Monday, March 30, 2009

Does Willis really have anxiety?

Detroit Tigers pitcher Dontrelle Willis was placed on the team DL Sunday. The stated reason for disabling him was "anxiety disorder."
This was news, mainly because there had never been any report before that Willis suffered from the disorder or even any speculation on the subject. However, it's certainly possible for someone with anxiety to conceal it, or for it to be mistaken for something else.
I've suffered from generalized anxiety disorder for a number of years now. It's not a stretch to say that it is "disabling." At its worst, the anxiety becomes so intense that it interferes with your ability to function on basic levels: to take care of yourself, to go outside, to interact with friends, to keep a steady job, to form a romantic relationship, as well as many other things.
But here's the most baffling part of the Dontrelle Willis story: Willis doesn't report having any symptoms of anxiety. This article in the
Detroit Free Press quotes him as saying that this is "not something where I'm too amped up, I don't know where I'm at, and I'm running sprints up and down the parking lot ... (The doctors) see something in my blood that they don't like."

Let me say now that I am not a doctor or psychiatrist or anyone qualified to issue a medical diagnosis. My opinions are just that, influenced as they are by years of dealing with the disorder myself.
Having said that, Willis' statement troubles me to no end. I'm amazed — and shocked — that Willis has been diagnosed with the disorder despite the fact that he seems to report no symptoms at all. Now, I admit that I don't know everything Dontrelle said to the reporters, just what was quoted. But I've looked through every version of this story that I can find on the internet and haven't found any mention by Dontrelle or a team doctor that he's suffered any symptoms of anxiety disorder.
This means that the sole reason for Willis' diagnosis was the blood test. But according to
mlb.com, "Research online suggests there's no lab tests to diagnose anxiety disorder, but such tests can be used to look for physical causes and symptoms." This goes along with my own prior experience. Anxiety doesn't show up in your blood like a virus. It's a mood disorder; its very existence is based on the fact that you have the symptoms and suffer from them. I'm no doctor, but this man is, and the article seems to address the anxiety test question. The New York Times has a more recent guide to medical help for anxiety sufferers.
The criteria for diagnosing anxiety is also out there. The criteria are published in the Diagnostic and Statistical Manual of Mental Disorders (4th Ed.), commonly known as the DSM-IV. The criteria are entirely behavioral; that is, it is all based upon the individual's behavior and thought processes.
Again I'm no psychiatrist — but everything I know and have read on the subject says that anxiety disorder isn't really anxiety disorder if you don't have any symptoms. I've never heard of any sort of mood disorder that involved no symptoms. And if it has no symptoms, then how can it be a mood disorder?
For the sake of argument, let's say that Willis does have the disorder without actually having symptoms. Then why disable him? If he has no symptoms, then he is not — technically — disabled from pitching. The only symptom would be his inability to actually pitch. And unless the DSM-V came out and nobody told me, that's not good enough to count in itself as a symptom of anxiety.
I may be wrong, but the only conclusion I can come to is this: the Tigers are looking for any excuse to get Willis off of their ball club, even if it means a false diagnosis for an all-too-real medical condition.
The timing of the Tigers' decision is telling — and strong circumstantial evidence that they're lying. It is beyond coincidental that Willis would be diagnosed with anxiety at such an opportune time for Detroit. Willis has had trouble pitching for over a year now. He's lost control to the point that he's not only uneffective, but also
so wild that it's questionable whether he'll ever pitch again. So why disable him now — when it's clear that he hasn't been pitching effectively since he came to town?
Not only do the Tigers need to free up a spot on their roster (which sending him to the DL would do), they need to do something about his contract. When the Tigers traded for Willis, they signed him — sight unseen — to a contract extension worth $29 million over three years. So Willis is due $22 million for 2009 and 2010, money for which the Tigers may not get any pitching at all.
The Tigers would love to make that money go away. And how can they do that? Insurance! Most teams carry insurance on player contracts, recouping the team some money if the player is disabled. Tigers GM Dave Dombrowski declined to comment on Willis' insurance situation, but it's fair to guess that they have coverage. And it ought to be good coverage, too — before he came to Detroit, Willis had a fine health record.

So unless I'm very wrong here — and God, I hope I am — the Tigers are falsifying an injury and perhaps defrauding an insurance company so they can save themselves $22 million. Instead of admitting their mistake and releasing Willis, the Tigers are going to try and con their way out of the situation. That is the most despicable thing I've heard of any team doing in years — and that's saying something.
If this is a fake (and I still say if), is it insurance fraud? Have the Tigers knowingly falsified medical information? I'm not privy to the blood tests, and I can only assume that the Tigers must have some actual medical evidence if they're going to send this to the insurance company. Even if all they've faked is the diagnosis, is that still fraud? If there are any lawyers in the crowd, let me know if you can shed some light.
I didn't think I was capable of feeling moral outrage toward baseball anymore. I guess I was wrong. Damn you, Dave Dombrowski. And damn you to any other Detroit personnel involved in this sham. I don't appreciate having my disease exploited to bail you out of your own stupid mistakes.
More details will come out in the days to come. I do mean it when I say that I hope I'm wrong. And if you have any expertise in psychiatry, mood disorders, neurotransmitters, or insurance fraud, please share your thoughts and/or correct my mistakes.


UPDATES (updated periodically):

  • The Detroit News asks some doctors who agree that anxiety can't be diagnosed by blood test.
  • FoxSports.com's Ben Maller quotes the above story and adds:


    "I smell a rat. Hope Dontrelle returns to form but I'm not buying what the
    Tigers are selling with the anxiety claims from a blood test."



  • BIG NEWS! I just got a response to an emergency e-mail sent to Baseball Prospectus injury guru Will Carroll. I'll just say that it's encouraging.
  • From Jayson Stark's espn.com chat today:

All I can tell you is that people I've talked to are very skeptical of this. As I've mentioned a few times, I keep forgetting to go to medical school. So I never like to second-guess anybody's diagnosis. But this one is s a head-scratcher. No doubt about it. Their only probable alternative, if Willis didn't go on the DL, was to release him. And that would have looked awful after the money they commited to him. So this was a way out for everybody, on every level.

2 comments:

Richard said...

Not being able to throw the ball over the plate can be seen as a symptom of anxiety disorder... see Rick Ankiel, Zack Greinke and others.

Aaron "W.K." said...

"Anxiety," such as performance anxiety or Steve Blass disease, isn't the same as an actual medical condition. Ankiel is like Willis; missing the plate is the ONLY evidence of anxiety. Greinke had terrible symptoms, even though he never had bad control problems.
I suppose if your baseball career collapsed around you, that you could develop anxiety as an actual mood disorder. But it's much more likely that a guy who can't throw strikes is just a guy who can't throw strikes. And Steve Blass disease has yet to crack the DSM-IV.