Healing Heartbreak Hill

PHOTO: Runners compete in the Invitational Mile on, April 19, 2014, in Boston in advance of the 118th Boston Marathon.
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Bob Spina, Jr. has breezed through several 20-mile runs in the past few weeks. The 50-year-old lawyer from Lynbrook, N.Y., has trained a steady 40 to 50 miles a week for the past year and said he is in top physical condition to run this year's Boston Marathon. He's just not sure he's mentally ready.

"I am emotionally fatigued by all of the new security measures and I'm not convinced I want to put myself through it or my family through it," Spina said.

A lot of this year's 36,000 Boston Marathon entrants are wrestling with the same sort of ambivalence. On the one hand they want to be there for their fellow runners and show support for those who died or were injured during last year's bombing. On the other hand, they want to feel safe.

Boston Marathon organizers acknowledge this emotional dilemma. That's why they've upped the marathon's usual psychological support staff from two to sixty.

"We'll have mental health professionals in 22 of the 26 medical tents along the route, at the chutes at the finish line and in both of the race's main medical tents," explained Jeff Brown, a cognitive behavioral psychologist who has been the marathon's psychology coordinator for the past decade. "We also have a private area at the runner's expo in case anyone wants to come in and talk anything from race strategy to how they're processing last year's events."

Brown said the beefed up mental health aid will help address the larger number of entrants in this year's race. Race officials increased the field of participants by 9,000 to accommodate runners whose times qualified them to run this year's race and those who were prevented from crossing the finish line last year.

Brown said he also anticipated the race could be a significant emotional experience for a lot of the marathoners. Though he said he wasn't expecting vast numbers of runners to be in psychological crisis along the course, he acknowledged that statistically about 10 percent of people who live through a traumatic event are later diagnosed with post-traumatic stress.

"Different places along the course will mean different things to so many people, whether it's making it across the finish line or crossing the 21-mile mark where they might have been pulled off the course last year," he pointed out. "We just want to ensure there are people in place to deal with each case appropriately."

Licensed mental health volunteers from all over the world will staff the race this year, Brown said. The majority will be drawn from the Massachusetts Psychological Association's disaster response network and people trained in disaster response by the American Red Cross. All volunteers were required to go through a special training with Brown to ensure they know how to deal with athletes in general and runners in particular.

"Runners are certainly a different breed," Brown said.

In addition to the larger mental health team, medical coordinator Chris Troyanos said the marathon's entire medical effort has been stepped up this year. More than 1,900 medical volunteers will be working the race. Ranging from physicians, nurses and certified athletic trainers, they'll be available everywhere along the course including at least 350 medical staff in each of the main tents alone. More will be stationed in emergency rooms throughout the Boston area.

"If there's any sort of crisis this year, the medical team will be prepared, just as they were last year. Troyanos said. "The Boston Athletic Association has the resources, the volunteers and the equipment to do what no other marathon can do."

Spina appreciates the effort race officials have put in to ensure the safety and well-being of runners. He said while reassuring, it didn't completely ease his anxiety. He's worried a copycat will try to gain notoriety by disrupting the race again and said he'll decide a few days before whether he'll run or not.

"I can't shake my reservations -- 26.2 miles is a long way to protect," he said.

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