"If I'm not laughing, then I'm crying. And I still haven't been that open about how dark and ugly it really gets," Howie Mandel tells PEOPLE

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Howie Mandel has been living with severe anxiety and obsessive compulsive disorder for nearly his entire life, but for the America's Got Talent judge, every day is still a struggle.

"I'm living in a nightmare," says Mandel, 65, who first exhibited symptoms of his OCD — repetitive and intrusive thoughts and fixations, often brought on by his debilitating fear of germs — as a child.

"I try to anchor myself. I have a beautiful family and I love what I do. But at the same time, I can fall into a dark depression I can't get out of," he tells PEOPLE for one of this week's cover stories.

Wed to wife Terry since 1980, Mandel, who is dad to son Alex, 31, and daughters Riley, 28, and Jackie, 36 (who also suffers from anxiety and OCD), says the pandemic was especially triggering for his mental health.

For more from Howie Mandel's exclusive interview, pick up the latest issue of PEOPLE, on newsstands Friday, or subscribe here.

Howie Mandel
Howie Mandel
| Credit: Shayan Asgharnia

"There isn't a waking moment of my life when 'we could die' doesn't come into my psyche," he says. "But the solace I would get would be the fact that everybody around me was okay. It's good to latch onto okay. But [during the pandemic] the whole world was not okay. And it was absolute hell."

Diagnosed in his 40s, Mandel didn't open up about his conditions until 2006, and admits he grappled with the decision to do so.

"My first thought was that I've embarrassed my family," he recalls. "Then I thought, 'Nobody is going to hire somebody who isn't stable.' Those were my fears."

Mandel says he's often used humor to get through the toughest moments. "My coping skill is finding the funny," he says. "If I'm not laughing, then I'm crying. And I still haven't been that open about how dark and ugly it really gets."

RELATED VIDEO: Howie Mandel on How His Family Gets Him Through Mental Health Struggles: "That's the Sunshine Worth This Pain"

Watch the full episode of People Cover Story: Howie Mandel on PeopleTV.com or on the PeopleTV app.

The comic, who got his TV start on the medical drama St. Elsewhere in 1982, says that his innate ability to find light amidst darkness has been life-changing. "Comedy saved me in a way," says Mandel. "I'm most comfortable onstage. And when I don't have anything to do, I turn inward — and that's not good." 

Today, Mandel, who says he still deals with bouts of extreme depression, acknowledges that the public might not understand the depths of his condition. 

Howie Mandel
Credit: Shayan Asgharnia

"People see inconsistencies, especially in the media," he says. "'Oh he hugged someone' or 'he shook someone's hand.' I can shake your hand. But then I'd think I didn't wash it well enough. And I'd go back and forth in a loop washing my hands for hours. I understand the funny in that. But it doesn't mean it isn't incredibly painful. And I don't want to defend my mental health. I just want to maintain it." 

Listen below to our daily podcast PEOPLE Every Day for more on PEOPLE's interview with Howie Mandel.

In speaking up now, "my life's mission is to remove the stigma," says Mandel. "I'm broken. But this is my reality. I know there's going to be darkness again — and I cherish every moment of light."