Opinion | The Iceberg of Mental Health

“Depression and anxiety are just the tip of the iceberg—beneath them lie deeper struggles like shame, perfectionism, and unspoken fears, shaping our lives in ways we don’t always see.”

The very first thing that comes to mind when we talk about mental health struggles is often darkness—gloomy, cold, and blue depression. Or the opposite: the crippling restlessness of anxiety, like chasing racing horses, crawling out of one’s skin, heart pounding as if trying to escape its own cage.

But mental health is far more complex than these surface emotions. Beneath visible struggles lie hidden battles—shame, perfectionism, unspoken fears, and the weight of expectations. Often, what we show to the world is just the tip of the iceberg, while the deeper pain remains buried.

For years, I believed my struggles were isolated, something to fix or push through. But healing is not about masking pain—it’s about understanding its roots. True resilience comes from confronting what’s beneath the surface, acknowledging our wounds, and learning to navigate them with self-compassion.

Eternal Doom- Depression

When someone is depressed, their natural inclination toward life is hammered down. A sense of endless doom and despair creeps in and takes root in the mind. According to the DSM-5, depression is “a mental health condition characterized by persistent sadness, loss of interest, and a range of cognitive and physical symptoms that significantly impair daily functioning.” In these moments, we disappoint ourselves by failing to show up for what matters—to us and to those we care about. We disappoint others too, and in doing so, we feel guilty. But what often gets lost in translation is that beneath guilt, there’s another, almost identical sensation: shame. You might ask, Shame? What am I ashamed of? That’s exactly what a friend of mine said when I told her that my therapist and mentor had suggested I might be struggling with shame.

Anxiety – “Seher-khaan”

If depression feels like drowning in slow motion, anxiety is the opposite—it’s like being trapped in a storm with no shelter. Anxiety doesn’t whisper; it screams, filling every moment with restless energy, racing thoughts, and an endless list of “what ifs.” It’s’s the pounding heart before a simple conversation, the constant second-guessing of every decision, the inability to sit still because your mind is already ten steps ahead, predicting disaster. “Anxiety is like a ‘seher-khaan’ with drums in his hands, but shame hides behind so many layers that no one ever sees it. We outright deny it because, consciously, we either know that we shouldn’t be ashamed,” said my mentor. While anxiety demands to be noticed, shame stays hidden—so deeply buried under layers of rationalization that we fail to recognize its grip on us. We mistake it for perfectionism, overachievement, self-sabotage—but at its core, it’s shame in disguise.

Guilt vs Shame

I’ll admit, it took me six months to even begin exploring the idea. Had my therapist asked me in our first session what I was ashamed of, I would have dismissed it as a naive and pointless question. What could I possibly be ashamed of? But like peeling an onion, each layer revealed yet another spiral of shame.

The dictionary defines shame as “a loss of respect or esteem; dishonor. A regrettable or unfortunate situation.” But in the mental health landscape, shame runs deeper. It is “a painful, consuming emotion rooted in feelings of unworthiness, inadequacy, or self-disgust.”

Unlike guilt, which is tied to actions (I did something bad), shame is tied to identity (I am bad). It often stems from perceived failures, social rejection, or deeply internalized negative beliefs. Shame doesn’t just weigh us down—it shapes how we see ourselves and how we move through the world.

How shame fuels anxiety and depression

Human beings are destined to make mistakes and be imperfect in life, and just like everyone else we all fail and mistakes but majority of us go through life thinking of those mistakes as experiences of life and not something that should define their self worth. Whenever a person who struggles with shame has to pursue something the voice in the head goes, “You did it wrong that time, you’ll fail again because you’re a failure, you’re not worth anything,” this causes the person to get even more hopeless, helpless and worthless and makes him rethink about their past experiences and hence depression dwells- a sense of eternal doom.

And then in order to stay on top of things, so that we don’t fail once again our mind tries to develop rigid structures, gets obsessed with a sense of control to perfect the outcome so we don’t get hurt, or we could silence this voice in our head but alas as much as we try, human beings are doomed to fail sometimes and be imperfect which doesn’t sit well with shame and just gives it more evidence and receipts about our apparent “worth”.

The layers of onion: Shame spirals.

When a person feels shame they develop strict defensive mechanisms so that no one gets to see how ashamed they are of themselves and how faulty they are. And these defensive mechanisms follow a proper order one fueling the other, keeping the culprit at the core hidden and safe- shame. For me personally, I developed a sense of façade confidence so no one would see how ashamed I truly feel of myself. This becomes a toxic cycle which needs interruption that happens from deep self awareness and mindfulness and possibly therapy. Here’s how I think the cycle goes:

The Cycle of Shame

For years, I believed my struggles revolved around anxiety and depression. I could name the symptoms—racing thoughts, restless nights, self-doubt. But when my therapist suggested the real battle was with shame, I dismissed it. Shame? What was I ashamed of? I hadn’t done anything disgraceful. Yet, as we peeled back the layers, I realized how deeply shame had shaped my life.

The Past That Never Left

Shame isn’t loud. It whispers, distorting reality. It rewrites the past, turning every failure, rejection, and moment of being overlooked into proof of unworthiness. Each time I was ignored or excluded, shame took notes, reinforcing the belief that I wasn’t important, that I didn’t deserve to be heard.

Over time, that shame grew heavier, feeding self-doubt. When friendships fell apart, I blamed myself. When I struggled academically, I saw it as confirmation of my failure. Even when I succeeded, the joy was fleeting—because shame was always there, whispering that I had merely fooled people into believing I was competent.

The Perfectionist’s Trap

To escape shame, I sought control. If I did everything perfectly, maybe I wouldn’t feel worthless. Perfectionism became my armor. I obsessed over details, overachieved, and pushed myself beyond limits, hoping to outrun my fear of inadequacy.

But perfectionism is a trap. The more I demanded of myself, the more I fell short. A single mistake felt like proof of my deepest fears. I didn’t need external criticism—I was already my harshest judge.

The Cycle of Self-Sabotage

Ironically, the fear of failure became so overwhelming that I sometimes avoided trying altogether. If I didn’t try, I couldn’t fail, right? But that avoidance was just another kind of failure. I wanted success, but the possibility of falling short felt unbearable. So I hesitated, procrastinated, and let opportunities slip by, stuck in a loop of anxiety and self-resentment.

Interpersonal Struggles

Shame didn’t just shape how I saw myself—it shaped how I connected with others. My anxious attachment made me crave closeness, yet my perfectionism made me fear vulnerability. If people saw the real me—flawed, insecure, struggling—what if they decided I wasn’t worth staying for? This tension played out in my friendships. I wanted reassurance but feared being too much. I wanted understanding but struggled to express myself. And when people pulled away, I took it as confirmation that I was unlovable.

The Weight of Expectations

Beyond personal struggles, there was external pressure—the expectation to be strong, to succeed, to never show weakness. In an environment where resilience was prized, emotions like sadness or self-doubt were seen as weaknesses, not struggles to be worked through. Therapy? That was for people with “real” problems, not someone like me.

But shame was a real problem. It dictated my choices, my fears, my relationships. It convinced me that I had to earn my worth when, in reality, worth was never something that needed to be earned.

How shame contributes to the stigma of going to Therapy.

In a society like Kashmir, which has long witnessed violence and conflict, therapy and mental health carry a heavy stigma. “Pagal hai kya?” “Mental hai kya?”—these phrases, used interchangeably, reduce mental health struggles to mere “craziness.” Another common assumption is, “Iska breakup ho gaya hoga,” as if therapy is only for those dealing with heartbreak. While breakups might be a reason for some, anyone who finds themselves in a therapist’s office is there because of their own struggles—their past, and the choices it has led them to make, whether academically, in relationships, or in their career.

Many of us carry deep, unaddressed wounds from the past. Instead of facing them, we slap on temporary band-aids, never properly tending to them, all the while bleeding internally. These unresolved issues often manifest in adulthood or young adulthood as attachment struggles.

Others turn to psychotherapy because they feel lost in life, only to be met with shame from society, treated as outcasts or misfits. In reality, many of them may simply be struggling with neurodevelopmental disorders such as ADHD, ASD, or DSD, or other learning and speech disorders—conditions that are often misunderstood.

Then there are those who seek therapy for severe mood disorders like bipolar disorder or borderline personality disorder. In the world of physical health, conditions like diabetes, hypertension, or kidney failure are met with sympathy, empathy, and support. But in the mental health landscape, what do they get? Stigma and shame—fueling their depression and anxiety even further.

Conclusion: Uncovering What Lies Beneath

Mental health is like an iceberg—what’s visible is only a small part of the whole. It’s not just about naming disorders but what fuels them and what we can do to cope with them. Beneath my struggles with anxiety, perfectionism, and self-doubt lay something deeper: shame. It shaped how I saw myself, how I reacted to failure, and how I sought validation.

But healing begins when we acknowledge what’s hidden. It’s about unlearning toxic beliefs, challenging the stigma, and allowing ourselves to grow beyond the labels we’ve internalized. True resilience isn’t about suppressing pain but confronting it with honesty and self-compassion.

The journey is not linear, nor is it easy. But beneath the weight of expectations and unspoken struggles, there is the possibility of something greater—freedom. And in that freedom, we find the courage to heal.

#killtheshame

The writer is the author of two books, writes for local newspapers and is pursuing Bachelor’s in chemistry at Amar Singh Coll

ege. Can be reached at musaibbilal.216061@gmail.com