What are ultramarathoners running from?
Participation in ultramarathons is booming. But a growing body of research shows that a startling number of runners who tackle these distances are battling complex psychological issues
IT’S AN OVERCAST day in Sydney with the cloud coverage keeping the Spring temperatures unusually cool. “Perfect running conditions,” says Jack Hanley with a grin.
Frankly, it’s hard to imagine what kind of weather could stop him. It’s just past midday but Hanley has already run 65 kilometres and still has a long way to go. After fuelling up on a McChicken Sandwich and a chocolate thick shake, the 28-year-old landscaper is now pacing around Centennial Park as he waits for his stomach to settle enough to pick up the pace. “I usually eat my lunch and walk 3km to digest,” he explains. “Then I’ll start running again.”
The reality is that Hanley can’t afford to stop for long. The ultrarunner is speaking on day 40 of his ambitious bid to run 10,000km in 100 days, an effort that’s so far taken him in a roundabout route from Cairns down to Sydney. A slightly built figure with a mullet and wispy ‘tache, Hanley concedes he’s already fallen about 870km behind schedule. His original aim was to try and knock off 100km each day, but his battered limbs rebelled at the prospect of tackling that unforgiving mileage over and over again with no respite.
“Nothing has gone too wrong physically so far – just a couple of little niggles here and there – but the hardest thing has been the fatigue,” he says. “I’ll do four days in a row where I manage to run 100km. But on day five my legs just don’t want to move for me, not because they’re stiff but I just have no energy.”
Despite that mounting exhaustion, Hanley is battling on. Each morning, he squeezes his runners onto his swollen feet before coaxing his aching body into a stiff-legged shuffle, hoping that, after a while, his body will eventually find some form of tolerable rhythm. But what also keeps Hanley going is that he’s running for his newly established mental health charity, Miles4Smiles. He’s aiming to raise $430,000 during his run to reflect the almost 43% of Australians that reportedly struggling with mental health issues.
Hanley is personally invested in the cause as he’s struggled with his own mental health and addiction issues in the past. “Cocaine was the worst,” he admits. “I had no ‘off button’ and would just go until all hours of the morning.”
Going to rehab in 2020, helped Hanley to initially get off the gear, but he credits running with making the real difference to his recovery. “Running has been a great tool and it’s certainly helped my mental health a lot,” he says.
“The feeling that you get after a run is the thing I love about it. If I’m having a bad day now, I’ll drop on my two shoes and go for a run and instantly feel better afterwards. Whereas back in the day I’d just go and get on the beers. I get the sort of same feeling from going for a long run that I used to get when I was out partying.”
HANLEY IS HARDLY the only person who’s found a form of redemption through long-distance running. There’s a reason why #runningismytherapy has emblazoned more than 1.3 million Instagram posts. For some people though, the slogan is more than a humblebrag and takes on a very literal meaning. A number of endurance athletes have publicly revealed how they use running as a personal tactic to manage some form of mental illness, trauma or addiction.
A library of memoirs explores the way that distance running can help people escape their destructive habits ranging from meth (Reborn on the Run by Catra Corbett) to booze (I Swear I’ll Make It Up To You by Mishka Shubaly) to crack cocaine (Running Man by Charlie Engle). Then there are the books that hail the healing powers of running for other psychic ailments from mental distress and anxiety (Depression Hates a Moving Target by Nita Sweeney) to deep-seated grief (The Long Run by Catriona Menzies-Pike).
The latter book distils how, if you’re struggling in some area of your life, running can conjure a valuable sense of order and control. “It’s my guess that the structure of training programs is what leads so many avowed non-runners to attempt marathons when their lives fall apart,” writes Menzies-Pike, a Sydney writer who discovered the benefits of running after her parents were killed in a plane crash.
These books reflect our growing fascination with ultra-endurance sport – classified as running any distance over 42 km or tackling any other distance event that lasts for six hours or more. A 2021 report revealed a 1676% increase in ultramarathons since 1996. Back then, there were 34,401 participations, a figure that by 2021 had rise to 611,098 worldwide.
You don’t have to have attempted the Marathon des Sables to appreciate how running can offer a practical form of mental salve. Set out on any reasonable length run and, at some point, your mind will start to unspool amid the rhythmic patter of your footsteps. Running can induce a form of mindfulness in motion as you’re compelled to engage in the present moment as you navigate the changing terrain. There’s also a heavy-handed symbolism inherent in the activity. Inclines may steepen, the rain may hammer down, but running teaches you to keep pushing forwards even when the going gets tough. That sense of positive momentum can take on an oversized power when you’re stuck in an emotional rut. In this way, running presents the chance to demonstrate your self-mastery and prove you’ve got the power to triumph over hard things.
The mood-boosting properties of the action are not imaginary. Running releases feel-good endorphins in the brain including dopamine and serotonin that act as natural painkillers during physical discomfort and which – if you’re lucky – can lead to the fabled runner’s high. Whether you’re pounding the pavement or dodging tree roots on a trail, running also helps to regulate your body’s release of the stress hormone cortisol and is proven to lead to improved sleep quality. One small study even claims that running can be as effective as antidepressants on improving depression and anxiety symptoms.
If running is beneficial for both mind and body, you might assume that doing more of it is a good thing. But a new wave of research is now questioning that perceived logic. When it comes to endurance sports, it argues, you really can go too far.
“Exercise can be really, really good for mental health and can be used to manage low level depression,” says Suzi Cosh, associate professor in clinical psychology at the University of New England in NSW. But she also stresses that there are limits to its power and efficacy.
Last year, Cosh published research on the relationship between mental health and compulsive exercise – a condition defined as a craving to train where people feel distress or guilt if they’re unable to get their fix. Interviewing more than a 1000 people, the study found that compulsive exercisers were more likely to have clinical levels of depression, anxiety and stress.
“Some people, I think, use exercise as a way of coping that’s more about avoidance,” Cosh suggests. “It’s avoiding thinking about the problem, avoiding those feelings, and channeling that into the running or into whatever their activity is… Running might help your mood feel a bit better right now, but it’s probably not going to resolve the actual issues that have got you to where you’re at. If people do have clinical symptoms, then running is not going to be enough on its own.”
SPEAKING TO MEN’S HEALTH over Zoom from her home in Italy, Jill Colangelo still has the lithe but steely frame of a triathlete and ultrarunner. She’s now retired from such pursuits, but is using her accrued wisdom in her role as a researcher in the Department of Forensic Psychiatry at Switzerland’s University of Bern specialising in the relationship between mental health and ultra endurance sport.
Last year, she wrote a narrative review paper that analysed data on the prevalence of mental health disorders in ultra endurance athletes. The results showed this was an underrepresented topic in sports medicine, identifying 25 papers that showed evidence of psychiatric issues and vulnerabilities in competitors. Eating disorders were evident in 15, depression in nine, anxiety in five, alcohol use disorder in two, psychosis in one and ADHD in one. “There is evidence of increased psychiatric disorders in the ultra-endurance-athlete (UEA) population, despite the known mental-health benefits of exercise,” the study explained. “Anecdotally, it could be argued that mental illness is a commonly recognised feature of the UEA community.”
There’s no denying that physical activity is largely a force for good, Colangelo admits. “But there is a place after which that U-shaped curve starts to turn down again, and we start to see that physical activity can have a detrimental effect, not only physically – we know you can literally run yourself into the ground – but that the mental health benefits also have a point after which we’re doing more harm than good.”
How then do we explain the dramatic number of mental-health difficulties in this super-fit demographic? Are people susceptible to these issues more likely to seek out ultra-endurance pursuits as a way to cope? Or do these wildly strenuous activities contribute or even provoke the conditions? The truth, Colangelo says, is that more research is needed. “As a scientist, I will tell you that there is evidence that both options are a possibility.”
Yet drawing on her personal insights as a former athlete who ended up with overtraining syndrome and who now mentors others suffering from the condition, Colangelo suspects that certain types of personality do gravitate towards these extreme pursuits. “
“Quite honestly, I think the sport scratches an itch. I really do,” she says. “That itch may take on different forms in different people, but I do think that there is something about ultra endurance sports that is compelling for a certain population of people because it does a number of things which, at first glance can appear to be healthy, but that can also substitute or compensate for other bad habits.”
The nature of that specific itch can massively vary, Colangelo says. Some people use ultramarathons to hide their eating disorders. Others come to the sport to manage substance abuse habits. Neurodivergent people can be drawn to the intense routine and level of preparation that endurance sport requires. Then there are those, she continues, who’ve suffered a situational trauma whether it’s recovering from a divorce or bereavement and seek the distraction of a long-term goal.
Yet whether running ultramarathons constitutes a healthy coping mechanism depends entirely on the individual and the specific nature of the issue they’re trying to deal with. Complex issues, Colangelo insists, require multi-faceted solutions and ultra-endurance sport is unlikely to work as a magic fix-all.
“If you are hoping that you can rest your mental health protocol on just running or just triathlon or whatever your ultra-endurance flavour is, you are asking that sport to do a lot of work,” she says. “One thing cannot be everything, by definition. The amount of pressure that you’re putting on that one thing to hold everything up, even just by physics, is unlikely to work.
“I advise people that our mental health approach needs to be multifactorial. It needs to have, yes, some physical activity, but also some social interaction, good nutrition, sleep, maybe a therapist, hey, how about some meditation too… In today’s complex world, we are all in need of a grab-bag of options rather than just focusing on one thing.”
CORY REESE IS unusually qualified to comment on this subject from both a personal and professional perspective. Having worked as a therapist for more than 20 years, he’s deeply familiar with treating mental-health problems. The 46-year-old is also a veteran runner having completed dozens of notorious ultras including Badwater, the 217-kilometre run across Death Valley commonly known as the world’s toughest foot race.
Yet what sharpens Reese’s insight is that he’s wrestled with depression himself, a condition that began five years ago following two life-changing events.
Living in Utah, he was brought up in the tight-knit Mormon community, so when he and his wife decided to leave the church it had severe repercussions on his relationships with family and friends. “I had to rebuild my whole identity and peer group. It was a really big life adjustment.” Reese says. While still trying to process this transition, he was then diagnosed with a chronic health condition called common variable immunodeficiency disorder (CVID), a genetic disease where your immune cells don’t make antibodies. Rocked by these challenges, his mental health began to fray.
“I had no idea what depression really was until I really experienced it myself,” he says. “Just that suffocating, smothering darkness where you feel like it’s hard to see a light at the other end of the tunnel.”
Does Reese believe his running habit was a positive force in helping him to cope? The answer, he says is “complicated” and it’s a subject that he explores at length in his memoir, Stronger Than the Dark: Exploring the Intimate Relationship Between Running and Depression.
On one level, Reese acknowledges that running was good for his mental health due to its physiological benefits. He was grateful, too, for the camaraderie of the ultra-running community that’s famously tight-knit and supportive. “The downside is that your identity can get tied to running,” he says. “And if that’s your primary source of coping with difficult things, then what do you do when that gets taken away? Suddenly you’re left with no coping skills.”
In the process of learning to manage his CIVD – a condition that requires weekly blood infusions to boost his immune system – there were periods when Reese was unable to run. “That highlighted the importance of having other coping strategies,” he says.
But he also believes one of the fundamental tenets of the ultrarunning ethos may have compromised the way he initially dealt with his depression. If you’re preparing to tackle a multi-day trail race, Reese explains, you need to foster a level of self-sufficiency and inner grit. Shoelaces will break, water bottles will leak, injuries will occur miles away from an aid station. Successful endurance athletes therefore have to be good problem solvers, too, in order to handle such challenges when they’re sleep-deprived and physically broken. That battling spirit is, understandably, venerated in the ultra-running world. Yet that same attitude can be problematic elsewhere.
“You end up kind of defaulting to self-reliance, because in a race you’re the only one who’s able to put one foot in front of the other, for mile after mile after mile. No one else can do it for you,” Reese admits. “But that mindset can then get instilled and show up in other areas of your life, and that can get you in trouble when you’re so self-reliant that you’re unwilling to ask for help.”
When his depression took hold, Reese thought that, given his professional experience as a therapist, he should be able to “fix it” on his own. He didn’t want to worry his wife or his friends with his troubles and so wound up silently languishing in his distress. “For a long time I didn’t tell anyone.”
Suffice to say, this is not the recommended course of action. Left untreated, depression is unlikely to go away on its own and seeking timely professional help can provide the emotional support and expert guidance to stop things getting worse. Instead, drawing on the hardy independence that had enabled him to conquer ultras like the Western States Endurance Run and the Wasatch 100, Reese tried to battle on single-handedly. “I didn’t want to be a burden,” he says. “But when you’re struggling with mental health stuff, it’s not a good attribute to be so self-reliant that you’re unwilling to ask for help.”
What eventually changed Reese’s mindset was an epiphany trigged by a multi-day ultra-marathon. It happened at kilometre 439 on day seven of the Vol State – a 500 kilometre race that travels from Kentucky to Georgia in the brutal heat of midsummer.
Reese was running with two friends, Jeff and Carol. But after an entire week of back-to-back exertion, Reece knew he was in trouble. The oppressive humidity coupled with the constant friction from days on the road had wrecked his feet. The throbbing pain from multiple blisters intensified until his soles felt like an “angry nest of murder hornets”.
Stopping at the small town of Monteagle in Tennessee, Carol noticed Reece’s distress and offered to try and help by straining his blisters and taping up his hotspots. Instinctively, he declined. He knew it’d be a revolting task that he didn’t want to saddle his friend with. But when Reece became aware he could no long walk, he reluctantly agreed.
Sitting down outside on some concrete stairs, he removed his sweat-sodden socks to allow Carol to begin stoically popping and patching each blister in turn. As she worked away, Reece was suddenly overcome with emotion. “I just broke down sobbing. It was such a raw, vulnerable moment for me to finally accept help that I’ve been so resistant to. Then I looked down and Carol was crying too. It was just such a connecting experience.
“In that moment, I realised that vulnerability is really what connects us with each other. I realised that we don’t have to do this all on our own. That it’s okay to ask for help. And so when I came home from the race after we finished, that’s when I opened up to my wife about my depression.”
To complete an ultramarathon you have to dig deep and keep going, no matter how hard it gets. Everyday life can sometimes require similar perseverance. The big difference, Reece insists, is that when it comes to the latter, you don’t have to struggle on alone. “My whole healing process really started when I finally got that realisation.”
Keep Reading
Why I Mo: Harry Cleary
Reading time 6 min read
What to expect from your first therapy session
Reading time 6 min read
6 key findings from the 2024 Real Face of Men’s Health Report
Reading time 5 min read
