On the surface it may appear that the biggest stars in sports are suddenly encountering mental health struggles. A decade ago it was rare to hear about top athletes encountering such challenges, let alone withdrawing from major events due to their struggles. Some may ask: Is this an issue with the “new era of athletes?” Are they “weaker” or “different” than athletes in the past?
But truth be told, there was no place for discussion about mental health and wellness in sports in years past. Struggles with mental health were equated with weakness, defectiveness, and unreliability; and disclosing challenges placed athletes at risk of stigma, rejection, deselection, discrimination, harassment, abuse, and other sports-related repercussions. The tide is changing, and some athletes feel it is worth taking the risk that accompanies disclosure to attend to their mental health needs.
It can be argued that established athletes like Simone Biles and Naomi Osaka are safe in their careers and that their disclosures won’t hurt them in the long run. This may be different for the less-accomplished athletes who are still fighting for their positions on teams and in their sports. But even for those more accomplished athletes, coming forward about their mental health challenges is not so easy.
Pressure Points in Sport
Billie Jean King once said, “Pressure is a privilege — it only comes to those who earn it.” But we must ask: How much is too much? Athletes are human beings after all. Are the multitude of demands (appearances, competitions, travel, training, sponsors, press conferences, social media, media coverage, etc.) pushing athletes over the top and beyond their threshold? Are they being pushed to their breaking point or are we seeing them step away before they hit it?
Even before setting foot in Japan, media coverage of the potential that Biles would perform the “dangerous Yurchenko double pike” was amplified, and she had a dedicated emoji created just for her. The media also buzzed about the potential for her to “more than double” her Olympic medal collection at this games, as a contender for six medals. As details about Biles’ performance and withdrawal were unfolding, social media was ablaze with polarized extremes of support, criticism, speculation, and reports that the American gymnasts “suffered a stunning upset” to the athletes representing the Russian Olympic Committee. Former teammate Aly Raisman took to Twitter (@Aly_Raisman) to defend her compatriots, presenting a different perspective with her statement: “Congratulations to the U.S. Women’s Gymnastics team for WINNING the silver medal!”
Biles spoke openly about her reasons for withdrawal after leaving the venue, indicating that her heart was no longer in (the sport) and “there was more to life than gymnastics.” She described drawing inspiration from Osaka’s stance on her own mental health and made the decision that she was “done.” Media coverage throughout the day following her withdrawal from the team event at the Olympic Games trended more toward support and advocacy for athlete mental health as the enormity of the impact of Biles’ withdrawal was recognized.
In the spring, Osaka was initially penalized for tending to her mental health needs by not appearing at a French Open press conference. Her subsequent complete withdrawal from both the French Open and Wimbledon for mental health reasons led to acknowledgement of the importance of mental health and support for her recovery. Biles was subjected to criticism for her “decision” as well. Would they have faced a different response if their struggles were related to physical injuries?
Biles wants to send a message that is larger than any of her athletic accomplishments, and it is time to listen. She hopes that talking about mental illness will have more of an impact than winning medals. “We are people at the end of the day, so we have to focus on that.” That is the message: Athletes are people first. Beyond the sound bytes, photo ops, autographs and commercials, they are human beings with the same emotions as the average person. While athletes are idolized, glamorized, and glorified, they are vulnerable to the same risk factors for mental illness as the general population (including trauma, adverse childhood experiences, genetics, traumatic brain injury), and several others that are more specific to high performance sport (including commodification, unanticipated burden of success, sport failure, injuries, post-competition “crashes,” and retirement from sport).
Mental Health Awareness in Sport
Although mental health in sport is becoming a more common headline, we are just scratching the surface in terms of education, prevention, detection, and response. These elements need to be discussed and addressed at every level of every sport by anyone involved with sport around the globe before we will see major shifts. The International Olympic Committee released a consensus statement on mental health in elite athletes in 2019, which was followed by publication of the Sport Mental Health Assessment Tool and the Sport Mental Health Recognition Tool to enhance screening and support for athletes demonstrating or experiencing signs or symptoms of mental illness. Some coaching associations offer free mental health education modules for members to attend to their own mental health as well as that of their athletes.
No Physical Health Without Mental Health
There is no performance or physical health without mental health. There is no sport without mental health. It is becoming increasingly evident that mental health is the most important ingredient to overall health and sporting accomplishment, and for the athletes, is more important than any podium result. Mental health should be discussed, addressed, managed, and incorporated into every athlete’s daily routine and comprehensive medical plan. Appropriate staff, including sports psychiatrists, should be part of core and event staff to navigate challenges that arise, assist in the development of policies and protocols, provide education and insight, and ensure appropriate messaging.
Mentally Healthy Sports
The messaging from Biles and Osaka is clear: Their mental health is their priority. These athletes are leveraging their influence on the sporting stage to broadcast the importance of mental health in athletes. It’s time to carry that momentum forward and cast the message across sports at every level. It’s time to embrace a healthier approach to sports and make mental health a normal part of the conversation.
Carla Edwards, MD, MSc, is a Canadian sport psychiatrist and the High Performance Mental Health Advisor for several Olympic programs. She is actively involved in direct care of high performance athletes and development of polices and programs to address and protect athlete mental health. She is also the current president of the International Society for Sports Psychiatry.