NEW YORK — History teaches us that movements require a moment. Nothing crystallized the cause of civil rights like Rosa Parks refusing to give up her seat on a Montgomery, Ala., bus in 1955. For the plight of mental health of athletes, the moment came when Simone Biles gave up her seat at the Tokyo Olympics.
Biles’ message upon her exit — athletes must heed the needs of their minds as well as bodies before risking “what the world wants us to do” — was a clarion call that echoes at the doorstep of another Olympics.
The message resonated with Ilona Maher, a U.S. Rugby team member who passes it on to her TikTok audience of 1.1 million.
“Here’s the best gymnast in the world who’s so amazing at what she does,” Maher said this spring at the U.S. Olympic and Paralympic Summit. “And she’s having bad days. People want to understand why.
“For me, it was like showing how human we are.”
Biles’ withdrawal came on the heels of a sexual assault scandal that resulted in a life sentence for USA Gymnastics’ former team doctor, as well as hundreds of lawsuits against the USOPC and USA Gymnastics, among other institutions. It precipitated seismic changes not only in governance, but also in treating the mental health of USOPC athletes.
Since the Tokyo Olympics in 2021, the number of licensed psychologists on the USOPC staff has increased from six to 15. The organization also consolidated its mental health and mental performance departments into a “psychological services team” with a network of more than 300 providers. Mental health screenings of up to three times a year can lead to red flags for everything from sleep and eating disorders to body-image issues to “suicidal ideation.”
Going into the Paris Olympics, the International Olympic Committee responded to increasing mental health concerns, as well.
Credit: TNS
Credit: TNS
According to a report in the Guardian, the IOC will hand out 2,000 licenses for the Calm app along with a mental fitness helpline; provide a “mental decompression zone” during the Games; and use AI to “identify and suppress” abusive posts or comments on social media, an attempt to create a buffer zone around athletes.
Dr. Jess Bartley, the USOPC’s senior director of psychological services, declined to comment on the impact of Biles or any athlete in particular out of privacy concerns. But she acknowledged the effect of high-profile athletes and celebrities in destigmatizing conversations about mental health.
“I think having some of those in the spotlight speak up is really valuable,” she said.
The increased emphasis was apparent at the summit, where athletes’ mental health was the subject of one panel discussion. The panelists spoke freely of their mental struggles evolving from issues of body image, injury and isolation.
Winner of the long jump at the World Athletics Indoor Championships this year and a favorite for gold at her second Olympics, Tara Davis-Woodhall’s bubbly persona is evident to a half-million Instagram followers as well as 782,000 subscribers to the YouTube channel she shares with her paralympian husband, Hunter Woodhall. They might be the most celebrated couple in track and field. Their 2022 wedding at D’Vine Grace Vineyard in McKinney was covered by People magazine.
The various media have also documented her troublesome mental health journey, which began her first year at the University of Texas after transferring from Georgia in the fall of 2020. Despondent at being unable to compete because of transfer rules and a fractured vertebrae, she didn’t leave her room for a week, occupying what she called “a dark place.”
“I didn’t want to be here anymore,” she said at the summit.
Through her own initiative as well as the help of a psychologist and therapist, she said she crawled out of that hole and learned to express her feelings. Talking about it on her platforms, she said, gives her “a purpose.”
Many athletes face pressures that require some sort of mental health care, Bartley said, but Olympic athletes, in particular, may be more susceptible. Training for an event that comes once every four years presents unique challenges. The problem with losing is obvious, but winning isn’t always a panacea, either.
Ryan Crouser, a two-time gold medalist in the shot put who won four NCAA titles at Texas, painted a vivid image of what athletes call “post-Olympic blues.”
“I’ll just say that you expect it to be this huge, life-changing moment,” he said at the summit. “And it is, but you spent years and years putting that moment on this pedestal that it’ll be life-changing. Then, you wake up the next morning, and it’s like, ‘Dang, I’m sore.’ You’re expecting everything to be vibrant, all rainbows and sunny. But, from a neurological standpoint, you just had the biggest dopamine hit of your entire life, winning that Olympic gold and standing on the podium.
“So then you’re going through a massive, massive dopamine withdrawal. So you think you should be happy. And everyone around you says you should be happy, but your brain has no dopamine. And you’re way down here and you just feel bad.
“It’s like, ‘I should be feeling good right now. Why am I not feeling good? I’m letting myself down. I’m letting all these people down that want me to be happy and share in that happiness.’
“It’s hard to say to them, ‘I feel terrible. I feel super depressed.’”
The USOPC’s psychological services team administers something called the Patient Health Questionnaire to monitor athletes’ moods. The nine questions require checkmarks on how often over the previous two weeks — not at all, several days, more than half or nearly every day — they experienced one of the symptoms described.
The first question is, “Little interest or pleasure in doing things.” No. 5 is “Poor appetite or overeating.” No. 6? “Feeling bad about yourself — or that you’re a failure or have let yourself or your family down”.
The last one: “Thoughts that you would be better off dead, or of hurting yourself.”
Credit: ArLuther Lee
Credit: ArLuther Lee
If the sum reaches a threshold constituting a red flag, the team usually responds within 15 minutes, Bartley said. Suicidal ideation or self-harm takes precedence. Athletes receive a follow-up call that can lead to a conversation, additional screening or contact with another mental health professional.
“We will track them down at the Games if they have not gotten back to us,” Bartley said, “just to make sure they know what their resources are. We’ll continue to follow up with them.”
More than half of athletes flag for sleep issues, the biggest area of concern. Next is body image or eating disorders, followed by anxiety and depression. Few are flagged for substance use or abuse, Bartley said.
The psychological services team screens just once a year, Bartley said, but some disciplines, such as skiing/snowboarding, swimming, gymnastics, figure skating and speed skating, test more often. The psychological services team is also a mandatory reporter to the U.S. Center for SafeSport, codified in 2017 to resolve abuse and misconduct reports throughout the USOPC.
Bartley called it “amazing” to see the welcoming reaction from athletes who flag. Any further help is covered by their elite athlete health insurance. There are no copays and no deductibles in network. Former Olympians are currently covered two years into retirement; Bartley said their goal is to stretch it to 10.
Mental health is increasingly a topic of conversation among athletes, Crouser said, but some are still afraid to talk about their feelings. The reticence answers why protocols weren’t instituted sooner.
“I get asked that question a lot,” Bartley said. “And the reality is, the stigma when I was coming in is still kind of there. The walls are coming down. More and more athletes are talking about it. We have kids that are more open about their mental health now. It’s a hot topic. So I think we did it at just the right time.”
Biles made it the right time.
Jade Carey, the woman who replaced Biles in the all-around in Tokyo, summed up the feelings of her peers when she said she saw “pure strength” in Biles’ decision to withdraw from five events after experiencing what gymnasts call “the twisties,” a mental block in midair.
Public reaction to her stunning withdrawal wasn’t as supportive at first. But, after Biles returned from a two-year hiatus to win a record eighth all-around title at the U.S. Gymnastics and a sixth world all-around title, a different narrative developed.
By the time she broke her own record in June with a ninth all-around title in Fort Worth, automatically qualifying her for the Olympic Trials, she’d developed another legacy.
Not that Biles is particularly comfortable on a pedestal for mental health. She told Vanity Fair in its January issue that she promises only to be “open, honest and vulnerable.”
For the sake of the movement, maybe that’s enough.
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