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It’s hard for Max to pinpoint exactly when his mental health began deteriorating. Was it when he quit the swim team in his senior year of high school? When he started avoiding friends and social gatherings? Either way, by his sophomore year at the University of Wisconsin–Madison, Max was failing all his classes and barely leaving his dorm room.

Yet when his parents called to check in, he’d say everything was fine. Minimizing — or downright denying — his decline seemed safer than being honest.

“I believed that revealing my situation would only lead to shame and embarrassment,” he recalls.

People coping with mental-health issues often feel just like Max: worried about revealing the depths of their struggle and convinced they’ll be judged or shunned. Awareness of mental illness has surged in recent years, but stigma casts a long shadow — and it’s more complex than meets the eye. Stigma manifests not only as fears of how others will perceive us but also in our own attitudes and beliefs about mental illness. Both can be a major barrier to getting help.

Understanding and overcoming stigma is a first step. Deciding when, how, and whom to ask for help is its own challenge — and reward.

The Many Faces of Stigma

Stigma comes in various forms. One is perceived stigma: our beliefs and assumptions about society’s negative perceptions. But stigma also resides within us. Personal stigma describes an individual’s own negative assumptions and beliefs about an issue, and it’s often the byproduct of internalized societal stigma, also known as self-stigmatization.

Common mental-health stigmas include beliefs that mentally ill individuals are dangerous, can never recover, or are responsible for their condition.

Certain demographics are more likely to hold these kinds of stigma beliefs — and therefore less likely to seek help — than others. Research is inconclusive but suggests that people of color, particularly African Americans and older or less acculturated Latin Americans, are more apt to carry stigma related to mental health. Gender also informs stigma: Adolescent males are more likely than young women to hold personal stigma beliefs about mental illness.

Arguably more important than gender or race is an individual’s lived experience. Those with greater knowledge of or contact with mental illness (having a friend or family member with a mental-health disorder, for example) are less likely to hold personal stigma.

However, perceived stigma is more common among individuals with the most direct type of lived experience — those who actually have a mental illness, like depression. In other words, people who know someone with a mental-health disorder are less likely to negatively judge the condition; those who have the condition are more likely to assume others will negatively judge them.

This dichotomy helps explain why Max was wary about disclosing his depressive symptoms to others — or even acknowledging them to himself. For a while, he sustained the image of a healthy, functioning college student. He hid his grades and lied about how he spent his weekends. Then the COVID-19 pandemic hit. He was forced to move back in with his parents in Minnesota — and forced, at long last, to face what he’d been avoiding.

Talking About It

Once we acknowledge that we need help, we can take the next hard step: asking for it.

Ideally, we should ask for support before things get too dire. For example, individuals experiencing thoughts of suicide are more likely to be met with a calm, measured response if they disclose these thoughts to a friend or family member before the situation reaches crisis level (even the best intentioned among us may not have the skills to respond effectively in a crisis).

When deciding whom to confide in, consider both context and character. Is the person you’re considering approaching a peer or someone in a higher or lower position of power? How long have you known them? How have they responded in the past when you or someone else disclosed something personal? Have they ever disclosed anything personal to you?

These kinds of conversations are most helpful when we let the other person know what we need. Sometimes it’s just a listening ear, and if that’s the case, say so. Often people go into fix-it mode when they aren’t sure how to help — a well-intentioned response, to be sure, but not always well received. (See “5 Ways to Be a Compassionate Listener” to discover how to transform your relationships by changing the way you listen.)

Sometimes we need the other person to hold us accountable in some way: supporting our sobriety by not offering a drink, for example, or encouraging social engagement by scheduling get-togethers. If this is the case, ask for what you need but be respectful of the other person’s boundaries. They have the right to set limits.

It’s also entirely appropriate to ask for assistance accessing professional help. In fact, depending on the severity of the problem, this may be the best option.

That was the case for Max. After he moved back into his family’s home, his mom grasped the severity of his situation. Though Max continued to deny he was depressed, his failing grades, flailing relationships, and the fact that he hadn’t visited a barber in months spoke for itself.

“What came next was life-changing,” he recalls. Max’s family helped him join an intensive treatment program, which provided invaluable skills and support. More important, he realized how much his family cared about him. “I was shocked by how caring my family was, which sounds weird in retrospect — I mean, they’re my family. But I truly was shocked.”

After completing treatment, Max opted to return to school. He transferred to a campus closer to home and enrolled in fewer credits. He continued attending biweekly support groups and was honest with his fellow group members when things started to slip.

Looking back on his experience, he wishes he’d asked for help earlier — but he’s grateful that he ultimately came clean and hopes others will do the same.

“To not reach out for help is to say, ‘I want my life to continue in the way it is,’” Max explains. “If your situation is anything like mine was, then it’s hard to imagine that asking for help will lead to your life changing for the worse.”


Know Your Rights at Work

Disclosing mental-health concerns to an employer may seem terrifying, but if you experience symptoms that interfere with your performance it may be the difference between keeping and losing your job.

For the vast majority of occupations, mental-health discrimination is illegal. Employers cannot reject you for a job or promotion, force you to take leave, or fire you because of a mental-health diagnosis. While most employees have the right to keep their condition private — and if symptoms don’t impact job performance, you may choose to do so — disclosure may be required in order to access accommodations or benefits such as the Family Medical Leave Act.

Exceptions exist. The Federal Aviation Administration may deny certification to pilots who report certain diagnoses, including mood issues like bipolar disorder and thought dysfunction such as schizophrenia. Individuals diagnosed with these and a handful of other mental illnesses can also be disqualified from serving in the military, depending on how the illness impacts their functioning.

For those who do choose to disclose a mental-health condition to an employer, it’s generally best to start with the company’s human-resources department. HR professionals may request documentation from a medical or mental-health professional. This may feel intrusive, but it’s a good reminder that mental illness — like physical illness — is real, and that those who struggle with it can and should seek help.

This article originally appeared as “Talking About Mental Health” in the July/August 2022 issue of Experience Life.

Alexandra
Alexandra Smith, MA, LPCC

Alexandra Smith, MA, LPCC is a licensed professional clinical counselor in Minneapolis.

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