Expert insight and practical tips on how to handle the shame, and self-stigma, that can arise when seeking mental health support

For many of us who live with a mental illness, it’s not just the symptoms and condition itself we have to navigate – there can also be complicated emotions that arise, including guilt. It seems to be intrinsically linked to how we perceive ourselves when we are going through a difficult time. And it’s this underlying sense of guilt that raises a question which plagues my mind when I’ve felt particularly unwell with bipolar disorder: am I a burden?

What impact does feeling like a burden have on recovery?

Although mental illness and mental health, in general, are now more openly discussed, stigma (whether real or perceived) still persists, and can create a sense of pressure to appear ‘well’. This impacts our judgement on whether we can, or are able to, seek support. We might refuse to reach out because we believe we shouldn’t talk about our feelings, especially if they’re perceived as negative, or we compare our experiences to others and either think we should cope alone, or that we aren’t as deserving of help. This is not an uncommon experience, as explained by therapist Sandhya Bhattacharya.

“It is common to hold guilt and shame around a mental health diagnosis, both for what it represents to us, and our perception about how others might see us,” Sandhya says, noting that these accompanying emotions can create added anxiety, and have complex consequences for individuals.

“Feelings of guilt and shame can be equally debilitating, leading a person to become stuck in thoughts around being ‘not good enough’, and therefore unable to be helped,” she continues. “More often than not, it is not the mental health diagnosis alone that hinders our ability to seek help; it is a sense of anxiety and fear that we may not be able to be helped that is debilitating.”

So, not only can the emotional repercussions be severe when we feel like a burden, having a further detrimental impact on our mental health, but it can also inhibit or delay someone receiving support full-stop. With the latter, we might hide what we’re experiencing from those closest to us, out of fear that we are burdening them with too great a responsibility. Our illnesses can cause us to self-sabotage, and not ask for the help and support that we both need, and deserve.

Changing the internal narrative

“In therapy, we often think about the idea that ‘shame begets shame through silence’. This means that the less we talk about what is shameful to us, the more ashamed we feel,” Sandhya explains. “Silence has the power to increase shame. While compassion and understanding help us recognise, and tolerate, shameful and anxious feelings.”

It is by no means easy to override that internal narrator, telling you that you’re not worthy of help. But the crucial thing to recognise is that silence creates an echo chamber for those feelings of being a burden – there are no other voices to reinforce that you’re not, or that you don’t have to face things alone.

When you talk about how you’re feeling, most of the time you’ll be met with love and support. It’s important to acknowledge that it isn’t easy for our loved ones when we are unwell – but this doesn’t undermine how much they care. They will have the urge to make everything better, to find some magical cure, and to fix everything. They want to find an answer, and sometimes, their frustration that there isn’t an easy solution can spill out in unhelpful words and behaviours – but this is why we need to communicate, and clarify expectations, rather than withdraw.

“Providing compassion and understanding means listening to one’s experience without needing to ‘rescue’ or ‘make it better’. Often, a person experiencing mental health difficulties is trying to make sense of their world, and is generally trying their best every day,” Sandhya says.

Our role is to recognise how challenging this can be for them, too, and to acknowledge there isn’t an easy route to follow. Instead, we should highlight how they can help us – even if that is just by listening or offering simple practical support – when so many things might feel beyond their control.

Having difficult conversations where we accept how each person feels, allows us to move forward together, and learn how to cope with mental illness a bit better each time.

Practical techniques to tackle feeling like a burden

Analyse your core beliefs

These are deep-seated statements and ideas we believe about ourselves. Notice when one arises, and write it down, such as: “I am a burden to others.” Then, use a critical eye to challenge it with evidence, and question whether it’s actually supported by any facts – what proves this, and what disproves this?

With this recognition that a thought isn’t always a fact, you could combat these limiting beliefs by focusing on what others have said, such as: “The people in my life who support and care for me are happy to do it. They have told me I am not a burden.”

Additionally, you can reframe it to review it in a more compassionate and balanced light. For example: “I take care of people in my life when they’re struggling, and they do the same for me.”

Challenge negative thoughts

Automatic negative thoughts can be our brain’s default, as a survival mechanism to protect ourselves – but that doesn’t make them realistic, or true. These tend to be more surface-level than our core beliefs, as reactions to what’s happening in the here and now. But, in a similar vein, identifying them when they crop up means we can begin to challenge them.

First, start with the trigger – what happened in the moment, and what was the accompanying thought? As an example, you might be going through a difficult time, and at the end of a long day, accidentally drop your dinner on the floor. The automatic thought might be: “Why can’t I do anything right?” Challenge yourself to identify the associated emotion when saying the thought aloud (which could be frustration, sadness, anxiety, or anger) to help understand why you’ve responded a certain way, without having to agree with it.

As with core beliefs, think about evidence that doesn’t support the negative thought, and then come up with an alternative: “Accidents are frustrating, but they happen. It’s not a reflection on me as a person.” Consider the associated emotion when you say this new thought out loud – the difference could be really transformative.

Show yourself compassion

Write a letter to yourself focusing on accepting your emotions. Start by describing a thought or situation that made you feel like a burden. Then, craft a response as if you are talking to a friend, and comfort them as if they feel the way you do. Read back what you’ve written, and keep the letter as a reminder when you need to gain a fresh perspective, and show yourself more compassion in future.

No one should feel guilt or shame for having a mental illness, and relying on others for support – we all go through ebbs and flows in life, and require different levels of connection and support to get through them. This does not make you a burden, and you deserve love, empathy, and compassion regardless of how much help you need right now.