Naomi Osaka’s Courageous Mental Health Advocacy

By Mai Uchida, M.D.

Naomi Osaka's shocking withdrawal from the French Open citing "bouts of depression" and "huge waves of anxiety," has sparked conversations worldwide about athletes' mental health. Her decision came after she was penalized for declining to participate in press conferences during the competition, referencing the subjection of players to questions that “bring doubts to their minds,” and the need to prioritize her mental health during the tournament. 

While much has already been written about the timing and politics of Naomi’s actions, I would like to focus on how her courageous stand shines light on the importance of young athletes’ mental health, a topic that has not been discussed nearly enough. I recently partnered with figure skater Mirai Nagasu and the MGH Center for Cross-Cultural Student Emotional Wellness to shine light on this very issue, along with its unique intersection with Asian American identity. I am so grateful for Naomi’s mental health advocacy and contribution to this critical public conversation.

Here are some key points that Mirai and I discussed in our video series that are important to keep in mind when discussing young athletes’ mental health.

They are young

Most elite level athletes in sports are teens or in their 20s. Naomi Osaka was 19 when she won her first Grand Slam, and she is 23 years old now. Mirai Nagasu was only 14 when she won the national championship, and 24 when she landed the triple axel at the Olympics.

Developmental neuroscience research tells us that the human brain doesn’t complete its biological development until our late 20s. Young athletes and prodigies are somehow expected to instinctively know how to manage these very difficult situations, not only within the sport itself, but also with regard to complex matters such as finances, relocation, politics within the sport, and the need to attract sponsors, all while their brains are still massively in development.

The transitional age from adolescence to young adulthood is a time when most kids are just starting to discover themselves and face social judgment, grown-up responsibilities, and changes in relationships with their peers and families. At the same time, these athletes are out there on center ice, the tennis court, or other public stage, usually alone, and being judged by commentators and spectators from around the world.

They are expected to attend press conferences even after they’ve just had a disappointing performance. Can you imagine being in a school play and screwing it up, then needing to answer questions about what happened right after you left the stage for intermission? Young athletes are forced to do this all the time.

Naomi was only 19 when she won her first Grand Slam at the U.S. Open in 2018. She described this as a “bittersweet victory”because she received her trophy amidst the boos of the spectators, who were dissatisfied with the refereeing of the game against her opponent, Serena Williams. In her most recent tweet, Naomi stated that this incident was the beginning of her “bouts of depression.” Can you imagine playing your best and winning against the most decorated player in the world, only to hear boos during your victory ceremony, and all as a teenager? Fans also need to remember that these are young human beings who are doing their best. We need to try to put ourselves in their shoes.

Perspective may be limited

Because of fully dedicating their lives to the sport, young athletes’ dreams and routines may be entirely oriented around just that one activity. It’s so hard and even dangerous to carry all your self esteem eggs in one basket, particularly when you are at a young age and lack additional perspective on the world and life experience.

For many athletes, participating or medaling at the Olympics may be the one and only goal they have. When there is only plan A on their list, “going to the Olympics,” and when plan A doesn't happen for them, many are left feeling the end of the world has arrived.

Most of us have plenty of do-overs, or at least a plan B to fall back on. If you didn’t get into one college or get a particular job, you can find another. Some people also pivot and change their life direction entirely. But for elite athletes who’ve dedicated their lives to chasing a single goal, anything short of that may feel meaningless or even shameful.

Adult Stakeholders

Young athletes have many adults who hold a stake in their successes and failures, including coaches, trainers, federation officials, competition holders, sponsors, agents and members of the press. These adults have a critical responsibility to help young athletes put each success and failure into context, and to teach them that there are in fact many ways to be happy.

While this is the ideal stance for helping young athletes develop, oftentimes the adults surrounding the athletes possess a conflict of interest in that they may share those same narrow aims of financial gain, reputation, etc., such that the athletes’ happiness and best interests are not actually these adults’ main goal. Not only do young athletes often need to take orders from the surrounding adults, they also have the investment and reputation of these various adults on their shoulders when they perform. This “dual relationship” and potential for exploitation presents a further challenge to mental wellbeing.

It’s crucial for these adults to try their best to find ways to expand their perspectives themselves, and to prioritize the athletes’ wellbeing. It is true that sacrifice is required to achieve greatness. How much must young athletes be pushed to achieve goals for which they are later grateful? How much is too much? While it is a complicated line to draw, I am sure that many of us can agree that success should not come at the expense of mental health.

Stigma, Culture, and Race

Mental health difficulties are sometimes considered a weakness or liability for athletes. Some athletes may worry that they won’t retain the federation’s support if they disclose they needed help. Some athletes worry about losing their sponsors. Many worry about how they’d be viewed by their friends and acquaintances.

In addition, there may be another layer of mental health stigma due to cultural factors. Mirai and I also discussed this during our interview video series given our shared Japanese heritage. The Japanese culture, while having so much strength, depth, and beauty, is also a culture that may emphasize blame on oneself and value endurance and tolerating pain rather than taking actions to change one’s situation. Additionally, the culture carries a lot of weight of shame. Asian American young women ages 15-24 have the second-highest suicide rate among all races, and similar to other East Asian countries, suicide continues to be a major problem in Japan. Asian Americans consistently seek mental health help at much lower rates than the rest of the population. In this context, Naomi Osaka’s decision to disclose her own mental health struggles as a Japanese woman is all the more remarkable.

Naomi identifies with a mixed racial and cultural heritage of Haitian and Japanese, along with a Japanese nationality but an American upbringing. She has experienced racism not only as a top non-White player in a predominantly White sport, but also within Japan for “not being Japanese enough.” I would imagine that the burden of representing multiple cultures while being attacked based on these very same attributes also contribute to struggles with mental health and identity. Despite this, Naomi has shown incredible resilience as an advocate for her community. In fall of 2020, she drew attention for her activism by showing up on the court wearing a mask bearing the names of Black men and women who had been killed by the police. As she progressed in the competition, at each game she wore a mask bearing a different individual’s name. Her activism and advocacy as a multiethnic and multicultural individual has granted her unique reach and impact, and I am grateful for her courage.

Seeking Help

Many sports psychologists do excellent work, but some athletes find that the type of therapy needed to optimize their performance is different from the psychotherapy needed to promote mental health. It’s OK to try both.

It’s also ok to see therapists without having any specific “problems” or a diagnosis. A therapist is someone who is not attached to your life; they are not friends, family, or federation members. Instead, they are trained professionals who you get to talk to on a regular basis about the issues you are facing. Many people (including Mirai!) have found that the time and effort spent on this therapeutic journey is very helpful.  

For more significant struggles and mental health symptoms such as insomnia, depression, and anxiety, there are also effective medications that may be helpful. 

Taking care of your mental health also involves prioritizing balance and self care. Make sure you have other interests and goals as much as your time allows. Also interact with non-athletes and learn what their life goals are.

“Our mental health is not something to be ignored. When you are feeling lost and you need guidance, it’s ok to reach out and ask for help. The older generations are trying really hard to make the knowledge of these resources more available. When I was younger, I didn’t have the knowledge and didn’t know what resources were available. It’s OK to ask a friend and ask for resources rather than bottling it all up, which is what I did. It’s OK to rely on others and to be vulnerable. I think the world looks much less intimidating when you share your hardships. Just to take care of your wellbeing, however that may be.”

- Mirai Nagasu

To The Press and By-Standers

Naomi’s decision was met with comments such as, “She’s a top athlete who is getting much financial gain from the sport, and she has a responsibility to engage with the press.” No matter how much they are paid or how well they play a sport, we should remember that these athletes are also human. We should respect any athlete’s choice to not expose themselves to non-sports-related situations where self-doubt is provoked, particularly during the tournament.

Some commentators expressed an opinion that Naomi is using terms such as depression and anxiety as an “excuse” to avoid her responsibilities. On the contrary, what Naomi is doing would best be described as advocacy and negotiation. Using her position as the top athlete in the world, she is opening up a dialogue to develop a respectful structure for interaction between journalists and athletes.

In sum, from a professional mental health perspective, I urge the press and the public to be mindful of the particular vulnerabilities of young athletes, who are asked to shoulder so much pressure while their brains are biologically still in development. Discussing failure is just as important as celebrating success, but we must do it with respect. The emotional journey of young athletes isn't talked about nearly enough, and it is important for all of us to try to understand this complex topic from the affected individual’s point of view. Rather than harshly criticizing, we should be grateful to Naomi for bringing this to light, and for giving us an opportunity to do better.

Thank you, Naomi.

Dr. Mai Uchida is Director of the Massachusetts General Hospital Child Depression Program, Assistant Professor of Psychiatry at Harvard Medical School, and Collaborating Faculty with the MGH Center for Cross-Cultural Student Emotional Wellness. As a child & adolescent psychiatrist and researcher originally from Japan, she is passionate about advocating for mental health, particularly for children and families underrepresented in conversations about mental health, including the AAPI community and athletes.

To watch the full video series of Mai & Mirai, and to learn more about this project, please visit Behind the Podium.

Photo of Naomi Osaka by pbepmaop98 is licensed under CC BY 2.0.