TOKYO – It started with Simone Biles, and it was extraordinary.
The gymnast withdrew from competition at the Tokyo Olympics to focus on her mental health and a discussion began to spread.
Noah Lyles, the American sprinter, burst into tears after finishing third in the 200 meters final and talked about battling depression and anxiety and taking antidepressants.
A night later, after winning the silver medal in the women’s pole vault, Russian Anzhelika Sidorova said mental health is a “very personal thing,” but later acknowledged she sees a therapist.
Maria Vicente, a heptathlete from Spain, praised Biles and said she too wanted to begin seeing a therapist after the Olympics.
Whether it was in Russian, Spanish, English or other languages, athletes at these Games showed striking willingness to publicly acknowledge their mental health struggles, and bring a new level of awareness to the issues.
Although the Tokyo Games were known for being contested amid a pandemic, it was COVID-19 that also exacerbated the feelings of anxiety, despair and loneliness.
Training cycles were disrupted by a one-year postponement of the Olympics, and some athletes endured uncertainty around the qualifying process for the Games just months before the opening ceremony.
In March, athletes learned family members, with the exception of some who were coaching them, would be prohibited from attending the Games. Mattie Rogers, a U.S. weightlifter, was among athletes who struggled without family support.
Her husband remained at their home in Hawaii.
“I called my husband, I was like, ‘I don’t know if I can do it. I’m so stressed. I’m so nervous,’ ” Rogers said. “And then (Biles) came out and she’s like, ‘Hey I’m struggling.’ And it just made me feel like I wasn’t the only one, and it gave me a little bit more courage to be here.”
‘Shame and stigma’
It was on July 27 when Biles abruptly withdrew from the women’s team final after dropping out of the air one twist short on the vault.
Robert Andrews, a therapist who has worked with Biles and is the founder of the Institute of Sports Performance in Houston, said the gymnast speaking out not only helped her but sent a powerful message.
“The expectations that come with being the GOAT … were too much for her nervous system, brain and body to handle,” Andrews said. “Shame and stigma of seeking out mental health support keeps many athletes from seeking help.”
But Biles had gone beyond asking for help. She walked away from the script that called for her to win five gold medals and build on her status as the greatest gymnast of all time.
“After the team final, we went to the village, and honestly I expected to feel a bit embarrassed,’’ Biles said, “and (athletes) were coming up to me saying how much I meant to them, how much I had done for their world. That was the craziest feeling ever.
“In that moment, I was like, ‘There’s more than gymnastics and medals.’ ”
The day after Biles withdrew from the team final, cyclist Tom Dumoulin of the Netherlands served as a potential model for struggling athletes.
In January Dumoulin stopped competitive cycling in part because of mental health concerns and only after a four-month layoff began preparing for the Olympics. Then he won the silver medal in the men’s individual time trial.
“It’s really good that athletes are prioritizing their health over performance,” Robert Schinke, president of the International Society of Sport Psychology, said while pointing out that mental health and athletes is not a new topic of discussion.
“I think it’s always been a prevalent discussion among athletes. I don’t think it’s been all that prevalent a discussion among the people surrounding the athletes, and part of the reason why is because their focus has been on performance.
“So not a whole lot of attention has been paid to wellness.’’
But Paul Wylleman, former president of the European Federation of Sport Psychology, said the quality of mental health support began to change about a decade ago. Programs grew more robust, first in North America, then in Europe, to a lesser degree in South America and finally seeping into Asia.
Wylleman said he has been working with Japan for the past six years and the country’s Olympic committee still is looking into how to introduce mental health awareness into a society where it is less acceptable than in the West. The same is true of China.
“They’re looking at a model of mental health that’s very different than ours,’’ Schinke said of Asian countries. “So it’s hard to judge which ones are better quality because we can’t use a singular standard across all cultures because all cultures have different needs.”
One case example: Brazil.
In 2014, the Brazilian Olympic Committee created a mental training department, which includes three sports psychologists and one mental coach supporting athletes at the Tokyo Games.
Brazil had three rooms here devoted to mental health, said Carla di Pierro, a psychologist who works with swimmers Ana Marcela Cunha, a gold medalist in open water marathon, and Bruno Fratus, a bronze medalist in the 50-meter freestyle.
“Our main objective is to create a good atmosphere and a space for decompression, where athletes could keep their routines for emotional regulation even during the Games,” di Pierro said.
‘I hope it’s going to change’
With similar developments across the globe gaining little public attention, it took an athlete to move the issue into the spotlight.
In 2020, Michael Phelps was an executive producer of “The Weight of Gold,’’ a documentary that touched on his struggles – severe depression and anxiety and thoughts of suicide in 2014 after his second arrest for driving under the influence.
Phelps, the most decorated Olympian of all time, also criticized the United States Olympic and Paralympic Committee.
“It breaks my heart because there’s so many people who care so much about our physical well-being, but I never saw caring about our mental well-being,” Phelps said during a conference call to promote the documentary. “We’re products until we’ve stopped competing, and until we are stopped being treated like we’re products, we’re not going to change the equation.”
Over the past year, USOPC spokesman Jon Mason said, the organization has expanded its services to include dedicated mental health officers at the Olympics. At the Tokyo Games, the USOPC has a staff of eight mental health professionals, which includes a licensed psychologist and a psychiatrist.
Dr. Shira Oretzky, a member of the USOPC Sport Psychology and Mental Health Registries, said she thinks early intervention is critical.
This would involve teaching athletes strategies to be able to calm the nervous system, giving them coping mechanisms to manage stress and helping them create a support network with their family and friends.
“When an athlete has a sprained ankle, for example, if they ignore that and continue to train on it, the injury actually will get worse, right?’’ Oretzky said. “And what happens if we ignore it and push it away? Often it can lead to becoming even bigger of an issue. And so the same is true of mental health. If we can address it early on, then it doesn’t have to kind of have to reach a crisis level in order to be able to help support these athletes.’’
Some countries have expanded beyond sports psychologists, said Wylleman of the Netherlands. He said sophisticated programs also include clinical psychologists and psychiatrists and that his staff has conducted research to better identify athletes’ needs.
One in five athletes will suffer from mental health issues and the same is true of the general population in the Netherlands, according to Wylleman. Studies have found approximately the same rates of mental health problems in the United States.
“It doesn’t seem like elite sports is aggravating mental health,’’ he said.
But Wylleman said struggling athletes still must be supported, especially if they’re expected to maximize their athletic potential.
Andrews, the therapist who has worked with Biles, recommends creating educational programs to teach athletes life skills.
“Avoid burnout, create healthier interpersonal boundaries, engaging in activities away from their sport that reenergize their system mentally, emotionally and spiritually,” he said, adding that athletes must understand that their identity is “more than who they are as athletes and how they compete.”
Carl Lewis, the American track star, reflected on his experience at the 1988 Olympics in Los Angeles, where he won four gold medals.
“I had so much pressure in LA in 1984 but I was too young to know any better,’’ Lewis said. “That’s just the way it was for us back then. I received death threats, hate mail, racist mail, the whole nine yards. You just kept going. I was 23 years old. It’s what we did.
“Of course there was no social media back then. Had it existed, it would have been insane. I can only imagine what I would have had to deal with.
“It’s mental health, it’s stress, it’s choices. It was hard then but there’s so much more now.”
Biles overcame it on the final day of the gymnastics competition, winning a bronze medal and widespread praise for competing in the balance beam final.
Her withdrawal from competition and comeback reverberated throughout the Tokyo Games.
At the Olympic Stadium, Belgian pole vaulter Nafissatou Thiam talked about Biles after winning a gold medal.
“That was quite sensitive a subject because I’ve been through up and downs mentally in the couple last years, so I thought it was good to talk more about it,’’ she said. “I feel like there is not so much done for mental health.’’
She also said athletes struggling to cope with pressure are perceived as lacking the mindset of a champion.
“I think it’s wrong,’’ she said, “and I hope it’s going to change.”
Contributing: Christine Brennan, Rachel Axon.