Mind Over Medal: Shining the spotlight on mental health issues among athletes

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August 01, 2021 4:00 AM

Athletes push their limits every day to become better, but it comes at an immense cost. American gymnast Simone Biles pulling out of the team final at the Olympics, following Naomi Osaka’s withdrawal from French Open & Wimbledon, has shone the spotlight on mental health issues among athletes, necessitating the need for initiatives to help, support and guide them

In the past, a number of athletes have increasingly opened up about their oft-hidden mental struggles.In the past, a number of athletes have increasingly opened up about their oft-hidden mental struggles.

Earlier this week, American gymnast Simone Biles made headlines around the world when she pulled out of the team competition at the Tokyo Olympics. The 24-year-old, who won four gold medals at the Rio Games in 2016, withdrew after a shaky start at the vault and said she had to “do what’s right for me and focus on my mental health”. A New York Times report said she wasn’t in “the right place mentally” to perform “difficult and often dangerous skills” that she is known for. Biles also cited feeling pressured, adding that she had been struggling with the stress of being “the greatest gymnast in history”.

A survivor of sexual abuse in the past, Biles has maintained very high scores throughout her career and across apparatus rotations. “Whenever you get in a high-stress situation, you kind of freak out. I have to focus on my mental health and not jeopardise my health and well-being,” she said in a press conference. “You know there’s more to life than just gymnastics.”

Biles’ pulling out from the team final at the Olympics follows Naomi Osaka’s withdrawal from the French Open and Wimbledon earlier this year, which also made waves around the world. In May this year, the 23-year-old Japanese tennis star announced her decision to pull out of the French Open after she was threatened with disqualification and fined $15,000 for refusing to attend a post-match press conference, citing mental health issues. Later, the four-time Grand Slam champion and the highest paid female athlete took to Instagram to share that she has suffered from bouts of depression since 2018 (Osaka defeated Serena Williams in 2018 yet was booed by the crowds) and that she needed “some time” away from the court. Later, Osaka, who wears headphones to escape social anxiety, bowed out of Wimbledon as well.

The Osaka and Biles incidents have shone the spotlight on the immense mental pressure that sportspersons go through. Striving hard to perform better, they undergo rigorous training sessions, keeping their careers over everything else—all for that elusive medal and a place on the podium. But this toil takes a big toll. Scientific research suggests that mental health disorders—from burnout and substance abuse to eating disorders, depression and anxiety— affect up to 35% of elite athletes at some stage of their careers. “While there isn’t any evidence to suggest that mental illness is more prevalent in elite athletes than the general population, it’s important to approach these problems in athletes, bearing in mind the special situation they’re in, and the big life stresses they face,” Richard Budgett, medical and scientific director, International Olympic Committee (IOC), says on Olympics.com.

In the past, a number of athletes have increasingly opened up about their oft-hidden mental struggles. Take, for instance, Lindsey Vonn. The former American Alpine skier, who has won four women’s World Cup overall championships, has talked about her decade-long battle with depression openly. Global tennis icon Serena Williams’s achievements, too, weren’t enough to keep depression at bay. In 2011, she revealed that she had been battling depression since winning Wimbledon the previous year, following injuries and health difficulties. “I cried all the time. I was miserable to be around,” Williams said in a 2011 interview with The Telegraph. She has also opened up about postpartum depression following the birth of her daughter Olympia in 2017.

Cricket sensation Virat Kohli also battled depression during a harrowing tour of England in 2014 where he felt like the ‘loneliest guy in the world’ after a string of failures with the bat. In 2019, Australia all-rounder Glenn Maxwell opted for an indefinite break from the game over mental health issues. Japanese swimmer Rikako Ikee, who made a comeback last month after battling leukemia and who qualified for the Olympics as a member of Japan’s 400-m freestyle relay and 400 medley relay, tweeted that she had been receiving traumatic messages on social media, asking her to withdraw from the Olympic Games, and that this had hurt her.

Raising awareness

After the 2012 Olympic Games in London, swimmer Michael Phelps opened up about his struggles with depression. This led the IOC to set up the Mental Health Working Group in 2019 to raise awareness.

The Indian Olympic Association (IOA), too, is prioritising the mental well-being of the Indian contingent at the Games. To improve the focus of the players amidst the ongoing pandemic, the IOA announced a partnership with Hyderabad-based Avantari Technologies-owned startup Dhyana for its smart meditation rings and health management services. Developed by chief national badminton coach Pullela Gopichand and biomedical tech entrepreneur and Oxford University alumnus Bhairav Shankar, Dhyana is a wearable device that helps players, coaches and staff tackle pressure and improve mental well-being through quantified meditation.

“The ring can measure mindful minutes, or the amount of time one focuses in a meditation session. It constantly tracks heart rate variability (HRV), or the gap between two consecutive heartbeats, which is further broken down into the three fundamentals of every meditation session-the quality of breathing, focus and relaxation,” says Shankar, MD, Dhyana, adding that this research can provide benefits of measured meditation to athletes, as well as the common man (the ring is priced at `6,999 and is available on Amazon and Smartdhyana.com). “The pandemic has triggered major mental health issues like isolation, anxiety and stress… meditation can help one stay emotionally fit. At least 21 minutes of mediation on a daily basis are required for maintaining good mental health, strengthening the heart and improving metabolism… Your body is important and so is your mind. Hence, meditation should be approached as a means of growing oneself,” he says, adding that the Dhyana app can serve as a parameter to gauge well-being.

“The organising committee, IOC, IOA and stakeholders have done their best to safely and securely organise the Games, but the age-old practise of meditation is key to help athletes overcome mental pressure. The teams have the required mental expert help to constantly monitor physical and mental fitness, and overcome pressures through devices like Dhyana rings. This can help athletes effortlessly monitor and improve their meditation techniques and mentally prepare to take on the world competition,” Rajeev Mehta, secretary general, IOA, said in an email interaction.

When Shankar and team were researching, they found that the Dhyana device helps hugely in reducing stress. “We saw a 15% dip in stress levels with the use of this device. It makes one tackle stress, increase focus and build a positive state of mind through the power of meditation, and that too in a scientific way. It is also capable of providing crucial bio-feedback during meditation,” says Shankar. “Our next step is to move into the corporate space as pandemic-induced isolation, depression and fatigue are some issues that are being witnessed now more often. These were once considered non-serious matters, but now, the pandemic has exemplified the entire situation and it is a common topic of discussion,” he adds.

Stress can affect athletes in many ways, explains Samir Parikh, consultant psychiatrist and director, Fortis National Mental Health Programme, Fortis Healthcare, Delhi. “It can lead to an impact on their sense of self and affect their mental well-being, causing them at times to experience fluctuations in moods or difficulties in managing their thought processes and their reactions to situations. Depression is the single-largest illness in the world, with 300 million people globally suffering from it… anxiety disorders can be found in over 200 million people,” says Parikh.

According to golfer Gaganjeet Bhullar, one is bound to have stress and anxiety at various points in the game, but that’s how one learns to work hard. “Some feel stressed, others don’t. It depends on how you perceive a situation. Thankfully today, athletes have mentors, coaches, yoga trainers to help them work on the goal and peak at the right time,” said the 33-year-old Arjuna awardee in a telephonic chat. “The competition level is so high that after intense training and games, your brain becomes dead, at times making you think of your hard work and value in sports. It’s a game after all, it may or may not click, but there is nothing one can do. All you can do is prepare for the next.”

Unfortunately, most sports ecosystems are outcome-oriented where athletes are perceived as medal-winning machines. “It doesn’t matter whether the athlete is happy or sad, as long as the outcome is in place. The sports ecosystem impacts the definition of success to an athlete as ‘winning medals’ to a point that most athletes’ self-esteem or self-worth depends on the number of medals they win,” says Singapore-based sport psychologist Sanjana Kiran, who has expertise in training athletes for the Olympics, World Championships, etc. “Training and competition experiences are mostly traumatic, given the outcome-orientation climate. This can impact mental well-being negatively,” adds Kiran, who is consultant head, sport psychology at Abhinav Bindra Foundation Trust. She is also chief consultant to the Directorate of Sports, Madhya Pradesh, and mental wellness expert for Royal Challengers Bangalore.

‘We’re not superhumans’

For a profession where winning is more important than anything else, Osaka and Biles prioritising their mental health is definitely significant. Not surprisingly, Biles’ decision to pull out drew the support of many, including former US First Lady Michelle Obama, 2018 Olympic team bronze medallist Adam Rippon, as well as teammates, fellow athletes and fans around the world.

On her part, Biles extended her support to Osaka. Others have done it as well. Talking about the Osaka incident, author Matt Haig tweeted: “Sports people take time off for physical injuries all the time. No-one judges them. But whenever there’s a hint people need some space for their mental health the usual fragile suspects are out in force saying they aren’t tough enough.”

Supporting Osaka, Serena Williams in a New York Times interview said that not everyone relishes the attention of being famous. “You just have to let her handle it the way she wants to.” Indian woman cricketer Mithali Raj, too, backed Osaka for not speaking to the media owing to her mental health issues and said that life in a bio-secure environment can get tough. In 2018, however, Raj had admitted that Indian women cricketers can’t afford to ignore media since they need its support.

Not all have endorsed Osaka’s actions though. Former tennis champion Boris Becker criticised the young star, saying dealing with the media as a professional tennis player is part of the job. “You have to learn to deal with it,” he said in an interview with The Times in June this year.

Whichever side the sporting fraternity chooses to take, one thing is clear: the Osaka and Biles incidents have spurred a movement. They have also made one wonder: aren’t sportspeople human too? Since time immemorial, sports stars have been idolised or scrutinised to a point that we forget that they are vulnerable, fragile human beings with real feelings, emotions and weaknesses. There is constant pressure to look or behave a certain way, and conform to a particular standard, which is linked to professional work, earnings, endorsements, etc. Everything is judged, written about, applauded, trashed or has a cascading effect—Portuguese footballer Cristiano Ronaldo’s action of moving Coca-Cola bottles on the side and asking people to drink water during a press conference in June saw Coke lose $4 billion in market value overnight.

In such a high-pressure ‘work environment’ many have succumbed to weaknesses. Take, for instance, American sprinter Sha’Carri Richardson, who missed the 100 m Olympic qualifier race this year because of a doping violation. Richardson had used marijuana to cope with the death of her biological mother and the pressure to perform at the US track and field Olympic trials. Other professional athletes have opened up, too, about using marijuana as an aid to mental health and physical recovery. In 2017, in fact, Minnesota Timberwolves basketball player Karl-Anthony Towns said the US National Basketball Association should allow players to use marijuana for medicinal purposes. “…just because we’re NBA athletes, we’re not superhumans. Some of us have conditions that could use (medicinal marijuana) to our benefit for everyday living, just taking care of our kids and our families,” he said in an interview to ESPN.in.

It takes time to build an image, but it takes just a few minutes for it to crash, says Mumbai-based Zirak Marker, senior psychiatrist and adviser, Mpower, an Aditya Birla Education Trust initiative to address mental healthcare gaps in India. “Players are not superhumans and are prone to stress and mental health concerns. When they go through a crisis or psychological breakdown, they are subjected to gossip and scrutiny with no privacy to heal whatsoever. We need to respect their lives and allow them to normalise the shifts from success and fame to failure or loss. There is a need to acknowledge their efforts, passion, hard work and journey. We need to ground our voyeuristic fascination and provide respect as we would for any other human that we look up to, admire or hero worship,” says Marker.

For many, the burnout takes over the moolah and fame. A fact acknowledged by Andre Agassi in his 2009 autobiography Open. “I hate tennis, hate it with a dark and secret passion and always have,” he writes. Remembering how Olympic gold medallist Abhinav Bindra admitted to experiencing a void and feeling listless after winning the medal, Kiran says, “They might win medals, but end up broken souls, owing to their robotic lives. Dealing with success can be challenging.”

The bubble effect

The pandemic has created a much tougher environment for athletes, affecting their training, mentoring and resulting in a delay of events. All this necessitates the need for mental well-being above all else. In April, former cricketer Sourav Ganguly and BCCI president said the pandemic has restricted the movement of players, allowing them to move only in bio-bubble environments. “You have to stay positive… you have to train yourself mentally. All of us have to train ourselves mentally, so that the good will happen,” he said in a virtual conference, adding that pressure is a constant in everybody’s life, “A little bit of a blip and it doesn’t stop people from scrutinising you and that goes for athletes too in a big way,” he added.

Olympic bronze-medallist shooter Gagan Narang, too, has spoken about how mental fitness was very important for him during the lockdown last year to face the challenges posed by the pandemic. “…If you aren’t mentally fit to make decisions, it reflects poorly,” he said.

The pandemic has also led to minimal interactions and the absence of live audience, making the playing conditions very different. At the Olympics, in fact, Japan has banned spectators at venues. Such a change in the performance environment, however, can cause stress or affect the performance levels of athletes. “It’s always good to be appreciated for your work. To play live is a great feeling as there is scope for improvement through appreciation. A sportsperson is a true entertainer. You are on the field to play good shots and entertain your fans,” says Bhullar.

The organising committee, IOC, IOA & stakeholders have done their best to safely organise the Games, but the age-old practise of meditation is key to help athletes overcome mental pressureRajeev Mehta, secretary general, Indian Olympic Association

Depression and fatigue were once considered non-serious matters, but now, the pandemic has exemplified the entire situation and it is a common topic of discussionBhairav Shankar, managing director, Dhyana

Stress can impact a sportsperson’s sense of self and affect their mental well-being, causing them to experience fluctuations in mood — Samir Parikh, consultant psychiatrist & director, Fortis National Mental Health Programme, Fortis Healthcare, Delhi

Training and competition experiences are mostly traumatic, given the outcome-orientation climate. Most athletes’ self-esteem or self-worth depends on the number of medals they win — Sanjana Kiran, a singapore-based sport psychologist

When sportspersons go through a crisis or psychological breakdown, they are subjected to gossip and scrutiny with no privacy to heal whatsoever Zirak Marker, senior psychiatrist & adviser, Mpower, an Aditya Birla Education Trust initiative to address mental healthcare gaps in India

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