Elite athletes seeking psychiatric treatment: Stigma, impression management strategies, and the dangers of the performance narrative

This study explores the reasons given by five elite athletes for choosing to seek psychiatric support and treatment outside, rather than inside, their own sport environments. Life story interviews were conducted with these athletes, who were recruited from an open psychiatric clinic in Stockholm, Sweden. The interviews were then subjected to a structural and a thematic narrative analysis. The former revealed the power of the performance narrative to frame the lives of the athletes by producing a single-minded focus on performance outcomes that justifies, and even demands, the exclusion of any form of psychological weakness or vulnerability. The latter revealed the relationship between the performance narrative and the process of stigmatization associated with psychiatric disorders in elite sport and how this pressures athletes to adopt specific Goffmanesque impression management strategies to protect themselves within their own sport environments. These strategies were as follows: wearing a mask (to hide their psychological suffering), adhering to a vow of silence (making stories of psychological suffering untellable in elite sport), and finding an alibi (a way of portraying suffering in an "acceptable" form). Finally, we reflect on implications for practice, including the potential of narrative care, to help elite athletes explore alternative narratives that might be supportive rather than dangerous companions when suffering from psychiatric disorders. Lay summary: Five elite athletes were interviewed about their experiences of living with psychiatric disorders, focusing on their choice to seek psychiatric treatment outside, rather than inside, their own sport environments. Stigma and adhering to a single-minded focus on performance forced the athletes to adopt different strategies to hide their psychological suffering. IMPLICATIONS FOR PRACTICE The performance narrative, characterized by a single-minded focus on performance that demands the exclusion of any form of psychological weakness, stigmatizes elite athletes with psychiatric disorders, making their stories untellable within elite sport. To protect themselves from stigma, these athletes developed impression management strategies to hide their psychological suffering within elite sport. Knowledge of these impression management strategies among different mental health providers working to support athletes, and the use of narrative care to explore alternative narratives, may facilitate elite athletes