Photographs by Djeneba Aduayom for TIME

Around 9 p.m. on July 27, as Simone Biles soared high above the vault at the Tokyo Olympics, she lost herself. You could see the confusion in her eyes, which darted sideways instead of locking onto the ground as she made her way back to earth. She would later reveal that she was suffering from a frightening mental hiccup, known as “the twisties,” that left her unsure of her whereabouts in midair.

As the Greatest of All Time (GOAT) in a sport that captivates the globe every four years, Biles is all about control. Her life is dedicated to micromanaging every possible element—her diet, her training, her sleep—that goes into performing, so when the lights are brightest, and the stakes highest, little is left to chance. But for Biles, control isn’t just about winning; it can be the difference between life and death. She now has four skills named after her, each a breathtaking combination of daring flips and twists. Avoiding disaster requires a constant, firm grip on mental acuity.

On that night, however, the careful tapestry of control that Biles, 24, had stitched began to unravel. Or at least started to, until she responded in a way that stunned millions of viewers around the world. In the middle of the Olympics for which she had trained for five years, and which was supposed to be the triumphant capstone on a historic career, Biles slipped on her warm-up suit, packed her competition bag and told her teammates she wouldn’t be competing with them, but rather cheering them on in the team event. Her mind and body weren’t in sync, she said, which put her at serious risk. She also withdrew from her next four events, returning only to participate in the final one. At an Olympics in which five gold medals for Biles seemed preordained, she won a team silver and a balance-beam bronze.

For her teammates, her withdrawal from events was a decision they didn’t have time to process as they scrambled to fill her position in the lineups. “We all knew we had to continue not without her, but for her,” says Sunisa Lee, who stepped up to win the all-around gold in Tokyo. “What Simone did changed the way we view our well-being, 100%. It showed us that we are more than the sport, that we are human beings who also can have days that are hard. It really humanized us.”

Photograph by Djeneba Aduayom for TIME

An athlete’s clout is increasingly measured in much more than wins and losses. If 2020 showcased the power of athletes as activists after the murder of George Floyd, this year demonstrated how athletes are uniquely positioned to propel mental health to the forefront of a broader cultural conversation. While a few sports stars have opened up about mental health—Michael Phelps, for instance, has been candid about his post-Olympic depression—in 2021, the discussion became more wide-reaching and sustained. After withdrawing from the French Open in May to prioritize her well-being, citing anxiety, Naomi Osaka wrote in a TIME cover essay, “It’s O.K. not to be O.K.” Biles, by dint of her status at one of the world’s most watched events, raised the volume. “I do believe everything happens for a reason, and there was a purpose,” she tells TIME in an interview nearly four months later. “Not only did I get to use my voice, but it was validated as well.”

While supporters lauded Biles, critics lambasted her for “quitting.” But what Biles did transcended the chatter: she fought the stigma that has long silenced athletes, and shrugged off the naysayers who belittled her decision. “If I were going to quit, I had other opportunities to quit,” she says. “There is so much I’ve gone through in this sport, and I should have quit over all that—not at the Olympics. It makes no sense.”

A month after the Games, Biles put her vulnerability on display once again. Along with three other of the hundreds of other athletes who had been sexually abused by former team doctor Larry Nassar, Biles gave emotional testimony before the Senate about the failures of institutions like the FBI, USA Gymnastics (USAG) and the U.S. Olympic and Paralympic Committee (USOPC) to stop him.

Colin Kaepernick, no stranger to criticism for taking a stand, praises Biles’ “grace, eloquence and courage.” “Simone Biles has used her remarkable position as the world’s greatest gymnast ever to inspire a long overdue global conversation on mental health,” he tells TIME. “Her influence extends far beyond the realm of sports and shows us that another world—a better world—is possible when we speak our truths with integrity and authenticity.”

At a time when anxiety and depression rates are skyrocketing—the CDC reports a 50% rise in suicide attempts by teenage girls during the pandemic—and many people are struggling with what they owe themselves vs. what others demand of them, Biles made clear the importance of prioritizing oneself and refusing to succumb to external expectations. With the eyes of the world upon her, she took the extraordinary step of saying, That’s enough. I’m enough.

Biles thought she was, as she puts it, “good to go” before the Games. In retrospect, she acknowledges that she was shouldering a heavy load as she trained. She was the face of Team USA, and fans around the globe were anticipating watching her gravity-defying skills. Gradually, she began to feel the Olympics were less about her fulfillment and more about theirs.

In the past, when she left the gym, she didn’t allow issues with certain skills to spill over into the rest of her day. But as Tokyo loomed, “my mind was racing and I wasn’t going to sleep as easily,” she says. The pandemic, which had delayed the Games from 2020, played a huge role in that, she thinks, since safety protocols meant she was limited to going to the gym and staying home. For the gregarious Biles, that meant more time alone with her thoughts. Things only got worse in Japan. “We couldn’t hang out because of COVID-19 protocols,” she says, “so things you normally don’t think about because you don’t have time, now you have hours on end to think about—those doubts, those worries and those problems.”

Biles at a Senate hearing on the FBI’s handling of the Larry Nassar investigation on Sept. 15 (Saul Loeb—Pool/Getty Images)
Biles at a Senate hearing on the FBI’s handling of the Larry Nassar investigation on Sept. 15
Saul Loeb—Pool/Getty Images

Biles is the only survivor of the Nassar sexual abuse scandal still competing, and pushing for USAG and USOPC to be held responsible is part of what’s driven her over the past few years. “I definitely do think it had an effect,” she says of that burden. “It’s a lot to put on one person. I feel like the guilt should be on them and should not be held over us. They should be feeling this [pain], not me.”

It took Biles about a year after the first Nassar survivors came forward to reveal publicly that she is one of them; her mother Nellie remembers Biles calling her in tears in 2017, saying she needed to talk to her. Training every day only served as a reminder of what she had been through and the lack of accountability by USAG. Biles didn’t feel she could even drive herself to and from her therapy sessions, so Nellie did, waiting outside in the car in case her daughter needed her.

That work, Biles felt, mentally prepared her for her second Olympics, which she attended without family because of COVID-19 restrictions. She had stopped going to therapy for about six months before the Games, Nellie says, insisting, “I’m fine, Mom.” But after her scare on the vault, she called Nellie crying. “The only thing Simone kept saying was, ‘Mom, I can’t do it. I can’t do it,’” says Nellie. In the days that followed, Biles says she got support from Team USA’s mental-health experts, who were on-site for the first time at an Olympics. That helped her make another courageous choice: competing in the balance-beam final. “At that point, it was no longer about medaling, but about getting back out there,” she says. “I wanted to compete at the Olympics again and have that experience that I came for. I didn’t really care about the outcome. On that beam, it was for me.”

Biles’ assuredness in speaking her truth and taking ownership of her fate offered permission for athletes and non-athletes alike to talk more openly about challenges they’d once kept to themselves. “Sacrifice gives back way more than it costs,” says Kevin Love, a five-time NBA All-Star whose 2018 discussion of his in-game panic attacks helped start to destigmatize mental struggles in his sport. “I do believe that it often takes one person to change the trajectory of a whole system.”

Olympian Allyson Felix, who gave birth to her daughter Camryn in 2018, knows how athletes are expected to make winning their everything. She says Biles will have more influence for stepping back and taking stock of what really mattered than she would have by snapping up more medals. “To see her choose herself, we’re going to see the effects of that for the next generation,” says Felix, who became the most decorated female track-and-field athlete of all time in Tokyo. “When thinking about role models for Cammy, wow, here is someone showing you can choose your mental health over what the world says is the most important thing.”

The message is already being put into practice. As head coach for women’s gymnastics at the University of Arkansas, Olympian Jordyn Wieber, another Nassar survivor, sees Biles’ decision as an opportunity for her team to “take those lessons she’s displaying on a worldwide level and apply them to their daily lives as student athletes.” During the Olympics, Ty-La Morris, 14, an aspiring gymnast from the Bronx, stayed up past her bedtime to watch coverage of the gymnastics events. When she heard people questioning Biles’ fortitude, she defended her. “Everybody kept coming after her, and nobody was in her shoes,” she says. Witnessing a Black woman thrive in a traditionally white sport gives Morris the confidence that she too can make the Olympics, but in addition, she’s now more likely to tell her coach if she’s having difficulty, which she wouldn’t have been comfortable doing before.

Experts agree that especially for young Black women, Biles’ actions were a signal that it’s acceptable to claim agency over both their minds and their bodies. Since the days of slavery, says LaNail Plummer, a therapist who specializes in providing mental-health services to Black and LGBTQ communities in the D.C. area, the bodies of Black women have been subject to fetishization: for purposes of labor, reproduction or athletic entertainment. Throughout their careers, for example, tennis stars Venus and Serena Williams have been the targets of racist and sexist comments because of their appearances. “Our bodies have always been under scrutiny,” says Plummer. “Oftentimes, Black women are not given the freedom to be able to just be authentic. Oftentimes, they have to be what somebody asked them or designed for them to be.”

So when a Black female athlete like Biles takes visible steps to safeguard her own mental and physical health, to indicate that it’s worth protecting, that action carries a special power. Plummer has noticed that since Tokyo, more personal and professional contacts have initiated conversations about their mental health. This is significant, as research has found that many Black women feel they must project an image of invulnerability and the stigma around mental health deters them from seeking help. And although Black adults are more likely than white ones to report symptoms of emotional distress, only 1 in 3 Black adults who needs mental-health care receives it. “It is a privilege of people who have money to see a therapist,” says Reuben Buford May, a professor of sociology at the University of Illinois Urbana-Champaign who studies race and culture. “Intertwined with that is that African Americans have disproportionately been among the poor and have not been able to have health care to pay for mental-health services.”

Biles alone won’t change mental-health inequities or force a society that has long paid lip service to the importance of mental health to do more. But she made it that much harder to look away. And, according to school psychologist Shawna Kelly, a member of the National Association of School Psychologists’ board of directors, Biles’ actions will help accelerate a trend that was already under way. Recently, Kelly has seen more kids asking for help, as well as expressing concern for their friends. “Often that’s before a real crisis, which is where I feel there is more opportunity to work with kids preventively and proactively.”

In June, before she had any idea of the experiences to come, Biles had Maya Angelou’s And still I rise tattooed on her collarbone. “It’s a reminder and a tribute to everything I had been through, and that I always come out on top,” she says. The Olympics did not go the way she or anyone else expected, but she’s not wallowing in what-ifs. She’s back in therapy, just finished headlining a U.S. tour and is feeling confident about the decision she made in Tokyo. “I was torn because things weren’t going the way I wanted,” she says. “But looking back, I wouldn’t change it for anything.” —With reporting by Nik Popli and Simmone Shah

TIME’s 2021 Person of the Year will be revealed on Dec. 13 at 7:30 a.m. ET. Watch the live event on YouTube here.

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