Mental health and elite sport: the pressure to perform 

She may stand only 4ft 8in tall, but Simone Biles is a giant of world gymnastics and one of the biggest stars competing at the Tokyo 2020 Olympic Games. The 24-year-old American, who is the most successful US gymnast of all time, arrived in Japan aiming to add to her tally of four Olympic gold medals, won at Rio five years ago.

As part of the US team in Tokyo she was due to take part in the women’s team final yesterday, but “walked off the mat after an uncharacteristically faulty vault”, Elle magazine said. Today, it’s been confirmed that she has also withdrawn from the individual all-around final tomorrow.

After missing the team final Biles said she had to step back and focus on her mental health. “After the performance I did, I just didn’t want to go on,” she said. “I just think mental health is more prevalent in sports right now. We have to protect our minds and our bodies and not just go out and do what the world wants us to do.”

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Biles’s statement comes just weeks after tennis star Naomi Osaka withdrew after the first round of the French Open and also missed Wimbledon. The 23-year-old said she would take a break from tennis after experiencing depression and anxiety, the BBC reported at the time.

‘The weight of the world’

When Biles strode into the Ariake Gymnastics Centre, the expression on her face said it all, said Alice Park in Time. “Normally all smiles and easy-going, Biles appeared sternly serious and maybe even troubled.”

In yesterday’s press conference Biles explained more about her decision to pull out of the team event. “I don’t trust myself as much anymore,” she said. “Maybe it’s getting older. There were a couple of days when everybody tweets you and you feel the weight of the world.

“We’re not just athletes. We’re people at the end of the day and sometimes you just have to step back. I didn’t want to go out and do something stupid and get hurt. ​I feel like a lot of athletes speaking up has really helped. It’s so big, it’s the Olympic Games. At the end of the day we don’t want to be carried out of there on a stretcher.”

Even though she wasn’t competing in the final, she returned to the arena to cheer on her team-mates. “Simone could have hid in the background,” said Sam Quek on BBC Olympics Breakfast. “She could have been in the changing rooms and left the world guessing about it, but she didn’t. She put her tracksuit back on, got out there and stood on and clapped her team-mates. That, to me, is a champion.”

Sarah Hirshland, chief executive of the US Olympic and Paralympic Committee, applauded Biles for prioritising her mental health “over all else”. “Simone, you’ve made us so proud,” Hirshland tweeted. “Proud of who you are as a person, teammate and athlete. [We] offer you the full support and resources of our Team USA community as you navigate the journey ahead.”

‘They are not superhuman’

Biles has received widespread praise for bringing attention to mental health, “dispelling the stigma that remains around the issue, and highlighting the immense pressure put on elite athletes”, Al Jazeera reports.

Becky Downie, who competed for Britain in artistic gymnastics at the 2008 and 2016 Olympics, said Biles made the right call. “I think it’s really brave of Simone Biles to put her own health and wellbeing first,” Downie wrote in The Telegraph. “People outside the sport may not recognise this, but gymnastics is really dangerous if your head’s not in the right place – especially at Simone’s level of performance, which a lot of gymnasts can't even comprehend.”

In a column for The New York Times, Lindsay Crouse said Biles joins a growing number of younger athletes who are “pushing against the traditional American narrative of gold at all costs”, including their own mental or physical health. “These young women and men have extraordinary talent and perform under incredible pressure, but they are not superhuman,” Crouse added. “We have no right to expect them to be.”

“Forget about the Yurchenko double pike vault”, said Maeve Higgins in The Guardian. It is Biles’s move – the defensive retreat, the protective step back – that “wins her all of my medals”.

A ‘whiplash’ moment

The “push for perfection” creates a huge mental pressure for elite sportsmen and women, says Amber Strong on Newsy. But in recent years, Olympians are “bucking a world where athletes were often told to power through their emotions and are opening up more and more about mental health”.

However, we seem to have created a particular kind of “24-hour rolling hell for our superstar athletes”, says The Guardian’s Barney Ronay. “Be brilliant, constantly…You will be asked to carry our hopes and fears. This is unsustainable. Osaka has already told us this, if we care to listen.”

Tara Sullivan of the Boston Globe agrees, and called Biles’s decision a “whiplash” moment for US sport. Sullivan believes we have to stop and take notice of what it is that she’s saying. “It is one of those rare instances where an athlete at her level – considered the best-ever in her sport, who has pushed it to new heights with all her tricks – to say that out loud that she lost her confidence. I think it’s one of those instances where we just need to stop and talk about it.”