Last week, Lawrence G. Nassar—who had been the physician for the American gymnastics team—was sentenced to 40–175 years in prison. Nassar was found guilty of molesting and assaulting more than 150 women, which he was able to do given his medical access to the young athletes. The case, with ramifications that have spread from the Olympics to Michigan State University, where Nassar worked, has also shined a spotlight on the world of competitive gymnastics. One of the experts in that field is Joan Ryan, whose 1995 book Little Girls in Pretty Boxes: The Making and Breaking of Elite Gymnasts and Figure Skaters exposed the abusive coaching, eating disorders, and high stress that accompany gymnastics training for so many young women.

I spoke recently by phone with Ryan, a longtime newspaper reporter and now a consultant for the San Francisco Giants. During the course of our conversation, which has been edited and condensed for clarity, we discussed the toxic culture in female gymnastics, what won’t change after the Nassar scandal, and America’s weird relationship to female athletes.

Isaac Chotiner: Was any aspect of the Nassar case surprising to you, and how do you think it fits in with the thesis of your book?

Joan Ryan: I think it fits in exactly, tragically, with the thesis of my book. It’s a culture where abuse is normal. The abnormal becomes normal. I was surprised by the scope of it, frankly. That it’s upward of, it could be 200 girls and young women over the course of 20-odd years. That’s almost unfathomable. But the fact that it happened is not unfathomable. I say that because pedophiles … and I actually didn’t really know this, but the word grooming, you know how they groom their victims to trust them? The girls are like, “This isn’t right, but I trust this guy.” That’s what happened with the culture in gymnastics. As I say in my book: You train when you’re injured, you starve yourself, so a coach can say to you, “No, you’re not injured. You’re not in pain. Get back up on the balance beam. You’re just being weak and lazy.” And they get back up on the balance beam.

For people who haven’t read your book or don’t know what the culture of gymnastics is like, can you talk a little bit more about how it is different from other sports that young people, or young women, engage in?

First of all, unlike any other Olympic sport or any sport I can think of in which these athletes are training to be the best in the world, you’re dealing with children. In men’s gymnastics, these guys are adults. They’ve gone through puberty. They’re usually not on the Olympic team until after they’ve gone to college or are in college. That’s not true for female gymnastics, so that’s No. 1. They’re children.

No. 2, they have a small window of opportunity to be the best in the world, often before they hit puberty. In the United States, it’s a culture that has been so influenced by Eastern Europe, really because of Bela Karolyi. He came over here after Nadia Comaneci, and he brought his system with him, which was a system of abuse. His job, and he says this, his job was to create gymnasts, not to create healthy young women. And other coaches followed his lead. American coaches followed his lead, because, frankly, it worked. He did create great gymnasts. Of course, we didn’t see all the bodies of the girls who didn’t make it. He would berate, belittle them, throw them out of the gym, call them fat, call them lazy, call them weak, and if parents didn’t like it, he’d say, “Go ahead. Take your daughter. Take her someplace else.”

These girls want this so much. They’re so driven. They’re not like the rest of us, as any great athlete isn’t like the rest of us. They are willing to do whatever it takes to be the best in the world and to follow their dreams. The parents get on that bandwagon with them, and they get as sucked into this culture as their daughters, and they stop being the parent and just go along with whatever the coach is telling them because they don’t know anything about gymnastics. All the other parents are doing the same thing they’re doing.

What about specific aspects of their training?

You have these girls basically training in isolation. Most of them are not going to school; they’re taking online classes. They’re going to school for a few hours, so they’re isolated. They’re not out in the world.

They’re so driven to … they love this sport, and then that drive and that love for that sport are used against them to push them to train injured, to have eating disorders, all of that. They’re denying their own feelings and giving that reality over to their coach. Whatever their coach tells them they’re feeling, that’s what they’re feeling. It’s a Petri dish that is just ready to explode in the way that it did.

I don’t want to imply that someone like Nassar couldn’t arise in any circumstance, but do you think there’s something about gymnastics and the focus on young women’s bodies? The focus on keeping their bodies in a certain shape, and the way they eat—there is something especially disturbing about it, at least to me. Again, I don’t want to draw unclear connections between that and someone like Nassar, who could arise in any circumstance, but how do you think about that?

I think it’s really a separate thing from the sexual abuse. I think one has to do with the up-close intimacy of an athlete and the trainer, which happens in every sport, and the girl’s disconnection with their own bodies and disconnection with their own reality. I do think there’s a huge issue in figure skating and in gymnastics about how our culture, the society at large, views these girls and young women.

How so?

I think that we expect them to be these “perfect” girls. I think that during the time over the last many decades, in which women athletes weren’t very well-accepted because they looked “too masculine, too strong,” whether they were basketball players or track athletes, the softball players, gymnasts were safe athletes. We were all really comfortable with a little girl in a little leotard who looked like she’s just romping on a playground and has these amazing, unbelievably technical skills. They’ve got their ponytails and little sparkle in their hair, and they’re barefoot, and they have their big ol’ burly coach there ready to give them a big hug. It all looks so wholesome and familial, and I think society is super, super comfortable with athletes who are like that. I mean, they’re literally wearing costumes and smiling as they’re doing all this. It’s bizarre in a lot of ways.

What’s sad about it is that they are among the greatest athletes you are ever going to see on Earth, and I don’t think they get as much respect for what it takes to do what they do because it’s all so prettied up.

You wrote your book a couple decades ago. Do you feel like the culture of gymnastics has changed?

I haven’t covered it since the 2000 Olympics. However, just seeing the outcome of this and, obviously, following it, the culture in general hasn’t changed enough or else these girls would have had an adult listen to them. They would have not stopped telling an adult until somebody heard them. So that culture of denying your own reality, being silent, that clearly hasn’t changed.

One thing that has changed is that you can see that there are actually women competing in women’s gymnastics now. The American team looks a lot different than they looked 20 years ago. They actually look like they’re women, a lot of them anyway.

What still needs to be done?

It’s so vast what needs to be done, because changing rules is really easy; changing a culture is really hard. I mean, obviously, they’re doing the right thing by getting rid of everybody higher up and putting in new people [on the USA Gymnastics board]. With the board now, the bylaws require that there be X number of people representing the gym, like gym owners and coaches and all that. But they need independence, board members who don’t have any skin in the game, who don’t have an agenda.

USA Gymnastics has been a mom and pop shop. It’s been very unsophisticated. Very anti-science. What does this training do to girls whose bodies are still growing? Their psyche is taking shape. The sexual abuse is what’s taking front and center now, but, as you peel it back, it’s a culture of abuse of all kinds.