The Cost of Telling the Truth: Disclosure, Serious Mental Illness, and the Systems That Decide Who Belongs

By Uma R. Chatterjee, MS, MHPS

I entered my career already “out” as mentally ill.

Long before I ever stepped into a lab, I was publicly sharing my lifelong experience of severe mental illnesses: obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), treatment-resistant depression, twelve suicide attempts, and much more. Advocacy came before science for me; disclosure came before credentials.

By the time I entered STEM, my story was already public–all someone had to do was Google me. Despite overall stigma against serious mental illnesses (SMI), I naively thought psychiatric neuroscience would be one of the safer places to live openly with them. Instead, I learned that even spaces dedicated to studying SMIs often remain intolerant of the people with lived experience (PWLE) who actually live with them.

I was told my disclosure and advocacy would ruin my career. While applying for PhD programs, I knew my transcript would inevitably raise questions: years earlier, I failed classes and dropped out of college at 20 with a 1.83 GPA. Even though I later returned, earned straight A’s, and even earned my master’s degree in neuroscience with a 4.0, I still had to explain the reason behind that trajectory, which was… untreated SMI.

I was warned by mentors who cared about me that this explanation would be unacceptable, and they told me to use cancer instead. But… that was a lie–cancer came later. By the time I was diagnosed with cancer at 22, SMI had brought me to a place of wishing for death–and cancer felt like a welcome reprieve.

My mentors’ advice was a horrific pill that I refused to swallow: that the lived experience that made me want to study the brain would be the very thing to disqualify me from the field.

When Disclosure Becomes a Risk

We often reduce disclosure down to solely a personal decision: whether someone is brave enough, comfortable enough, or “ready” enough to share. But disclosure is not just a personal choice. Often, it is a forced calculation for survival. PWLE often have no choice but to disclose at work, school, in healthcare, or at home to explain symptoms, treatment, absences, accommodations, or context behind behaviors otherwise misread as incompetence, instability, or lack of worth. Yet that very disclosure can determine accommodation, opportunity, exclusion, and discrimination.

Disclosure is not simply about telling the truth. It is what happens after the truth is told.

A student discloses suicidality and becomes seen as unstable rather than suffering. An employee takes leave for intensive treatment and stops being viewed as dependable, promotable, or capable under pressure. A patient discloses violent intrusive thoughts and is feared, reported, or punished instead of understood and treated. A person discloses psychosis and is no longer perceived as credible in their own reality. A person in recovery discloses addiction and remains permanently suspect.

The question is not only, “Should people disclose?” It is: What have we built that makes telling the truth so dangerous?

The False Divide Between Illness and Competence

SMI remains uniquely stigmatized because it is too often conflated with character, judgment, stability, and worth. When someone discloses a condition like cancer, diabetes, autoimmune disease, or a cardiac condition, the illness is understood as medical. When someone discloses a condition like OCD, bipolar disorder, schizophrenia, PTSD, depression, or substance use disorder, people instead wonder whether that person is safe, rational, or capable.

That critical difference bears consequences on admissions, hiring, promotions, leadership, mentorship, healthcare, families, and careers. Because PWLE know this, many hide symptoms until crisis, avoid accommodations, and overperform to compensate for bias. The resilience required to survive under that stigma is admirable–but it should not need to exist in the first place.

The Cost of Hiding–and What Support Can Catalyze

PWLE are often forced to split themselves into pieces: the professional self, the sick self, the public self, the private self. Hiding becomes framed as protection and survival, but when hiding is the only safe option, the cost becomes immense.

As a non-traditional student, it is impossible to explain my academic path without explaining the role SMI played in it. My transcript does not make sense without my lived experience. But telling the truth also means risking whether people still see me as capable or worthy.

That is the catch-22 PWLE face. If we disclose, we risk stigma. If we do not disclose, we risk being miscontextualized. If we ask for support, we risk being seen as less capable. If we do not ask for support, we are forced to function in systems never built for us. When people are punished either way, the issue is structural failure.

But I also know what becomes possible when disclosure is met differently.

When I started my neuroscience PhD program, I did not expect to last even one year. I did not believe there would ever be a lab or mentor that would accept–let alone support–someone so openly living with SMI. Feeling like I had nothing to lose, I navigated laboratory rotations with full disclosure upfront because I needed to know whether an environment would actually accept my full self.

I fully expected my disclosure to slam doors in my face. Instead, to my complete shock, I found my thesis advisor, Dr. Michael Cahill. Instead of pathologizing my lived experience, treating disclosure as a liability, or framing my mental illness as a burden, he embraced both my scientific identity and lived experience as part of my full humanity. Support, flexibility, accommodations, and understanding were never treated as burdens, special privileges, or things I had to earn–they were offered freely, without punishment or negative valence, as a basic expectation of decency and mentorship that allowed me to work with my brain and body rather than against them.

And the result was the exact opposite of everything I had been warned would happen.

With Mike’s support, I started an entirely new OCD-focused project in his lab–one using reverse-translational neuroscience to connect human-relevant genetic and molecular findings to brain circuits, behavior, and lived experience. I harnessed my lived experience to establish more translationally relevant paradigms of OCD-relevant behaviors and generated data that led to over $150,000 in independent PhD funding through competitive predoctoral fellowships and more than $17,000 in professional development, training, and travel awards. I independently led the proposal and procurement of extremely rare human postmortem brain tissue from individuals with OCD through the NIH NeuroBioBank–leading us to conduct the first known protein-level studies in human OCD brain tissue. And just last week, after three successful years in my neuroscience PhD program, more than 20 invited scientific presentations, and two publications, I officially passed my qualifying exams and defended my dissertation proposal to become a PhD candidate!

Because my needs were acknowledged and supported, I flourished in ways I genuinely never thought would be possible for me. I surpassed every expectation and milestone I could have dreamed of in graduate school, not because my mental illness disappeared, but because I was finally in an environment where I did not have to spend all my energy surviving concealment and stigma.

None of that happened in spite of my lived experience–it happened because of my lived experience and being uplifted as my whole self.

That is the power of disclosure when it is accepted, protected, and empowered. It does not make illness disappear. It makes the person safe and supported enough to bring their full insight, labor, creativity, rigor, and humanity into the room.

When Systems Mistake Support for Risk

A core damaging assumption is that SMI makes someone less capable, rigorous, or trustworthy. But needing support is not lacking ability. Accommodations are not incapacity. Flexibility is not lowered standards. Treatment is not weakness.

The question is not whether people with SMI can succeed–many already are. It is how many more could succeed if environments stopped forcing them alone.

Tolerance says: You can stay, as long as your needs do not inconvenience us. Support says: You belong here, and we will build conditions where you can thrive. Tolerance says: Keep your mental illness separate from your work. Support says: Your lived experience may shape your insight, questions, leadership, and contribution.

Disclosure without structural support can become extraction. Workplaces and institutions often want vulnerability in campaigns, panels, recruitment materials, and awareness initiatives, but not when it requires real flexibility, protected accommodations, equitable hiring and promotion practices, or rethinking how people with SMI are evaluated, supported, and trusted in everyday professional life. That is not inclusion. That is performance.

Beyond Disclosure as the Goal

My experience in STEM is one example of a broader issue. Across workplaces, schools, healthcare systems, and leadership spaces, disclosure can shape whether someone is trusted, accommodated, promoted, licensed, supported, or excluded.

Stories matter, but disclosure alone cannot carry systemic change. Stories can open doors, but policies decide whether people can walk through them.

The goal is not to pressure every person with SMI to disclose. Choosing not to disclose is often a wise and necessary decision made within environments that have not earned trust. The goal is to build conditions where disclosure is no longer punished: where support exists before crisis, opportunity does not depend on concealment, and people with mental health conditions are not forced to choose between honesty and survival.

From Awareness to Action

So where do we go from here?

We stop treating disclosure as a personal burden and start treating safety as an institutional responsibility.

That means building workplaces where seeking treatment does not derail someone’s career, schools where accommodations are not treated as evidence of lesser capability, healthcare systems where honesty is met with care rather than punishment, and laboratories where researchers with lived experience are recognized as essential contributors rather than liabilities to rigor.

It means responding with belief instead of suspicion. Building structures rather than statements. Protecting opportunity rather than restricting it. And centering lived experience not as inspiration alone, but as expertise.

Every time we make disclosure safer, something changes. Someone stays in school. Someone seeks treatment earlier. Someone remains in the field instead of leaving it. Someone realizes they do not have to disappear to belong.

Efforts such as One Mind’s Flourish@Work and Lived Experience Initiative, Mental Illness in STEM, Made of Millions’ Made Academy, Students with Psychosis, and broader lived experience leadership movements are helping push this conversation beyond awareness and toward structural transformation.

Because disclosure is not the problem. Stigma is.

The question is not whether people with SMI belong. It is what becomes possible–for science, medicine, workplaces, leadership, and humanity itself–when we finally build spaces where people are enabled to thrive and flourish–not in spite of who they are, but because of who they are.