When someone troubled by thoughts of suicide is ashamed to seek treatment, a life is at stake. When severe emotional trauma is deemed too awful to talk about, it festers. Read on as suicide attempt survivors and mental health experts discuss the harmful effects of stigma and why it’s crucial to clear the air.

Permanent Record?

It’s a rare, perfect summer day in the District of Columbia. Misha Kessler, 24, a recent and thriving graduate of George Washington University, sits on a bench on a grassy square within the city campus. He’s relaxed and looking forward to an international trip. Life is good.

But in 2011, during his sophomore year, Kessler came close to taking his own life, after belatedly seeking help for the depression enveloping him. He was reluctant to reveal his growing abyss of anxiety, restlessness, insomnia and nightmares. “I was convinced I could take care of it myself,” he says. “‘It’s a matter of self-control; it’s all willpower. There is nothing I can’t do. If I read the right self-help books, if I think the right thoughts, if I’m constantly being mindful, I’ll be fine.’ And of course that wasn’t the case.”

He holds himself responsible for avoiding mental health care. “I was very scared to have that on my record,” Kessler says. “I really wanted to go into government work, and I was convinced if I started seeking services and taking medication, I would never get a government job ever again. There was definitely my own internalized stigma.”

After his near-suicide and hospital release, Kessler persuaded school authorities to let him return to his dorm. However, other suicidal students at various universities have faced forced withdrawal — a practice Kessler has since spoken out against, among his many public awareness efforts.

Now Kessler is forging a new career path — as CEO and co-founder of a startup that will use social media to help people with mental illnesses.

Fear of Consequences

“Stigma prevents people from seeking out help,” says Dr. Dan Reidenberg, executive director of Suicide Awareness Voices of Education and managing director of the National Council for Suicide Prevention. People experiencing suicidal thoughts, or mental health issues in general, may worry that disclosure could affect their insurance coverage or future employment potential.

“There’s also just the shame,” Reidenberg says. “They’re worried about people knowing about it at work, whether it’s a human resources department or it’s a manager. They’re worried about whether or not they’re going to get a promotion. So stigma keeps people from talking about it.” That fear, he says, is especially prevalent in the military.

A subtle effect of stigma is that it keeps people from hearing suicide awareness and prevention messages. “They think it’s not for them — they won’t listen,” Reidenberg says. “So putting out a radio ad or a billboard or a television commercial — they will turn it off. They won’t pay attention.”

Taboo Topics

Taryn Aiken, 39, is a study in resilience. Raised in a religious Utah community, Aiken made the first of several suicide attempts at age 12. After she was released from the hospital, the reaction was a mixture of silence at home and speculation at school.

“Nobody said, ‘OK, let’s go talk to your teachers and tell them what’s going on,'” Aiken says. “It was just, ‘Pretend this didn’t happen and go on about life.’ There was a lot of talking about me, behind my back.” She overhead comments from peers: “‘She’s just doing it for attention’ or ‘Oh, she just must be crazy.'”

People didn’t realize the emotional trauma Aiken had suffered. As a young girl, she was sexually abused by the teenage daughter of a family friend. And even more so than suicide, that just wasn’t discussed. She recalls feeling very misunderstood, carrying a huge secret she believed would only make others despise her. When she was 9, she found her father unconscious from a drug overdose, which she believes was among the earliest of his multiple suicide attempts. Years later, Aiken was the one who found him when he died.

It wasn’t until she was hospitalized again at 15 that Aiken disclosed the abuse. That began the long, slow process of recovery and healing, complicated by her own issues with addiction.

Now the mother of two teens, Aiken, a hairdresser by trade, is a full-time student working toward a psychology degree. As chair for the Utah chapter of the American Foundation for Suicide Prevention, she reaches out to others by publicly sharing her struggles.

She knows that as an attempt survivor, her own risk remains higher. “I still live with suicidal ideation,” Aiken says. “But I know what to do with the thought — I tell somebody else.” When Aiken encounter s stigma, she pushes back. “More of us sharing our stories is going to help remove that stigma, that something’s defective with us or that we’re weak,” Aiken says. “I’m not weak — I’m a pretty strong person. I’ll still have my days because I’m human.”

Loaded Words

“Stigma” is a confusing term that doesn’t get at why people react like they do to the subject of suicide, says Dr. Victor Schwartz, medical director of The Jed Foundation, a nonprofit focused on mental health and suicide prevention in young adults, with a focus on college campuses.

“When we think about serious mental illness, suicidal behaviors and suicide, it evokes anxiety, shame, confusion [and] sometimes anger, depending on the circumstances,” Schwartz says. “And somehow ‘stigma’ has become a kind of catchall to attempt to capture all the above.” That only makes the issue murkier, he says. “And if you don’t understand something, you can’t take sensible actions to think about it or respond to it.”

Suicide stigma has a long history, says Michelle Cornette, executive director of the American Association of Suicidology. In Dante’s “Inferno,” written in the 14 ^th century, the act of murder landed people in the first ring of the seventh circle of hell. The act of suicide, however, banished people to the even-worse second ring.

The term “committed suicide” is still part of mainstream U.S. culture, Cornette points out. “You commit a crime, just like you commit suicide. You commit a sin,” she says. In 2015, stigma around mental illness and suicide has eased somewhat, she says: “There has definitely been significant progress made, especially if you look back to the late 80s and early 90s, but there’s a long way to go.”

If you have concerns about suicide for yourself or a loved one, the National Suicide Prevention Lifeline is available 24/7 at 800-273-8255.

Out of Denial

Public speaking, much less revealing extremely personal details to people she’s never met, doesn’t come naturally to Jessica Caudle, 33. But she does it anyway, as a speaker during Out of the Darkness Walks, which she helps organize as an AFSP volunteer.

Caudle, like Aiken, has a family history of suicide. Now living in Mansfield, Texas, Caudle grew up in Oklahoma. Her father died when she was 7 but the cause wasn’t made clear to her. However, she heard the rumors in her small town. When Caudle asked her mother in the following months, she “either didn’t know how to respond or wasn’t comfortable talking about it,” Caudle says. “My grandmother was in denial about the whole thing.” But when she was 13, she was given the opportunity to look through the police report of her father’s death, through a friend’s father. The report contained the truth she’d suspected. “That was very concrete to me,” she says.

After high school graduation, Caudle left home and traveled the country, landing in Los Angeles. She grew to realize she was a lesbian, but she had a fear of coming out, not certain how well that would go over at home. She became involved with drugs and at her lowest point was suicidal. Her life-changing moment was becoming pregnant. She sought help, moved back to Oklahoma for a time and turned things around. Caudle gave birth to her son in April 2005. By then, she had come out of the closet and connected with a partner, with whom she now shares a home in Texas with their son. In June, Caudle graduated from Tarrant County College, in Texas, where she works as a surgical technologist.

Caudle’s 10-year-old son doesn’t know her complete story yet. “But I plan on eventually talking to him,” she says. “My involvement through the foundation and the campus walks — he’s been there with me through it all. And he asks questions. I’m not afraid to have those conversations with him. I think it’s important.”

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Suicide and Stigma: Moving Past Silence and Shame originally appeared on usnews.com