Madness and Sports: Enjoy the Game, But Control the Gaming

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

As an athlete and fan growing up, I loved sports. However, I detected some psychiatric caution during medical and psychiatric training when the book Madness in Sports came out.¹ Some of the concerns were of the crowds obsessed with their teams and the violence of some of the sports.

Later on, around the turn of the new millennium, a colleague and I developed the first Sport Psychiatry Institute at the Medical College of Wisconsin, which morphed into an international sport psychiatry organization.

Betting was not too much of a problem back then. It was illegal and thereby covered up. There was no sense that gambling could be an addictive or obsessive disorder. I bet a little, especially in card games, but fortunately stopped after I started dating my wife.

All that has changed more recently, when the Professional and Amateur Sports Protection Act of 1992 was overturned in 2018 during the first term of President Trump. Thirty-eight states now allow betting in some form and 7 states allow full online casinos. Advertisement, especially on the internet, is enticing. Gambling is now even available throughout an entire event.

We are in the month of March Madness. That madness refers to the annual collegiate basketball tournament, but not directly to the tournament’s gambling which exceeds that wagered on the Super Bowl.

Yesterday, my wife and I just happened to have on a TV show called the Morning Blend before we went to the doctor. The guest was called Vegas Matt, I think, and the positive discussion was about a conference coming up to enjoy March Madness and the associated gambling.

Thankfully, a courageous psychiatrist has spilled the beans about all that data and the dangers in a self-disclosure article on March 18, 2025, in Psychiatric News. She was a heavy gambler back in 2022. Most knew her as a mother, friend, karaoke enthusiast, high school valedictorian, and the incoming president of the Pennsylvania Psychiatric Society.² But, as she confessed, they did not know about her struggle with gambling. A year after using her first online casino app, she lost her savings, part of her retirement, and almost her home.

Now she is trying to warn every psychiatrist to screen patients for gambling disorder. I am trying to spread the word. Shame often prevents sharing by the overly involved public and patients. One recommended screen is the Lie/Bet scale. Particularly at risk are younger, impulsive individuals. Most of the gambling industry’s profits come from just 5% of the gamblers.

The symptoms are often severe. Half of problem gamblers contemplate suicide and 20% will attempt it. When gambling reaches the danger category, there are common red flags: chasing losses, secrecy, financial distress, and emotional distress. Gambling disorder is a DSM-5 classification.

Proven treatments are still being researched. Cognitive behavioral therapy with motivational interviewing is promising. There often is underlying low self-esteem and a trauma history, which winning can temporarily relieve. Psychiatry also needs to press for safer legislation to reduce the societal risk and provide public education to enjoy the games, but control the gaming.

As far as my March Madness, I will not gamble, but I will root for my Alma Mater, the University of Michigan, “the leaders and best.” Go Blue!

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Beisser A. Madness in Sports. 2nd Edition, Charles Press; 1977.

2. Fischer K. The real madness of March - why every psychiatrist should be screening for gambling disorder. Psychiatric News. March 18, 2025. Accessed March 27, 2025. https://psychiatryonline.org/doi/10.1176/appi.pn.2025.04.4.50