Simone Biles places spotlight on mental health for athletes of all ages and abilities

July 30, 2021
Simone Biles
A decision by Olympic gymnast Simone Biles to drop out of team gymnastic finals at the Tokyo Olympics sent shockwaves through the sports world. Her story puts a spotlight on mental health for athletes of all ages. In this photo, she competes on the balance beam in the Rio 2016 Olympics. Photo by Mark Reis.

By Rick Ansorge, for UCHealth

Gymnast Simone Biles is one of the world’s shortest superstars, standing just four-feet eight-inches tall.

But she made a giant statement when she withdrew from one of the world’s biggest competitions: the women’s gymnastics team finals at the Tokyo Olympics.

She could have taken the easy way out and claimed she injured herself during her disastrous vault performance.

But that would have been a lie. Instead, she explained that she dropped out of the team finals and wouldn’t participate in another signature event – the individual all-around competition – because she had to take care of her own well-being.

“After the performance I did, I just didn’t want to go on,” Biles told reporters. “I have to focus on my mental health.”

Biles’ decision sent a shockwave through a sports world that has crowned her the GOAT, the greatest of all time, and for good reason. She’s the winner of an unprecedented 30 combined medals in the Olympics and World Championships, including four Olympic gold medals.

To her millions of fans, she was invincible.

Instantly, Biles – the bright, shining face of this year’s Olympics – became the story of the COVID-cursed Summer Games.

But that’s actually a blessing in disguise, according to Dr. Justin Ross, PsyD, a UCHealth clinical psychologist.

Dr. Justin Ross gives advice on handling pandemic fatigue
Psychologist Justin Ross said the big takeaway from the Simone Biles story is that ‘there is no health without mental health. Photo courtesy of Justin Ross.

“Everybody is covering this story and talking about it, which I think is a great thing,” Ross said. “This puts the spotlight on mental health for athletes of all ages and performance levels.”

As director of the Workplace Well-Being Program for UCHealth, Ross specializes in health, wellness and human performance. He works with elite athletes and coaches from the U.S. Olympic and Paralympic Training Center in Colorado Springs, is vetted as a provider for both the NFL and NBA, and works with amateur athletes looking to up their game.

“The big takeaway from this story is that there is no health without mental health,” he said. “And performing on the world stage requires both. What we’re seeing today is that Simone Biles recognizes she is struggling mentally with something. We can only speculate what that something is. But she had enough self-awareness to see it and enough courage to step aside and ask for help in a critical moment with the world watching.”

Ross allows that it must have been difficult for Biles to assume the role of de facto coach at the team finals, cheering on her teammates from the sidelines, and to sit in the stands during the all-around competition. On Monday, news broke that Biles would compete in the individual balance beam competition.

Ross believes her her choice not to compete in the team competition and three individual finals was best for herself as well as her teammates.

“I didn’t want to go into any of the other events not believing in myself,” Biles told reporters. “So I thought it was better to take a step back and let these other girls do the job.

“And they did.”

Although teammates Sunisa Lee, Jordan Chiles and Grace McCallum were unable to overtake the Russian Olympic Team and win a gold medal, they went on win a silver medal.

“She’s a human being first and an athlete second,” Ross said of Biles.

“I think sometimes the public loses sight that athletes are not superhuman,” he added. “They’re not automatically able to brush aside pressure and stress, and it impacts them in very deep ways as it does all of us. Her decision to step aside for the benefit of her team to focus on her mental well-being humanizes the fact that each and every one of us struggles from time to time.”

Experts agree that mental and physical health are equally important for peak performance.

“We would never ask an athlete to go out and perform on a broken leg,” Ross said. “That’s a no brainer. You just accept that they’re injured and need to heal. Unfortunately, mental health has historically not been given the same level of permission. That conversation is changing, however, with athletes such as Michael Phelps and Simone Biles bringing attention to this concern.”

Simone Biles competes in the Rio 2016 Olympics
Simone Biles competes in the 2016 Olympics in Rio. Photo by Mark Reis.

After a sub-par performance at the prelims before the team finals, Biles hinted that her mental health might be shaky.

“I truly do feel like I have the weight of the world upon my shoulders at times,” she posted on Instagram. “I know I brush it off and make it seem like pressure doesn’t affect me but sometimes it’s hard, hahaha! The Olympics is no joke.”

After the team finals, Biles told reporters that she wanted the Tokyo Olympics to be for her and her teammates. She explained that the extra year of training and the pressure of being the GOAT were not for the benefit of her sponsors, USA Gymnastics, the U.S. Olympic Committee, or even her adoring public.

But that dream evaporated during her vault performance, which left her feeling lost in space as she attempted to complete a double-and-a-half twist and ended with an awkward, forceful landing that easily could have caused a serious injury.

“I was like, ‘I am not in the right headspace,’” Biles told reporters. “I am not going to lose a medal for this country and these girls because they’ve worked way too hard to have me go out there and lose a medal.”

The “headspace” comment quickly became an Internet meme, a positive one in Ross’s view.

“It shows great self-awareness,” he said. “Any high performance requires being in the right state of mind, especially in a sport like hers where making a mistake can result in a calamitous injury. It took great courage to admit that she was not in the right position to execute her moves.”

He called that an inspiring message for everyone from top elite athletes to weekend warriors and everyday folks.

“Pressure is pressure, regardless of the stage,” he said. “This happened to be the world stage in an Olympic event that only happens once every four years.”

“When you’re repeatedly touted as the greatest gymnast of all time, and you’re put on that stage and the world is watching, the expectation is that you not only are going to win but you are going to demolish the competition and dazzle the audience. That pressure builds and it takes a toll on mental well-being.”

Exposed to sportscasters who breathlessly describe elite performances as “unbelievable” and even “superhuman,” many fans come to believe that top-tier athletes tower above most mere mortals.

“They don’t have superhuman powers in regards to their psychological well-being,” Ross said. “They’re just as vulnerable as we are. They have emotions, life history, traumatic experiences, stresses, and anxieties just like every other human being.”

Biles has certainly experienced more than her fair share of trauma. Her mother was addicted to drugs and alcohol and was in and out of jail, leaving Biles and her three siblings shuttling back and forth between foster homes.

Biles was finally adopted by her loving maternal grandfather and his wife, but she was mercilessly bullied in school because of her bulky muscles, treated by a sports psychologist at age 16, and diagnosed with ADHD, a condition that was publicly revealed by hackers who broke into her health records.

In 2018, her older brother was charged in the fatal shooting of three people at a New Year’s Eve party. He was acquitted this spring after a judge ruled there was insufficient evidence to convict him.

Also in 2018, Biles revealed that she was among the more than 100 female gymnasts who were sexually molested for months and years by disgraced team doctor Larry Nassar at the USA Gymnastics training facility.

“It is impossibly difficult to relive these experiences and it breaks my heart even more to think that as I work towards my dream of competing in Tokyo 2020, I will have to continually return to the same training facility where I was abused,” Biles said on Twitter at the time.

In September 2019,UCHealth announced a commitment of $100 million to help meet behavioral health needs in Colorado. Here are highlights of the program:

  • Integrating behavioral health with primary care: Teams of licensed clinical social workers and psychologists are working hand-in-hand with primary care physicians to provide immediate resources to the largest number of patients in need.
  • Tele-behavioral health consultation services: When patients and providers in emergency departments, primary care clinics or inpatient hospitals need consultations with a psychiatrist, UCHealth’s Virtual Health Center provides the video connection.
  • A new inpatient behavioral health unit: The expansion of University of Colorado Hospital will enable a new inpatient behavioral health unit, likely opening in late 2023, to expand the services already available in other UCHealth locations.

Read more here: UCHealth dedicates more than $100 million for behavioral health care | UCHealth Today

Shortly thereafter, USA Gymnastics permanently shut down the training facility.

Biles recently retweeted a colleague’s supportive post, which hinted that Nassar’s abuse influenced her decision to withdraw from the all-around competition.

“Stress is cumulative,” Ross said. “The more stressors we have the harder it is to function in any content. So she’s had a lifetime of trauma in addition to the pressure of this unique Olympic experience.”

The specter of COVID looms large at the Tokyo Olympics. “One of the things we don’t see as spectators is the isolation that these athletes have faced given COVID protocol,” Ross said.

Athletes spent months training alone, only to end up wearing masks and performing in nearly-empty stadiums where even their closest family members couldn’t step inside.

“Those stressors add up,” Ross said. “At some point, they become insurmountable. We all have the capacity to manage stress to a certain point. When stressors exceed our ability to cope with them, we start to have issues with concentration, performance and trust.”

Biles admitted to reporters that she was losing her self-confidence. “I just don’t trust myself as much anymore. I don’t know if it’s age, I’m just more nervous when I do gymnastics. I feel like I’m also not having as much fun. I know this Olympic Games, I wanted it to be for myself. I’m still doing it for other people. And that hurts my heart that doing what I love has been taken away from me.”

So far, the public reaction to Biles’ mental health issues has been overwhelmingly positive. But there have been some naysayers who’ve called her a soft, selfish quitter who should’ve gutted out the competitions.

“I saw it as the complete opposite,” Ross said. “She didn’t quit. She removed herself knowing that she wasn’t in the right headspace to perform at her peak. She put the team first.”

Biles said she was inspired to focus on her well-being by Japanese tennis star Naomi Osaka, who had the honor of lighting the Olympic cauldron atop a representation of Mount Fuji.

Stress – much of it related to mandatory press conferences after events – prompted Osaka to pull out of the French Open in May and skip Wimbledon in July.

At the Olympics, Osaka – the second highest-ranked player — was eliminated in the third round of the women’s singles tournament by a competitor who was ranked 42nd.

After Osaka’s defeat, organizers said Osaka left the stadium and would not speak to the media.

Biles, however, is staying talkative. “There’s more to life than just gymnastics,” Biles told reporters. “It’s very unfortunate that it happened at this stage, because I definitely wanted it to go a little bit better. [I will] take it one day at a time …”

Ross applauds such honesty and humility, “She had to take care of herself,” he said.

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