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As vital as Greinke would become to Kansas City, his success had a more profound effect on baseball culture. "I hate to make this comparison, but Zack was like Jackie Robinson," says Sweeney, now a teammate and friend of both Snell and Bradley in Seattle. "Whether he likes it or not, he's the guy who really paved the way for the modern player to come out about these types of issues."
The introverted Greinke, who credits therapy sessions and antidepressants for his recovery, proved that emotional disorders are treatable injuries. And in confirming that therapy patients can increase in market value, Greinke helped push players' attitudes about mental health closer to the increasingly open-minded views of the rest of the country. Before his treatment Greinke was so consumed by nervousness and anger that he punished himself by overtraining; he would work out, by his estimation, 90% of his waking hours. "The medicine is unbelievable," Greinke said this spring. "I'm still the same person, but my attitude about everything is different."
"Zack Greinke is the perfect example for players today," Pulsipher says. "I mean, if you can talk to someone about your issue, and that fixes you? Or take a pill once a day for 10 years? Why wouldn't you do that?"
Old-timers like Blass consider that rhetorical question even today. "If I was playing now," Blass says, "I'd haul my butt up to Harvard Medical School and just say, 'Here I am. Fix me.'"
But if Blass were to go to a research university for extensive brain imaging, he'd find that emotional disorders are not entirely biological or chemical: Everything from genetics to social pressures can act as triggers, and in unclear ways. "We don't have reliable diagnostic, objective tests for any emotional disorder at this point," says Franklin Schneier, a professor of psychiatry at Columbia and a leading researcher into anxiety. "There's no doubt that there's something different going on in the brain—the fMRIs of those with social anxiety disorder can reveal differences in the activation of fear circuitry—but even if you cut a head open, you couldn't definitively tell. There's not one smoking gun."
Indeed, the 886-page fourth edition of the Diagnostic and Statistical Manual of Mental Disorders is premised on the reporting of symptoms and observation of the distress they cause. Many illnesses date back to childhood (such as Khalil Greene's), but others come to the fore only in adulthood (such as Scott Schoeneweis's depression, which was set off by the sudden death of his wife, Gabrielle, in May 2009). "We would love to have hard and fast rules," says professor Stefan G. Hofmann, director of the Psychotherapy and Emotion Research Laboratory at BU, "but such disorders really can happen at any time." Making matters still more complicated, there is no blood test or X-ray that a player can produce to verify his suffering.
The background of one man in particular hints at the difficulty of bridging the gap between the clinic and the clubhouse. Harvey Dorfman, the godfather of mental coaching and the co-author, with Karl Kuehl, of The Mental Game of Baseball (1989), remembers being asked not to stay in the same hotels as the major leaguers he was summoned to counsel. But for all the deserved plaudits he has received for his work in baseball—All-Stars such as Alex Rodriguez and Roy Halladay say he helped save their careers—Dorfman isn't a trained clinical psychologist. He has a master's degree in education and took some courses in psychology, but he was a high school teacher and a freelance journalist for 27 years before he began seeing players with the A's in the '80s. "When I started, there were no graduate courses in sports psychology," says Dorfman, who has also worked for the Marlins and the Rays and is now employed by agent Scott Boras. "I laugh at the guys who are wannabes—people who may get the degree but don't know the game or how to talk to athletes."
The question, then, has been how to elevate the field professionally—and get rid of some of the game's oldest rituals, such as the shot (or two) of vodka that former Mets team psychiatrist Allan Lans often saw players take to deal with stress—without alienating potential patients. "I'm a big believer in credentials," says Conte, who estimates that he receives a résumé from a non-Ph.D. claiming psychological expertise every two weeks during the season. "It does comfort me that there are now more true psychologists and psychiatrists out there."
The biggest step toward striking the right balance was the establishment of the EAP regime by the commissioner's office in 1981. Every team must have a program to deal with the personal issues of players, either directly or through referrals to outside experts. At first the program primarily addressed problems of substance abuse—that's why Karesky was plucked from St. Luke's Hospital in Phoenix by then Oakland executives Sandy Alderson and Kuehl—but now EAP reps from each major league franchise meet twice a year to discuss a greater range of issues, including mental health.
Best practices have emerged. As the Orioles' McDuff noted in a 2005 article for the journal Clinics in Sports Medicine, "dramatically [increasing]" EAP usage rates depended on the regular presence of an EAP staffer at the ballpark, as well as collaboration with the team's physicians, strength and conditioning staff and—crucially—trainers. In Baltimore the EAP usage rate among players had risen from 10% in 1996 to an average of nearly 40% from 1999 to 2004, the early years of the current cultural shift.