How to Disclose a Mental Health Issue
Mental health and illness is largely invisible. But whether or not to disclose your struggles puts a ton of pressure on your shoulders. Should you tell your best friend? Your date? Your impatient boss? This week, Savvy Psychologist Dr. Ellen Hendriksen walks you through this tough decision.
This week, an anonymous podcast listener from Brooklyn, NY, wrote in and wondered if she should tell people about her social anxiety. She gets anxious when people watch her eat or drink, especially if she doesn’t know them well. She wonders if it would be helpful to announce it: “Sometimes eating in restaurants makes me nervous,” or if that would just elicit raised eyebrows and awkward questions.
Coming out about your mental health can be tough in any situation. Should you disclose to colleagues? To friends? On a first date? On a twentieth date? To your Michael Scott-esque boss? Any way you slice it, it’s a decision only you can make.
Many people stay silent because they anticipate rejection, judgment, or outright discrimination. But others decide to disclose to gain support, exercise their civil rights, and break the stigma.
For what it’s worth, there’s already a whole lotta disclosing going on. Even with a heavy topic—specifically, suicidal thoughts among individuals living with schizophrenia, bipolar disorder, or major depression—a study led by University of Southern California researchers found that 77% of participants had already disclosed to someone in their social network, and every single person—100%—planned to reach out if suicidal thoughts came back.
But it’s still a hard decision. Disclosures, like diamonds, are forever; they can’t be unseen, just like the uncanny resemblance between the Monopoly guy and the guy on the Pringles can. (Or maybe that’s just me. The mustache? The bow tie? Anyone?)
Regardless, let’s think through whether or not to disclose your mental health, plus how to do in a style that works for you.
First up: a study out of King’s College London pilot-tested a decision aid for people pondering whether or not to disclose their mental illness to employers. There is much to think about, including these four points:
Point #1: Consider your needs.
What compels you to speak up? Do you want encouragement and understanding? Do you feel burdened or isolated by a secret? Maybe you need help finding a doctor or want your buddies to understand why you’re not drinking anymore. Maybe you need the reasonable accommodations mandated by the Americans with Disabilities Act Amendments Act of 2008, like a few hours of flextime each week to attend therapy or breaks dictated by need rather than by the clock. Regardless, think about your end goal: what do you need or want out of the conversation?
Point #2: Reflect on your values.
Each person who discloses helps chip away at silence and stigma around mental illness, but you may not feel ready to bear that responsibility, and that’s okay. Think about your own values. Maybe you value being open and candid. Or perhaps you value your privacy.
In addition, examine your values and beliefs about mental illness itself. Challenge any notion that you are somehow weak for needing help, and question feelings of guilt or shame around having mental health struggles in the first place. Trust me, you did not bring this on yourself.
Point #3: List the pros and cons of speaking up and the pros and cons of keeping quiet.
Because you’re a human being, you probably have mixed feelings about disclosure. You may want to be open with your friend, but worry she’ll slowly back away from your friendship. You may be concerned about stigma at work, but worry unexplained symptoms might endanger your job even more.
Challenge any notion that you are somehow weak for needing help.
To get some clarity, list out not only the pros and cons of telling, but also the pros and cons of staying quiet. You may think the pros of telling are just the mirror image of the cons of not telling, but you’d be surprised at what helpful nuances can pop up when you put pen to paper.
Point #4: Think about who to tell.
Disclosing doesn’t mean telling everyone. You don’t have to commission a Macy’s Thanksgiving Day parade balloon or airplane advertising banner to announce the news about your mental health. You can tell just one person. And if that goes well, maybe tell another. It’s all up to you.
When you’re just starting out, begin with someone who would love and support you even if you disclosed that you enjoy dressing up as SpongeBob and mooing at the full moon. A good first experience lays a solid foundation for tougher disclosures.
Also, consider the emotional savvy or psychological-mindedness of each person. If your boss makes Mr. Burns look understanding, it might be better to start with HR. If your school clique is full of Slytherins, play it close to the vest. Of course, even the crustiest of people may surprise you, but in general, you’re not going to get blood—or support—from a turnip.
But something the King’s College London study doesn’t address is how to disclose, which may be the trickiest part of all. While you can’t control others’ reactions, you can control how you present it. You get to set the tone. You can make it serious and in-depth, off-hand and light, or anything in between. You can dip a toe in to see what reaction you get, or, to mix my metaphors, rip off the Band-Aid all at once. If you’re not sure what feels right, rehearse beforehand with someone you trust—a friend, your partner, or your therapist. There are infinite variations, but here are 4 basic ways to make it happen…
Version #1: Test the waters.
On one end of the spectrum, disclosure can be partial and very subtle. Slip it in as part of a conversation to test the waters. For instance, rather than, “I have social anxiety,” you could simply say, “I always feel so awkward meeting new people,” or, “I go blank when I’m the center of attention.” Drop some breadcrumbs of disclosure to get more info on the other person’s responsiveness and understanding. From there, you can decide to move forward or hit pause.
Version #2: A natural segue.
Moving up the continuum, you might work a deeper disclosure into natural conversation. Bring up your OCD after Howie Mandel gives feedback on America’s Got Talent. Or talk about your bipolar disorder after Demi Lovato discusses her diagnosis on a talk show. You don’t have to set it up as a dramatic reveal complete with a Law and Order “dun dun.” Instead, it can simply come up in conversation when it’s natural.
Version #3: Frame it as doctor’s orders.
Another consideration: frame it as you would a physical health issue. Think about how you would disclose a new hypertension or diabetes diagnosis, and use that as a template. For instance, you may say by way of introduction, “I got some news from my doctor I want to share,” or simply, “I want to update you on my health.”
Version #4: A serious sit-down.
Of course, you can always go whole hog, especially if the person you want to tell isn’t the greatest listener or has a history of laughing things off. In such a case, frame the discussion beforehand. Tell them you want to talk about something important and challenging and that you trust them and want their support.
No matter how you decide to disclose, hopefully, people who get it will want to know how they can help. So consider giving them something concrete to do. Ask for whatever you need, whether it’s encouragement not to drink, some slack if you’re irritable as you trial new medications, extra encouragement to get out of the house and see friends, or just a hug once in a while.
Finally, there’s no need to sugarcoat things, but give them something positive to walk away with—say that you’re a fighter, that you’re taking steps in the right direction and sharing with them is one, or that you’re grateful for their friendship and support.
Disclosure doesn’t always go as expected. Sometimes that means disappointment, but sometimes it means being surprised with an outpouring of support. And who knows? Sometimes you may even get a disclosure in return.
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Alone in a crowd image courtesy of Shutterstock.
About the Author
Dr. Ellen Hendriksen was the host of the Savvy Psychologist podcast from 2014 to 2019. She is a clinical psychologist at Boston University’s Center for Anxiety and Related Disorders (CARD). She earned her Ph.D. at UCLA and completed her training at Harvard Medical School. Her scientifically-based, zero-judgment approach is regularly featured in Psychology Today, Scientific American, The Huffington Post, and many other media outlets. Her debut book, HOW TO BE YOURSELF: Quiet Your Inner Critic and Rise Above Social Anxiety, was published in March 2018.
