People experiencing severe mental health conditions often report receiving less sympathy and social support than those with milder or more familiar psychological difficulties, a paradox that mental health researchers have increasingly examined. While public awareness campaigns have reduced stigma around common conditions such as mild anxiety or situational depression, individuals living with complex or chronic disorders frequently encounter misunderstanding, fear or social distance.

One explanation lies in what psychologists describe as “perceived controllability.” When symptoms appear disruptive, unpredictable or difficult to comprehend — such as in cases of psychosis, severe personality disorders or substance use disorders — observers may attribute the behaviour to personal weakness rather than illness. Attribution theory suggests that people extend more empathy when they believe a condition is involuntary and treatable, but withdraw sympathy when they perceive it as controllable or threatening.

Stigma intensifies when symptoms challenge social norms or comfort zones. Severe mental illnesses can involve behaviours that are socially awkward, emotionally intense or functionally impairing, which may create discomfort in interpersonal settings. Research in social psychology indicates that perceived dangerousness — even when statistically exaggerated — significantly reduces public willingness to engage, employ or befriend individuals with serious psychiatric diagnoses.

Another factor is compassion fatigue and emotional distance. Supporting someone with a long-term or severe mental health condition can require sustained emotional labour, which friends, colleagues or even family members may struggle to provide. Over time, repeated crises or relapses may lead to frustration rather than empathy, particularly in environments lacking mental health literacy or institutional support systems.

Experts argue that improving responses to severe mental illness requires shifting from awareness alone to deeper structural understanding. This includes education about the neurobiological and social determinants of mental disorders, expanded access to treatment and community-based rehabilitation, and media portrayals that avoid sensationalising extreme cases. Reducing stigma at the severe end of the spectrum is essential not only for social inclusion but also for ensuring that those most in need of care are not further isolated by diminished public sympathy.