Having the 'Twisties' in Athletics and in Life: Prioritizing Mental Health in American Society

Emily S. Goncalves, MD, MBA


September 13, 2021

I have been encountering different friends and colleagues who have recently opened up to me about their own mental health struggles, and I've found it to be quite common to seek care from a therapist and/or psychiatrist, yet it's rarely discussed — even among my profession. Besides the usual gripes that every resident has, I haven't had a candid discussion with my co-residents on how their mental health is.

Watching the Olympics revealed how important mental health is during athletics and competition, yet a critical and taboo culture surrounded the topic. Gymnast Simone Biles revealed her struggles with mental health during the Olympics and faced widespread criticism. If she had sprained her ankle, would she have drawn so much criticism? I highly doubt it.

She was called a quitter by many, and her mental toughness was questioned. As a psychiatrist and a competitive runner, I believe that her mental toughness should be praised rather than questioned. The courage that Simone had to drop out of the Olympics at a time when she felt that her mental health would endanger her physical health is commendable.

I am not personally familiar with the "twisties" but I can imagine that it is vital for gymnasts to have awareness of where they are in the air. Distance running has also been largely affected by my own mental health. As a young high school runner, I felt lost navigating my anxiety over championship races, often leading me to underperform. This underperformance, in turn, increased my anxiety. As an adult runner, I've learned how to manage these anxieties and realized that the mental component of running had a huge impact on my performance.

American society has a "win at all costs" attitude. It has shaped both medicine and athletics. Most physicians I know push through fatigue, illness, and burnout and are praised for their toughness and strong will. Of course, there are times when we are not our best and need to get through hard days, but should most days be like this? I certainly hope they are not.

I'd like to change the narrative on "mental toughness" and praise those like Simone Biles, who know that their mental health is a priority and therefore take a step back to care for themselves. I believe that "mental toughness" can be taking time off when needed, stepping back, and seeking care. Asking for help makes us stronger, not weaker, and my hope is that receiving mental health care, and discussing this care, becomes easier and more frequent.

During my residency, it seems more vital now than ever to take care of ourselves and those around us in the highly competitive world we are living in. Let's not live on the edge of burnout but rather find ways to strengthen our mental health.

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About Dr Emily Goncalves
Emily S. Goncalves, MD, MBA, is a psychiatry resident at Delaware Psychiatric Center in New Castle. She is a competitive runner and ran for Syracuse University. She continues to live an active lifestyle and has competed in eight marathons, including the Boston Marathon. Emily hopes to share her passion for running with her patients and is interested in pursuing a career in consultation and liaison psychiatry. She also enjoys writing about her running adventures.


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