“We hear the term ‘functioning alcoholic’,” Paul Pook says, “well, sometimes I think of myself as a functioning suicidalist.” He apologises for the comparison, says he isn’t sure whether it’s inappropriate, only he can’t think of a better way of explaining it. Pook has spent the past 20 years working as a high‑performance coach, for the Irish rugby union team, the Russian Olympic Committee and the Australian Institute of Sport. He has helped athletes to win grand slams and gold medals. And all the time, he had these thoughts. The doctors call it “suicidal ideation”.

Pook describes being on a flight from Moscow when the plane hit turbulence. “And I’m thinking: ‘This could be it, the plane is going to crash and I wouldn’t feel this pain any more.’” He is bipolar, and he talks about the illness in terms of a sliding scale “where one is suicidal, five is normal, and 10 is psychotic. I’ve been at one five times in my life, I spent a lot of time around three, and maybe once I was up at eight or nine.”

That was when he was so overwhelmed by the patterns of coincidence he saw in the world that he ended up running into a church, “and I looked up at this statue of Jesus and he had his hand up, and he only had four-and-a-half fingers on it, well I’ve only got four‑and-a-half fingers myself …” He holds up his right hand, which is missing the tip of his pinkie. “So in my mind I was linked to Jesus, I remember phoning my daughters to say: ‘Look, Daddy is going to become really famous.’ A week later I was in Covent Garden meeting with a publisher to try to persuade them to tell the story.

“That was the most manic I’ve been. But there have been manic phases, where I’ve been very impulsive, made bad decisions, and people close to me have suffered as a result. The knock-on effect, like with all illnesses, is that your family and friends also suffer.”

Pook survived because of the love he felt for his two daughters. It was his deterrent. He felt as if he didn’t want to live, but he couldn’t bear to be dead. He did six years of psychiatry, was prescribed 11 medications, lithium, antipsychotics, anticonvulsants, and had spells where he went cold turkey. “And all the while I was trying to work out why I was suffering.” His depression had never made sense to him. It started when he was working at Harlequins in the early 2000s. “And I was so content then, happy in the job, married with a beautiful daughter.”

This year he got an answer. Before he was a rugby coach, Pook was a player for Bridgend, West Hartlepool, Llanelli and Ebbw Vale. He retired in the late 90s after a series of bad concussions, one after another. Soon after, he started having petit mal seizures, and problems with bladder control. “But I almost brushed it under the carpet, and it gradually dissipated.” Then the depression started. Pook always suspected they were linked. Now he says it has been confirmed by a series of specialist tests arranged by the team organising the legal action against the game’s authorities.

Paul Pook in 2001, during his stint as Harlequins’ physio, when his depression first took hold.
Paul Pook in 2001, during his stint as Harlequins’ physio, when his depression first took hold. Photograph: Reuters/Alamy

Pook is one of the 225 former rugby union players involved in the legal case. He is described as an outlier among the group because has bipolar and hasn’t been diagnosed with early onset dementia. “The scans show evidence I had a brain haemorrhage, and it’s very likely that that haemorrhage led to my mood disorder and depression which then grew into bipolar.” He knows that mental health is a result of “colliding variables” but “the evidence clearly suggests it was caused through rugby” for him.

The diagnosis was a relief. “It was like ‘ah, there is finally a reason for my illness’, but at the same time I felt conflicted because I didn’t want to use it as an excuse for my behaviour, like the bad decisions I made are rugby’s fault. I don’t see it that way. I feel responsible for, and try to make amends for, things I’ve done in the past.” He was finally able to tell his older brother about his illness. “He was my source of approval, someone I always wanted to impress. I hid my problems from him for 15 years but told him an hour after I got the diagnosis from the neurologist.

“My brother immediately said: ‘I’m not going to let my son play rugby.’” Pook told him not to do that. He still loves the game “because I’m still so grateful for what it has given me, the opportunities, and the friendships I would never have had otherwise”. He has picked up many of those old friendships again in the past few months, and made some new ones. Pook still works as an elite coach, he is developing a project with a former top-10 ranked tennis player, but he is spending more and more of his time helping former rugby players.

Pook says he has coached himself on how to cope with his illness. He took training in mental health, and a course in non-pharmacological brain health. Now he is in a position to do it for others too, whether they have early onset dementia, or depression. “These players need immediate support, and hope. I’m a coach. I lean towards evidence-based coaching around sleep, nutrition, mindfulness, movement, and I’d like to offer that support to the players. Some things aren’t in our control, like the brain injury, but some are. There is no cure, but there are certainly things everyone can do to improve their quality of life.”

He has been taking players to have oxygen therapy, and is evangelical about the value of learning new skills and developing new hobbies. He has taken up tennis, and drumming. “I’m trying to raise hope. Life will always ebb and flow, you have to accept that. There’s no worse feeling in the world than feeling suicidal. But there’s no better feeling in the world than not feeling suicidal. So for me, when I go for my morning walks in the sunrise, I start crying with gratitude that I’m feeling good, that I’m functioning, and that I think my suffering is behind me.”

In the UK and Ireland, Samaritans can be contacted on 116 123, or email [email protected] or [email protected]. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org.