The International Society for Sports Psychiatrists (ISSP) Manual for Sports Psychiatry is timely because it provides a ‘pocket text’ for sports psychiatrists working within an emerging and niche field. It develops new themes initially described in recent years by Clinical Sports Psychiatry – An International Perspective by Baron et al Reference Baron, Reardon and Baron1 and Sports Psychiatry by Currie and Owen.Reference Currie and Owen2
This Manual is organised into non-contact and contact sports. The authors have further subdivided into individual sports. This is a useful framework for the stated aims of the Manual, which allows authors to focus on individual issues relevant to each of the sports covered. Each chapter is written by a specialist within each field. Dr David MacDuff, a leading American expert, contributes significantly to four chapters in the second half of the book.
Most chapters begin with a history from within the specific sport. Each describes unique psychological aspects as well as challenges of diagnosis, epidemiology and treatment. One example of this is in the rowing chapter where ‘benign masochism’ is considered and expanded upon. The authors define this as being ‘an enjoyment of negative bodily reactions safely and pleasurably in the context of mind over body.’ This would be an essential psychological concept for a psychiatrist to broach during any assessment prior to diagnosis and formulation.
The chapter on boxing is a particular highlight of the Manual and I found it to be most informative. It touches upon the hot topics in sports medicine and sports psychiatry: concussion/chronic traumatic encephalopathy, depression and substance abuse. Dr Ronald Kamm balances scientific information, psychological themes and diagnosis/treatment options succinctly. He provides useful insight into ‘end of career transition’ and how this can be a difficult phase for boxers from a mental health point of view. This can be generalised to other sporting realms. This is the only chapter to discuss and differentiate the interface between amateur and professional sports participation.
Along with interesting insights into rowing and boxing, less mainstream sports are well served within the Manual; for example squash and weightlifting would not necessarily be sports that would immediately attract attention or one would expect to be included. The chapters give information on the likely prevalence of disease and treatment options. The unique ethical challenges within weightlifting are also considered.
Areas for advancement in further publications could include expansion of the cricket chapter. One of the first of the high-profile ‘disclosures’ in the UK national media was a well-known English opening batsman. This led to an increase in interest in mental health issues within cricketing circles. There was a realisation that the format of the County cricket circuit within England, as well as the travel associated and being away from home with a national team, may not be the easiest to navigate from a mental health perspective. The cricketing authorities have been proactive in addressing this and there are now mental health professionals working within cricket.
A chapter on rugby including union, league or sevens would be welcome. Rugby, among differing codes, is well established and popular in Australia, New Zealand, Pacific Islands, UK and Ireland, France and South Africa. It is rapidly growing in North America and Asia, with this year's World Cup due to be staged in Japan. Rugby has a culture of ‘being tough’ with macho, masculine traits encouraged. There also persists a drinking culture within rugby, particularly within the amateur game. Therefore, given the popularity of rugby worldwide and some of its maladaptive psychological characteristics, it deserves a separate commentary.
Historical backgrounds to each sport is a theme running throughout the book. Although interesting, I felt this has minimal relevance in the majority of sports featured. Omission of information may lead to more space for the discussion of clinical issues. Case studies are used in these types of texts in other areas of medicine and should be considered for further publications.
Overall I would recommend this manual to psychiatrists interested in the field of sport psychiatry, sports psychologists and sports medics. Managerial staff and coaches should also be attracted and the text would likely develop their understanding. The Manual is conveniently set out, easy to read and meets most of its stated aims. The general topic will expand in the near future. This text contributes to the expertise of doctors treating the brain as any other muscle in a sporting environment.
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