Yes. We are not free to speak. Writing about mental health without the cover of a pseudonym could be a reason for an employer in an at-will employment state cause for termination (states rights vs federal rights). People with HIV and co-occurring disorders absolutely cannot always come out and discuss his/her status and mental health issues without retaliation.
Because we are heavily sensored via punishment (by being terminated by employers, dropped by insurance companies, investigated and screened out by future employer background checks, etc.) for speaking out, doing it undercover suits many. Losing insurance or your job for the average Joe is simply not an option. Sorry to bring you more bad news about America. It’s complicated and I really understand why people hide their identities. If I told everything I know based on what I do for a living in my real name I would not be employable. Black-balled. It’s complicated.