Simone Biles and Pressure: Talking About Mental Health

Performing under pressure: It’s something all of us have had to deal with, whether it’s that big presentation at work, speaking in front of a crowd—or just trying to live up to daily expectations or past accomplishments.

It’s those expectations and the pressure we put on ourselves that often wreak the most havoc.

“Can I be just as good as I was before? Can I continue to put on that perfect veneer when I feel like I’m crumbling inside? What will people think of me if I fail?”

Pressure – and its effect on our mental health – has been in the news again lately. Decorated Olympic gymnast Simone Biles, seen by just about every expert as a shoo-in to lead the U.S. team to Olympic gold, withdrew from the team event on July 27, citing pressure and mental health issues.

Biles eventually returned for one individual event and won bronze on the balance beam – a much lesser medal count than everyone expected.

The gymnast’s decision sent shockwaves through the sports community, inspired numerous think pieces, and also spurred a deluge of criticism. Many called Biles “a quitter,” among other things. After all, how could someone so gifted and perfect and considered the GOAT (greatest of all time) of her sport simply…not compete?! If it were me…

Positive reactions

But the positive reactions to Biles’ struggle have outweighed other complaints. Her agonizing decision to withdraw has helped normalize discussions about mental health in our country, according to Eric Raab, D.O., a psychiatrist at Lee Health’s Behavioral Health Center.

The gymnast’s withdrawal came hot on the heels of another star athlete, tennis champion Naomi Osaka, who cited anxiety and mental health issues when she opted out of the French Open and Wimbledon earlier this year.

“I do think (athletes) help the mental health discussion. The thing I always tell my patients is that as a society, and, in the past, a lot of people saw mental health problems as a weakness,” Dr. Raab says. “I always tell patients that when they acknowledge that there is something that they need to work on, that’s a strength.”

Dr. Raab agrees that awareness of mental health challenges – especially in light of the COVID-19 pandemic – has increased in recent years, and more people are willing to talk about the issues they face.

“Now we see that there is a slow change, recognition that we need to take a break once in a while. Biles, Osaka, even Michael Phelps – they are raising awareness. And you see some organizations now are coming around on giving employees mental health days, various activities and having more resources,” Dr. Raab says.

Biles’ case and the twisties

Experts and mental health advocates are quick to point out that pressure is just another name for stress. We all know what stress does to our lives and bodies – especially chronic stress, the kind that leaves our hearts racing, our brains foggy, and our body reeling with unfamiliar and often frightening symptoms.

In Biles’ case, the pressure she felt under the bright lights and the scrutiny of millions upon millions of strangers watching her led to something called “the twisties.”

This means that her mind-body connection, honed into muscle memory from years of intense practice, suddenly betrayed her, and she lost track of herself in the air – quite a problem when spinning and flipping at top speed. A gymnast dealing with “the twisties” opens themselves to serious injuries.

“Missing a foul shot is one thing, but missing a twirl is another – there is a high rate of injury,” Dr. Raab says about gymnasts. “You can break your neck, in her case, and that’s a whole other level of pressure. There’s so much where you have to know where your body is in relation to the ground. If you are not 100 percent, then it’s dangerous.

“But even outside of that, athletes at the top of their game, there is a lot of pressure there.”

Superhuman vs. Human

There can be a tendency for athletes to be seen as superhuman or somehow immune to mental health challenges – especially when many of them are idolized and paid millions of dollars for our entertainment.

“The media and fandom can be rough – for instance, sports talk radio is brutal. We all read our reviews. That extends to all of us. One person says something critical, suddenly it gains traction, and negativity gains followers and comments,” Dr. Raab says.

Part of being human, and part of the maturing mental health discussion, is the idea of practicing compassion and empathy – trying to see the world through someone else’s eyes and experiences.

Behind the scenes, Biles recently revealed that her aunt died shortly before the Olympic competition. And Biles was also one of many young gymnasts sexually abused by USA Gymnastics team doctor Larry Nassar. In fact, Biles had said that one of the reasons she wanted to compete this year (after winning multiple golds at the previous Olympics) was to help shine a light on Nassar’s abuses and show that such horrors could be overcome.

“I think it’s so easy to judge somebody. And you have no idea what’s going on. We don’t know how much Nassar plays a role. Going back to competition, that could have been a trigger,” Dr. Raab says. “From a news perspective, it’s people’s job to commentate on things, but in reality there are probably a lot of layers to this story, and I think as a society we try to make judgments we don’t even know about.”

Also, Dr. Raab points out, if we’re pushing ourselves non-stop – in any profession – someday our body will just say no.

COVID-19 stress and burnout

Stress and pressure are a constant in our lives these days thanks to the ever changing COVID-19 pandemic. Besides having to learn to adapt to new schedules, ways of working, and social distancing, many are also suffering from burnout – especially healthcare workers, Dr. Raab says.

“It's tough, but we do tend to think more about self-care rather than 24/7 production these days, and that’s good. Companies are seeing that employees will produce more if they are rested and it actually helps the long-term gain for the company as well,” Dr. Raab says.

Dr. Raab says we all have to take the time to check in with ourselves a little bit and maybe take a step back – in a way similar to Biles that is appropriate to our daily lives.

That could include finding things you enjoy and committing to them such as:

• Meditation
• Yoga
• Taking frequent breaks at work – especially if you are working from home. Just because you have a laptop on hand 24 hours a day doesn’t mean you should use it.
• Staying mindful and grateful
• Watching Netflix or other entertainment distractions
• Frequent walks or regular exercise
• Indulging in your favorite hobby or learning a new one

Primary care physician: Someone you can talk to

Talking to someone is the first step, but it’s one that can frequently be the most difficult. Dr. Raab suggests talking to your primary care provider. Having a caring, compassionate doctor makes all the difference.

“The idea of going to see a therapist, somebody new in a different building, can be intimidating. But you already know your primary care physician and are comfortable with them; that’s a good first step,” Dr. Raab says. “If you are too anxious to make that call to another place, primary care is a perfect place to start, along with telehealth options.”

In the end, Dr. Raab reminds us that celebrities and sports figures are kind of a reflection of daily life. These high-powered individuals are frequently put on a pedestal, and, whether we realize it or not, many of us put unrealistic expectations on them. And then we put unrealistic expectations on ourselves.

“I think it is good that they are high profile – people see this in the news and take a second thought,” Dr. Raab says. “Maybe there’s not as much stigma. Maybe the conversation can begin.”