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Simone Biles’s Olympic withdrawal opens a new chapter on the discourse around athletes and their mental health

Simone Biles (center) withdrew from the team portion of the Olympic gymnastics competition on Tuesday.DOUG MILLS/New York Times

Simone Biles made international headlines Tuesday when she withdrew from the team portion of the Olympic gymnastics competition, no surprise given her status as the most dominant and successful competitor the sport has known.

Then Biles told the world why she pulled out of the competition in Tokyo, and the headlines got bigger.

She cited concerns for her mental health, describing a potent mix of fear, uncertainty, and anxiety that not only put her team’s medal hopes in jeopardy, but her own physical well-being at stake, too. And in doing so, Biles opened an extraordinary new chapter in an ongoing discussion in sports. As attitudes and understanding about mental health issues evolve, athletes are increasingly viewed less as machines who should power through injury or obstacle regardless of the personal cost, and more as individual humans who can, and sometimes do, admit they can no longer go on.


“What a sigh of relief she must have felt to be able to speak those words,” Dr. Hillary Cauthen, executive board member of the Association of Applied Sport Psychology, said in an interview. “She is helping shift the culture and view on athlete’s mental health. Hearing her words maybe can make us all take a breath and moment to reflect.

“It’s impressive.”

But it’s still relatively rare, reflective of longstanding attitudes that applaud a certain type of toughness in sports, an expectation that athletes who can withstand pressure are not only the most successful, but also the most admired and respected. Gymnast Kerri Strug will always be remembered for helping the United States win gold in 1996 by landing a vault on a severely injured ankle. But time, and a new lens, alters that focus, with questions about how much she endured in order to compete asked in ways now that they weren’t back then.


Even if the situations aren’t entirely comparable, with Strug’s injury of a physical nature and Biles’s challenge on the mental side, the notion of how much an athlete should push themselves is the same. And it is in that arena where professionals are asking us to hear what athletes are saying.

“My first thought was, ‘Good for you for understanding yourself well enough to do that,’ ” said William Mayer, a clinical sports psychologist and senior lecturer in the psychology department at Sacred Heart University. “I say that because she has a very long history of pushing herself very far, so if anyone wants to question whether she is capable of doing it or can handle something difficult, the track record is out there. She certainly can.

“The routine is complicated, and also dangerous, and she was saying, ‘I wasn’t here, I wasn’t right, and I don’t want to do that.’ ”

In the world of mental health, that is progress, replacing standards of a tough-guy exterior with those of interior honesty. And it’s not just in women’s sports. Think of NFL player Josh Gordon. His multiple suspensions for drug use cost him the chance to be among the game’s best receivers, and also cast him as a person of weak character — too selfish to be deserving of sympathy. But as we learned more details about how Gordon repeatedly tested positive for marijuana, and how he used it to help combat anxiety and mental health issues, that scorn has been replaced by understanding.


“The environment may not have accepted or had understanding four years ago, and fear of stigma of mental health and mislabeling an athlete as ‘mentally weak’ could have occurred,” Cauthen said. “However, I want to keep in mind her status as being the [greatest of all time] and being an athlete who has won numerous medals in high caliber events as aided in her ability to use her voice and gain acceptance. I challenge our welcoming and courageous understanding if this was a first-time Olympian who didn’t make a podium.”

Perhaps that is the next frontier, but there’s little doubt the high-profile advocates in sports, such as Michael Phelps, Kevin Love, or Kyrie Irving, are providing much-needed representation. What’s needed now, Cauthen said, is action behind those words, and not just from one courageous athlete willing to step away from the biggest stage, but from the coaches, teams, leagues, and others around them. Just as teams have medical personnel at the ready to respond to physical injury, so too should they have infrastructure in place to respond to mental health needs.

“While the awareness is building, we need to see the culture shift into action,” Cauthen said. “Looking and treating mental health as a part of a training plan and being a preventative approach beyond the response approach we have seen.

“This is the challenge; it cannot be an individualized decision. Hopefully it will be voiced by the individual, and they have a team approach to help support the best decision together, understanding, and having the knowledge behind the risk-reward scenario. How does this help an athlete? Are they at risk for severe injury?”


In Biles’s case, the answer was an unequivocal yes. Gymnastic injuries can be catastrophic, bodies hurtling themselves toward immovable, inanimate objects or sailing to the ground from similarly unforgiving apparatus. One wrong intersection can be life-altering. The 24-year-old Biles knows that better than anyone, so skilled at pushing athletic boundaries that she is accustomed to having gymnastic moves named after her. But that knowledge, when combined with the perspective she’s learned as one of the elders of her sport, became a detriment.

“For an athlete experiencing emotional distress — the invisible injury to the public — they can be at risk for injury as well,” Cauthen said. “When their emotional and mental state is not functioning well an athlete can lose body awareness, focus, control, and can cause a change in physical output and mistakes may occur.”

That’s precisely what Biles seemed to be experiencing in Tokyo, where she told reporters: “I have to focus on my mental health and not jeopardize my health and well-being. We have to protect our body and our mind. It just sucks when you’re fighting with your own head.

“You usually don’t hear me say things like that because I usually persevere and push through things, but not to cost the team a medal,” she added. “So they were like: ‘OK, if Simone says this, we need to take it pretty serious.’ I had the correct people around me to do that.”


Tara Sullivan is a Globe columnist. She can be reached at Follow her @Globe_Tara.