Biles has elevated a discussion about caring for athletes’ mental health. Here’s what experts say must come next.
Simone Biles performs with such power and precision, the gymnast has practically vaulted herself into a class of her own. She routinely pulls off moves previously considered too dangerous for women to even attempt; several are named after her. In one vault, she spins so quickly in the air — blink and you’d miss her many permutations — one physicist calculated she rotates at about a third the speed of the blades of a helicopter. But in her most radical act yet, Biles’ body was at rest. Seated at a post-competition press conference, with a silver medal draped around her neck, she confidently explained why she decided to withdraw from the team final at the Tokyo Olympics.
“I just felt like it would be a little bit better to take a backseat, work on my mindfulness and I knew that the girls would do an absolutely great job,” Biles said. “I didn’t want to risk the team a medal.” She subsequently pulled out of the individual all-around competition. Of the individual events, she will compete only in the beam, as of now.
In an organization that holds as one of its most triumphant moments 18-year-old Kerri Strug being pressured to stick a vault on an injured ankle before collapsing onto her knees at the 1996 Summer Olympics, Biles’ decision was shocking. The ethos of “playing through the pain” resonates through most sports, but particularly in gymnastics where athletes are accustomed to performing while chronically injured, says sports psychologist Carlin Anderson, Ph.D., who worked with Team USA at the 2018 Winter Games and is herself an accomplished gymnast.
Biles won this year’s national championships with broken toes in both feet and a 2018 world championship with a kidney stone. She is no stranger to pain. But dealing with a mental health issue on the world stage is another beast, and performing under that strain can be extremely dangerous. Gymnastics fans will remember Julissa Gomez’s tragic vaulting accident in 1988, which left the budding athlete paralyzed below the neck and has haunted gymnasts even years later.
Before Biles withdrew, spectators may have noticed she seemed off. On one vault in particular, where she was expected to attempt a stunt with 2.5 twists, she launched herself into the air, executed 1.5 twists and took a big hop after landing.
Those with experience in the sport immediately diagnosed her. Biles’ former teammates Laurie Hernandez and Aly Raisman, who won gold with her in the 2016 Rio Olympics, both said she had gotten “lost in the air.” The “twisties,” as they’re called, is a phenomenon that can strike gymnasts of all levels.
“It’s like getting the yips in golf or in pitching, where athletes say they feel like they’re performing the way they normally would but they cannot get their physical body to do the skill or physical maneuver the way they want,” Dr. Anderson said.
When that occurs and a gymnast is several feet in the air, it can be “very, very nerve-wracking,” akin to steering a car into a turn while the vehicle disobediently plows straight ahead, Dr. Anderson said.
Biles has spoken about the intense pressure she’s felt at the Games. On Instagram, the 24-year-old wrote: “I truly do feel like I have the weight of the world on my shoulders at times. I know I brush it off and make it seem like pressure doesn’t affect me but damn sometimes it’s hard.”
Heaped on top of the pressure to represent her country and “Black and brown girls over the world” — as she told the New York Times — is competing as a survivor of sexual abuse. Biles has discussed the depression triggered by former Team USA doctor Larry Nassar’s abuse, saying she at one point was sleeping constantly “because it’s the closest thing to death.”
Biles is the only victim of Nassar competing at the Games and has said she thought it was important that a survivor be present.
“I feel like if there weren’t a remaining survivor in the sport, they would’ve just brushed it to the side,” Biles said, referring to U.S. gymnastics organization. “Since I’m still here and I have quite a social media presence and platform, they have to do something.”
“The standards are set very high and very few people are talking about how this pressure can negatively affect them and their performance,” said Reshawna Chapple, Ph.D., a Talkspace therapist.
Perceived pressure can be crushing even for amateurs and collegiate athletes, said Dr. Chapple, and can lead to anxiety, depression, eating disorders, and substance abuse issues.
Dr. Anderson noted, “This year, I had a college athlete tell me they felt they were letting down the entire university and the state that they competed in because they perceived they underperformed.”
Now consider having millions watching and scrutinizing your performance, being the face of a skincare brand and the star of an international competition. There aren’t many people in the world who can even begin to understand that type of pressure. Two that come close, and who have both also spoken openly about their mental health struggles, are Naomi Osaka and Michael Phelps.
Osaka, one of the biggest tennis stars on the planet who was also tapped to light the Olympic torch, pulled out of the French Open citing concerns for her mental health. In an essay in Time, she wrote about the need to treat athletes like you would anyone else — as potentially vulnerable to a mental health crisis as the average person. “Athletes are humans,” she writes.
Michael Phelps, the most decorated Olympian of all time, narrated and helped produce a documentary released last year about the mental health challenges Olympians face. In The Weight of Gold, he examines the psychological strain Olympians, who have spent their whole lives training for a single competition, are under, and the reluctance of some to seek help. He describes Olympians in the film as a “group who want to keep their pain out of sight.”
“You need to show the world that you are strong,” American figure skater Sasha Cohen says in the documentary. Admitting that you’re struggling psychologically seems “so fundamentally at odds with being a competitor,” she says.
But Phelps, Osaka, and Biles are all chipping away at that stigma. And attitudes toward mental health care in the sports world are starting to shift, says Hillary Cauthen, an executive board member at the Association for Applied Sport Psychology.
More resources are being made available to athletes at all levels. The U.S. Olympic & Paralympic Committee last year formed a Mental Health Taskforce, a good chunk of NCAA Division I programs have embedded sports psychologists and counselors, and the players’ associations at the professional level are pushing to provide more support for their members. In 2019, the NBA even mandated that each team have at least one full-time mental health professional on staff after Kevin Love opened up about his anxiety and depression in an essay.
But it’s still not enough. “We train thousands of hours physically and put all this attention on nutrition and equipment and access to facilities and sleep. But yet, most athletes will tell you in these big moments that the main factor they attribute to their best performances is something that’s mental. They’ll say, ‘I just felt confident, I felt in the flow, I felt supported,’” Dr. Anderson said. “It poses the question, why aren’t we spending thousands of hours training mentally and attending to our mental wellbeing?”
In her memoir, Bravey, distance runner Alexi Pappas writes at length about that disparity. Pappas, who competed for Greece in the 2016 Olympics, fell into a depression after the Games. It wasn’t until she was made to understand that it was essential to treat and care for her brain like she’d nurse a sprained ankle, that she began to stress the importance of seeking out mental health care, she told us.
“When it comes to physical health, there is nobody more attuned to their bodies than an elite athlete — that’s ingrained in the culture; it’s part of what it means to be elite,” Pappas said. “But the same cannot be said about mental health.”
But adequately supporting athletes shouldn’t just mean treating them when they’re in crisis, or when an issue emerges, Cauthen says. Players should be educated early in their development and equipped with skills to care for their mental and emotional states. It’s a holistic approach to training an athlete that can be preventative and used to boost their performance, Cauthen said.
That evolution in mental health treatment has been slowly taking shape in the NHL. In 1996, the players association founded the Substance Abuse and Behavioral Health Program. That initiative has been a tremendous resource for the league’s athletes but was conceived as a measure “for when the wheels come off, when something really bad happens,” NHLPA executive Mathieu Schneider told ESPN.
Last year, Schneider said they began discussing how to reshape the program, how to help their members before they reach rock bottom. They’re still thinking through a model, but their first step has been reaching out to players and making sure they’re aware of all the resources available to them.
These may be small advances. But what Biles has done in Tokyo hopefully provides more momentum for improving how we care for the mental health of athletes, competing at all levels.
“They are leading by example,” Pappas said of Biles and Osaka. “If Olympians like them can get mental health ‘injuries,’ then it’s OK for any other athlete who might be struggling to admit that they need help, too. And that is a very good thing.”
