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Ten years ago, or even five, an athlete of Simone Biles’ stature might have been reluctant to say that she struggled with pressure, much less to have withdrawn in the middle of an Olympic competition.

“People might have labeled an athlete mentally weak,” Hillary Cauthen, a clinical sports psychologist in Austin, Texas, said Tuesday, hours after Biles, the greatest gymnast in history, had bowed out of the women’s team event at the Tokyo Games, and one day before she said she would also skip the all-around individual competition.

But a shift in cultural acceptance began to take place in 2015-16, when the NCAA created a mental health initiative, Cauthen said. Just before the 2016 Summer Games in Rio de Janeiro, swimmer Michael Phelps, the most decorated Olympian ever, began to discuss wrestling with depression and suicidal thoughts. Since then, NBA players DeMar DeRozan and Kevin Love and figure skater Gracie Gold, among other athletes, have gone public to say they grapple with anxiety and depression.

Though sports psychologists say a stigma persists about athletes and mental health, and Biles was surely disappointed not to have lived up to enormous Olympic expectations, she was also widely embraced as the latest active, elite athlete who had the courage to acknowledge her vulnerability.

“What a sigh of relief she must be experiencing just to be real, to say, ‘You know what, I’m not OK,’” said Cauthen, a member of the executive board of the Association for Applied Sport Psychology.

Sian L. Beilock, the president of Barnard College in New York and a cognitive scientist who studies athletes, business people and students and why they succumb to pressure, said that Biles was likely to experience some backlash for not completing the Olympic team competition as her teammates fought on to win a silver medal.

But Beilock said, “I applaud the fact she was able to ascertain that she wasn’t in the right state of mind and step back. What a hard thing to do. There was so much pressure to continue. And she was able to find the strength to say, ‘No, this is not right.’”

After withdrawing, Biles assured reporters she was not injured, saying, “It’s been really stressful, this Olympic Games.” She said she wasn’t certain if she would continue to compete.

Biles’ withdrawal, Beilock said, was an attempt to take control of a situation that had seemingly spiraled out of control when she lost her sense of positioning in the air during a twisting maneuver. It was not unlike tennis star Naomi Osaka’s withdrawal from this year’s French Open rather than face what she considered invasive and dispiriting questioning from the media. Osaka lost to Marketa Vondrousova of the Czech Republic on Tuesday and exited in the third round of the Olympics.

The increasing willingness of athletes to speak up, Beilock said, confirms that mental health issues affect everyone. For a public that has faced the strain of a pandemic lockdown, and may soon again, Beilock added, candid acknowledgments by Biles, Osaka and others are “really important for the everyday Joe to do the same thing. It sort of gives them permission.”

Biles entered the Tokyo Olympics as more than a superstar gymnast. She was the face of the Summer Games for NBC. She had become a leading voice against sexual abuse by speaking up about the crimes of Lawrence G. Nassar, the former doctor for the U.S. women’s gymnastics team and Michigan State University athletics.

All the while, Biles’ corporate sponsors, fans and the media expected her to collect gold medals like refrigerator magnets.

“Clearly Simone has been under tremendous stress,” said Steven Ungerleider, a sports psychologist in Eugene, Oregon, and a former collegiate gymnast who has worked with hundreds of Olympic athletes.

Simone Biles of the United States during training in July | REUTERS
Simone Biles of the United States during training in July | REUTERS

As the coronavirus pandemic forced a one-year postponement of the Tokyo Games, Ungerleider said, it was extremely difficult for elite gymnasts who lacked regular access to gyms, coaches and national training camps. In May, Biles competed for the first time in 18 months. At these Olympics, she has performed before a largely empty arena, unable to feed off the energy of the crowd.

“As a gymnast,” Ungerleider said, “you have to be touching, feeling, interacting with bars and the beam. If you’re not on that equipment and not with a coach and not being spotted, those are five-, six-, seven-hour days for 17 months that she had limited access to.”

Biles was still able to hone singular, unprecedented maneuvers. But the lack of regular competition for many athletes was the equivalent of a muscle atrophying, said Nancy Hogshead-Makar, a lawyer who won three gold medals and a silver in swimming at the 1984 Los Angeles Olympics.

“It’s not that they’re choking; it’s not that they’re out of shape,” Hogshead-Makar said. “Almost no athlete does that, go for a year with no competition. There is no replacement, when all eyes are on you and you need to be able to perform when the time is right.”

Regular competition teaches athletes how to deal with adrenaline, raising and lowering it as if it were a thermostat, she said. And competing allows them to get into a state of grace and flow, Hogshead-Makar said, to “let go of the handlebars” of training and feel a calmness and centeredness, as if the performances were happening by themselves.

“You’re really not into cognitive thinking,” Hogshead-Makar said. “I used to feel that my soul was condensed into a needle. I was only really aware of breathing. I was not my arms and my legs and my head moving around. I was not this cacophony of splashes and movement. I was a sliver. It was these shared moments with God, that’s the only way I know how to describe it.”

Performing poorly at the most anticipated and visible moment of an athlete’s career can be crushing, Nyjah Huston, an American skateboarder who was a favorite in the street competition and finished seventh, wrote candidly on Instagram. Describing himself as “so damn competitive,” Huston wrote that the “downside to that is me being really hard on myself when I don’t skate good. Like days after contests when I just don’t wanna talk to anyone and replay everything I did wrong over and over. Or chugging alcohol in the hotel room by myself after a loss thinking it would make things better.”

“Mental health,” he added, “is so important!”

Leroy Burrell, the head track and field coach at the University of Houston, is a former world-record holder in the 100 meters and was among the gold medal favorites in the event at the 1992 Barcelona Olympics. But he entered the Games with back problems, reacted sluggishly after a false start and finished a disappointing fifth.

“Often you hope if you’re successful, it opens more doors and opportunities and could be a generational change for the trajectory of your family,” Burrell said. “I can’t imagine the challenges Simone has been facing. She’s basically been the face of the Games for Team USA. I really feel for her. There is a tremendous amount of pressure. Your whole identity is wrapped around your performance, multiplied by 1,000 going into the Games.”

When disappointing things happen during the Olympics, Burrell said, “they can stay with you forever.

“You never forget those things. You have to learn to live with them and not let them define you. You try to find some other things that really matter to you.”

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