at once, the police talked of suicide, and his widow, Teresa, who had to identify the body at the scene, said at a news conference Wednesday that Enke suffered from a depression he feared could result in their family being broken up. Germany was in shock. The mood from Chancellor Angela Merkel down was of silent waiting. Enke, 32, had an adopted 8-month-old daughter, Leila, and lived on a farm where he and his wife, both animal rights campaigners, kept many pets.

The German national squad, in Bonn preparing for a friendly match against Chile on Saturday, canceled training Wednesday. The match was also canceled. Enke could have been with the team but for a recent intestinal infection, and Oliver Bierhoff, the national squad manager, summed it up, “We are too shocked to find words.”

Enke’s car, a Mercedes, was found near the crossing, unlocked and with his wallet on the passenger seat. The two train drivers saw a man on the track and applied the brakes, but at 160 kilometers an hour, or 100 miles an hour, it was too late to prevent the death. The police said there was a suicide note, and German newspapers ran with two lines of commentary. One was that Enke, a quiet and reserved individual, was a troubled man ever since his biological daughter, Lara, died at the age of 2 in September 2006. She had a rare heart malformation. The other was the loneliness, the uncertainty, of a goalie’s situation.

On Wednesday afternoon, Teresa Enke said at a news conference attended by her husband’s psychologist that he was first treated in 2003. “When he was acutely depressive, he lacked motivation and hope,” she said. “I tried to be there for him. I said football is not everything, there are many beautiful things in life, it is not hopeless.”

The psychologist, Dr. Valentin Markser, said Enke had a fear of failure. Enke had chosen as a boy to play in the most exposed position, the last line of defense, and the one first blamed when things go wrong. Born in Jena, in East Germany, he joined SV Jena Pharm in 1985, when he was 8. He moved to Carl Zeiss Jena the next year and had been moving on ever since.

There were three years at Borussia Mönchengladbach, three years in Portugal with Benfica, a squad that went through three coaching changes while he was there and had financial difficulties that resulted in players sometimes being paid late. Enke’s counseling began when he moved to Barcelona. He was the eternal understudy there, the rising German keeper given just three opportunities with the first team. Barcelona thought highly of him, but lent him to Fenerbache of Istanbul, then to Tenerife. His Turkish misadventure lasted just one match, a loss after which Fenerbache fans bombarded him with firecrackers and missiles in their anger at losing.

Finally, he found relative security at Hannover, where he stayed for five years despite offers to move to more glamorous clubs. He was the team captain, chosen in part by his fellow players. When Jens Lehmann retired from Germany’s national team after Euro 2008, Enke was expected to be entrusted with the jersey. It was not certain. In goalkeeping, more than any other position, you are only as good as your last mistake. Trust is between the coach and the last man standing, and that presupposes that the goalie has the style, the personality and the authority that defenders in front of him also like and trust.

Enke was being pressed by René Adler, the 24-year-old Leipzig-born goalkeeper. Enke had more experience, Adler has youth, greater height and reach, and the advantage of playing for Bayer Leverkusen, which currently leads Germany’s Bundesliga. Joachim Löw, the coach, was thought to favor Enke for the 2010 World Cup. But of course no trainer would make such a promise to one goalie, because it would be too great a disincentive to the others.

It seems the professional uncertainty fed Enke’s anxiety. Illness and injury could not have helped. A year ago, shortly after Lehmann left the national squad, Enke lost two months to a broken bone in his hand. In his final game for the German national team in August, he had a goalkeeper’s dream score, shutting out Azerbaijan. Then he contracted an intestinal virus that cost him another nine weeks. He had just returned to Hannover’s lineup.

The loneliness of a player sidelined for months, the exclusion from the team training and comradeship, are all part of the professional experience. As fans laid wreaths and lighted candles at the gates of the stadium, Teresa Enke faced the news media there. She said: “He was scared of losing Leila if his depression came out. Now it is coming out anyway. We thought we could do everything with love, but you can’t always do it.”

And so along with his widow, a club and the national team also mourn for a man who took his own life near the peak of his sporting career.

http://www.nytimes.com/2009/11/12/sports/soccer/12hughes.html

@mattbrowne Glad you found it useful; it helped me understand the story and its impact better.

I find that depression makes me unusually sensitive to the pain of others. It makes me want to fix it. If I’m not given an outlet, it gets worse. Maybe if we channeled the energy of depressed people into opportunities to empathize with others, it could be a constructive thing.

@daloon – If it’s okay to ask, How many people in real life know about your depression?

@mattbrowne My wife and children, one college friend, and several local friends that I don’t see except in the context of creativity, where everyone claims to be bipolar. And a half aunt and a first cousin once removed, both of whom are bipolar and have been sworn to secrecy. Oh, and my support group. I’m very careful about who knows because I have no interest in having to deal with any discrimination. Especially from my extended family.

It’s only online where I talk about it in anonymity. I’m not stupid and I’m not brave.

Why?

@Yetanotheruser Good point. I have read similar information on ADD/ADHD and concur personally with those findings.

@Yetanotheruser, and @RedPowerLady – The difference between “a difference” and a mental illness is this: different people do just fine in life. They graduate from school, hold jobs, marry, have children, and hobbies, and friends. They might have to choose a particular profession or avoid certain tasks they cannot do well, but over all, they live typical if not normal lives.

Someone who is mentally ill has difficulty with all of this. They lose jobs, they fail at school, they have great difficulty retaining relationships, staying married, or getting along with their families. They have few if any friends, no productive hobbies, and often end up needing therapy, medication, hospitalization, or other social services. And all too often, they end up in jail or homeless.

The problem these days with those who are merely different is that much of society values success so highly that any person who isn’t smack dab in the middle of the bell curve doesn’t fit in, unless they are also smart enough (or have parents smart enough to help them) to be able to change how they do things. Thus, folks who once were merely different often end up with a label they don’t really need.

In the meantime, folks who are truly mentally ill are lumped in with those who are just different and are told they aren’t ill, they just need to try harder or stop being lazy. ADHD is a real illness. Fortunately, it is one that has a decent treatment, and folks who are mildly ADHD do end up in specific professions (for example, car salesman, professional motocross racer, sports coach, landscape maintenance, computer work).

However, some folks are so ADHD that medication really doesn’t help and they end up losing jobs and never finishing anything they start. In the “good old days” these were the people who didn’t live to grow up because they took too many risks, or they were the ones who took off for the frontier, when there was a frontier to take off for. Now they can and do grow up because we make them wear bike helmets, and don’t give them dangerous toys, but there is no longer a frontier for them to go off and explore. Thus, medication is the solution of choice. But they still have a higher than normal rate of failure.

Add in some of the things that go along with ADHD, such as ODD (oppositional Defiant Disorder), Bipolar Disorder, Schizoaffective Disorder, and other things, and you end up with a kid who has a higher than normal risk of suicide, and a 2 out of 3 chance of ending up in jail.

ADHD may be over-diagnosed, but it is a real illness that can prevent normal functioning.

@Darwin I’m actually trained in the field of counseling so I completely understand the difference between mental illness and other phenomenon. Although I appreciate your point in outlining the difference.

First, on a personal note, I would also like to say that I do not lump mentally ill people in any category and I don’t think that my views on labeling or the treatment/diagnosis of ADD/ADHD somehow shows that I do such lumping.

In response to your answer, I am not saying that no person can have serious problems from the disorder (being that they truly have a disorder). What I am saying is I disagree with the labeling, the overdiagnosis, the treatment, and quite specifically how the values of society lead to it being much worse that it needs to be. There will always be people with chemical imbalances that need medication or severe treatment. I am not diminishing those people, imo, by stating that the majority of those diagnosed with ADD/ADHD are being misrepresented in some way (ways in which i have listed above).

In fact, in terms of this issue, and all mental health issues I believe labeling is more detrimental than helpful. This is especially true and harmful in cases such as with ADD/ADHD where it is severely overdiagnosed. I know not everyone agrees with this POV. I would prefer to deal with each person on an individual basis, however difficult that may be.

Thanks @daloon for sharing this. You mentioned the root cause of the problem: potential discrimination.

I had a more thorough look at NAMI. Thanks @Judi. Good material. Good approach. It will take time.

Discussions like this are an excellent start. It’s going to take a long time, espescially in some cultures, before the stigma is gone. It’s going to take medication that doesn’t turn us into drooling zombies. It’s going to take us holding our heads up high and not letting others put us down. It’s going to take a radical change in how the media portray us.

Nami is a good place to start. Join in their walks- they’re tons of fun.

I can’t really do much about society in general, yet I can help battle the stigma within my own sphere. I don’t walk into a room with my tail tucked anymore. I’ve found, as with coming out, the more you have the attitude of ‘Yeah, so what?’ the less people will demonize you socially. There will always be a few jerks- but that’s no different than anything else.

We also need to get affordable legal aid to those who have been discriminated against either in housing, work or the like.

I think the first step is just opening up a dialogue and talking about what it’s like to be mentally ill. The more questions the merrier because it’s so important to get the right information out there. That we’re not freaks or sickos and we’re not going to hurt you. (Hell, if we’re on seroquel the most we’re going to do is ask if you have any chocolate on you.)

@gemiwing – Yes, you see, something’s happening in Germany right now. Thousands of fans realize that Robert Enke wasn’t a freak a sicko and that he didn’t hurt anyone physically. I wonder if Nami is connected internationally. There must be organizations in Europe as well. I need to check this.

I like the Mental Health Foundation and Mind.org.uk I’m not familiar with any Germany-specific groups. Nami is mainly a US thing, afaik. Like I said, the conversation being started is a huge plus.

It’s worth mentioning that shame and alienation are part of the disease. The stigma is real, and should be dismantled, but the shame is also a part of the illness. That’s what makes it so destructive.

<——— Mr. Shame Man.

I read a recent article in the Spiegel. Enke was on medication. Her had a very severe and rare form of depression and his psychotherapist feared he might commit suicide one day. The article was very interesting. Obviously there are genetic factors influencing the mechanisms of the

http://en.wikipedia.org/wiki/Blood-brain_barrier

so sometimes medication is more effective and sometimes it’s less effective because of this.

@Darwin I am in no way trying to minimize the difficulties of those who have mental illnesses. I think the difference between a “difference” and a true mental illness is often one of degree. I have known many people who were diagnosed with any of several conditions that fall into the category of mental illness. Some were able, with medical and psychological help, to either overcome or manage these conditions. Others, however, seemed unresponsive to any type of treatment. Looking back on the experiences of these individuals, it seems the blood-brain barrier, mentioned above by @mattbrowne, may have something to do with the effectiveness of treatment.

@Yetanotheruser – The yardstick by which difference is measured and compared to mental illness is this: If you can have a satisfactory life without medications, although you may have to limit some of your choices, you are different. If you fail in all parts of your life sometimes even with medication, you are different enough to be classified as mentally ill.

Yes, the difference between the two is one of degree, but also one of function. If your life is fine as it is or with the changes we all make, you don’t need or deserve a diagnosis.

@Darwin The degree would certainly affect the ability to function. I don’t disagree with you at all.