When United States gymnast Simone Biles, four-times Olympic and 19-times world gold medalllist, dropped out of the team final here after taking a first, clearly sub-par vault, she said: "I have to do what’s right for me and focus on my mental health and not jeopardise my health and well-being. That’s why I decided to take a step back."

Biles had been publicly hesitant about pushing on to compete at these Games once the pandemic had caused them to be postponed and said before the team final that she was feeling the "weight of the world on her shoulders".

She subsequently withdrew from the all-around individual final and on Saturday announced that she would not compete in at least two of the four apparatus finals for which she has qualified - the vault and uneven bars.

The England and Wales Cricket Board then announced that 30-year-old all-rounder Ben Stokes, player of the match when England won the World Cup in 2019, "will take an indefinite break from all cricket with immediate effect," adding: "Stokes has withdrawn from England’s Test squad ahead of the LV= Insurance Test series against India starting next week to prioritise his mental wellbeing and to rest his left index finger, which has not fully healed since his return to competitive cricket earlier this month. The ECB fully supports Ben’s decision and we will continue to help him during this period away from the game."

In both cases, you feel, a physical reason for the withdrawal from competition could have been cited. But mental wellbeing was upheld as being the most important factor.

In elite sport, where weakness has always been something to keep from one’s rivals and opponents and to prey upon if detected, this represents a profound shift in attitude.

In June, Japan’s 23-year-old Naomi Osaka, winner of four Grand Slam tennis titles, withdrew from the French Open after she had been fined for not participating in a regulation post-match press conference. She then subsequently skipped playing at Wimbledon.

Despite widespread speculation that she might also miss her home Olympics, Osaka stepped up, literally, to light the cauldron at the Opening Ceremony and took part in the tennis event, albeit losing in the third round to world number 42 Markéta Vondroušová of the Czech Republic.

Again, Osaka need not have gone down this route. She could have used an excuse of a physical symptom. But she chose to be honest.

Biles cited Osaka as an inspiration and said she thought it was good to be open about mental health in sports, and her attitude has been replicated by many other elite athletes across a range of sports.

"We also have to focus on ourselves because at the end of the day, we're human too," Biles said. "We have to protect our mind and our body rather than just go out there and do what the world wants us to do."

Asked about his opinion on Biles speaking out about athletes and mental health, Sweden’s world pole vault record holder Mondo Duplantis responded on Saturday: "It’s great that she is speaking out about these issues. It can be tough as an athlete and it’s good that the issues are being raised now."

The change in emotional climate was indicated in the run-up to the Tokyo 2020 Olympics when Simone Manuel, who, at the Rio 2016 Games, became the first African-American to win Olympic swimming gold when she won the 100 metres freestyle, spoke emotionally at a press conference following her failure to qualify in that event at the United States trials. She said she had been experiencing depression, anxiety, and insomnia as a result of overtraining syndrome. Happily she qualified in the 50m freestyle by winning on the final day of the trials.       

Ben Miller, a psychologist and president of the California-based Well Being Trust, told Reuters: "Other athletes that might have struggled with similar issues now feel like it's OK for them to talk about it. “There's something very powerful in that moment." Miller went on to praise athletes for making it clear their minds need to be cared for with the same diligence as their bodies. "The sooner we are able to consistently connect the two, and not always see them as separate, the better we will be as a society," Miller added.

Jay Ruderman, president of the Ruderman Family Foundation, also issued a statement thanking Biles for using her platform to put mental health to the fore. "Due to the chilling effect of that [mental health] stigma, especially in the sports world, we often only learn about mental health's role in such a decision through rumours or media reports," he said. "But today, Simone's transparency enabled mental health to take its rightful place in the public discourse."

And psychologist Jill Emanuele of the Child Mind Institute said in a statement that athletes like Biles can inspire young people and their parents to speak up when sports and extracurricular activity stop being fun and begin to damage individuals' mental health. "It's a brave decision to make to take care of yourself and go against all of the pressure being placed on you," she said.

On the subject of Biles’s withdrawal in Tokyo, multiple Olympic swimming champion Michael Phelps, who has spoken of his own issues with depression and anxiety in the past, told broadcaster NBC: "It broke my heart. But also, if you look at it, mental health, over the last 18 months, is something that people are talking about."

Robert Andrews, a mental training expert who worked with Biles for about four years from March 2013, told Reuters he suspected stress played a large factor in this past week’s turn of events. "Gymnastics, probably more than any other sport ... requires laser, pinpoint focus," said Andrews. "Being a global presence, the greatest of all time, all that starts creating interference."

After her withdrawal from the team event last Monday, Biles reappeared in her warm-up suit and offered exuberant support as her colleagues earned silver. But she spoke later of feeling "lost" after the vault and deciding that she needed to "call it," stressing that she had made the decision and not her coaches.

That description chimed in strongly with one used by Britain’s 2004 Olympic 800 and 1500m champion Kelly Holmes when she discussed her experience after retiring from competition in December 2005. "Making a decision to retire after being an elite performer is something that many competitors are scared to do - because they have to address what to do next," she told me once as she reflected on that time in her life. "A lot of competitors are lacking in confidence at that point in their lives. I know how I felt at that point - I felt lost."

For elite athletes, so used to structure and routines, year in, year out, the sudden absence of them is often bewildering -- Holmes, characteristically, ended up being pro-active about this, setting up the Dame Kelly Holmes Trust which was partly engaged in supporting retired elite athletes.

And recently, there has been another cause of the abrupt end to routine beyond simple retirement. 

Phelps alluded to the COVID-19 pandemic that has cause so many profound perturbations and alterations to everyone’s life over the last 18 months. Suddenly, what is known is unknown. Suddenly, controlling the controllables, another of the elite athlete’s mantra of choice, is a profoundly more circumscribed operation. And, unlike the general populace, athletes have an obligation to keep themselves in the best possible shape against a background of blocked training and travel opportunities.

A consensus statement from the International Olympic Committee found that in elite athletes, including Olympians, rates of anxiety and depression may be as high as 45 per cent, Insider reports. While Biles has received huge levels of support from the public and fellow athletes, there have been hostile and scornful reactions on social media to her stance and comments. Some have suggested that to offer such evidence of vulnerability goes against all notions of elite competition.

More than 20 years ago opinion on these matters seemed more straightforward.

In an excellent opinion piece written for the Sydney Morning Herald last year, Greg Baum recalled what he described as the shameful treatment meted out by much of the Australian – and international - media to the French runner seen as the only big threat to home hope Cathy Freeman in the women’s 400m at the 2000 Sydney Olympics, defending champion Marie-José Pérec.

Pérec, who had a wary relationship with the media, stayed in a city hotel rather than the Athletes’ Village. On the day she arrived, she was chased through Sydney Airport by the press. In the end, she left Sydney without fanfare, although her actions became high profile when a scuffle between her boyfriend and a cameraman at Changi airport in Singapore caused her to be interviewed by police for 11 hours before being released to fly on to Paris.

She never ran competitively again.

Pérec felt media and public harassment, including a face-to-face threat from someone who knocked on her hotel room door, made it impossible for her to train and run in a fit state of mind in Sydney. "The 400m in Sydney was not a race against Cathy Freeman, it was a race against an entire nation which had its problems," Pérec said later. "I was only prepared for a 400m."

Her exit prompted a welter of headlines using terms such as: "Petulant". "Temperamental". "French missy". "Precious mademoiselle". "Scared". "Seriously disturbed". "Fantasist". "Sadly deluded". "Brittle". "Disgraced". One Australian paper described her as: "Mademoiselle La Chicken."

As Baum points out – how much worse would it have been had there been social media at that time?

One significant figure refused to join in. I was at the pre-event press conference where Freeman, who has had her own mental health difficulties with which to deal, announced: "I hope that you guys are treating her nicely and giving her all the respect she deserves. I'd like her to be happy and comfortable in my country, I'd like her to be happy and healthy wherever she is."

Pérec said that being left alone was a key part of her being able to win the 400m at the 1992 Barcelona Olympics and the 200/400m double at the 1996 Atlanta Games.

Having had her preparations undermined by injury and illness – the draining Epstein-Barre syndrome - she gave an interview about a month before coming to Australia and said she would give no other. It worked for her then – up to that point at least. Nowadays? Not a chance.

This, in essence, was the question raised by Osaka when she objected to having to take part in the post-match press conference at Roland Garros. The authorities cited the fact that such interviews helped to develop and enhance the sport, and that all involved had equal responsibility to accept the rules. Her resignation from such duties raised the genuinely difficult question of what is the fair balance between privacy and engagement with the media.

The nature of that question has been profoundly altered by the arrival of the myriad of social media outlets. Athletes may now, if they so choose, communicate direct to fans and followers without the brokerage of press or TV. But that has become a two-way street on which, all too often, the traffic coming back in athletes’ direction has been harsh, destructive and, in many cases, anonymous.

Societal change is hard to track and pin down. At what point do opinions change? But at a point in time when so many people in the world have been obliged to review their own personal worlds and suspend so many habitual social actions, it would be surprising if we all simply reverted to life as normal once higher levels of personal security have been, we hope, restored through medical initiatives.

Some of the old models of how athletes are supposed to behave, and how media are supposed to report upon them, are simply breaking up like old continents. The unsayable is being said. And the sky is not falling down…