Football's Hidden Killer

Ronald Reng, author of the award-winning book about the life and suicide of Robert Enke, tells Ian Herbert that only now are the game's unique pressures beginning to be understood

It was the look on Ottmar Hitzfeld's face – and the tears in his eyes – which conveyed a message more poignant than any words could this week.

He is the manager they always called der General at Bayern Munich and the apparent epitome of that inner strength which German football holds so dear. But a different Hitzfeld revealed himself when he was asked to discuss the psychological effects of pressure in football, for German television.

The 62-year-old immediately cast back to his dismissal as Bayern Munich manager, in 2004, after six years of service. It had been a blessing, he admitted, because he found himself liberated from a pressure which had sapped everything from him and had left him a vastly diminished man. "Yes, it was a relief for me when they said they wanted to terminate the relationship," said Hitzfeld, who has managed the Swiss national side since 2008. "I did not have the strength to quit on my own. These six years felt like 20 years."

This was not an entirely surprising disclosure to those who have known him best. He effectively asked to be released from his job when his Bayern side beat Valencia to lift the Champions League in 2001 but the club gave him a categoric "no" and he was sent back into what we now know were three more years of purgatory. Having finally escaped, he was offered the German national job but turned it down and needed three more years to summon the strength to go back to the game.

For those in Germany who saw Hitzfeld's moving testimony, there was a collective shudder – the first thought for many being that this was the kind of experience which killed Robert Enke. The Germany goalkeeper spent much of his career in what was to prove a losing battle with depression, unknown to many of his team-mates – a battle chronicled brilliantly by Ronald Reng in A Life Too Short, his biography of Enke which was a worthy winner of the William Hill Sport Book of the Year award this week.

Reng was Enke's friend and while, as the writer reflected yesterday, the book "won't bring Robert back; we've lost him for ever," the tragedy and its extraordinary, haunting depiction has certainly helped awaken German football to the scourge of mental illness.

"There is a much higher awareness within German football, now, about depression," Reng told The Independent. "Players are much more ready to seek help for some kind of mental stress."

Comparisons with Gary Speed, here, are inevitable, though treacherous. We simply don't know that Speed suffered in the way that Enke did. But the Wales manager's death, which will be commemorated today at Elland Road in the presence of his wife, Louise, has at least reopened the debate on the mental struggles which can lie behind the machismo of the game, in the same way that Enke's did. There was a consolation of sorts in the fact that the Sporting Chance clinic revealed that within 72 hours of Speed's death being announced, 10 leading players had sought help for stress and depression.

The same awakening is far further advanced in Germany. "Clubs are now alerted and alarmed by signs of strain," said Reng. "It is easier to go public and one of the problems with Robert was that he simply couldn't do that." Ralf Rangnick, the Schalke manager who led the side to last season's Champions League semi-final with Manchester United, stepped down in September, only six months after taking charge of the club, citing burn-out. Michael Sternkopf, a member of the management team at Offenbach in the German second division, is the fifth former team-mate from Enke's Borussia Mönchengladbach days to take similar preventative action. "During a game, I sat on the bench, and was suddenly totally mentally gone," Sternkopf told Bild last month. "I was looking around and feeling all the spectators and the stadium on my shoulders. This knowledge of the responsibility has overwhelmed me at the moment."

Enke found an environment far more formidable than this. It was his misfortune to emerge as a supreme German goalkeeping prospect in the aftermath of the Oliver Kahn/Jens Lehmann struggle for top spot, which was always framed as a test of who could best handle pressure. Kahn loved that challenge – "the pressure, the pressure!" was his mantra – and it was also Enke's desperate misfortune that until the late 1990s a good German team was perceived, above all, to be one that could handle pressure.

The notion that the public tragedies of Enke, or possibly Speed, have a capacity to limit the private agonies of others is sadly simplistic, though, because Enke did everything right and still died. He admitted that there was a problem, in a way few depressed people can. He sought treatment, sought medication and had a circle of close friends who were aware. That his father, Dirk Enke, should have been a psychotherapist is one of the many haunting facts to emerge from Reng's work. And yet, on 10 November, 2009, he kissed his daughter on the forehead, said goodbye to his wife, left a list of jobs on the magnetic kitchen board in felt tip pen and, at the age of 32, stepped out in front of a train.

The idea of a neatly traceable pattern by which sportspeople, with all the pressure attendant on their jobs, are more vulnerable to mental illness than other groups is something else which eludes us in cases like this. Oxford University's Centre for Suicide Research, which found that veterinary surgeons are more likely to kill themselves than other professions, has never examined sport.

The broader consequences of a tragedy like Enke's are also horribly unpredictable. Reng describes in his book how many people misunderstood his death and some took their own lives, acting on "the lunatic notion that then they would be like him, then they would be close to him". This was, as he writes, a "tragic misunderstanding". Depressives who attempt suicide do not want to die. They just want the inner darkness which has subsumed them to go away forever. The copycat deaths suggest that public outpourings which have followed the deaths like those of Enke and Speed, and which will continue into this weekend, perhaps don't help in every way. Disclosing only minimal details on the way an individual dies – there are no details of how Enke died in A Life Too Short – is the only way of preventing more tragedy. "There are media guidelines, which include the fact that the means of death should not be described too much," said Reng. "When a case is high profile like this it has to be reported, but not romanticised."

The mental health charity Rethink has found that the high-profile cases have at least helped others to admit to a problem, in a British nation where the organisation finds 87 per cent of those suffering from mental illlness still report subliminal discrimination. But the charity's director of communications and campaigns, Mark Davies, believes that "there is a slight danger that high-profile cases make it appear that mental illness is the preserve of those with high-powered, high-pressured positions." The suicide rate in this country is actually at its lowest for 50 years, though it accounts for 20 per cent of all deaths in men aged between 15 to 24. Amid the ceremonials at Elland Road today, spare a thought for the mother of Michael Raven, a 12-year-old schoolboy who was found hanged at his home in Burnley, Lancashire, on Tuesday. It is hard to imagine anyone suffering more. Speed's death – whatever its cause – should at least give reason to reflect on the value of Rethink's "Time to Change" campaign, which seeks to ensure that those on the outside of sport's bubble can share their troubles, too.

Davies speaks of a discrimination that is "subtle, not aggressive" and certainly a long way from that of John Gregory, who when Stan Collymore announced in 1998 that he was suffering from stress, retorted: "You just need to switch on the news to discover what 'stress' really means." Those words are an anachronism, now.

In Cologne this week, minds turned back once again to Enke, as the referee Babak Rafati a Fifa-listed Bundesliga referee, placed himself under psychiatric care after his attempt to bleed to death in a hotel bathroom before a match. "I hope it is not business as usual, so soon after the death of Robert Enke," said Wolfgang Mierswa, a local refereeing official. This was not a case of German complacency, though, or indeed a case of anything quantifiable at all. It was simply another individual unable to bring himself to take preventative action which, in the final outcome, failed to save Enke's life. "Robert's death showed what a monster illness this is," said Reng. "It is a life threatening illness. Just as with cancer, you might just survive. Or you might not."