Soccer as Therapy for Mental Illness

Sports therapy has long been considered helpful for those suffering from conditions such as post-traumatic stress disorder, abuse, amnesia and even shyness. But Italian doctors have taken this often-marginal treatment a step further: they're using the highly strategic game of soccer as part of a treatment plan for complex mental illnesses like schizophrenia and depression.

The physicians have found that it helps with socialization, concentration and confidence building. It also aids in breaking down the stigma of mental illness, say its coordinators—especially in soccer-crazy Italy, where the game is as much a part of life as pasta. How effective is it? Dr. Santo Rullo, a psychiatrist who has used soccer therapy as part of a treatment program for more than 600 men over the last 14 years, says its success can be measured by his patients' reductions in medications and their return to their regular lives. "In the beginning, it didn't matter what time of day we scheduled games," says Rullo, a founding psychiatrist in the use of soccer therapy. "But now so many patients are back at work or have other social obligations, we need to work around schedules."

Rullo is featured in a new Italian documentary that follows a soccer season of Il Gabbiano, a soccer team whose players use sports treatment to help in their battle against conditions that include schizophrenia, depression, bipolar and multiple-personality disorders. The group practices twice a week and travels across the country for league-style games against similar teams. The documentary, called "Matti per il Calcio," ("Crazy for Soccer") by Volfango De Biasi and Francesco Trento, premiered in Milan on Jan. 16. Rullo spoke with NEWSWEEK's Barbie Nadeau by phone as he traveled to Rome from Milan with the Il Gabbiano team.

NEWSWEEK: How do you use soccer to help treat mental illnesses?
Soccer is used for socialization in the treatment of many mental illnesses. Since soccer is such a part of our national culture, it is a natural way to help our patients touch base with their core and their backgrounds. It gives them a sense of balance. All of our patients played soccer as children and teens; many played in organized clubs. It is not a new sport they must learn, it is almost inherent in them, and that is what makes it such a useful tool. In many ways, it helps them return to the concept of fun and play.

So soccer therapy would work best here in Italy or Brazil, or other countries where soccer is the predominant sport?
Yes, here in Italy, soccer is part of daily life and often family life. For Americans, basketball or baseball would probably work much the same.

What forms of mental illness are best treated through soccer therapy?
Our patients are primarily battling depression, schizophrenia, multiple-personality disorders and bipolar disorder.

What other sports work to treat mental illnesses?
Swimming has also been a very successful tool as part of an integrated treatment plan.

Does the degree of the mental illness make a difference in how patients respond to treatment?
In many cases, we have better success with patients who are more deeply depressed. In other mental illnesses, it depends on the individual and the level of medication and length of illness. Once soccer is integrated into the treatment, it is invariably useful, but in many cases, it depends on progress in other areas before we can implement soccer therapy and guarantee a patient will be safe and get the most from it.

In the documentary, many of the patients you follow seem to be talking about their illnesses very objectively in off-field interviews, almost as if it's not about them.
The thing everyone needs to understand about mental illness is that those who have it are not always sick. It's like a diabetic—the only time a diabetic is obviously diabetic is when they have an attack or bad reaction. Many mental illnesses work this way as well.

Many of the patients also talk about how, when they get out on the soccer field, the voices stop or they feel normal.
This is precisely the benefit of soccer as a therapy. It is really the social inclusion. The problem is that mental illness is almost always treated first by exclusion. A group sport like soccer helps to facilitate the inclusion of each member. The most important aspect of this program is that we also make sure the patients have information about their illness, that they are aware of their own limitations and fully understand the parameters of their illness, when possible.

The word "crazy" seems politically incorrect when used to describe those suffering from mental illness, yet you use it in the title of your documentary.
Normally, it is a politically incorrect term, but we decided to authorize the political incorrectness of it for this film to help combat the stigma. Nobody denies a connection between mental illness and being crazy, [so] we thought we'd lay it out to fight the stigma instead of pretending no one makes that connection.

There are no women featured in the documentary. Is there an equivalent therapy for women?
Yes, for our female patients, we have had the same success with bowling.

Ten-pin bowling?
Yes, there is a fairly big bowling culture in Italy, and it is a team sport that integrates socialization with physical concentration, but the women who use sports therapy are a minority; we tend to use other forms of social integration than sports.

Is soccer a last resort or a first line of treatment?
Soccer therapy is very much an integrated treatment along with clinical treatment like counseling and pharmaceutical treatments. In our patients who have gone through the soccer program, we have seen very few cases of relapse back to institutions or back under heavy medication.

You also released a report today on the Zidane-Materazzi head-butting incident at the 2006 finals between France and Italy at the World Cup. You give a very clinical analysis of French player Zinedine Zidane's momentary "calciomatto" [madness].
It is in part for fun, but we wanted to underscore the complicated nature of the concept of "craziness," and the incident last year in mainstream soccer was perfect. A person who is normally sane can have moments of craziness and vice versa. Nothing proves that like what happened during last year's World Cup.