Why even try?

A number of runners cross the Boston Marathon’s finish line with their arms raised high, expressions of joy lighting up their faces. Conversely, others find themselves collapsed in a medical tent with Jeff Brown, the chief psychologist for the Boston Marathon’s medical team.

“We aren’t discussing, ‘Oh, I need some ice for an ankle,’” Brown remarked regarding these finishers. “Somebody may be significantly overheated or too cold. They might be experiencing cramping issues. They could feel disoriented, perhaps unaware of their exact surroundings.” Lying on cots are individuals with critically low sodium levels in their blood, alongside others feeling depressed, anxious, and restless without clear reasons. Brown’s duty, along with his group of mental health professionals, is to conduct psychological assessments and identify signs of various medical issues.

Witnessing such extreme levels of acute distress just meters from the finish line prompts some to ponder, “Why even try?” Alternative methods exist for getting fit or raising funds that do not involve a grueling test of cardiovascular and muscular stamina for several hours amid unpredictable weather.

This is a query that Brown, a lecturer at Harvard Medical School, psychologist at McLean Hospital, and author of “The Runner’s Brain,” contemplates every year as thousands of runners pass him. It will surely be on his mind this coming Monday during the 129th edition of the Boston Marathon.

The motivations, Brown noted, are boundless, but what they share in common is that they are “very, very individual, and ultimately it is that personal drive and dedication that sustains people, regardless of their circumstances.”

Over the years, he has encountered countless individuals running in memory of those recently lost, grappling with a cancer diagnosis, or fundraising for cherished charities. He has seen women who — closely monitored by medical personnel — completed the marathon in later stages of pregnancy, as well as athletes who completely disregarded doctors’ advice, running with fractured femurs, torn muscles, recent sprains, and diabetes complications. “Perhaps it’s no surprise,” Brown remarked, “that they find their way to us in the medical tent eventually.”

A marathon channels participants’ energy into a structured, concentrated goal, particularly at Boston, it is one that brings a sense of prestige. “It allows individuals to reconcile with themselves,” Brown shared. “Regarding self-perception and belief in one’s abilities, we always perform better when there is some form of objective measurement.”

This objective aspect is essential, according to Brown. Not only do participants complete a race, but they also receive a medal placed around their neck upon finishing. “I consider that as a sort of transformational moment,” he stated, “because it’s something that was once a hope that is now realized as a fulfilled wish. It is the intersection of mind and body.”

He finds joy in witnessing those he has treated gather the strength, both mentally and physically, to depart from the medical tent and ultimately collect their medals. “It feels almost as if they get a chance to reassess their entire experience once again,” he said, “and it might hold greater significance for them.” He has observed wide grins, tears, and quiet contemplation. “I believe that illustrates the vast array of emotions and purposes that individuals associate with running the Boston Marathon.”

“For a brief period after finishing a marathon, you’re somewhat of a hero.”

Marathon participants commit varying degrees of time and effort in preparation for the event. Some are younger, single individuals who forgo late-night outings and leisurely weekend mornings to set a personal best. Others are older, first-time runners who may be taking time away from their children and spouses to check off a bucket-list item. A few aim to enhance their professional running careers, while others arrive having done minimal training.

A medal — along with some bragging rights — is far from the sole incentive that drives some individuals to invest countless hours in race-specific training while others choose to disregard sound medical guidance from their physicians.

“In a world saturated with criticism, it’s a remarkable approach to receive affirmations in a positive way,” Brown shared. “And at our core, we all desire to be treated with respect.”

Running is also a chance to reshape your own identity and, at least for a few hours, alter how others perceive you. “For a brief time after finishing a marathon, you’re somewhat of a hero,” Brown remarked. “You’ve accomplished something that many others would never dare to attempt or even contemplate, which is incredibly impressive.”

The psychological aspects of running continue to captivate Brown and have kept him part of the Boston Marathon’s medical team for over two decades.

“On that single day, with 30,000 runners, there are 30,000 unique ways to complete that marathon,” said Brown. “Consider the multitude of thoughts, psychological experiences, reflections, motivations, and both negative and positive emotions that accompany those 30,000 individual journeys.”