When you think of someone who is ill, what do you picture? You might think of someone who is coughing, sneezing or feverish. They might have a greenish hue or flushed appearance; a stuffy nose…or they may use a mobility aid, such as a wheelchair or cane.

In reality, however. this picture only encompasses one type of illness: visible illnesses. Many illnesses are also invisible, meaning they cannot be seen by the naked eye. Invisible illnesses include chronic physical conditions like diabetes, fibromyalgia and certain autoimmune diseases — but also mental illnesses.

Because mental illnesses cannot be seen — i.e. they are invisible — people who have one or more mental health conditions may suffer from stigma, shame regarding their mental illness. This stigma results from society’s view of people with mental illnesses, which is oftentimes negative in nature.

These biases create a sense of shame that leads people with mental illness to stay quiet about their symptoms and even endure bullying or trauma related to their mental health condition. Here’s how invisible mental illnesses can affect a person’s life, how stigma manifests and what you can do to help.

Which Mental Illnesses Are Invisible Illnesses?

Sometimes, mental illnesses can be visible. A person with obsessive-compulsive disorder (OCD), for example, may visibly take part in compulsions like washing their hands too much or locking doors over and over again. But the same person also suffers from obsessions that are not visible to the naked eye. Plus, other people with OCD have mental compulsions that cannot be seen.

These subtle differences in groups of people with mental illness make it difficult to define which mental illnesses are visible and which are invisible. However, every mental illness is considered invisible to some degree in that our thoughts and emotions cannot necessarily be seen by others.

A person may be able to infer that we are feeling anxious from our body language, such as jiggling our legs or biting our nails, but they do not know what is running through our head just by looking at us. This means it’s impossible to understand what a person with a mental illness is going through without being able to read minds — which is why all mental illnesses are considered invisible.

Other people with mental health conditions may show no outward signs that they are unwell. They may be high-functioning, meaning that their mental illness does not severely interfere with their ability to complete tasks or socialize with others, but on the inside, they may find these interactions and tasks much more difficult than the average person.

Some examples of mental illnesses that may be invisible at times include:

  • Not all people with depression show signs that they are in distress. They may dress normally, wear makeup and smile as if they were perfectly happy, but on the inside, they may be struggling to complete their tasks and function as if they were a healthy individual.
  • Anxiety disorders. Anxiety disorders can cause some physical symptoms, like shaking or sweating, but most of the time, it is not obvious when another person is suffering from anxiety — or even when they are having a panic attack. Like many mental illnesses, anxiety takes place mostly in our minds.
  • Bipolar disorder. Severe bipolar disorder, known as bipolar I disorder, can cause hallucinations and downright strange behavior. But other types of bipolar, like bipolar II or cyclothymia, are milder. In these cases, you will most likely not be able to tell a person has bipolar simply by looking at or even by interacting with them. Their bipolar diagnosis is based on their subjective experiences and the thoughts that run through their heads that we don’t know about.

In short, it’s impossible to tell just by looking at a person what they might be going through. The safest choice is never to make assumptions about another human being based on the way they look — and not to assume that someone does not have an illness simply because we cannot see it with the naked eye.

How to Explain an Invisible Illness

When people find out that we have an invisible illness (most likely because we chose to tell them), they may initially have a lot of questions. These questions can be difficult to answer, especially when people have difficulty understanding the concept of an invisible illness.

Many times, people assume that someone with a mental illness can “get over it” by “toughening up.” They may think that someone with anxiety is being too sensitive or that someone with depression just needs to be cheered up.

Other times, people may assume that mental illnesses can be cured with simple lifestyle changes like exercise or good nutrition, rather than seeing them for what they are: illnesses that require professional attention just like any other medical condition.

These attitudes and beliefs can make it difficult to explain invisible illness to people we care about. However, it’s important to remember that most people don’t intend to be hurtful when they make these sorts of comments. Usually, these misguided suggestions come from a place of love. When we remember this, it makes it easier to respond to these comments with kindness and compassion, despite the fact that we are hurt by them.

Comparing an invisible illness with a physical illness can sometimes help someone understand what you are going through. For example, no one tells a person with the flu to “just get over it.” They encourage them to take medications, drink fluids and rest up until they feel better.

Similarly, a person with depression or anxiety may require medication, therapy and self-care to get back to feeling like themselves again. Mental illnesses are just that: illnesses — and any illness is too big to deal with entirely on your own.

What is Mental Health Stigma?

Unfortunately, sometimes comments about our mental health do not always come from a place of love. Sometimes, they are downright mean and hurtful — and usually, this is a product of stigma, a type of shame generated by society’s negative portrayal of mental illness.

When was the last time you saw a movie or television show that illustrated a mentally ill character in a positive light? People with mental illness may be portrayed as violent or villainous, or as weak and lacking self-sufficiency.

This portrayal dates back to the early days of human history. Before doctors understood what mental illness was, they used to confine mentally ill persons to jail or to institutions where they were often treated poorly or violently. Women, in particular, were said to have a disease called “hysteria,” which implied that they were overly-emotional and irrational rather than recognizing their human suffering.

As a result, people in our culture have grown to see this negative stigmatization of those with mental illness as an “accurate” portrayal of what it’s like to suffer from one of these diseases. Sadly, this creates a lack of understanding that may lead some people to make hurtful comments directed at someone with a mental illness.

When a person with a mental illness suffers from negative treatment due to society’s view of mental illness, they are said to be dealing with stigma. Mental health stigma can have a powerful effect on a person’s self-esteem and make it more difficult for them to get better. They may not want to seek treatment, for fear that someone they know will find out about their mental illness and treat them badly for it, or they may feel that there is something wrong with them, rather than recognizing their mental illness as the culprit.

These days, mental health stigma is lessening in the United States and other developed countries — but we still have a long way to go before the stigma surrounding mental illness will be fully eradicated from our lives.

In Therapy - Invisible Illness - Hillcrest

What Can I Do About Mental Health Stigma?

If you are a loved one or caregiver of someone with a mental illness, it can be incredibly difficult to cope with stigma. If you have a mental illness yourself, it can be even harder to cope.

As someone who falls into one of these categories, you may be wondering if there is anything you can do to help reduce mental health stigma in the world around you. The good news is, yes!

You can take several steps to actively reduce mental health stigma in your workplace, at home and in the wider community around you. For example, the National Alliance on Mental Illness gives the following suggestions:

  • Use person-first language. People with mental illness do not deserve to be defined by their mental illness. They have a personality and an identity that is completely separate from their illness. That’s why we don’t call somebody with depression “a depressive” or someone with bipolar “bipolar.” We say that the person has depression or experiences bipolar disorder.
  • Challenge misconceptions. If you hear someone using hurtful or stigmatizing language, don’t sit back and endure it. Speak up and say something to defend those you love who may be struggling with mental illness. Teaching others in a polite way how they can better talk about mental illness will help spread the message of inclusion across our society.
  • Don’t use mental health conditions as adjectives. Someone who is moody should never be described as “bipolar,” nor should you call yourself “OCD” because you like things to be clean. These are real mental health conditions that are incredibly difficult for people to deal with, and using this type of language is insensitive to their struggles.
  • Don’t use words like “crazy,” “psychotic” or “insane.” Likewise, calling someone “crazy” when they are experiencing hurtful symptoms outside their control is unfair and makes them feel even worse when all they are trying to do is get better.

If you are suffering from mental health stigma in your community or are a loved one or caregiver of someone who experiences stigma, you may want someone to talk to who can empathize with your concerns. At Hillcrest, we have many professional counselors who would be happy to listen to you talk about how stigma affects your life and advise you on how you can help your loved ones live in a more inclusive environment for their mental illness.