The Life of a New York City Ballet Principal: A Sports Psychiatric View Through the Opera Glass

The American Psychiatric Association (APA) and the International Society for Sports Psychiatry (ISSP) sponsored a joint presidential symposium during the 2018 APA Annual Meeting in New York. Dr. Antonia Baum, past president of ISSP, chaired the event and interviewed Wendy Whelan, a retired New York City principal ballerina. The audience learned about the field of sports psychiatry and the efforts of practitioners in the field to optimize the physical health of athletes as well as to manage psychiatric disorders in this population. Practitioners in the field also strive to enhance athletes' performance by helping them to improve their coping skills and individual psychological strengths (1). Athletes are often exposed to numerous stressors, including the demands of rigorous training, performance under intense competition, and susceptibility to physical injuries such as traumatic brain injury. They are also prone to psychiatric disorders, including anxiety, depression, eating disorders, and substance abuse (2).

Ms. Whelan talked about her upbringing, her development as a world-renowned ballerina, and her recent retirement. She described her struggles with congenital scoliosis and spondylolisthesis. These conditions caused significant physical and mental distress, particularly during efforts to maintain body posture while dancing. She related how her anxiety, dysphoria, and pain were difficult to suppress but that psychiatric treatment "released" these symptoms.

Similar to gymnastics and figure skating, ballet dancing seems to promote a lean body shape. Moreover, the exercise routine of a ballet dancer mirrors that of athletes in various other aesthetic sports such as gymnastics. Consequently, there is a high prevalence of eating disorders among ballet dancers and athletes of other "aesthetic" sports (3, 4). Ms. Whelan recounted the anxiety she experienced early in her career around maintaining her physique. She described how she practiced "unhealthy eating behaviors" in her efforts to restrict her weight to 100 pounds or less. As a result, she developed a heart murmur. At this point, her ballet teacher stepped in and helped her to recognize the body image distortions she developed and encouraged her to achieve and maintain a healthy lifestyle.

Lastly, Ms. Whelan talked about her struggles with depression and how both pharmacologic and psychotherapeutic approaches helped in her recovery. In her words, antidepressants broke "the concrete block over [her] head and allowed the sun's rays to pass through."

While in training or in practice, psychiatrists are not often exposed to the niche field of sports psychiatry. This symposium provided an excellent platform to learn about this practice area through the mental health story of a famed ballet dancer. Despite a lack of specificity regarding symptom duration and severity, as well as the need for elaboration on treatment approaches, Ms. Whelan's story is a reminder to the medical community that athletes are at risk for mental illness and that providers should be proactive in recognizing this high-risk group. Narrative accounts like Ms. Whelan's highlight the mental health challenges faced by this unique population of professionals whose lives are defined by striving for excellence.