What mental health struggles led Simone Biles to withdraw from the 2020 Tokyo Olympics, and how did her decision change the conversation around athlete well-being?

Simone Biles withdrew from several events at the Tokyo Olympics in the summer of 2021, citing mental health concerns and a specific gymnastics phenomenon known as the twisties. The twisties refer to a dangerous condition in which a gymnast loses spatial awareness mid-air, becoming unable to track their body's position during complex aerial maneuvers. For a sport that demands extraordinary precision and where errors can result in catastrophic injury, this condition is not merely a performance issue but a genuine safety crisis. Biles described feeling disconnected from her body and unable to trust her instincts in the air, which for someone performing skills at the difficulty level she attempts could easily result in a broken neck or worse. She had also been carrying enormous psychological weight as the face of American gymnastics and one of the most scrutinized athletes in the world, compounded by the ongoing trauma from her experience as a survivor of sexual abuse by former USA Gymnastics team doctor Larry Nassar. The accumulation of these pressures, both the acute physical manifestation of the twisties and the longer-term emotional burden she had been carrying, led her to step back from the team final and several individual events. Her decision ignited a global conversation that had been building for some time around the mental health of elite athletes. Prior to Biles, tennis star Naomi Osaka had withdrawn from the French Open just weeks earlier, citing anxiety and depression and refusing to participate in mandatory press conferences. Together, these two high-profile decisions from two of the most dominant athletes in their respective sports forced a reckoning with how sports culture treats psychological well-being. For generations, the dominant narrative in elite athletics had been one of pushing through pain, suppressing vulnerability, and treating mental struggle as weakness or lack of competitive drive. Athletes were expected to compartmentalize, perform, and deal with personal difficulties privately and after the fact. Biles directly challenged this framework by choosing her own safety and health over medals, over national pride, and over the expectations of millions of fans and sponsors. The reaction was sharply divided, which itself illustrated how deeply ingrained the old attitudes were. Some commentators and public figures criticized her harshly, calling her a quitter or suggesting she had let her country down. These responses revealed a tendency to view athletes as performance machines rather than human beings with psychological limits. But the overwhelming response, particularly from fellow athletes, mental health professionals, and younger generations, was one of support and admiration. Many athletes came forward to share their own struggles with anxiety, depression, burnout, and the psychological toll of elite competition, creating a kind of collective unburdening that had rarely been seen so publicly in sports culture. The longer-term impact of her decision has been meaningful in several ways. Sports organizations began taking more seriously the need for mental health resources and support structures for athletes. The conversation around the twisties specifically helped educate the public about the fact that mental and physical performance are deeply intertwined, and that psychological disruption can manifest in ways that create genuine physical danger. Biles herself returned to competition in the floor exercise and balance beam finals in Tokyo, winning a bronze medal on beam, which demonstrated that her withdrawal was not about giving up but about making a calculated and courageous decision to protect herself and return when she was ready. She later went on to compete again at the highest levels, winning multiple medals at the 2024 Paris Olympics and continuing to redefine what excellence and resilience look like. Her decision also had particular resonance because of who she is. As arguably the greatest gymnast of all time, someone who had already proven her competitive toughness and mental fortitude countless times, her acknowledgment that she had limits carried a weight that might not have been as powerful coming from someone with less established credibility. It made it harder to dismiss her as simply not tough enough. In many ways, Biles modeled a more sophisticated and sustainable understanding of athletic performance, one that recognizes the athlete as a whole person whose psychological state is inseparable from their physical capabilities. The conversation she helped spark continues to influence how coaches, sports organizations, and the public think about what we ask of elite athletes and what kind of support systems they deserve.