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When Simone Biles withdrew from the Olympic gymnastics team final competition on Tuesday last week, and later from the individual all-around final before it began Thursday, she ignited a national conversation about the mental health of athletes.
Simone didn’t withdraw because of a torn ligament or broken bone. Instead, she cited a mental block that gymnasts call “the twisties” — a cutesy name for a scary and dangerous lack of air awareness. Her decisions prompted many to question how an elite athlete at the top of her career, used to competing through immense pressure combined with painful injuries and the grinding wear and tear of her sport could be felled by...her brain?
Simone is the latest in a string of athletes — specifically Black women athletes — to prioritize her mental health despite incredible pressure to compete. In May, Naomi Osaka pulled out of the French Open, saying she needed to tend to her mental health and revealing a long-term battle with depression. And, when Sha’Carri Richardson was suspended from the Olympics because of marijuana use, she said she had used the drug to cope with the emotional pain of her mother’s death, adding “Don’t judge me. I am human.… I just happen to run a little faster.” Before these three, Michael Phelps revealed in 2018 that he contemplated suicide even as he became the most decorated athlete in Olympic history.
As more and more open up about the debilitating mental health impact being a revered athlete can have, we're reminded that winning competitions isn’t the only way they can show strength.
“Sports culture has consistently prioritized winning over well-being, which has reinforced the idea that it’s more important to perform well than to take care of yourself mentally and emotionally,” said Annie Christman, 23, a former Division I gymnast at Brown University and a co-founder of Galea Health, a platform that links athletes to therapists and sports psychologists who understand the athlete experience.
We all have mental health, and Lisa Bonta Sumii, a licensed clinical social worker in California and Nevada, points out most of us will experience a mental health challenge or a mental illness. Do elite athletes experience mental health challenges differently than the rest of us? No, says Bonta Sumii, who has a specialty in mental sport performance and works with collegiate, professional, and Olympic athletes. But she identified two things top athletes must contend with that differentiates their struggles: Pressure and athlete identity. “Pressure is a form of stress,” said Bonta Sumii. “Pressure to perform can come from coaches, from within, from parents, or from a particular competition, game, or race.”
And how athletes perform, said Bonta Sumii, can be intensely tied to how they view themselves, their core identity. Failing to perform can lead athletes to label themselves as losers “Coping with pressure and managing athlete identity are key to the elite athlete’s mental health,” Bonta Sumii said. Additionally, she added, athletes have higher rates of obsessive-compulsive disorder (OCD). A 2017 study showed that college athletes experience OCD at twice the rate of the rest of the population. Eating disorders, depression, anxiety, and substance use disorder, said Bonta Sumii, all affect the elite athlete population.
But in the five years since the last Olympics in 2016, athletes at the top of their game — whether Olympians or professional athletes in the big leagues — discussing their prioritization of mental health has become a welcome trend.
Christman credited athletes who are using social media to advocate for mental health awareness. “The more athletes use their voices and platforms to change the narrative about mental health, the more sports culture has shifted to view vulnerability as a strength rather than a weakness,” she said. “We still have a long way to go, but it’s inspiring to see the incredible progress that's been made in the last few years.”
Allison Schmitt, a swimmer competing in her fourth straight Olympics this week, came forward in 2016 with her story of battling depression. Schmitt said her friend and training partner Phelps helped her seek therapy. She now advocates for better mental health support for Olympians like herself — and Phelps, and Alexi Pappas, and perhaps, too, Biles and Osaka — who find themselves adrift after the adrenaline high of competition at the highest level wears off.
The Olympic distance runner Pappas wrote a memoir, Bravey, published in January, in which she revealed that she endured a crushing depression and suicidal thoughts after she competed for Greece in Rio de Janeiro in 2016. “The brain is a body part,” she wrote in an Instagram post directed at Biles last week, using a line from Bravey that she said transformed her thinking about depression. “It’s ok to walk away for a while or as long as u need.” Pappas asked, in a 2020 New York Times Op-Doc, why elite athletes are not given access to mental health treatment on the same level as the trainers, orthopedists, and other medical staff who surround them to keep their physiques in fighting shape.
Other athletes like San Antonio Spurs guard DeMar DeRozan and Kevin Love, a power forward and center for the Cleveland Cavaliers, have been open about mental health. And, Dallas Cowboys quarterback Dak Prescott said he began experiencing anxiety and depression during the height of the coronavirus pandemic in 2020. “I think it’s important to be vulnerable,” he said in an interview on “In Depth With Graham Bensinger.”
Being vulnerable, here, means pushing past the idea that asking for help means you are admitting weakness. Christman noted that, in her experience, there is a persistent stigma among athletes about addressing mental health issues. “So much of sports culture is built around pushing through pain and demonstrating grit, and while these are often admirable, strength-building qualities, the emphasis on toughness can also silence vulnerability and support-seeking,” said Christman.
Indeed, when Biles withdrew from the team final, she was accused on social media and in comment sections of being a quitter. Whether it’s because the twisties are invisible, unlike, say, a broken leg, or because of that perception of mental illness as an inherent weakness instead of something that needs a diagnosis and a treatment plan, the speculation that Biles just couldn’t hack it and wanted an easy way out frustrated her fans.
“Simone’s ability to recognize when she needed to take a step back, when she needed to go against all of the expectations and pressure that have piled up on her, is the opposite of weak or easy,” said Christman. Christman defined the twisties as a “disconnect between mind and body” that results in a gymnast losing the muscle memory of her skills. “Imagine losing all of the muscle memory that makes driving second nature in the midst of a tricky merge on the highway,” she said, by way of analogy. “You’re panicked, confused, and frustrated that your body has forgotten what it needs to do in the exact moment that it matters most.”
Osaka received similar criticism, including from the organizers of the French Open, who tweeted that other tennis players in the tournament “understood their assignment” to speak with the press. They later deleted the post, but the damage was done. Osaka has said that doing press conferences after her matches sows doubt in her mind and worsens her anxiety, and wrote in an essay for Time that the decision to skip a press conference should be no different for a professional tennis player than taking a personal day for an office worker.
One problem for elite athletes in recognizing a mental health challenge when it occurs, said Bonta Sumii, is that they are often trained to ignore their physical health and to push through pain to perform. “So, if they are taught to often ignore their physical health, do they even realize that they have mental health, that it even exists, and that it needs to be paid attention to as well?” asked Bona Sumii. In Biles’ case, for example, “she is not just a gymnast. She is touted as the GOAT. There is pressure to uphold that. She is also a woman, a Black woman, a sexual abuse survivor, whose life is broadcast freely over social media. She is competing on the world’s biggest stage, in a global pandemic, with no fans, no family. I’m sure the pressure is unsurmountable,” Bonta Sumii said.
That athletes like Biles and Osaka are realizing, and publicizing, their experiences of mental health challenges even in the midst of big competitions and amid that enormous pressure, is a positive sign because it shows them branching beyond their athlete identity for support. They are personalizing their challenges, and in doing so, normalizing seeking help.
Biles said Thursday on Instagram that the support she received after withdrawing from the team and individual all-around finals at the Olympics “made me realize I’m more than my accomplishments and gymnastics which I never truly believed before.”
Biles’ statement shows the importance of developing an identity beyond that of the athlete, the Olympian. “As young as possible, from a preventative approach, athletes should be shown they are valued as human beings,” said Bonta Sumii.
Christman agrees. “We need to view athletes holistically, and respect that they have challenging, nuanced experiences,” said Christman. “There’s a whole lot more to them than toughness and a gold-medal floor routine.”
On Tuesday, Simone returned to the Olympic competition floor and won a Bronze medal for her performance on the balance beam.
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Want more from Teen Vogue? Check this out: Simone Biles Has Teammates’ Support After Olympic Withdrawal to Protect Her Mental Health