When I worked at the New England Medical Center in the 1990s, I was part of a sports medicine clinic that served professional and college athletes, and dancers in the Boston Ballet.

Far and away, the last group was the most interesting to talk to, as were what I call the “regional” athletes: string, piano and wind instrumentalists, and others, who in their way were every bit as skilled as athletes. 

In the 1990s, coaches at the college and professional level were well aware of the importance of mental as much as physical fitness, to performance at any level of sport, especially the highest level in individual sports such as one-on-one challenges in tennis. 

That combination of mental fitness and physical skills was very much on display in the recent Wimbledon final when Carlos Alcaraz and Novak Djokovic faced off at centre court in the final. Alcaraz is 16 years younger and far less experienced than Djokovic, widely known to be mentally tough as well as highly skilled.

Yet, despite losing to Djokovic a few weeks earlier at the French Open final, when Alcaraz suffered anxiety and stress-induced cramps, he came back to beat Djokovic convincingly at Wimbledon in five tough sets.

That was at least partly because of the mental conditioning and support he received from his team and, of course, Alcaraz’s prodigious talent. 

When I grew up in the 1940s and ’50s, mental toughness was seldom brought up or if it was, it was framed as guts and admired or lack of guts, weakness and letting the side down. Combat fatigue was poorly understood in the First World War and not much better in the Second World War.

However, by the Vietnam war, psychiatrists such as the character Maj. Sidney Freedman in the long-standing TV series “M*A*S*H” were finally coming to grips with managing the horrific challenges faced by so many young men in combat. 

In my neurological practice, I often used Sidney as an example of an excellent psychiatrist because he listened to soldiers without judging, understood what they were going through and did his best to help them recover.

He famously helped Hawkeye, the show’s chief surgeon, who toward the series end finally “broke down” and was nudged back to health by Sidney.

Even so, many men and women exposed to intense combat continue to suffer for many years because of memories of what happened to them and their buddies. 

These days, major health care institutions are increasingly aware of the importance of mental health, and fortunately, they no longer see positive psychology and mindfulness practices as fringy but essential to the health of their patients and the health care staff who serve them.

I was somewhat surprised recently when I mentioned the upcoming series on mindfulness at the NOTL library to my son, an ENT surgeon: Tim fully embraced the practice for mental health for staff as well as patients. Good for him. 

Looking back 30 to 40 years in my practice life, attitudes toward the medical profession were far less enlightened and not a few physicians were struggling including our family physician of those days, Bill Mace.

He had been a M*A*S*H surgeon in the Second World War who I learned, many years later, became a chronic alcoholic whose patients’ needs were sometimes covered by colleagues in the ER and operating room.

That’s how things were handled in those days when some physicians were as sick in the head as their patients and neither received much sympathy or help.

Stress often betrays itself by bodily symptoms related to the skin, esophagus, bowel, respiratory tract, headache, as well as anxiety, shifting unstable moods, troubled sleep, difficulties focusing and attending to matters at hand and withdrawal from social contacts to name a few of the more obvious symptoms.

Should stress-related symptoms continue too long, they can seriously affect health in ways that can be risky such as hypertension, cardiac arrhythmias, heart attacks and strokes and even cognitive declines. 

The good news these days is that understanding the relationship between mind, body and external influences can be a powerful tool for reducing stress-related symptoms and the long-term risks they pose to general health by improving mental and physical well-being. 

Healthy dietary habits, regular exercise and more peaceful minds less cluttered with negative, unproductive thinking and habits work better. The solution for most of us is not a psychiatrist or psychologist but more healthful awareness of what’s going on in our heads and taking control of our emotional lives, without using medications. 

There are many programs from excellent sources. I’m impressed with what Harvard University now offers as online courses on subjects such as positive psychology, including mindfulness, stress management and meditation to name three closely related programs. 

What I like about the Harvard programs is that they’ve done their homework and carefully vetted what they say using Harvard’s outstanding faculty and the best of the current literature. Much the same is on offer from the Mayo Clinic and to a lesser extent by McMaster University’s medical school.

If you’re interested, sign up with Debbie Krauss for the mindfulness program at the NOTL Public Library.

Dr. William Brown is a professor of neurology at McMaster University and co-founder of the InfoHealth series at the Niagara-on-the-Lake Public Library.