The following is part of a three-piece series looking at mental health in esports. The series, reported by Veronika Rodriguez and Noam Radcliffe, includes in-depth interviews with professionals in esports and psychology and explores the wide-ranging effects of various mental health issues among the competitors in different esports. You can view the other parts of the series here and here.


Justin “Plup” McGrath was a competitor and fan favorite to win the Super Smash Bros Melee event at EVO, the largest fighting games tournament in the world, last year. Within reach of the finals, Plup experienced his first panic attack during a crucial game.


Tens of thousands of viewers, in the audience and watching from home through Twitch, witnessed Plup show visible signs of pain and significant discomfort during his match.


After being eliminated and finishing the tournament in third place, Plup confirmed what happened.


“It's quite disconcerting knowing I could start spazzing out any time I get on stage,” he wrote. “It's one more thing to worry about for tournaments, and just writing this is making my heart race.”


When it comes to mental health in sports (esports or otherwise), anxiety and depression are some of the biggest problems players face. Being a professional player in a sport means the pressure to win always exists. Whether the activity consists of running on a field or playing a game on a screen, the pressure to win is the same. The expectations come from fans, from the team, from the organization, and from the players themselves.


It might seem like a child’s dream to get paid to play video games, but the reality is esports can be as stressful and demanding as any traditional sport.


Matthew “Matt” Elento is a League of Legends player who opened up about his experience with anxiety last year. He said he never experienced anxiety until January 2017, when he had a panic attack while scrimmaging with his team.


“I was on edge, best described as if I was constantly feeling the same sensation that you would feel if you tripped over something,” he wrote. “The difference being for me, the feeling of something terrible about to happen didn't stop after half a second. It felt like I was about to die.”


Matt's struggles don't appear to be uncommon, and he wrote in the same post about lifestyle changes he made to improve his mental health. But it's not always easy.


Ismael Pedraza, a performance coach who formerly worked with Misfits' League of Legends team, described esports as more of a mental game than traditional sports. A basketball player likely cannot practice at high intensity for 10 hours per day because the body would start to shut down out of need for recovery; there's nothing to prevent that from happening in video games. The still-burgeoning and under-developed esports industry also means fewer resources and fewer people equipped to handle players' mental health.


“The values of the team are developed (in traditional sports); the values of the organization are too,” Pedraza said. ‘You have experts around the coaching staff who are able to help this environment to healthily develop. I think it is important and a big difference between esports and sports at the highest level.”


Esports fans are used to seeing the words “mental health problems” in an announcement regarding a favorite player. In the Overwatch League, Kim “Pine” Do-hyeon became a quick fan favorite last year during the league's inaugural season. Cheers would erupt from the crowd when he was subbed into matches, but fans were surprised he was nowhere to be seen in the second leg of the season, which started only 10 days after the first leg -- called stages in Overwatch League -- ended.


It wasn’t until the second stage finished that Pine explained his break from playing games was because of anxiety -- a “panic disorder,” he wrote. Pine added the stress of the games caused him to develop an anxiety disorder on top of already existing depression.


Photo by Robert Paul/Blizzard

Professional careers in esports begin usually when the players are teenagers. Most esports careers also end early, with many pros still in their mid 20s or early 30s when they stop playing.


Carl Daubert is a former performance coach who has worked with esports organization Immortals, various Overwatch League players and traditional sports athletes. He explained how the importance of performing well and performing well now can affect the mental health of players. Performance coaches push the perspective that players must focus less on the outcome and more on what they can do to improve, which might clash with the organization’s need for results.


“Players get in this tug of war because they are being told to be in the moment and not focus on the end result, and a lot of coaches and staff are saying ‘well this is the big one, we need you to win,’” Daubert said. “There's a lot of factors that are constantly swirling on a player’s head at any given moment.


“I think players can get really overwhelmed when they're trying to keep track of all that and keeping everyone happy when their career might be only four or five years -- and they want to get the most out of those years.”


Anybody could theoretically be replaced by another -- often much younger -- player who has the same skill. The mindset of “if I’m going to do this, I need to do this now” can accentuate the struggle of focusing on the moment without worrying about the pressure to perform.


One of the charms that comes with esports is the accessibility of almost every player. Most esports players keep up with their own fans by streaming through Twitch. Their viewership can range anywhere from hundreds to tens of thousands of viewers watching them play and sending them messages. That can open the doorway for negative comments after a particularly bad performance, and seeing hundreds of harassing messages can multiply a player’s feeling of unhappiness.


Dr. Alan Bunney, a physician and the CEO of esports organization Panda Global, explained the stigma of mental health is another factor that prevents players from seeking help. It's taboo to feel like there's a problem with your mental health, let alone talk about it.


“I have some patients who come in and are suicidal before they decided to come to the doctor because their parents tell them, ‘Well, just get over it,’ or ‘What do you have to be sad about? You win, why should you be sad?’


“Thinking a little bit of willpower is all you need is bullshit,” Bunney said.


Photo courtesy of Riot Games

Not everyone who plays video games professionally has depression or anxiety, but Gen Z, the generation in which many esports pros fall, seems to be on a downward trend. An article from The Atlantic discussed the link between teenagers who spent a lot of time in front of screens -- whether it’s a computer or smartphone -- and depression. Since the release of iPhones and the boom of smartphones in general, teens are more likely to be unhappy or depressed the more time they spend in front of a screen, the article concluded.


“Boys’ depressive symptoms increased by 21 percent from 2012 to 2015, while girls’ increased by 50 percent—more than twice as much,” the Atlantic reported.


Dr. Sarah Rose Cavanagh at Psychology Today disputed the Atlantic article and warned its findings shouldn't be used to define an entire generation. There are other factors to take into consideration, such as social context and positive effects of social media usage.


Ignoring the positives in the era of screens and social media would be disingenuous. Like Cavanagh implied, it would be challenging to link all of those mental health problems to smartphones and being in front of screens. There is more that factors into those situations and problems.


Still, it's worthwhile to wonder how being in front of a screen for so long per day -- 10 to 12 hours of training for some esports teams -- can affect their mental health.


Photo by David Patlut/DreamHack

As the industry matures, mental health is starting to become more of a focus. Taylor Johnson, a performance coach who worked with OpTic Gaming’s esports teams in titles like Counter-Strike: Global Offensive and Overwatch, called esports a “work in progress” when it comes to mental health. But he is optimistic about how the industry is evolving and doing a better job than it did before.


Johnson’s past did not begin with esports. He worked with the San Francisco 49ers and eventually left and was recommended to esports. He said he was fascinated and found esports a perfect opportunity to promote health and wellbeing to kids worldwide. During his time with Infinite Esports (OpTic's parent company), he carried over some of the practices used in traditional sports.


“They would get movement training, access to nutrition -- the whole nine yards -- the same thing you would see within a traditional sports team,” he said. The wellness in other areas of a player’s life, whether it comes to hygiene or ensuring physical wellness, was just as important.


Since Plup’s onstage panic attack, he began taking medication he said was helpful. He continued to attend tournaments and still regularly streams on Twitch. Matt has said publicly he does not take medication but finds comfort practices like breathing exercises and writing down his thoughts.


“Talk therapy was a big help for me. Luckily I was able to have someone who was a licensed therapist to talk to every day through Skype,” he said.


Esports is an industry that still needs to find a stronger ground when it comes to player wellness. It’s new enough for players to be overwhelmed easily by the new lifestyle, attention, and stress brought on by playing video games professionally. But its future is far from bleak. With performance coaches and sports psychologists becoming more and more of a staple in teams and organizations across esports titles, there is still hope for the industry’s progression into better mental health.


Photo illustration by Kevin Gomez/Minute Media