According to Mental Health America, one in five U.S. adults will have a diagnosable condition in any given year, from anxiety to depression and more.

Years after my dad passed, my family sifted through boxes of his military records, snapshots of a life marked by discipline, service, and sacrifice. We were all affected by his death. But among the documents, they found an old health record, and one phrase quietly stood out: “mildly schizophrenic.” My older brother told me what they had found, and it caught me off guard. It felt clinical, unexpected, and haunting. I had questions, so many. Who diagnosed him? What did that mean for him back then, especially in a time when mental health was barely whispered about? What did he think about this? Why didn’t we know?

Years later, my eldest brother, deeply affected by our father’s death, would uncannily receive the same diagnosis. Suddenly, that buried line in my father’s records wasn’t just a detail; it was something else. Once the word “schizophrenia” entered the room, I could feel something big shift, perhaps reshaping us all in varying ways. I speculated on how the pure labeling of the diagnosis might have antagonized my father and brother, how it changed our perceptions of who we thought we were, now more vulnerable, and perhaps less durable than we may have once believed. So many thoughts back then.

Today, being more well-versed in mental health issues from years of training and experience, I have learned from the many clients I’ve seen that the burden of mental health issues comes with a galvanized dynamism, as varying degrees of impacts may effect everything from daily functional skills to one’s essential quality of living, all the way down to perceptions of self, both internally and socially (Schoemaker et al., 2022). Stigma is not an orthogonal phenomenon, but rather, it intersects with a great many things. For many, it begins with self, where stigma becomes deeply internalized.

The warped mirror effect

Stigma is essentially a “psychological rupture” between identity and acceptance that fractures perspective. Think of the metaphor of a “warped mirror” that distorts, presenting a grossly contorted reflection made up of only exaggerated flaws. Stigma reshapes our psychology and is layered in social dynamics, cutting across cultures, targeting personal traits, social deficiencies, or group identities unfairly (WHO, 2022).

Many “people with lived experience” (PWLE) say the stigma they face is incredibly more painful than the symptoms themselves (Thornicroft et al., 2022). As well, visibility, how apparent a mental health issue is to others, is another key dimension on which stigmas may vary (Carel et al., 2025). To this end, researchers have identified four important, distinct forms of stigma:

• Self-stigma (related to internalized shame)
• Public stigma (prevalence of negative societal attitudes)
• Structural stigma (impediments in institutional systems)
• Stigma by association (negative impacts by proximity and relationship)

Understanding these layers with stigma is key to dismantling the barriers that may keep people from seeking support, speaking openly, or feeling seen.

Stigma’s forms and what to look for

Self Stigma

“I assumed if I didn’t tell anyone, it would just go away. But the silence just made it worse inside my head.”

Self-stigma usually manifests through an individual’s “suppression efforts” to extinguish recognition of the issue by staying silent, or avoiding help-seeking behaviors due to internalized fears of judgment, or minimizing symptoms, and maybe isolating oneself. Suppression is a refusal to acknowledge feelings associated with an experience and can usher in a snowball effect for the person.

Public Stigma

“At work, no one asks how you’re really doing. People may see you struggling, but shy away from asking anything. It feels like a wall you can’t climb over.”

This form of stigma is the “external face” of the issue, where the public becomes an activating agent, contributing to stigma through people’s actions and behaviors. Co-workers, friends, and the community may engage in avoidance, distraction, change the subject, offer platitudes, or be complicit in their silence. Microaggressions and benevolent stigma behaviors (“you’re so brave”) may also surface.

Structural Stigma

“The system didn’t say ‘you don’t matter,’ it just never said ‘you do.'”

Stigma can become embedded in company policy, hidden in its systems, or sometimes buried beneath the veneer of institutional culture. You will see it in the absence of mental health resources, protections, or advocacy. It may manifest in “bravado” cultures where the “stay tough” attitudes prevail, or unrecognized through “organizational blind spots,” and even company reluctance to explore mental health and employee well-being more deeply. It can also be evidenced in passive “don’t ask, don’t tell” environments.

Stigma by Association (SbA)

“I didn’t know if I could talk about it. Ever. It wasn’t my story, but it was part of my life, and it eventually shaped some of my life.”

Family and caregivers closest may experience secondary stigma. SbA arises where people are labeled by proximity and relationship. It can arise as gossip mongering through acquaintances, exclusion from social events, and more. Caregivers may attempt to regain control by masking conditions, pruning away friends, or isolating while trying to help the family member. Advocacy resourcing may be avoided due to fears of public “knowing.” Here, familial loyalty versus societal pressure becomes the painful conflict.

Reframing stigma

Reframing is a CBT strategy of changing the internal narrative. If silence is the hammer stigma wields, then reframing the narrative is its counterforce. Reframing can be a great disruptor of silence seen through acts of allyship, storytelling, advocacy, reform, social networking, caregiver validation, therapeutic reflection, self-compassion, and “naming the experience.” Every time we speak, whether in therapy, in workplace surveys, or the community, we can alter the course of stigma.