Category Archives: mental health

Lesson 2: Admit There Are Things You Don’t Know

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“Well, I am certainly wiser than this man.  It is only too likely that neither of us has any knowledge to boast of; but he thinks that he knows something which he does not know, whereas I am quite conscious of my ignorance.  At any rate, it seems that I am wiser than he is to this small extent, that I do not think that I know what I do not know.”                                                                                  —Plato, Apology

Rest assured: recognizing the existence of uncertainty or confessing to lack knowledge on a given subject doesn’t make one’s position any weaker.  One could do worse, after all, than take the lead from Socrates, who posited that awareness of one’s ignorance is a step along the path of learning.

In that spirit, here’s some stuff I don’t know:
●    What actually happened that day: what the relevant parties said, thought, felt, or did (beyond what is represented in the IADT & CAS reports).
●    If Viktor Troicki has ever used PEDs or was doping in April 2013.  (Some will argue that this is the only thing that matters & since Troicki didn’t submit blood for testing that day, he himself forestalled further discussion of the case.  Obviously, I disagree with that position.)
●    Whether Troicki &/or the DCO deliberately misrepresented anything (to anyone) on the days in question or in their subsequent testimony.
●    Anything about the DCO involved other than what’s contained in (and can be deduced from) the two decisions.
●    What was in the written statements submitted on behalf of the parties or the oral testimony of witnesses at either hearing, unless it was quoted in the case summaries.
●    What I would have done in the position of any of those concerned.
●    Many, many other things—for instance, what’s in appendices two, three, five, or six of this rather lengthy TADP document.

However, since the end of last July, when Troicki’s suspension was first announced, I’ve filled in a few gaps in my knowledge.  At this point, I should probably note that while my blog’s name is a reference to Lucy van Pelt’s sideline offering psychiatric advice, I am neither a medical doctor nor a psychologist.  Luckily, one doesn’t have to be a board-certified MD or a licensed mental-health provider to enter the phrase “needle phobia” into an internet search engine.  Here’s what I learned in a matter of minutes, thanks to Google.

●    “Needle phobia” is the common name for a specific phobia of the “blood-injection-injury” type.  Specialists estimate that between 4-10% of the population suffer from it.
●    A specific phobia—called that because it is an “unwarranted fear of specific objects or situations”—is, in turn, a subset of the broader category anxiety disorder.  As probably goes without saying, both the specific blood-injection-injury phobia and anxiety disorders are medically-recognized conditions, the criteria for which are outlined in professional guides such as the Diagnostic and Statistical Manual of Mental Disorders.
●    Blood-injection-injury phobias (BIP) are marked by “a strong, persistent fear that is excessive or unreasonable,” and can be triggered by not only a present object (e.g., a needle) but also an expected procedure.  Whatever the specific stimulus, the response is anxiety, with physical discomfort and distress that can be severe—that is, a panic attack &/or loss of consciousness.  According to one clinician’s guide, “A person who must face one of these feared activities or objects will immediately begin to feel nervous or panicky, a condition known as anticipatory anxiety…. When it causes a patient to avoid feared situations, anticipatory anxiety can be a major inconvenience; it can even interfere with working” (259).  That the person may be aware his/her fear is “out of proportion to the actual danger or threat in the situation” doesn’t mean he/she has the power to control his/her response to it (6).
●    The condition—aspects of which can be genetically inherited, as well as learned—is a “neglected diagnosis,” in part because people who suffer from it “typically avoid medical care.”
●    Physiological symptoms associated with BIP include: sweat, muscle tension, trembling, heart palpitations, numbness, nausea, dizziness, lightheadedness, pallor, and difficulty breathing.  (While I consulted more authoritative sources than Wikipedia, much of the essential information is on that site.)
●    Significantly, BIP is also the only variety of specific phobia associated with vasovagal response, a type of neuro-cardiac episode involving decreased heart rate &/or blood pressure which can result in fainting.  Even if he/she doesn’t faint, a person suffering from a vasovagal episode “may experience an almost indescribable sensation of weakness or impending doom” (9).
●    As scientific studies have observed, BIPs “can be so severe that they interfere with receiving necessary medical care.”  Also, unlike patients with other kinds of phobia, those who suffer from BIP “are typically less responsive to relaxation techniques, which in fact may be counterproductive.”
●    Because BIP can cause fainting, falls, & associated trauma, it’s important that those drawing blood from a needle-phobic patient be aware of the condition and have ready assistance.

With this information at hand, let’s return to Pete Bodo’s assessment: “Personally, I have some trouble buying the idea that a strapping, 6’3” professional athlete in the full bloom of health is so squeamish that he can’t give blood.”  In concluding his post, Bodo observes, “The reality is that not you, not I, not even the great former No. 1 and six-time Grand Slam champion Novak Djokovic, really knows the truth about how and why Troicki decided to skip that blood test.”  He’s not entirely wrong, is he?  We don’t know the whole truth: after all, none of us were in the room or, more importantly, in Troicki’s body that day.  But here are a few things someone even minimally curious about blood-injection-injury phobia does know: that it’s not about being “squeamish” (consider both the imprecision and connotation of that word choice, if you will); that one of the three basic criteria of the condition is avoiding needle procedures altogether or, when unavoidable, enduring them with considerable distress; and that, yes, a professional athlete—whether “strapping” or not—can suffer from it.  That’s the thing about such medical disorders, which (in Troicki’s and some 75% of needle-phobes’ cases) have both inherited physiological and learned psychological components: they don’t discriminate.  And they don’t cease to exist or cause real difficulty in people’s personal and professional lives because some unaffected others are resistant to “buying the idea.”

While Bodo is certainly not the only tennis expert to establish himself as something less than that when it comes to needle phobia, his invocation of Troicki’s size, strength, and line of work in expressing his skepticism does considerably more harm than others’ inaccuracy or silence on the subject.  For starters, Bodo is among the most accomplished and respected of anglophone tennis writers; so, his word carries more weight than it might if he had a lesser reputation or smaller platform.  Next, he perpetuates ignorance and incuriosity about a mental-health condition by displaying his own—if not proudly, then certainly without hint of self-consciousness.  Further, he reinforces the stigma associated with the condition by implying it’s a kind of weakness.  (Although Bodo didn’t go the extra step of telling the Serb to “toughen up,” plenty of others suggested precisely this as a solution; one example is in the first reader question to which Tignor responds here.)  Not merely privately doubting but publicly questioning if Troicki—neither a tennis aesthete nor one of the WTA’s “tear-stained drama queens” but, let’s face it, a manly man—really suffers from an occasionally debilitating anxiety disorder speaks volumes about Bodo’s assumptions about physical ability, gender, mental health, and the relationship between them.  More than that, it speaks to the freedom people feel to judge and dismiss things they don’t understand.

This sort of attitude wouldn’t be so troubling if it weren’t so common.  That it is, unfortunately, so can be seen in many pop-cultural spheres, though sports appears to be lagging behind other parts of the entertainment industry when it comes to mental-health awareness.  Not incidentally, one of the best pieces of sports writing I read last year is “Man Up,” an essay Brian Phillips wrote on masculinity and mental health in response to a bullying scandal in the National Football League.  Tennis is not the NFL, and the mere fact that the former is an international, individual sport in which women and men compete alongside one another—on the same courts and, often, for equal prize money—means that there is more awareness of and sensitivity to difference than there might otherwise be.  But, as I’ll discuss in the next lesson, tennis is hardly ahead of the athletic pack when it comes to tackling mental-health issues among its ranks.

That Viktor Troicki suffers from a needle phobia—as opposed to being a person who simply “doesn’t like giving blood” or “didn’t want to provide a sample that day for his own personal reasons,” per Richard Ings’ characterizations—is abundantly clear from the IADT summary.  And if one doesn’t want to take Troicki’s word for it that “the giving of blood is something that he faces with trepidation and that induces feelings of panic,” that he has fainted during the procedure in the past, and “that he feels unwell for the rest of the day after” the process, there’s the testimony of Professor Slobodanka Djukić.  A specialist in microbiology and immunology who has treated Troicki in Belgrade, Professor Djukić confirmed that he “reported dizziness with vertigo, nausea and chest pain following the taking of blood samples” (B9I).  We might know even more about his condition had the IADT or CAS quoted from the statement the FFT’s Dr. Bernard Montalvan submitted on Troicki’s behalf.

Since neither the original decision nor the appeal went into much detail about how Troicki has responded to previous needle procedures as an ITF athlete undergoing required anti-doping tests or a human being seeking routine medical care, I decided to look into it myself.  Taking a bit more time than in my initial Google search, I gathered the following information about the condition.

●    Blood-injection-injury phobia—in part because it was only added to the DSM in 1994 and in part because people wrongly assume it’s “a simple issue”—is poorly understood and often dismissed, even by health-care professionals.  Still, as this clinical psychologist notes, “Good management of needle phobia can literally save lives.”
●    One of the challenges of researching BIP is that “the physical body is studied ‘in pieces’ in a number of different disciplines…. This is very apparent when reviewing the quantitative literature in and around needle phobia.  Classification as a specific phobia places needle phobia within the realm of psychology and psychiatry… and yet this is a fear that is accompanied by wide ranging physiological responses” (21).  In other words, while BIP isn’t “all in your head,” it is often regarded as the exclusive concern of proverbial “head-shrinkers.”  Several of the pieces I read indicated that needle-phobes are actually (even if not consciously) afraid of vasovagal syncope, not needles or blood—that is, of their body’s response, not the procedure in question.
●    Though many who suffer from BIP simply try to avoid triggering stimuli (e.g., by staying away from doctor’s offices), the condition can also be managed through alternative injection methods; with medication, from topical anesthetics & anti-anxiety drugs to sedation; and in therapy, particularly of the cognitive-behavioral variety.  Matthews notes that stories about treatment suggest “therapy, at best, needs to be highly individualized and is both very time consuming, expensive, and has variable success” (13).
●    Specific tips for managing phobias can be found here.  It bears repeating that trying to get someone who is needle-phobic to relax may well be the wrong thing to do, as it can actually increase the possibility of fainting.
●    A cognitive-behavioral psychologist I consulted recommended this title from the self-help aisle (and I can attest it makes perfectly decent airplane reading): Overcoming Medical Phobias: How to Conquer Fear of Blood, Needles, Doctors, and Dentists.
●    Unfortunately, “doctors, nurses, and other people tasked with administering vaccinations and drawing blood are not typically properly educated about needle phobia.  They’re accustomed to patients who dislike needles and may reassure them with promises that the puncture won’t hurt or will only take a minute.  But with a true needle phobic, these reassurances don’t work.”
●    As I wish went without saying, “the behaviour, skill and care afforded by health practitioners makes a significant difference in both preventing the development of needle phobia in children… and in lessening the phobic response and reported fear of adults” (13).  Chapter six of Matthews’ study offers recommendations for clinical practice, “in terms of [both] caring for patients with needle phobia and supporting and assisting nurses to provide expert technical and pathic care” (96).  Perhaps someone who works for the ITF &/or IDTM should read it.
●    Some evidence to support the claim that everything’s on YouTube: video tips for medical professionals who deal with patients’ fear of needles during the phlebotomy process.  Of course, not all such fears meet the diagnostic criteria for BIP.
●    Last, but not least, more needle-free procedures may soon be in our future.

What I take away from all of this is that there was nothing in the least unusual about Troicki’s seeking to avoid a needle procedure on that April day—or, for that matter, on any other.  Ings is no doubt correct when he observes, “seeking a pass that day was not necessary.”  At the same time, a statement like this fails to take the nature of the phobia into account.  Although it may not have been medically necessary “to skip it this time,” it clearly felt necessary to Troicki; in his words, he was “not able” to give blood (3.15C).  People with untreated BIP never want to give blood; they’d always prefer to bypass needle procedures—such is the condition.  In a case like this, where occasional blood testing is one of his professional obligations, Troicki has to cope with his condition better than he did that day.  This might be easier for him to do if he sought treatment (for all I know, he has done so over the past year).  In all likelihood, his condition would also be easier to manage if Viktor felt confident that the BCOs with whom he interacts on the job had been trained to deal with the challenges to the routine process someone like him poses.

There are so many “what if…?” questions we could ask about how the circumstances and outcome of that encounter might have been different.  What if Troicki had only been selected to give a urine sample that day?  What if he weren’t already feeling physically ill?  What if he’d encountered a DCO less inclined to be sympathetic and accommodating (this is not my view but, rather, how both Troicki and the CAS interpreted her behavior; see 9.12-14 and 9.28C) and more inclined to speak in authoritative, unequivocal terms about the seriousness of the situation?  I’m sure anyone reading this can think of other such questions.  The hypothetical question I think is most important (because it has implications far greater than Troicki’s one-year suspension) is this: what if the ITF recognized that needle phobia is a psychological disability that needs to be accommodated—for example, by modifying sample-collection procedures, as the International Standard for Testing, adopted by WADA signatories, allows for other forms of disability (see Appendix Four, section 5.4 and Annex B)?  I’ll return to the issue of disability in sports in lesson 4.

As I said at the outset, I don’t blame the DCO for not having been better prepared to handle the predicament last April.  It’s not her fault that “this was the first time [in 15 years of anti-doping work] that [she] found herself in the precise situation which she faced with Mr Troicki” (29aI).  (For that matter, we don’t even know if “the precise situation” refers to dealing with a player who’s requesting to get out of or delay giving a sample, dealing with a needle-phobic player, or both.)  Going forward, however, I will blame the ITF if they do little to learn from what transpired that day.  That writers weighing in on the subject, or other players and fans opining on it, could also stand to learn a bit more is fairly obvious from responses to Troicki’s case.  But the stakes of their not knowing relevant things—and, in many cases, seeming not to be aware they don’t know—are much lower.  Regardless, all those responding, whether formally or informally, would benefit from practicing empathy, the focus of lesson 3.  (Return to the discussion overview here.)

Lesson 1: Do Your Homework

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A little learning is a dang’rous thing;/ Drink deep, or taste not the Pierian spring.—Alexander Pope, “An Essay on Criticism”

Different tennis constituencies—including players, the ITF, and sports journalists—have work to do in order to avoid or better respond to similar situations in the future.  Many discussions of the case have focused on Troicki’s seeming naiveté or ignorance of the Tennis Anti-Doping Programme, suggesting the problem could have been avoided if only he’d known and followed “the rules”—that is, had he not sought an exemption from them in the first place.  This “lesson” identifies and discusses a number of other things that the case reveals need, at minimum, review.

Players
The 2013 anti-doping cases, as well as responses to them, have revealed that some—perhaps many—players don’t know as much as they should about a key aspect of their professional lives.  (We assume they know the rules of the game itself, but not even that is always so, as USA Today’s Doug Robson discovered last year at Indian Wells.)  A few players’ public statements on the issue, including Troicki’s, also raised eyebrows— whether with confusion, concern, surprise, or disapproval.  While top players, especially, have certain media obligations during tournaments, no player is required to answer any specific question from a journalist.  Particularly if asked about a controversial subject, responding with some version of “No comment” is always an option.  Players choosing to speak on the topic du jour—be it time limits between serves, equal prize money, or anti-doping policy and procedure—would do themselves a favor to know whereof they speak.

●    When in doubt about tennis basics, players—as well as fans, media, & officials—can always consult the ITF’s various rule-books.
●    Regarding the Tennis Anti-Doping Programme (TADP), this “wallet card” outlining the essentials is a must-have for both players and their team members (ahem, Jack Reader).  New in 2014: a “wallet card” for mobile phones.
●    That players need to understand the TADP requirements, familiarize themselves with standard procedures, and know which substances are prohibited—as well as, more broadly, what constitutes a rule violation—seems like a no-brainer.  At the same time, I think it’s a bit much to expect players to have read the entire TADP document or to know the sanctions for rule violations they have no intention of committing.  (I don’t know about you, but I can’t tell you how much speeding tickets cost in my city, though I exceed the limit knowingly and on the regular.)
●   As important as players’ TADP responsibilities are their rights.  Note that there are a number of valid reasons for a player to delay reporting to—or temporarily leave—the Doping Control Station (DCS).
●   Significantly, the ITF’s sheet on players’ rights & responsibilities is missing one key point listed on WADA’s Doping Control Form: “If you are an athlete with a disability, [you have the right to] request modifications to the sample collection procedure” (4; I discuss why this might be so in section 4).

Viktor Troicki, were he more familiar with his rights or had he consulted his wallet card (what are the chances that players bring their wallets to the DCS after a match?), may have been able to remind the DCO of the following: “Provided that [players] are chaperoned, [they] may delay reporting to and/or leave the DCS for one of the following activities: …obtaining medical treatment… [and] other exceptional circumstances, which must be approved by the DCO.”  Even if Troicki wasn’t aware of this right, the DCO—noting “he did not look well; he looked tired and weak,” having been informed of his needle phobia, and hearing his concerns about giving blood in this condition—certainly could have sought assistance herself or recommended he seek medical attention from another doctor (11I).

In fact, the CAS addressed this possibility both directly and indirectly.  First, they included the following detail, missing from the IADT report, in their overview of the case’s “factual background”: the DCO’s supervisor, when informed by e-mail of what had happened with Troicki that afternoon, responded by asking, “Did you call for the ATP doctor on site?” (3.21).  Comparing the CAS decision with sections 18-19 & 21 of the IADT document, it becomes clear that the latter presents the matter as if the player’s actions, not the DCO’s, were in question.  After hearing from her supervisor, the DCO made several inquires about whether Troicki had subsequently gone to see a doctor, and even suggested to the ATP supervisor that it “was not good for him” that he hadn’t.  (There’s no indication where that idea originated, but one effect of it in the IADT text is to imply that neither player nor coach took Troicki’s condition seriously.  There are certainly other ways of interpreting the flurry of activity on the DCO’s part, as well as the fact that Troicki wasn’t the one who took the initiative to follow up with officials the next morning.)  Second, they note that they would expect a DCO to “have been provided with the telephone numbers of relevant tournament personnel she could have contacted to assist her in such a situation” (9.28.1). Unfortunately, she wasn’t; nor did her office have internet access.  Third, their conclusion observes that the panel “finds surprising that there is no provision in the [TADP] requiring a DCO to call for the attendance of an ATP representative (for example an ATP doctor) in any case where an athlete refuses or fails to submit a sample collection, for medical or other reasons, or to remind the athlete about his or her rights and duties under the Programme” (10.2).  Not incidentally, while both the IADT and CAS decisions make numerous references to requirements and responsibilities, this sentence contains the only mention of a player’s rights in either document.

The CAS analysis confirms that the DCO didn’t clearly articulate the possible—indeed, likely, if not certain—consequences of failing to submit a sample to Troicki or his coach (see sections 9.9-14 and 9.28).  What the the arbitration panel didn’t do, in my view, is press further regarding other ways the DCO and Troicki could have resolved their impasse.  Specifically, they didn’t seem to challenge a rather beside-the-point comment from the DCO: that “the DCO and his or her assistant cannot leave the DCS” (9.28.1).  As the TADP materials establish, the player may temporarily leave the DCS, as long as he/she is chaperoned.  As it happens, Roger Federer provided an example of such “exceptional circumstances” in London: once, after being selected to provide a urine sample, he couldn’t “go to the toilet.”  “It’s happened to me one time,” he shared; “Then the [chaperone] has to stay with you all night.  It just becomes really complicated.”  (Maybe it’s me, but that sounds more awkward than complicated.  Was Mirka there, too?)  In the case at hand, the player or his coach could have gone to fetch an ATP doctor—whether to provide treatment or to assist with the drawing of blood.  And had Troicki been accompanied by a chaperone over night, his blood test the next morning may have meant much more than it did.  So, while it may be true that the DCO didn’t have the authority to tell Troicki if his medical condition was a “compelling justification” for skipping a blood test altogether, it’s not the case that players aren’t ever allowed to delay giving samples.  Unless I’m misinterpreting the TADP, that is, both Troicki and the DCO had other—likely mutually agreeable—options that fell within the rules.

✍✍✍

As for players speaking to media on anti-doping issues, I was impressed by the measured comments in press from most who were asked about the subject.  (Reactions from the week after the two ATP suspensions were announced are here.)  However, when addressing the Troicki case, specifically, I think a few players erred in saying too much on the basis of too little knowledge.  For instance, Federer’s comments in Shanghai and London suggest he wasn’t following the case very closely (which is, of course, his prerogative).  His general responses wouldn’t be a problem in the least if those quoting them noted that they were just that—general responses.  Granted, it doesn’t make for great copy to quote the GOAT saying, “Uhm, look, I don’t know the conversation, the situation, exactly what happened” or “Honestly, I don’t talk a whole lot with other players about it.”  But it wouldn’t hurt to acknowledge that he is speaking largely from personal experience, so that statements like “I believe whatever [the CAS] decided on” should be taken with a grain of salt, since they’re not coming from someone who has spent much (if any) time looking over their decision.

On the other end of the spectrum from the diplomatic Swiss is Djoković, who was arguably following the Troicki case too closely and not closely enough at the same time.  What I mean is that Novak, while proving to be a loyal friend and passionate advocate of players’ rights, did not always establish himself a master of objectivity or reading comprehension.  This last may be a bit unfair, as I doubt Djoković had time to read a 31-page document (in its entirety or closely) before making his “statement” following a match with Federer the day of the CAS decision.  But, in both London and Beijing a month earlier, Novak made what I think are ill-advised, even irresponsible, comments about the DCO in Troicki’s case, saying “she was lying a lot” and accusing her of “negligence and… unprofessionalism.”  Though I appreciate that he was speaking from the heart, and believe he had plenty of worthwhile criticisms of both the procedure in this case and larger issues of tennis politics, his legitimate points were somewhat overshadowed by the less accurate, more sensational (and thus headline-grabbing) ones.

ITF
As Troicki’s case makes abundantly clear, the ITF—and, specifically, the IDTM firm to whom they’ve outsourced their drug-testing efforts—needs to improve sample-collecting protocols to decrease the possibility that their staff are muddying, rather than clarifying, the waters.  Comparing the IADT and CAS decisions, it’s tough not to be struck by the different pictures they paint.  Little of this helps the ITF’s credibility with regard to anti-doping efforts.
●   The CAS panel’s analysis (especially sections 9.7-14 and 9.27-28) and conclusion merit review by everyone involved in the TADP.
●    ITF president Francesco Ricci Bitti is certainly right to encourage interested parties to read the CAS decision, and probably isn’t wrong that some “critics of Viktor Troicki’s doping suspension have misunderstood” aspects of it.  At the same time, I doubt it’s true that all disagreement with the decision is due to “a problem of words”—for instance, a failure to grasp the difference between “no fault” and “no significant fault.”  Ricci Bitti might earn some credit with players by indicating a willingness to listen to critics’ legitimate concerns about how this case was handled by both the IDTM representative and the IADT, in particular.
●    The ITF has already indicated procedures are “likely to be changed in 2014 to say that, where a player refuses or fails to provide a sample (as Mr. Troicki did), the doping control officer should try to offer the player an opportunity to speak to the event supervisor or referee to confirm the player’s responsibilities under the program.”  Hopefully, this change will also mention that players should be given a chance to speak to a doctor or other advocate—not merely rule-enforcers—before or during DCS visits.
●   From manager Stuart Miller on down, those involved in any aspect of the TADP might review players’ rights under the program (elaborated upon in Appendix 4 of the TADP).
●    The ITF leadership could also stand to reflect a bit more on the fact that the stated purpose of the TADP is not only “to maintain the integrity of tennis” but also “to protect the health and rights of tennis players participating in Covered Events” (1.1).

In reading over the relevant documents, I didn’t find a lot of evidence to support the idea that the DCO in this case did much to “to protect the health and rights” of a player who was physically ill, experiencing anxiety about his needle procedure, and looking to avoid a full-blown panic attack and/or fainting episode when he entered the DCS.  On the one hand, I don’t blame her: regardless of whether the Blood Collection Officer holds a medical degree, it’s not actually the DCO’s job to treat patients.  Instead, as their titles— emphasizing “control” and “collection”—indicate, they are officers of the “law” that is the TADP: specifically, the World Anti-Doping Code (see 1.2, 1.7).  Further, if this DCO was less than adept in handling a needle-phobe, she is hardly unique in this and likely didn’t get much help from the player, as I’ll discuss in the next section.  On the other hand, while they are not technically doctors caring for patients but officers implementing (and, to some degree, enforcing) the “law” upon its “subjects,” BCOs are still operating in the guise of health-care professionals.  The procedure they are responsible for isn’t an administrative transaction (like filling in a form) but one involving fairly intimate contact with real—and sometimes vulnerable—human bodies.  So, in cases like this, as the CAS suggested, it’s reasonable to expect the DCO to seek assistance from another doctor on site or at least advise the player to get medical attention elsewhere since he/she is not in a position to provide it.  Neither of these things happened in Monte Carlo last April.

Nor did I find evidence in the IADT or CAS decisions to indicate that they gave much thought to the matter of Troicki’s “health and rights.”  Although both groups accepted his needle phobia diagnosis as a fact, it was barely discussed in their decisions.  They did acknowledge Viktor’s “stress” as a mitigating factor when it came to determining his penalty (46I).  But they didn’t, in my view, take it sufficiently seriously when addressing whether he had a “compelling justification” for committing the rule violation in the first place or in considering how the ITF, going forward, might adjust their procedures to accommodate needle-phobic players—specifically, with reference to the part of the TADP that addresses, in a limited way, “modifications for athletes with disabilities” (Appendix 4, section 5.4.1 and Annex B).  That Troicki’s preexisting medical condition played a significant role in the interaction between him and the DCO would be self-evident to anyone who understands what needle phobia entails.  But maybe that’s precisely the problem: it’s not obvious that the anti-doping authorities involved—from the DCO on up to the two doctors who sat on the IAD tribunal—had the requisite knowledge.

Nevertheless, the IADT felt free to repeatedly opine on Troicki’s “state of mind” (50I).  Most notably, they judged his credibility as a witness, assessed how “reasonable” he was on the day in question (39, 44I), and concluded that “Mr Troicki acted in the way that he did in consequence of the stress that he was under—in this case, as a result of a combination of his physical condition and his panic at the prospect of giving blood” (46I).  Call me crazy, but it would be my preference that those using “a little psychoanalysis”—as Tignor describes the Tribunal’s process in deciding to accept the DCO’s account of events over Troicki’s—be trained in the field and experienced with the medical condition in question. (The IADT members in this case are specialists in sports medicine, physiotherapy, and anti-doping; as far as I’m aware, no psychologist provided testimony.)

Tennis Experts                                                                                                                Many of those addressing anti-doping policy and procedure need to take greater care with such work, starting with reading the IADT or CAS rulings before commenting on specific cases.  While I’m using “experts” to refer to journalists above all, I also have in mind tv commentators, bloggers, and those with expert or informational power, if not formal positions, in the tennis world.  (Among the second group, for example, I include the anonymous blogger who runs the THASP site and Richard Ings, the former umpire who headed the ATP’s anti-doping program a decade ago, whose Twitter feed focuses on “drugs in sport”).  The expert’s professional position—and social media platform—brings with it some responsibilities.  Since informing readers is first among them, it seems worth double-checking to see that one has gotten the facts right, quoted sources accurately, provided relevant context, and not left out any important details.

For what it’s worth, I don’t blame anyone for not wanting to wade through lengthy documents about the Troicki case.  After all, not every tennis writer relishes close-reading texts or has a law degree (though at least three North Americans—Courtney Nguyen, Kamakshi Tandon, and Jon Wertheim—do).  But if one is going to discuss it in print, can’t we agree there’s a minimum amount of preparation one should do?  After all, an opinion unsupported by a decent grasp of the issues is next to worthless to tennis fans, who can access the reports themselves.

Before proceeding, let me be clear that I don’t think any journalist discussing the case deliberately or maliciously distorted it to favor either Troicki’s or the ITF’s claims.  Repeatedly, though, writers got aspects of the case wrong—or not quite right.

A sample:
1.    A BBC article on the case claimed that “two independent panels have concluded that [the DCO] did inform the Serb of the consequences of leaving the anti-doping room without first providing a blood sample.”  This is simply not so.  The IADT accepted the ITF’s argument that the DCO hadn’t given Troicki “unequivocal assurance, without any qualification” that “he definitely would not be sanctioned if he did not give blood on that occasion” (39, 44I; my emphasis).  Further, the CAS agreed with them that the DCO a) told Troicki that she did not have the authority to determine if his reason for delaying the blood test was valid, and b) eventually got him to sign the BCF acknowledging awareness that his behavior “may be treated as an anti-doping rule violation” (12I, my emphasis; the corresponding phrases in 9.29C note that he “could” or “might face sanctions”).  However, they were quite critical of a number of things the DCO “did and did not do,” going so far as to say that she’d “failed to heed [IDTM] recommendations” that might have prevented Troicki from exiting the DCS believing there would be no problem (9.11, 9.13C).  Notably, there was no evidence that the DCO told Troicki that the standard penalty for breaking the rule in question is a two-year suspension.  Had she done so, there would have been no need for this information to be conveyed in a footnote of the IADT ruling (40I) and, needless to say, no reason for the CAS to make the recommendations they did (10.2-3C).

2.    Predictably, Serbian media were most interested in Troicki’s version of events and the reactions of their other top players.  Unfortunately, there was widespread failure to note that short of the CAS overturning the IADT decision, the one-year mandatory minimum ban was the best possible outcome for Troicki.  Nor did local journalists correct Djoković’s assertion that his teammate’s not being allowed to enter Belgrade Arena during the final stages of Davis Cup was “not a normal situation.”  Who knows if ITF spokesman Nick Imison’s idea of circulating hard-copy excerpts of the relevant policy for suspended players resulted in more accurate coverage of the matter; after all, a headline quoting Novak—“Troicki’s not a terrorist or murderer”—draws more eyeballs.

3.    In various English-language outlets, including Sports Illustrated, Troicki’s reasons for seeking to avoid or delay having blood drawn were understated, with writers saying Troicki didn’t “give a sample because he said he felt unwell,”  “was ill on the day,” or was “too sick.”  (In fairness, both Nguyen and Wertheim had mentioned Troicki’s fear of needles in earlier posts on the topic, although only the former used the clinical term “phobia.”)  Still other articles, while raising plenty of good points about the case, didn’t mention Troicki’s mental &/or physical condition—only that he did “not want to take a [blood] test.”  Such oversights seem telling, even if it’s not obvious what they’re saying.

4.    Unsurprisingly, then, top players also described aspects of the case in incomplete, if not entirely inaccurate, ways.  For example, Federer: “I do believe that when you are requested for a sample, you have to give the sample.  It doesn’t matter how bad you feel.  I’m sorry.”  As I’ll elaborate in the next section, “feeling bad” doesn’t adequately capture what’s involved during a needle-phobic episode; nor does it address the other factors contributing to the misunderstanding between Troicki and the DCO.

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At the risk of alienating my friends at Tennis magazine, I’ll single out their colleague Pete Bodo for not doing his homework before weighing in on the matter.  Focusing on three sentences of his “Three Controversies” post should be enough to make my point.  Bodo offers: “Personally, I have some trouble buying the idea that a strapping, 6’3” professional athlete in the full bloom of health is so squeamish that he can’t give blood.”  I’ll get to the most problematic parts of this comment in the next section.  Suffice it to say here that anyone checking Troicki’s ATP profile will learn he’s 6’4”; further, witnesses to the day in question attested to his lack of a rosy glow (including the DCO, who had nothing to gain by doing so).  It may seem petty or pedantic to call attention to minor errors like this, but my motivation is a serious one.  If readers can’t count on writers to get basic, easily verifiable facts right, how can we trust them on more complicated matters of interpretation or argument?

“What happened to Troicki was a manifestation of the drug-testing protocol working exactly as it should,” Bodo continues.  Other than Stuart Miller and other ITF executives looking to save face in the wake of a major controversy, how many people familiar with the case would endorse this claim?  Bodo is, of course, welcome to disagree with Djoković—and to agree with the CAS and virtually everyone in the anglophone media—about whether Troicki had a “compelling justification” for failing to give blood when selected.  But even those who take no issue with the ultimate outcome of the investigation and appeal are likely aware of the problems with the ITF’s testing procedure illuminated by Troicki’s case.  Can’t or don’t want to read the full CAS report before pressing “publish”?  That’s ok.  You could skip ahead to its conclusion and peruse two paragraphs to discover this statement is off-base.  If you have a bit more time on your hands (say, enough to read five pages), you could look over the measured criticisms of the process in section 9, too.  For that matter, you could read Steve Tignor’s analysis of the decision, posted the day before his colleague’s piece.

According to Bodo, the ITF’s testing protocols operate by way of the “same rules for all, zero tolerance for cheats or excuse making.”  This statement is fine—in the abstract.  But how well does it apply to Troicki’s case, in particular?  Not even the ITF tried to prove that the Serbian player was a “cheat.”  Those who read the CAS analysis know the panel agreed with the IADT’s finding that “there is no suggestion that this failure or refusal [to give blood] was in fact prompted by the player’s desire to evade the detection of a banned substance in his system” (9.28.4).  Was Troicki “making excuses” on that April day or engaged in “outright lying” subsequently?  Interestingly enough, all four aspects of his argument for “compelling justification” (a pre-existing needle phobia, physical illness, a panicked state of mind, and the DCO’s lack of clarity) were either accepted as fact or granted considerable weight by the CAS.  They’re the reasons, after all, that his appeal was partially upheld.  Lastly, is it even a good idea for the system to treat a player with a needle phobia the same way that it treats a player without one—that is, to fail to acknowledge or accommodate a disability?  The criticisms Djoković and others have made is not of a rule, per se, but of how it was and should be implemented in practice.  In sum, Bodo’s presentation of the case leaves a lot to be desired and leads us to lesson 2: feel free to admit when there’s something you don’t know.  (Return to the discussion overview here.)

Headcases & Homework: Reactions to Viktor Troicki

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Preface: I posted parts of this introduction in December, then decided to hold off on the rest until the completion of Troicki’s ban.  Now that he’s returned to action, the time seems right to reflect on what we did and didn’t learn from his case.

In a review of the 2013 tennis season, Steve Tignor called doping suspensions the “controversy of the year.”  Here, I’ll focus on reactions to the case that generated the most debate, aiming to develop a point Tignor makes at the outset of his column: “the game’s testing system remains a learning process for all concerned.”  Perhaps unlike him, I consider those concerned to include not only players and doping authorities but the tennis media and fans as well.  Because I’m not writing for a tennis publication, I’ve also got more latitude in drawing four general lessons from Troicki’s case and connecting them to issues in the wider world.  So, expect fewer citations of anti-doping policy from me and more references to psychology, philosophy, and even literature (does Peanuts count as “literature”?).

As will become increasingly clear, I’m interested in one dimension of the Troicki story above all others: the mental-health angle (an imperfect phrase I’ll parse in lesson 2).  Why this is so has partly to do with the extent to which it seems to have been neglected in most discussions of the case, and partly to do with how important the matter of mental health is—not simply in this specific instance, or sports more generally, but in life.

After this introduction, I’m not going to rehearse familiar details of the case, as they are available for all to read and have been dissected elsewhere.  Instead, I want to stake out a position from the start: I believe this incident, including how it was resolved, raises more questions than many others writing about it (not least, those publishing 140 characters at a time) seem to.  Further, I don’t think it makes sense to separate the issue of whether Troicki submitted the required blood sample that spring day in Monte Carlo from that of why he did or didn’t do so—something we can’t address without exploring his needle phobia in greater depth.  Troicki’s failure to fulfill his professional responsibilities has gotten plenty of attention.  What has generated less discussion than I think they deserve are his rights—how he should, ideally, have been treated as both a professional tennis player and a human being.

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Analyses of the case, including the ITF’s Independent Anti-Doping Tribunal (IADT) and Court of Arbitration for Sport (CAS) appeal decisions, tend to rest on three questions.  The first is about as straightforward as they come: “Did Viktor Troicki give a blood sample immediately after he was notified that he’d been selected for testing?”  Since Troicki himself doesn’t dispute that the answer to this is “No,” most concluded that he had clearly broken an anti-doping rule and moved on to the second question, one of judgment rather than fact: “What is the appropriate sanction for this violation?”  Not even Troicki’s staunchest public defender, Novak Djoković, argued that his compatriot bears no responsibility for what transpired in Monte Carlo: “as a tennis pro, our job is to play, of course, tennis and respect all the rules and know all the rules of our sport…. I’m not saying that it’s completely not his fault,” the Serb acknowledged during the World Tour Finals in November.  But because he nevertheless regards the outcome of the appeal as a “total injustice,” we can assume Djoković disagrees with the CAS on the stickiest point: “Did Troicki have a compelling justification for failing to provide a blood sample?”

Like many others viewing the case, the then-ATP #2 zeroed in on the “he said, she said” conflict between the player and the Doping Control Officer (DCO) as central to the case. (Though one is tempted to refer to them as “patient” and “doctor,” this is would be a mistake, for reasons I’ll elaborate in lesson 1.)  Did the DCO tell the player that “it will not be a problem” and it “should be all right” if he didn’t give a blood sample that day, as Troicki claims (16c, 3.13.1*)?  Whereas the IADT found the DCO’s account much more credible than Troicki’s (and thus concluded the DCO had not offered “an unequivocal assurance” [39I]), Djoković, unsurprisingly, believed the word of his friend of nearly twenty years.  Though they still assigned the player a degree of fault, the CAS panel scrutinized the DCO’s role in the interaction more closely, calling it “a misunderstanding,” enumerating a number of the DCO’s “acts and omissions” that contributed to it, and reducing Troicki’s suspension to the ITF-mandated minimum of one year (9.9, 9.14).  As Tignor has observed, “Djokovic may not agree with the CAS’s decision, but the CAS agrees with him,” offering both criticisms of the procedure and suggestions for how it might be improved.  Given that the CAS determined Troicki bore “no significant fault or negligence” with regard to the rule violation, it’s entirely possible they would have reduced his penalty still further had that been an option.  (*Parenthetical citations refer to paragraph numbers in the two rulings, abbreviated I for IADT and C for CAS.)

I take a different position from both Djoković and the CAS, though I similarly focus on the interaction between player and DCO, as well as between the DCO and others, including her supervisor at IDTM, to whom she reported immediately after the initial encounter.  (Those familiar with the case will recall that player & officer met again the next day, at the latter’s initiative; see 21-24I and 3.22-25C for details).  Troicki’s team argued that the case against him should be dismissed due to four intertwined factors: not that “the facts of his illness at the time, his phobia of needles and his panic at the likely physical consequences for him of giving blood would of themselves amount to ‘compelling justification’” for not providing a sample that day but, rather, that these three things “in conjunction with” the DCO’s assurances do (38I).  Based on my research, I believe their interaction was likely complicated by additional factors not discussed in the IADT report and mainly alluded to by the CAS: namely, that Troicki was not aware of his rights—particularly, but not only, as a player with a disability—and that the DCO was both unaware of (or ignored) other options available to her and ill-equipped by her training to handle someone experiencing a phobic reaction to the prospect of a needle procedure.  Ultimately, both of the latter, if accurate, are failings that must be addressed at the administrative level by the ITF.

Because I was not in the room last April and, more importantly, am not an expert on needle phobia, some of my claims are necessarily speculative.  (Call those “thought experiments,” if you wish.)  The evidence I invoke to support my points, I hasten to add, is not.  My view, developed at what is almost certainly too great a length for most readers, is that Troicki’s was a mismanaged disability case, in addition to—or perhaps more so than—a case of a Tennis Anti-Doping Programme (TADP) violation.  In other words, I believe the above-mentioned circumstances amounted to compelling justification for Troicki’s breaking the rule in question.  In the best-case scenario, of course, that would have been avoided altogether through a joint effort by both player and DCO, in consultation with other officials on site and in line with established policy.  However, I don’t believe that Troicki’s condition at the time or lack of awareness of his rights is a justification for representatives of the ITF not to respect them, either during or after the fact.  It’s obviously too late now for the CAS to reconsider the case or for Troicki to get a year of his professional life back.  But given that similarly challenging situations may arise, with Viktor or another needle-phobic player, both the ITF and those governed by their rules need to be better prepared.  In order for that to happen, policy and procedure related to the taking of blood samples require updating, and affected players and staff need educating.  Such things, in short, will require advocacy and follow-through on someone’s part.  While, to my knowledge, no one with power to effect change is actively discussing these issues or pursuing them through concrete steps, I hope to be corrected.

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From Umag, where Troicki first learned of the ITF’s decision to suspend him, to Washington, where other ATP players responded to the news, from Belgrade to Beijing and London to Lausanne, this case made for much controversy.  On Twitter, in online comment sections, and in press conferences—not least, of Serbian Davis Cup team members—there was often more heat than light.  The source of this heat ranges.  Look and you will find strong emotions, misinformation, ignorance, hyperbole, conspiracy theories, and (what is to me) unwarranted certainty.  Also significant are a number of oversights, oversimplifications, and silences, the reasons for which may be more difficult to pinpoint.

In case anyone reading needs this reminder: learning is a lifelong process.  Here are highlights from the lessons I’m taking away.  For further discussion &/or more sources, please click on the individual section numbers.

1. Do your homework.

A little learning is a dang’rous thing;/ Drink deep, or taste not the Pierian spring.  There shallow draughts intoxicate the brain,/ And drinking largely sobers us again.
—Alexander Pope, An Essay on Criticism (1711)

Different tennis constituencies—including players, the ITF, and sports journalists—have work to do in order to avoid or better respond to similar situations in the future.  Many discussions of the case have focused on Troicki’s seeming naiveté or ignorance of the TADP, suggesting the problem never would have arisen if only he’d known and followed “the rules”—that is, had he not sought a partial exemption from them in the first place.  This section identifies and discusses a number of other things that the case and subsequent coverage reveal need, at minimum, review.

Troicki’s resistance to having his blood drawn at the requested time was greeted with surprise and incredulity in both media and player circles.  A typical response, for instance, was to point out that “the rule is there for a reason and is pretty simple.”  The thing is, there’s not much evidence to support the claim, made by too many to name, that Troicki disregarded or didn’t understand the rules.  He reported to the Doping Control Station directly after his match, gave the required urine sample, and then asked to be excused from giving blood; he also delayed signing the requisite form until after he’d had a discussion with the DCO.  Say what you will about those last two steps and their implications (and I’ll say lots more about the former), the fact is that neither of them is against the rules and actually show an awareness of them.  Nevertheless, people discussing the case and Troicki’s reaction to the penalty implied that he “arbitrarily” broke the rules by “skipping” a test, as if he rather capriciously failed to show up altogether, and was then confused about why he got in trouble.

One of the most frequently misrepresented aspects of the case is the suggestion that Troicki asked to and “claims he was told by the ITF official that he could take the test the next day.”  In fact, Troicki did not ask to take the blood test the next day.  What he was after was not a 24-hour delay but a pass, essentially, until the next time he was randomly selected for testing.  Per the IADT report, “he asked if there was any chance that he did not have to give blood on that occasion” (15b).  In Troicki’s own words, from the explanatory note he appended to the required form: “I always did blood tests before, and I [will] do them in the future, but today I was not [able to] provide [a] blood sample” (15e; my emphasis).  That he ended up giving blood the next day is almost entirely a result of the fact that the DCO herself initiated contact with him.  She went looking for him, enlisted the ATP supervisor’s help in finding him (recall that, as he had lost the day before, Troicki was officially out of the tournament), and told Viktor “there could be a problem” (see sections 21-24I).  Upon hearing that, as if for the first time, the player then asked, “Does it make any sense to do the blood test today, since I am feeling better today?”  If the DCO were entirely confident about how she’d handled the previous day’s encounter, would she have gone in search of him and would he have had the opportunity to ask this question?  We’ll never know.  But the fact is that she certainly didn’t need to talk to him or take his blood the next day.  Nor was that procedure something Troicki, who left the DCS the day before thinking he’d gotten out of the blood test altogether, is likely to have requested if left to his own devices.  Why this is so will be discussed in the next section.

2. Feel free to admit when there’s something you don’t know.

Socrates: “Well, I am certainly wiser than this man.  It is only too likely that neither of us has any knowledge to boast of; but he thinks that he knows something which he does not know, whereas I am quite conscious of my ignorance.  At any rate, it seems that I am wiser than he is to this small extent, that I do not think that I know what I do not know.”                                                                                              —Plato, Apology

Rest assured: recognizing the existence of uncertainty or confessing to lack knowledge on a given subject doesn’t make one’s position any weaker.  One could do worse, after all, than take the lead from Socrates, who posited that awareness of one’s ignorance is a step along the path of learning.

Unfortunately, saying “I don’t know” doesn’t bring many readers to one’s website, newspaper column, or talk-show (for you youngsters, a “podcast”).  Journalists, bloggers, tweeters, and other sports commentators make a name for themselves and develop a following by having opinions and being able to come up with them as quickly as the news cycle (or tennis calendar) demands.  This is obviously not the place to diagnose the current condition of sports journalism.  Rather, I want to point out that the need to say something—fast and frequently—can yield less than well-supported views and positions, which are often not adjusted, even if or when new information is acquired.

In terms of the Troicki case, needle phobia is the topic most commenters would have done well to acknowledge an insufficient grasp of—both in general and in terms of how it may have affected the events of that specific day.  Many addressing the controversy simply ignored this aspect of the incident (which is certainly one, if not the best, way of dealing with the unfamiliar).  But some writers took the opposite approach: not proceeding as if it didn’t exist or wasn’t worth discussing but acting all-too-certain about its relevance.  As I’ve noted above, I think Troicki’s needle phobia is central to understanding the case; hence, it’s the focus of this “lesson.”

I’d already written this section when I ran across a recent piece that’s an example of the type of thing that set me off on a weeks-long research binge last November.  As a result of that reading, I can state with confidence that Troicki’s needle phobia is a corroborated matter of fact.  It’s a preexisting medical condition with both psychological and physiological symptoms—not a claim, not a suggestion, not a figment of his imagination, and not an “excuse” Viktor came up with one day because he was selected to submit a blood sample.  It was accepted as such by both the IADT and the CAS on the basis of, among other “clear and convincing evidence,” the testimony of one of the French Tennis Federation’s chief medical officers, Dr. Bernard Montalvan (9I).  In spite of this, numerous journalists felt free to dismiss it as a significant factor in the case—in the process, casting doubt not only on Troicki’s word (plus that of his coach, trainer, father, Davis Cup teammates, and friends/colleagues since childhood like Andrea Petković) but also, if indirectly, on that of the medical experts who submitted statements supporting it.

While this may seem, to some, an overly strong reaction to the skepticism, my view is that any journalist who suggests this part of “Troicki’s story was not corrobarated [sic] by the authorities” is open to numerous charges, including poor reading comprehension skills, sloppiness, laziness, irresponsibility, &/or bias.  Frankly, unless you’re an experienced phlebotomist, psychologist, or someone familiar with current thinking on blood-injection-injury phobias, I don’t want to hear your musings on whether “having a little blood drawn was. . . going to harm Troicki if he was feeling a little under-the-weather.”  In fact, I think it’d be best if no one heard such ill-informed speculations.  I do my best in this section to help readers become more informed about the condition and consider the ways in which it may have influenced matters for both Troicki and the DCO that day.

3. Practice empathy.

As we have no immediate experience of what other men feel, we can form no idea of the manner in which they are affected, but by conceiving what we ourselves should feel in the like situation.  Though our brother is upon the rack, as long as we ourselves are at our ease, our senses will never inform us of what he suffers.  They never did, and never can, carry us beyond our own person, and it is by the imagination only that we can form any conception of what are his sensations.  Neither can that faculty help us to this any other way, than by representing to us what would be our own, if we were in his case.  It is the impressions of our own senses only, not those of his, which our imaginations copy.  By the imagination we place ourselves in his situation, we conceive ourselves enduring all the same torments, we enter as it were into his body, and become in some measure the same person with him, and thence form some idea of his sensations, and even feel something which, though weaker in degree, is not altogether unlike them.  His agonies, when they are thus brought home to ourselves, when we have thus adopted and made them our own, begin at last to affect us, and we then tremble and shudder at the thought of what he feels.  For as to be in pain or distress of any kind excites the most excessive sorrow, so to conceive or to imagine that we are in it, excites some degree of the same emotion, in proportion to the vivacity or dulness of the conception.
—Adam Smith, The Theory of Moral Sentiments (1759)

None of us—not members of the two tribunals, the tennis media, other players, or the author and readers of this piece—witnessed what happened in the Monte Carlo tournament DCS that day.  Though we may have read Troicki’s brief version of events in the case documents or a handful of interviews, what we haven’t heard in vivid detail is what it feels like for him to go through a phobic episode.  I suspect there are good reasons for this.  For example, while the word “phobia” appears three times in the IADT (B9, D38, E46) and once in the CAS decision (3.8), Troicki himself doesn’t use that word in any of his quoted statements.  This linguistic choice, which likely reflects “a tendency to downplay the fear and the significance it had in [his life],” aligns with what researchers have observed: “The very nature of the fear means it is not generally thought or talked about” (54, ii).  Nevertheless, it’s unfortunate because it means we’re missing a key part of the story.  But even in the absence of first-hand experience, observation, or abstract knowledge of something (what some might call “book learnin’”), we can still use our imaginations.

This section focuses on the difficulty of talking about mental-health issues in public—and thus, of combating both ignorance and stigma.  These difficulties may very well be why we haven’t seen much discussion of Troicki’s condition in media reports on his case. However, recognizing that something’s unfamiliar or difficult isn’t a reason to avoid it.  On the contrary, it’s a reason to pursue it by whatever means we have at our disposal.  My effort is ongoing: I’ve reached out to the player’s representatives and hope to interview him once he’s settled back into the routine of week-in, week-out life on tour.  But there’s no guarantee he’ll be willing to delve into the topic that I think most needs his insight.  After this “lesson,” I hope more people will understand why Viktor might be reluctant to do so on the record.

It’s worth emphasizing from the outset that practicing empathy in this case doesn’t necessitate changing your position on whether the CAS decision was correct or Troicki’s suspension just.  What I’m most trying to encourage readers to do, going forward, is imagine what needle-phobes (in general) and needle-phobic players (in particular) experience every time they’re faced with a blood-drawing procedure.

4. Acknowledge ambiguity & complexity.

Theory is good, but it doesn’t prevent things from existing. —Jean-Martin Charcot

The Judge does not make the law.  It is people that make the law.   Therefore if a law is unjust, and if the Judge judges according to the law, that is justice, even if it is not just.                                                        —Alan Paton, Cry, the Beloved Country (1948)

This section is dedicated to two groups, in particular: those, like Andy Murray, who seem to believe that following the rules is the (only or best) solution to the problems Troicki’s case presented; and those who haven’t to this point understood why some think the outcome of the CAS decision was unjust.

If you’re someone who has made categorical statements along the lines of “Read and respect the rules and everything is very simple,” “He should have taken the test,” “A player would only refuse to be tested if there was something to hide,” or “No excuses,” this section’s for you.