Abstract
Understanding the high rates of depression, anxiety, and other mental health disorders in female athletes requires a holistic approach to the larger context in which they play. Female athletes are beholden to the expectations and limitations society places on women, while simultaneously competing in a system designed for men. Various stressors and pressures of competitive sport affect all athletes—male, female, and nonbinary—but the contradictory nature of the world in which the female athlete competes can make those stressors all the more intense. From patriarchal belief systems to a lack of resources and research, there are plenty of big-picture issues to acknowledge regarding the mental health of women in a formerly all-male sport space that still has a lot of catching up to do when it comes to serving women.
Past efforts to limit women’s participation in sport were the result of judgments about the “unladylike” nature of competition and fears rooted in blatant pseudoscience. For instance, in 1898, a German doctor wrote in an academic journal for physical education that “violent movements of the body can cause a shift in the position and a loosening of the uterus . . . with resulting sterility, thus defeating a woman’s true purpose in life, i.e., the bringing forth of strong children.” (Even as recently as 2010 the president of the International Ski Federation said on ESPN’s “Outside The Lines” that ski jumping is not appropriate for women because the uterus might burst during landing.) Brazil banned women’s soccer (and other sports) from 1941 to 1979 with a law that declared that “violent” sports are “not suitable for the female body.” The German Football Association banned women from competing in sports from 1955 to 1970, because, they claimed, “in the fight for the ball, the feminine grace vanishes, body and soul will inevitably suffer harm.” In 1971, when asked about women’s soccer internationally, the president of the Royal Spanish Football Federation said, “I am not against women’s football, but I do not like it either. From the aesthetic point of view, a woman in a t-shirt and pants is not preferable. Any regional dress would suit her better.”
Imagine trying to win the World Cup while wearing a dress, concerning yourself with displaying feminine grace and taking care not to harm your soul.
After centuries of widespread effort to limit women’s access to physical activity, women’s sport changed radically in the 1970s. First, the United States passed Title IX of the Education Amendments of 1972, prohibiting sex-based discrimination in any school or other education program that receives federal funding. And in 1978, UNESCO adopted the International Charter of Physical Education and Sport, which states, “[E]veryone should be free to develop and preserve his or her physical, intellectual, and moral powers, and . . . access to physical education and sport should consequently be assured and guaranteed for all human beings.” As a result of Title IX, participation opportunities for high school girls in the United States grew exponentially. More college opportunities followed and then professional leagues. Despite this progress, the majority of schools are not in compliance with the law and major inequalities remain. There are 1.1 million fewer high school sports opportunities for girls than boys and 60,000 fewer collegiate sports opportunities for girls than boys, according to a recent report by the Women’s Sports Foundation.
Title IX and the adoption of the International Charter of Physical Education and Sport did not solve the problem of the opportunity gap, nor did they magically erase long held sexist beliefs and judgments about women in society or in sport. In a 2017 Pew Research poll, honesty and morality topped the list of traits people say society values in men, at 33%, with professional and financial success at 23%. For women, 35% said physical appearance and beauty were what society most valued in women, with empathy, nurturing, and kindness at 30%. These results are not surprising. Society values men who are powerful, rich, and principled. Women should be, above all else, beautiful, gentle caretakers.
Kim Bissell, SuYu Chou, and Emily Dirks have studied professional female athletes who have publicly spoken about their struggles with mental health. The authors point to social identity theory and how the way these athletes identify first as an athlete might affect their ability to deal with the pressure of competition, particularly when they fall short of expectations or goals. Worth noting, especially when trying to reconcile higher rates of mental health issues in female athletes than men, is that these athletes likely first identify as women, even before they identify as athletes. As a result, they suffer most deeply from gendered expectations and limitations.
Even if professional female athletes are not consciously trying to abide by expectations—or are actively trying to reject them—they still must exist in the society that established them. How can you be beautiful if you are panting, yelling, grunting, and fighting? Wearing a boxy uniform or a stifling sports bra? Covered in sweat, dirt, or blood? “Too muscular” or “not feminine enough.” Physical exertion can be beautiful, but a fundamental aspect of sport is exhaustion, depletion, and prioritizing outcome and performance over aesthetics. The awareness of being seen—being observed—pervades a women’s public experience. Whether or not they believe it is fair, female athletes understand that they are more likable, successful, and marketable if they are beautiful. The very real notion that “sex sells” can be deeply affecting for athletes who recognize how beauty dictates their sponsorship deals and Name, Image and Likeness (NIL) opportunities. In some cases, whether or not an athlete can appear “cute” and “girly” while playing a sport might even influence whether she plays at all.
In addition, many people cannot wrap their heads around the idea of women tackling, sliding, blocking, or punching each other in pursuit of victory, when women are supposed to be empathetic, kind, and nurturing. The idea of an athlete centering herself instead of others runs contrary to beliefs about her ultimate role as caregiver (an extension of mother, the aforementioned “true purpose of life” for women). Elite women athletes may feel uncomfortable asking for services from trainers, coaches, and sports psychologists if they have internalized the idea that women should not be demanding, difficult, or needy. Society repeatedly tells women that other peoples’ needs come first. That desire to serve, nurture, and please can translate to reluctance to address issues or ask for help.
These issues can be exacerbated by a lack of resources. Female athletes at high school and collegiate levels who grow up under-resourced learn to perceive their value as less than that of male athletes. They often have smaller coaching staffs and limited or no access to trainers, psychologists, and other resources usually afforded to boys and men. It can be difficult to change established patterns of not asking for help or not expecting help to be available, even if those resources became available later as a professional. Female athletes who have grown accustomed to burying injuries, anxiety, or disordered eating might not have the tools to change that behavior.
Lack of research focusing on women’s bodies generally and women athletes specifically can also contribute to mental health issues. In her book, “Good for a Girl: Running in A Man’s World,” Lauren Fleshman writes, There is something wrong with our sports systems, and deep down we know it. The sports environments we fought so hard to have equal access to were built by men, for men and boys. Our definition of gender equality has been “getting what men have, the way they have it,” and it’s backfiring. We fold and smash women and girls into a male-based infrastructure, and then scratch our heads when the same friction points show up again and again.
Fleshman, a retired professional track and field athlete, notes that the college sport years coincide with peak athletic performance for men—their highest levels of testosterone, maximum ability to train, best rate of recovery; but women aged 18 to 22 are in peak fertility, with higher levels of estrogen making them softer and fattier. The best years for women athletes are in the mid-20s, but they are expected to peak and continue to improve at the same time as male athletes. If performance does not improve, often the response is to demand weight loss or presume laziness or lack of ambition. Athletes often blame themselves for plateauing or regressing in their early 20s, causing depression, disordered eating, or even suicidal ideologies. Research into women’s bodies is, thankfully, finally, increasing, but centuries of ignoring female bodies has resulted in a broken system.
Media Coverage of Mental Health
Until fairly recently, most athletes tried to keep private their struggles with anxiety, depression, disordered eating, and other mental health issues. They feared the stigma associated with mental illness, from both the public and within their sport. Could admitting to mental health issues affect their next contract offer? Would coaches or front office executives question their durability, availability, or longevity? Would brands be less likely to work with them? Would fans consider them “weak?” As more athletes are coming forward to publicly discuss their issues, acceptance and empathy for mental health seem to be on the rise.
In an effort to counteract damaging stigma associated with mental health struggles, much of mainstream media coverage has displayed empathy to those willing to speak about their issues. There are, of course, notable examples of media members who were deeply critical of the decisions made by gymnast Simone Biles and tennis player Noami Osaki to pull out of competition. On “The Charlie Kirk Show” podcast the conservative activist said Biles was “a shame to the country” and “weak.” Television personality and journalist Piers Morgan wrote in an op-ed for the Daily Mail, “Sorry, Simone Biles, but there’s nothing heroic or brave about quitting because you’re not having ‘fun.’” After Osaka withdrew from the 2021 French Open, Morgan called her the “world sport’s most petulant little madam.” Oliver Brown, a sportswriter for The Telegraph, said she displayed “diva behavior.”
When looking at public criticisms like these it’s worth examining how a player’s popularity or reputation before speaking out about their mental health might play a role in media coverage. Have they been the “girl next door” or a “bad girl?” Friendly and personable or sullen and withdrawn? Neutral and safe or outspoken and controversial? In Biles’ case, some critics were put off by the rhinestone-studded goat silhouette that appeared on her leotards beginning with the 2019 U.S. Gymnastics Championships. Confident women who own and acknowledge their success sit in conflict with society’s preference of quiet humility in women. In Osaka’s case, her activism and vocal support of groups like “Black Lives Matter” has made her a favored target for conservative pundits and journalists. It might be a worthy study to look at the tone and tenor of coverage about an athlete before and after they have spoken publicly about mental health. How does their popularity and likability (or lack thereof) affect how media and fans react to their disclosure? If they have been outspoken about political or social issues, does support for them post-admission tend to come only from media that’s aligned politically?
I also want to know how previous media coverage of those athletes falling short of expectations in competition compares to coverage of the same athletes after they have publicly acknowledged their struggles. Before publicly discussing their anxiety and depression, both Osaka and figure skater Gracie Gold faced wide criticism for either performing poorly or pulling out of competition altogether. Once those struggles were linked to mental health issues, coverage softened. Does the timing of their announcement affect how it is received? If they seem to have their issues under control and are reflecting on previous struggles, is that more palatable than someone acknowledging struggles in the moment? If they need to step away just before a championship game or Olympic event, are they more likely to be criticized than if they are taking time off during their offseason? Given stereotypes about what triggers depression, are journalists and media personalities more understanding when athletes suffer after a loss than when they report depression after a highly successful tournament or event?
Essentially, have the media actually started to factor in the humanity of athletes or only when the words “mental health” are used in the context of their competitive failures or setbacks? In the winner-take-all world of sport, are we truly ready as a society to consider more than wins or losses, or do we do so only in cases of mental health struggles (either because of true empathy or to avoid seeming callous about an issue for which society is now showing compassion)?
In the future, how will media coverage of so-called “clutch” players or “chokers” be affected by increasingly incorporating mental health factors into our discussions of sport? Injury-prone players are occasionally the butt of jokes for their frequent setbacks and absences but are rarely blamed for physical injury. Contrarily, athletes who routinely shrink in big moments, fail in high-pressure situations, or otherwise “choke” are excoriated by media and fans alike.
In June 2022, Senior Director of Psychological Services for the U.S. Olympic and Paralympic Committee Jessica Bartley joined my podcast, “That’s What She Said with Sarah Spain.” Bartley often analyzes individual cases using a model called “Bio, Psycho, Social”—a mix of biological, psychological, and social influences that can cause mental health issues. I asked her about criticism for NBA player Ben Simmons, who is often pilloried for his poor play late in games. Bartley, who did a fellowship in eating disorders, replied using what she has learned about disordered eating: Some of us . . . are predisposed to disordered eating/eating disorders and it’s almost like a light switch. So, you need the psychological, social influences to turn that light switch on [to] have someone slide into disordered eating/eating disorders. So, someone could have the same social, psychological influences as the person sitting next to them and because they have a different genetic makeup they will not necessarily turn to eating disorders as far as coping or the kind of behaviors that they use. So, it’s really important to think of that combination of things [and] that some of us are more predisposed to eating disorders, to alcohol issues, to depression and anxiety.
If we see the stress of a high-pressure, late-game situation as a light switch for the kind of anxiety that affects elite athletes, will we consider their struggles a function of mental health? Will more research into the psychology of sport, combined with more empathy for players as human beings, cause fans and media to see “chokers” as mentally predisposed to struggle in those moments and therefore less deserving of criticism? Can we truly reconcile that kind of empathy in the high-stakes world of competitive sport? Will media be expected to take into account a player’s mental state mid-game in determining whether to be critical of a choice or an outcome? Will psychological tests end up side-by-side with physical tests to determine players who are both physically and mentally elite?
Can athletes with a predisposition toward mental health issues thrive in the pressurized world of sports as we know it? Bartley told me, What’s been most reassuring when thinking of that light switch is that we know light switches can turn off. Again, we can actually fight that biology. . . . You have tools that can actually overcome this genetic predisposition at times–therapy, it could be medication, it could be just tools and skills that you’re using–turn that light switch back off.
Meanwhile, outside influences, like social factors that can trigger mental health issues, can be better controlled. The more discussion about mental health, the better the public will understand and empathize with those who are struggling. The deeper and more comprehensive the coverage offered by the media, the more likely the stigmas surrounding mental health will continue to ebb. The more research into women’s bodies and female athletes, the more likely the systems and spaces within which women compete will begin to reflect their genetic realities. The more evolved society becomes on ideas of gender, the less pressure women will feel to meet patriarchal expectations of beauty, selflessness, and “feminine grace” while simultaneously striving for dominance in sport.
As beloved television show host Fred Rogers said, “Anything that’s human is mentionable, and anything that is mentionable can be more manageable.” Continued curiosity and investment in understanding both the big picture and the specificities around mental health in women’s sport will only make it more manageable.