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4 August 2021updated 13 Sep 2021 5:00am

Athletes like Simone Biles are not weak – they are pioneers for a new understanding of mental illness

Nobody would be expected to play through a hamstring injury, so why do we not take mental health seriously? 

By Philip Collins

There was a time when entry to the lunatic asylum at Bedlam in London was free for tourists. Hundreds of thousands of people came to visit, to gawp at the exhibition made by the mad. We have come a long way since then but the stigma of mental illness has not disappeared yet. Perhaps there will, eventually, come a day when we think of mental illness as an extension of physical illness, an affliction of the same undeniable kind, but we are not there yet.

In the past week Simone Biles, the most decorated American gymnast, pulled out of the Olympic team event citing that she needed to protect her mental health. Ben Stokes, one of the great all-rounders, took indefinite leave from all cricket to concentrate on his mental health. And Adam Peaty, certainly Britain’s greatest ever swimmer and probably one of the finest breaststroke competitors of all time, took some flak for his declaration he was now going to take a break, to preserve his mental wellbeing.

[See also: The Olympics shouldn’t just be about medals]

The reaction to all three was mixed, but Piers Morgan spoke for a vocal minority when he expressed the traditional view that coping with pressure is supposed to be the distinguishing mark of great sportsmen. To fall away citing the pressure of the occasion is akin to admitting to not being very good.

This was pretty much how John McEnroe reacted at Wimbledon when Britain’s next great hope 18-year-old Emma Raducanu pulled out of the women’s singles and admitted that “the whole experience has caught up with me”. Suddenly, athletes are admitting that fragile mental health is as much a part of their composition as a physical injury.

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The England centre-back Tyrone Mings has said he found it hard to sleep before the two matches he played in the recent European Championships as doubts about his ability set in. Mings, who is a forthright and intelligent individual who had no compunction in taking on Home Secretary Priti Patel when she labelled the England team’s decision to take the knee as “gesture politics”, voices the modern sensibility. Of the doubts that plagued him, he says “I have no shame in admitting that because there was so many unknowns about me going to that game”.

How strange, in a way, that shame should be the emotion at issue. When Mings’s colleague Trent Alexander-Arnold pulled out of the championships before they began with a thigh injury, nobody would have thought to ask him if he felt ashamed.

[See also: How we misunderstand depression]

The difference is that mental illness is an invisible affliction and therefore easier for the uninitiated or the unsympathetic to dismiss. A mental illness is not an evident lesion. It is a set of symptoms and behavioural responses which are diagnosed and christened by a doctor. The condition of “schizophrenia” was named, for example, by Eugen Bleuler in 1911 and, to this day, sufferers endure a very wide range of different experiences of a disease which is defined under the same rubric. These are diseases for which there is no easy lateral flow test. And treatment is uncertain and unreliable. In Doctoring The Mind, Richard Bentall points out that drug-based psychiatry is not significantly more effective than the wiles of the ancient apothecaries.

We need to take the mental health of sports people seriously, and sympathetically. The recent examples are admirable but the problem was already clear before their intervention. Andre Agassi’s brilliant misery memoir is a reminder of the pressures of tennis at the highest level, especially when the star player wants to be anywhere other than on court. Serena Williams and Michael Phelps are two of the greats of American sport who have suffered with depression.

Marcus Trescothick and Jonathan Trott are international cricketers who both found the burden of performance hurt too much, mentally. In Silence of the Heart David Frith explored the mixture of anxiety, repetitious failure that has led to an unusually high rate of suicide among cricketers. Silence of the Heart is a sort of companion volume to Peter Roebuck’s account of the strains of county cricket, It Never Rains… A Cricketer’s Lot. In 2011, Roebuck took his own life.

Mental illness is a modern curse which the pandemic has worsened. Research by the Evening Standard showed that half a million children now need support who had no diagnosed mental health problem before Covid struck. There has been a 68 per cent rise in suicidal thoughts among pupils in secondary schools. Demand for professional support for eating disorders has tripled and schools have reported a doubling in the number of students they have referred to child and adolescent mental health services. The health service is not equipped to cope. The average wait for a young person to receive mental health treatment is currently 53 days. Children are taking up orthodox paediatric medicine beds for weeks at a time, having been admitted for suicide attempts or for disturbed psychotic behaviour.  

The examples of Mings, Biles, Peaty and Stokes are all to the good. They are role models prepared to be open about their struggles rather than soldier on. Nobody would be expected to play through a hamstring injury; indeed, nobody could. The closer our attitude to mental health approximates to the sympathy we offer for an episode of physical ill-health, the closer we will come to being appropriately generous. The current generation of athletes are not weak. They are not shrinking violets or snowflakes. They are pioneers for an idea of mental illness to which we have been groping ever since the doors were closed on visitors to Bedlam.

[See also: Mourning and melancholia: the psychological shadow-pandemic]