The expert view - Big strides have been made
Jonathan Trott has been ruled out of the remainder of the Ashes tour with a stress-related illness. Brett Morrissey, a cognitive behaviour consultant, who has worked with professional sports people including Michael Yardy who left England's 2011 World Cup campaign in a similar situation, explains to ESPNcricinfo about the illness, the improved understanding of it and breaking down barriers.
What is a stress-related illness?
It's an all-encompassing phrase. It could mean several things. In one way it protects the person because the public do not need to know the specifics. When we see people from any walk of life you will make a more specific diagnosis based on the things they can tell you. It can include anxiety, depression and agitation as responses to the stress involved.
What strides have been made over recent years in the understanding and treatment?
The biggest stride was someone like Marcus Trescothick coming out in public, it makes everyone aware and also takes away the stigma. In sport, especially, there is a macho environment and you don't want to be seen to have what some people would term a weakness. You can tend to hide things away or bottle things up, put on a front and get on with it. Marcus did lots of people a favour.
You find that in any walk of life. If someone at work confides in a colleague then you will find others coming forward and saying they've been suffering or having treatment. Raising the awareness was key, within the sports teams themselves as well. Coaches and doctors are now spotting things earlier and there are procedures in place to form a support network.
Do cases vary from person to person?
Certainly, like any illness, they can be different from case to case. They'll be different types of problems and different intensities from one case to the next, from severe to milder episodes that you can go through. There is some thinking that there can be a genetic element, that some people are more predisposed than others, but there can also be a connection between life events. Also, people have a threshold where, up to a point, you can manage stresses - for example if they are spread out - but when they combine it goes beyond that point where normal coping mechanisms aren't effective
How has the thinking developed into the causes?
The current thinking is that there are two models. There's the mental model where the current thought is that there can be changes in levels of chemicals in the brain - usually serotonin - where you have a reduction, which can be treated with medication. The other model is the way people think, known as cognitive behaviour therapy, and how they interpret things. For example you may see something as threatening but it isn't, it's the way you've interpreted it. It's how we think, how we behave and how we feel. You can get a lot of automatic thoughts which aren't true and that's what we work on when trying to help a person.
Clearly it is not just an issue for those with high-profile lifestyles
I'm not aware of any figures about having a high-profile life making you any more prone. The current numbers suggest 5% of the population at any one time can be suffering from depression and with anxiety up to 10% at any one time. But, from a sporting point of view, what they found with the South African rugby union team after one World Cup was quite a high amount of depression among the players straight after the event; two years build up and all the emotion of the event put such physical and mental strain on them and then suddenly it's all finished. A similar process can happen in retirement, both within sport but also within any walk of life.
What is the recovery process?
It's hard to say without knowing the individual but over weeks or months people can make a very good or full recovery and can get back into their professional life, although it all differs from a case-by-case basis. Also, it isn't always the work itself that has caused the illness - even if it is where the problems has come to the fore - it can be many other things. Work can actually be somewhere you are comfortable with your role, know what you are doing and have support from friends and colleagues.
Sport can sometimes be slightly different because of the intensity you are under - it's not a normal job - and part of the recovery process will be looking to deal with that and any other causes of stresses. From Jonathan Trott's point of view he will have fantastic support and help from the ECB, who work very closely with the PCA and counties, and have an excellent system in place to help their players.
Andrew McGlashan is an assistant editor at ESPNcricinfo