Should an employee with a history of mental illness disclose that to an employer? New York Times writer Alina Tugend recently wrote about the case of Patrick Ross, an employee at the US Patent and Trademark Office. Ross's colleagues were confused by his erratic behavior, which included outbursts and unprovoked abrasiveness.

Eventually, Tugend writes, Ross disclosed to his employer that he'd been diagnosed with bipolar disorder. His supervisors were understanding, and Ross later wrote a book about the experience.

The decision to disclose very personal information — perhaps compromising, in a certain light — can be a difficult one. Many workplaces don't have official protocols for disclosure, and the employee may wonder when and how much to reveal. Often, people say nothing.

"The stigma around mental illness is enormous. A lot of these mass shootings we've seen recently have linked up mental illness to violence," medical ethicist Art Caplan said Wednesday on Boston Public Radio. "They have become the paradigm for mental illness."

Caplan said efforts to accommodate mental illness are often thwarted by the public's dim understanding. "The stigma is just huge. It gets over to a kind of, 'suck it up, hang in there, (...) you can overcome this.' Nobody would say it about cancer. Nobody would ever say that about a broken bone. But a mind that's damaged or has issued — we tend to be kind of intolerant."

Boston Public Radio host Jim Braude agreed. "I don't see a dramatic change at all in the public perception of mental illness being no different than a visible physical illness or ailment," Braude said.

Caplan thought it was understandable so few people tell employers. "I don't know that I'd talk to the boss about this unless I had some reason — you know, I was applying for disability, or I needed some extra time off. But generally, nope, I can't say I would do it either."

Caplan said within his own field of medical ethics there is still a dearth of interest in mental illness. "They haven't paid as much attention to mental illness," Caplan said. "Mental illness affects tens of millions of people, and yet bioethics, too, doesn't pay attention. It's not sexy, (...) it's controversial, and to tell you the truth, (...) the mentally ill often have competency issues, and that's really tough to deal with. (...) I think the bioethics crowd, my crowd, likes cleaner cases."

The Substance Abuse and Mental Health Services Administration estimated approximately one in every five people in the US was dealing with a mental illness. With tens of millions of people working in the US, it stands to reason mental illness often goes unreported.

"Mental illness still carries that stigma of cowardice," Caplan said. "No one who's an air-traffic controller or somebody who's going to be holding other people's lives in their hands wants to admit to stress or depression or anxiety."

>>To hear the entire conversation with Caplan, click the audio at the top. You can also read his book Applied Ethics in Mental Health Care.