Whenever a tragedy happens like what happened in Texas last week, I cringe. Yes, I mourn, and empathize with the families but I cringe because here comes the media with their generalization of this individual has a mental illness. This is a way we know that mental illness is not seen as a health condition yet in spite of the press it gets. If someone has a physical health condition we don’t generalize with they have a physical health condition, rather we say he has asthma, or she has high blood pressure or they have cancer etc. Whenever there is a tragedy at the hands of someone who most likely had a mental health condition media reinforces the reason many don’t seek the help they need. I have a mental health condition but that doesn’t mean Im going to take someone’s life. Just means Im going to have some bad days, take my meds, and talk to my therapist.

A recent study found that 66 percent of adolescents with ADHD “substantially underreported” symptoms because of the shame and embarrassment from mental health stigma. Doctors say this is a huge, persistent problem.

When I’m feeling so low that I cancel plans with people I love in order to binge-eat noodles with my hands, I feel like a jerk, and I definitely don’t want to talk about it. Symptoms of mental illness, including a lethargy so debilitating I can’t bring myself to grab a fork from the kitchen, can feel like personal failings. For me, it’s the sign of a mood disorder, and I’m not alone: According to the National Institute of Mental Health, as of 2015 about 18 percent of Americans suffer from some form of mental illness, but few seek treatment. A 2014 report from the US Centers for Disease Control and Prevention found that only 35.3 percent of people with severe depressive symptoms said they’d had contact with a mental health professional in the previous year.

People feel shame about their psychiatric disorders, in part, because they’re exhibiting symptoms that are generally considered “bad,” like sadness, inattentiveness, and irritability. Unlike the symptoms of strep throat or the weird rash on your knee pits, symptoms of mental illness are as terrifying to talk about as they are difficult to identify. In the years before my depression diagnosis, I thought I was just exceptionally sad, and the idea of disclosing this—and worrying family and friends—was so stressful it gave me gas. (Yes, stress gas is a phenomenon.)

“These are medical conditions that affect the very fabric of who we are: how we think, how we feel,” said Carol Bernstein, associate professor of psychiatry and neurology at the NYU School of Medicine. “People will say, ‘You’re depressed because of A, B, and C. It must be something you’re doing to yourself.'” The uniquely American pull-yourself-up-by-your-bootstraps mentality convinces people with mental illness that they aren’t doing enough yoga or eating enough omega-3s.

Talking about the inner turmoil that you yourself might not even understand is the key to finding treatment, but that is what people suffering from mental illnesses struggle with the most, according to a number of studies, including a recent one in the journal Assessment that found people with attention deficit hyperactivity disorder (ADHD) tend to underreport their symptoms; in that research, 66 percent of adolescents “substantially underreported” their symptoms, and 23.6 percent didn’t report their symptoms at all. The problem of “underreporting”—that is, not fully communicating, or even recognizing, your symptoms—is often caused by mental health stigma and its malicious cousins: negative self-talk, fear of being labeled as crazy, embarrassment. So people stay quiet, preventing them from getting the treatment they need.

“We receive no education about mental illness in school, and the media continues to portray extreme stereotypes,” said Larry Davidson, professor of psychiatry at Yale University and senior policy advisor for the Connecticut Department of Mental Health and Addiction Services, adding that only one in three people with a diagnosable mental illness will seek treatment. (Some estimates put this number closer to one in two.) “People assume mental illness only happens to other people. [They] don’t recognize the experiences they’re having as symptoms or manifestations of mental illness.”

This confusion is rooted in a widespread lack of education about the lived realities of mental illness—the ones that exist beyond mass-shooting headlines and brief asides in textbooks. “We have lots of data that suggests that people don’t want to tell people because they’ll just be told they’re crazy,” Davidson said