Putting the pieces back together

A pitcher's manhood is routinely defined by what he throws instead of who he really is. Does he have the self-assurance to pitch inside? Is he "man'' enough to throw the breaking ball on a full count, or tough enough to go eight or nine innings and save the bullpen for the following night?

Justin Duchscherer became conditioned to view himself through the prism of wins, losses and ERA in five seasons with the Oakland A's. But in truth, his most enduring display of fortitude came far from the pitchers' mound, in a terminal at Phoenix's Sky Harbor Airport in late July.

The journey began with a flash of self-awareness, followed by a desperate plea for help.

While the baseball world was preoccupied with trade rumors at the July deadline, Duchscherer stayed busy completing his rehabilitation from spring training elbow surgery. After five months of doctor's visits and solitary workouts, a part of him exulted over the prospect of taking the final step and rejoining his teammates in Oakland.

But as crunch time approached, Duchscherer's competitive instincts gave way to a sense of isolation and despair. As he prepared to board a flight to Triple-A Sacramento for his final rehab outing, he placed a frantic call to Dr. Ray Karesky, the psychologist who runs the A's employee assistance program.

"I was in the airport and it was time to go and I froze,'' Duchscherer says. "I couldn't even get on the plane to do something I've loved my whole life. You go from excited and looking forward to being back with the guys and playing ball to sitting at your house saying, 'What happened?'

"I guess the word that best describes it is 'overwhelmed.' I was so confused, I didn't know if I should retire or if I even cared about baseball anymore. I didn't know what was wrong.''

In late August, Duchscherer revealed that he was putting his baseball career on hold to undergo treatment for clinical depression. Rather than mask his problems with a pulled hamstring or pseudo-malady, he chose to acknowledge his personal baggage and address the issue publicly.

Those efforts have taken him to a better place, less cluttered with internal conflict and self-doubt, and allowed him to concentrate on being a better father and person. If Duchscherer isn't necessarily a new man at age 32, he can take pride in being a more enlightened, grounded version of the old one.

That's a development worth celebrating as he spends Thanksgiving at his mother's house in Lubbock, Texas, with his son, Evan, age 6.

"It was really important for me to change -- to accept how I viewed myself and the things I've been through,'' Duchscherer says. "If someone says, 'He's weak' or 'He's soft,' that's not my problem. It's on them.''

A downward spiral

Baseball players, like all male athletes, inhabit a culture in which sensitivity is perceived as a sign of weakness, and the inability to deliver a base hit in the clutch is regarded as a character flaw. But as society grows more cognizant of emotional disorders in the age of Oprah, the clubhouse seems more accepting of frailties that can't be measured on the 20-80 scouts' scale.

Cincinnati first baseman Joey Votto, St. Louis shortstop Khalil Greene and Detroit pitcher Dontrelle Willis made news for their struggles with anxiety-related issues last season. And Zack Greinke, the brilliant young Kansas City Royals pitcher whose career was nearly derailed by a depression and social anxiety disorder, won the American League's Cy Young Award last week.

Duchscherer, a bright and introspective Texan, is the type of player who's routinely described as an "overachiever.'' Boston selected him in the eighth round of the 1996 draft, and he spent eight years in the minors before sticking with Oakland in 2004. Duchscherer went on to make two All-Star teams -- one as a reliever and another as a starter -- despite a skinny frame and a fastball clocked in the 86-88 mph range.

I felt like a total failure. I felt like, 'I can't stay healthy enough to perform, so I'm not doing my job, and I failed at my marriage.' I started to get into a lot of negative thought patterns.

-- Pitcher Justin Duchscherer

Yet the same perfectionist's streak that drove Duchscherer to succeed also made him brutally hard on himself. Damon Lapa, Duchscherer's agent, saw it firsthand in a game against Boston in late May 2008: After throwing eight one-hit innings to beat Josh Beckett and the Red Sox 3-0, Duchscherer spent more time lamenting the fastball that David Ortiz hit for a single than celebrating his victory.

"Instead of looking at the game as a success -- like, 'I just one-hit one of the best offenses in the game' -- I went home and I was disappointed because I gave up a hit,'' Duchscherer says. "I kept ruminating over what I could have done differently to Ortiz. It was just a terrible way to look at things.''

Even as Duchscherer's baseball career blossomed, his personal life began to unravel. He separated from his wife, Michele, in April 2007, and their four-year marriage officially ended in late 2008. The ordeal dredged up unresolved issues from Duchscherer's parents' divorce when he was 10, and led to feelings of guilt and shame.

The strain of a ballplayer's life didn't help. Since he's on the road eight months a year and Evan lives in New Jersey with his mother, Duchscherer sees his son sporadically. During the 2008 season, he was able to channel his anguish over his failed marriage into his pitching, but he didn't have that luxury this year. When the A's broke camp in April, Duchscherer stayed behind in Arizona to focus on his rehab. The more time he spent alone, the more he missed Evan and dwelled on his shortcomings as a husband and a father.

"It was a combination of baseball and the divorce,'' Duchscherer says. "I felt like a total failure. I felt like, 'I can't stay healthy enough to perform, so I'm not doing my job, and I failed at my marriage.' I started to get into a lot of negative thought patterns.

Duchscherer's downward spiral took him to a dark, lonely and all too common destination. The World Health Organization defines depression as a "a common mental disorder'' that results in "depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy and poor concentration.'' The malady affects about 121 million people worldwide, and is a significant factor in the estimated 850,000 suicides annually.

Depression can be treated successfully up to 80 percent of the time by psychotherapy, medication and changes in diet, exercise and lifestyle, but the WHO reports that fewer than 25 percent of people afflicted receive treatment.

Ballplayers aren't immune

Karesky, who has a master's degree in education from Harvard and a Ph.D. in counseling psychology from Arizona State, has seen dozens of Justin Duchscherers in big league clubhouses. He runs employee assistance programs for the A's, Toronto Blue Jays and San Diego Padres, and has done counseling work for the Arizona Diamondbacks, Tampa Rays, Washington Nationals and the Major League Baseball umpires.

In a sense, Karesky was ahead of the curve. He was working at St. Luke's Hospital in Phoenix in the mid-1980s when A's officials Sandy Alderson and Karl Kuehl met him during a search to find someone to organize a counseling program for the Oakland players.

"They asked about my background, and I told them I had worked a great deal with disturbed adolescents,'' Karesky recalls. "They looked at each other, smiled and said, 'Sounds good to us.'"

Karesky has been a counselor to corporate executives, firefighters and Vietnam War veterans as well as ballplayers. Although he acknowledges the unique pressures faced by those in life-or-death occupations, he says it doesn't minimize the challenges that professional athletes encounter.

"The public doesn't recognize that it's a stressful lifestyle,'' Karesky says. "Most of these kids leave the security of home and have heavy demands placed on them at a young age. They're expected to perform at the highest level of their profession in front of vast amounts of people, in a 24-hour news cycle where everything they do wrong is repeated over and over on the Internet and blogs.

"I can see people out there saying, 'How can we feel sorry for these overpaid, pampered guys?' Baseball players have the attitude, 'Hey, we're not asking for anybody to feel sorry for us. We know we have a good deal.' But one of the problems is, they buy into the idea that they shouldn't have these issues. They're very hard on themselves.

"Just because somebody gives you money and fame doesn't mean it gives you wisdom, common sense or maturity. The reality is, ballplayers are in an extremely demanding environment that produces stress they're not trained to deal with. It's a pressure cooker, and over time that stress can build up and take a real toll.''

To those who contend that baseball players were tougher or more "manly'' in the good old days, Karesky counters that depression and other mental disorders were just as prevalent in previous generations. Just because ballplayers failed to acknowledge it and drifted toward alcoholism or other destructive behavior didn't mean the problems were nonexistent.

In his work with the A's and other clubs, Karesky tries to break the barriers gradually. He engages players in casual conversation at the ballpark, where they're in their element and more inclined to let down their guard and confide in "Doc Ray.'' It was that sense of trust and comfort that prompted Duchscherer to call him from the airport that fateful day in Phoenix.

Self-acceptance, unconditionally

Duchscherer has been on a journey of self-discovery during his ordeal. He's read books on anxiety, depression and psychosomatic disorders. He has also become a devotee of Albert Ellis, a renowned psychologist who pioneered the concept of U.S.A. -- or "unconditional self-acceptance.''

You're going to have the same emotions whether you have a million dollars or five dollars in the bank. Sure, it makes it easier to pay your rent. But when you're divorced and separated from your son, having money doesn't make it feel any better.

--Justin Duchscherer

During his treatment, Duchscherer was fortunate to receive whole-hearted support from his agent, Lapa, and the A's, who treated him as a friend in need of help more than a commodity or a drain on the payroll. David Forst, Oakland's assistant general manager, declined to address the specifics of Duchscherer's condition because of medical confidentiality laws, but said the A's are aware of the burden that depression places on players.

"It's not something we have a ton of experience with, but we recognize that being a Major League Baseball player doesn't make someone immune from the issues that people in everyday life have to deal with,'' Forst says. "That certainly extends to mental health issues. We know it's serious, and we would always say that life comes before baseball.''

The A's aren't alone in this age of enlightenment. Every news flash puts a crack in the traditional male culture, which regards it as a sign of weakness to admit to emotional or mental setbacks.

"Teams are becoming more educated and aware about the severity of this condition,'' Lapa says. "It's not just an old boys' attitude anymore of, 'Rub some dirt on it and get back out there.' There's a newfound understanding that this cuts across all lines, all races, all economic statuses. It's something that knows no boundaries.''

For all the progress Duchscherer has made in sorting out his life, there is still work to be done and a career to resume. He's looking to land a job as a starting pitcher through free agency, and works out regularly at trainer Brett Fischer's facility in Phoenix.

It appears that he'll have no difficulty finding work. Lapa says that interested teams seem to regard Duchscherer's history of depression as more a "technicality'' than an "obstacle'' to overcome. As long as clubs think he can still pitch, it's more a yellow caution light than a red flag.

If Duchscherer can help remove the stigma of depression by sharing his story -- and convince another athlete to seek help -- it will be a wonderful fringe benefit. That consideration pales next to the feeling he has when he wakes up each morning. He's discovered that it's liberating to live by his own definition of success, and not somebody else's.

"I thought once I got to the big leagues and made my first million dollars, that's where true happiness was,'' Duchscherer says. "It's not the case. You're going to have the same emotions whether you have a million dollars or five dollars in the bank. Sure, it makes it easier to pay your rent. But when you're divorced and separated from your son, having money doesn't make it feel any better.''

Duchscherer continues to miss Evan when they're apart, but he's come to realize that the paternal bond is rooted more in quality time than the quantity of hours spent together. Father and son talk daily on the phone about Evan's fondness for soccer, karate and video games. And when the schedule brings them together, they cherish their trips to the zoo or the amusement park or Chuck E. Cheese.

Four short months ago, Justin Duchscherer was paralyzed at an airport gate and barely knew where to turn. Now he's content with his life's direction and comfortable in his own skin. It's amazing how far a man can travel when he's willing to take that first step.

Jerry Crasnick covers baseball for ESPN.com. His book "License To Deal" was published by Rodale. Click here to order a copy. Crasnick can be reached via e-mail.