Simone Biles: Re-modeling Mental Health and Female Self-Esteem

Listening to Simone Biles at Tuesday’s press conference, I was struck by how comfortable she appeared with her decision. Let’s be clear: Simone is not the problem. We are.

In our media-driven culture, where appearance is confused with substance and simple solutions are thrown at complex problems, Simone taught the country a lesson: mental health matters. Though she didn’t owe us one, Simone provided a sound explanation for her decision, knowing some wouldn’t understand. It was obvious she had learned a skill I teach everyday: how to self-validate. I can’t help but wonder if this is one of the reasons she excels at her sport.

Some of the headlines regarding Simone’s decision referred specifically to athletes. But this is about more than performance. As a former Army Social Work Officer and practicing therapist, I’ve seen first-hand the damage we inflict on each other due to ignorance and fear of mental health. Americans don’t know what they don’t know. They use labels, like Bipolar Disorder and PTSD, with little understanding of diagnostic criteria. They regard counseling as a sign of weakness or for “crazy people” rather than the complex and transformational process that it is. It’s not their fault. Society has failed to educate them.

Meanwhile, media outlets rarely discuss mental health and, when they do, it is limited to clinical conditions such as Major Depression, Panic Disorder or Anorexia. They don’t consult mental health experts like they do experts in other fields such as law, national security, politics, and medicine. And they don’t associate mental health with adjustment issues like stress and anger management, parenting and communication skills, relationships, self-esteem, generalized anxiety (worry) and problems on the job. In other words, the challenges Americans face everyday. This is the bulk of my work.

Why does our society compartmentalize mental health? We don’t do this with physical health. We don’t equate the word “medical” with “disorder.” We don’t discourage or shame people for seeking medical care. We don’t tell people they should be able to treat physical illnesses without medical intervention. We don’t assume we know as much as medical specialists. Mental health is as vital to our existence as physical health. Unfortunately, cultural norms have prejudiced us to place greater value on one over the other. Whether or not we acknowledge mental health, its impact on personal lives and society can be as destructive as the COVID pandemic.

But there is another reason why Simone Biles’ decision is relevant: the example it sets for girls. There’s an exercise I frequently do with female adolescent patients, called the “Inner Eye Exercise.”1 First, I draw a big circle on a large piece of paper. Second, I draw a small circle in the center of the big circle, creating a donut shape. Third, I draw lines to break the donut into four equal parts. And lastly, I draw an eye in the “hole” of the donut. Then I explain to the patient, “This circle is you, and this is your inner eye. It allows you to see inside of yourself.” A therapist can give each quadrant whatever label is clinically appropriate. I always label one quadrant “inner critic.” Then I ask the patient to write down messages from the bully in her head. The answers I receive are heart-wrenching: stupid; ugly; lazy; boring; annoying; untalented; worthless; and the like.

Is is any wonder that the Centers for Disease Control reports, a “51% increase in suicide attempts among teenage girls” last year, (not including suicide attempts that go unreported)? In fact, suicide, not physical illness, auto accidents, or drug overdose, is the leading cause of death among teenagers. While there are numerous reasons teenage girls experience depression, the common denominator is inadequate coping skills – remaining silent being the deadliest of these. Public schools could be teaching these skills: how to manage anger, anxiety and depression; resisting peer pressure; conflict resolution; problem solving; decision making; constructive communication; and self-esteem building.

Simone Biles is an athlete and celebrity, but the media’s portrayal of this as justification for her decision is exactly the problem. Why must there be an external justification for emotional discomfort? And why must external factors be severe in nature to warrant caring for one’s mental health? What constitutes stress? It means different things to different people. What about biopsychosocial history? For example, Simone Biles is a survivor of sexual abuse. If not dealt with, trauma can debilitate a person for the rest of his or her life.

Charlie Kirk and Piers Morgan called Simone Biles’ decision “selfish.” Kirk also observed that the country is “raising a generation of weak people.” Morgan and Matt Walsh mocked the idea of mental health as a reason for withdrawing from competition. (Ironically, Walsh uses Michael Phelps as an example, a celebrity athlete who has been very outspoken about his own struggles with depression.) While their concerns are valid, their sincerity is belied by name-calling. What is it they hope to accomplish by this approach? Furthermore, they have no expertise in mental health or child development. (They are welcome to invite me on their shows to address their concerns.)

You may argue what Simone did was selfish to her teammates and the country. This is a matter of opinion and we will never get everyone to agree. Far from selfish, however, the vast majority of girls (and women) are excessive people pleasers – to their own detriment. They second guess themselves, mind read, self-bully, compare themselves to their peers, anticipate others’ needs and put those needs before their own. All out of fear of rejection or failure.

We should be empowering girls to make their own decisions, to trust their instincts, set boundaries and assert themselves, to be as kind to themselves as they are to others. Women should be regarded as capable of making good decisions, whether or not others agree or understand (or, as I like to put it, without “looking for permission”).

Given what I know about women, I am confident Simone’s teammates told her the same thing.

PLEASE NOTE: for the purposeds of this article, I elected to focus on the events of this week. However, I wish to acknowledge and commend Naomi Osaka for asserting her needs under overwhelming social pressure and for raising awareness of mental health.

1 Sinclair, T.M. (1998). The Personality Pie. In Kuduson, H., Schaefer, C. (Eds.). 101 Favorite Play Therapy Techniques (pp. 72-76). Northvale, NJ: Jason Aronson, Inc.

2 CDC Reports 51% Increase in Suicide Attempts Among Teenage Girls – Foundation for Economic Education (

3 Drug Overdoses Killed A Record Number Of Americans In 2020, Jumping By Nearly 30% | KPBS

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Elaine S. Belson, LCSW-C

Elaine Belson has 30 years combined clinical, military, political and teaching experience. She obtained her bachelor's degree in Psychology in 1987 from the University of Maryland at College Park and her master's degree in Social Work in 1993 from the University of Maryland at Baltimore. Ms. Belson has worked in a variety of settings, including private practice, community agencies, and hospitals. She has also taught psychology at the college level and held several legislative positions. Ms. Belson served in the US Army as a Social Work Officer, including a deployment to Afghanistan, from 2008-2010. She was also the Executive Officer (XO) for the Medical Command in Afghanistan. Ms. Belson currently has her own private practice and serves on the School Safety Advisory Council for her county's Board of Education. View all posts by Elaine S. Belson, LCSW-C

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