People with a mental illness struggle with symptoms ranging from crushing depression and crippling anxiety to powerful delusions and hallucinations that force them to actively sort out the real from the imagined.
And if that weren't enough, they also have to deal with the way the rest of the world perceives their inner struggle.
Stigma associated with mental illness remains widespread in US society, despite some progress made in demystifying these medical conditions, said Michael J. Fitzpatrick, executive director of the National Alliance on Mental Illness (NAMI).
"It's pervasive, but it's nuanced, too," Fitzpatrick said. "Most Americans understand that mental illnesses are treatable illnesses. I think people basically understand depression. Depression is talked about in the media and is considered a treatable disease. But when you reach psychosis and schizophrenia, there's still a lot of misunderstanding and fear."
As a result, people with a mental illness often feel isolated, afraid and rejected by society - a stigma that causes many people to go without the treatment they need, said Dr Garianne Gunter, an adult and child psychiatrist with the South Carolina Department of Mental Health.
Not seeking treatment
An estimated one in five people will suffer from a mental or neurological disorder at some point in their lives, according to NAMI. Yet two-thirds of people with a known mental disorder never seek treatment.
"A lot of times, people won't seek help for mental illness because of the stigma," Gunter said. "They won't get help until they're near suicide or they are suffering from very severe symptoms."
The US military has recognised this as a problem for troops returning from active duty in a war zone, Gunter said. Soldiers with post-traumatic stress disorder or another form of mental injury, she said, won't seek help because they are worried it could end their careers.
Both the US and British armed forces have launched efforts to reduce the stigma attached to mental illness, urging soldiers to come forward for treatment. The "Real Warriors Campaign" in the United States and the "Don't Bottle It Up" initiative in the United Kingdom aim to convince troops that mental illness is treatable and should not be looked upon with shame or embarrassment.
"I was very impressed to know they were doing that," Gunter said of the armed forces' stigma campaigns.
Societal stigma also can hamper treatment if people don't receive the support they need from family and friends, she said, adding that all too often, people diagnosed with a mental illness find their loved ones acting differently toward them.
"It affects their network of support," Gunter said. "If you were diagnosed with cancer or diabetes, you'd tell everyone and you'd be supported and prayed for and nurtured. If you tell people you have been diagnosed with a mental illness, you won't necessarily receive that same level of support."
Ignorance is not always bliss
Misconceptions and ignorance regarding mental illness fuel the stigma, Fitzpatrick added.
"People don't know where to go for treatment. They don't know what they're seeing," he said. "Mental illnesses are kind of where cancer was in the '50s. Not a lot is known about either the disease or the treatment."
That's why problems such as depression and anxiety are becoming more accepted - the spotlight has shone brightest on these disorders, creating better education among the populace, he explained.
However, media portrayals of mental illness sometimes foster and reinforce people's worst fears.
Mental illness usually hits the news when tragedy has struck, Fitzpatrick said, such as when US Rep. Gabrielle Giffords was shot in Tucson, Ariz., last January. Jared Lee Loughner has been charged in the case.
"The booking photo of Loughner in Arizona brought the cause of battling stigma in this country back about four steps, and it was run over and over and over," Fitzpatrick said.
It's often no better in fictional accounts of mental illness. Gunter said that people with a disorder rarely are given sensitive treatment in movies and on television, instead often portrayed as deranged lunatics.
"If you see mental illness in the media, a lot of times those illnesses are shown in people who are a real danger to society," she said.
Ending the stigma
To help end the stigma attached to mental illness, NAMI has created a program called Stigma Busters, which encourages people to report portrayals of mental illness that reinforce stereotypes and promote prejudice.
"We push back when we see stigmatising language, and the media has gotten more responsive," Fitzpatrick said.
Another NAMI program, Breaking the Silence, goes into classrooms to teach school kids about mental illness, Gunter said.
"You would be so surprised about the lack of information these kids have regarding mental illness," she said. "We are teaching them to change this idea of mental illness."
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