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Editorial • Braz. J. Psychiatry 43 (5) • Sep-Oct 2021 • https://doi.org/10.1590/1516-4446-2021-0036   copy

Pressure is not a privilege: what we can learn from Simone Biles

Authorship SCIMAGO INSTITUTIONS RANKINGS

The whole world was shocked when, on July 28, 2021, the gymnastic superstar Simone Biles decided to abandon the Olympic Games in Tokyo. Biles gave up the opportunity to repeat her four-gold-medal-winning performance in Rio 2016 for an even more worthwhile goal: her mental health, and she has been intensely praised and criticized ever since. Her bold attitude leaves a perfect stage for mental health professionals to discuss the burden carried by high-level athletes and how costly the “winning at any cost” mentality can be.

Biles was not the first. Two months earlier, tennis player Naomi Osaka quit the French Open due to “long bouts of depression.”11. Naomi Osaka withdraws from French Open & reveals ‘bouts of depression’. 2021 May 31. www.bbc.com/sport/tennis/57310701
www.bbc.com/sport/tennis/57310701... Her struggle ironically started when she won her first Grand Slam, the 2018 US Open. She described symptoms of depression and social anxiety that are worsened by press conferences. The legendary perfect-ten gymnast Nadia Comaneci also publicly discussed her struggle with bulimia and anorexia, further exacerbated by the urge to maintain the high level of performance that others expected from her.22. Rendell M. The perfect ten. The Guardian. 2004 Jul 4. www.theguardian.com/sport/2004/jul/04/athensolympics2004.gymnastics
www.theguardian.com/sport/2004/jul/04/at... Biles’s, Osaka’s, Comaneci’s, and many others’ fight reveals a concerning aspect of elite athletics: their busy lives, hectic routines, and high standards do not take mental health into account.

The sacrifices demanded from athletes to achieve success are often abusive. Inspiring biographies are pervaded by real-world suffering from excessive training loads and media exposure, harassment, fear of failure, and a super-human need for consistently outstanding performances. This engenders a way of living that mental health professionals would hardly recommend to their patients, and a double standard for elite athletes is surprisingly accepted in our society. But, at the end of the day, how else would people accommodate their needs for heroes?

The prevalence of depression/anxiety in elite athletes is 34%, higher than in the general population. The same happens with alcohol use disorder.33. Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock ME, Kerkhoffs GM, et al. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53:700-6. This is likely aggravated by high levels of stigma that prevent elite athletes from seeking treatment.44. Castaldelli-Maia JM, Gallinaro JG, Falcão RS, Gouttebarge V, Hitchcock ME, Hainline B, et al. Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment. Br J Sports Med. 2019;53:707-21. Therefore, risk factors for mental disorders in athletes should be identified, and specific interventions should be crafted. This should include, for instance, training coaches to identify early signs of mental suffering and encourage their athletes to seek treatment when necessary.55. Hainline B, Reardon CL. Breaking a taboo: why the International Olympic Committee convened experts to develop a consensus statement on mental health in elite athletes. Br J Sports Med. 2019;53:665-6. Also, sports organizations and government policies for sports should encourage elite athletes to develop a mindset of continuous care for their well-being.55. Hainline B, Reardon CL. Breaking a taboo: why the International Olympic Committee convened experts to develop a consensus statement on mental health in elite athletes. Br J Sports Med. 2019;53:665-6.

In 2019, the International Olympic Committee released a comprehensive statement with recommendations for mental health care of elite athletes.66. Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med. 2019;53:667-99. The document underscores that physical and mental health are inseparable, and that treatment should consider the impact on performance. This is a crucial step to overcome barriers when caring for this population. For example, in a survey of 120 Brazilian female athletes that participated in the Rio 2016 Olympics (58% of the total of participants), 83% received psychological care, and 91% of those considered this support very valuable and essential for their performance.77. Parmigiano TR. Avaliação do conhecimento e do cuidado relacionados à saúde ginecológica da mulher atleta olímpica brasileira participante dos Jogos Olímpicos do Rio de Janeiro, 2016 [dissertation]. São Paulo: Universidade Federal de São Paulo; 2020.

Another critical aspect of Biles’s attitude is her tremendous contribution to minimizing the stigma concerning mental health issues. When an icon for many people worldwide, especially child and adolescent aspiring athletes, clearly speaks to her concerns and the value of her mental health, as she normalizes the search for mental health care. By doing so, Biles may make it easier for millions of people experiencing mental suffering to search for help.

Iconic athletes such as Michael Phelps,88. Scutti S. Michael Phelps: 'I am extremely thankful that I did not take my life'. CNN Health. 2018 Jan 20. edition.cnn.com/2018/01/19/health/michael-phelps-depression/index.html
edition.cnn.com/2018/01/19/health/michae... Serena Williams,99. Serena Williams reveals that she has been battling depression since winning Wimbledon last year. The Telegraph. 2011 Mar 16. www.telegraph.co.uk/sport/tennis/williamssisters/8387048/Serena-Williams-reveals-that-she-has-been-battling-depression-since-winning-Wimbledon-last-year.html
www.telegraph.co.uk/sport/tennis/william... and Ronda Rousey1010. Coppinger M. 'I did a whole lot of crying': the spectacular fall and rise of Ronda Rousey. The Guardian. 2018 Aug 18. www.theguardian.com/sport/2018/aug/18/ronda-rousey-wwe-interview-depression
www.theguardian.com/sport/2018/aug/18/ro... have spoken about facing severe mental health problems throughout their careers. Others, like the footballer Adriano,1111. Searles M. 'I was drunk at training but Inter Milan told the press I was injured': Adriano opens up on boozing and depression issues that ruined his career. Daily Mail. 2018 Aug 30. www.dailymail.co.uk/sport/football/article-6113581/Adriano-opens-drinking-depression-ruined-career-Inter.html
www.dailymail.co.uk/sport/football/artic... cut their careers short because of this. After seeking treatment, Phelps made it through his symptoms and is currently a mental health advocate.1212. Bruton M. Michael Phelps’ message to kids: mental health is just as important as physical health. Forbes. 2021 Apr 23. www.forbes.com/sites/michellebruton/2021/04/23/michael-phelps-message-to-kids-mental-health-is-just-as-important-as-physical-health/?sh=5765b217100a
www.forbes.com/sites/michellebruton/2021... Other athletes, like Raven Saunders1313. Veera S. Raven Saunders: from thoughts of suicide to winning silver at Tokyo Olympics. The Indian Express. 2021 Aug 1. indianexpress.com/article/olympics/tokyo-2020-raven-saunders-shot-put-silver-suicide-thoughts-7432697/
indianexpress.com/article/olympics/tokyo... and Alana Smith,1414. Yurcaba J. Unapologetically themself: Nonbinary Olympian shares powerful message. NBC News. 2021 Jul 27. www.nbcnews.com/nbc-out/out-news/unapologetically-themself-nonbinary-olympian-shares-powerful-message-rcna1520
www.nbcnews.com/nbc-out/out-news/unapolo... thrived after periods of deep mental suffering, and their participation in subsequent Games raised the flag of representativeness. As for Simone Biles, she is today just as much of an example as she has always been.

References

Publication Dates

  • Publication in this collection
    15 Oct 2021
  • Date of issue
    Sep-Oct 2021

History

  • Received
    4 Aug 2021
  • Accepted
    4 Aug 2021
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