• Sahar Abdulaziz, MS

When Just Fine Means Wearing a Mask

Masked Girl

The way we look to the outside world and how we really feel inside can be the complete opposite. The way we present ourselves to the public is not necessarily a mirror image of what is in fact taking place on the inside. When someone is suffering from a mood or anxiety disorder, all too often, the outside world uses what they have available to judge a person, and that sadly, is usually only how the person appears. Because mood and anxiety disorders do not always present themselves on the outside, this type of measurement falls exceedingly short and is quite inaccurate. For those who suffer, they may appear problem free, carefree, and upbeat to family, neighbors, and co-workers, but on the inside, where no one can observe or see, lurks the real deal; a collection of debilitating painful symptoms, that can cause a wide range of deep psychological pain, fatigue, anxiety and profound loneliness.

Each day, for those who must face the daily challenges that their mood and anxiety disorders present, is another day where the dichotomy between image and reality face off. They struggle to discover how to use a whole new set of coping techniques to make their daily struggles more manageable. Those who feel anxious, gloomy, frightened or pained must find a way to mask their symptoms, juggle their responsibilities and mimic a vision of health on their ‘outer’ person so that they can appear to the outside world as just fine.

One woman, Lorna A. lives with both depression and panic disorder. “Most people who don’t really know me think I am a very laid-back person because I hold a lot of the anxiety inside. It is easy to hide it. It seems other people think that depression and anxiety are easy to get rid of just by changing one’s attitude about things, but sometimes that does not work. I can hear people say, ‘Just snap out of it!’ I even wonder myself why that isn’t easy to do. For me it takes medication as well as love and support from my family and friends. And then there are times that all of these things simply do not prevent my having a panic attack or period of depression.”

Concealed symptoms are just that- hidden and undetectable by merely looking at a person. Because easily concealed mood disorders can be disguised, that also means they can be masked behind a fake façade of contentment, false bravado or calm. The struggle of those who are chronically depressed struggle each and every day to hide their painful symptoms, but this conflict has consequences and those are in the way it can alter the self-image or self-worth of the sufferer. It colors their perception of who they really are and how they will see and experience the world around them. More often than not, it tests the already fragile self-esteem while their interest for life becomes chronically impacted, interfering with every aspect of their life, including career and personal relationships.

Dr. Cassandra Friedman understands and speaks about the tremendous impact depression and anxiety disorders have on family and relationships. “Any time one has a chronic issue, the condition becomes a family affair, bringing about anger and exhaustion.”

Besides being draining, the jumbled up concoction of extreme highs and lows experienced below the surface run contrary to how the person feels inside and keeps them feeling different and apart, shame and guilt. Managing their lives becomes overwhelming and what was easily managed before feels absolutely impossible now. Grappling with a whole new set of norms is not easy to accomplish even when you’re not suffering from a mood or anxiety disorder! Learning to accept the limitations of having a chronic mood or anxiety disorder, and embracing a new method of approaching daily decisions and actions, while conceding to the new norm and then implementing it isn’t as simple as it sounds. It is fraught with change, and change is not always easy to accept or handle.

Many people are not diagnosed right away, despite suffering from their mood or anxiety disorder for weeks, months or even years. While some feel a sense of relief when their condition finally has a medical name, offering validation that their disorder is in fact real and not fabricated for all those Debbi-Doubters who may have questioned their existence in the first place. Others who hear their diagnosis for the first time become frightened and experience a personal crisis. They question whether or not the diagnosis is correct and what it will mean going forward. How will I cope?

Coupled with the psychological pain and now a new named diagnosis is the fact that most people while in the midst of suffering aren’t usually able to think proactively when it comes to their needs or care, yet they are expected to navigate the medical system, possible remedies, the insurance companies as well as other mental health resources all on their own. Sifting through a plethora of treatments and all those health ramifications, speaking with a variety of health care providers and jumping through medical claims form-hoops can leave a person feeling even more depressed and very vulnerable. It can be a very scary time, laden with a multitude of changes and challenges, while all along inside, they are not feeling just fine at all!

Another hoop to jump through is what I refer to as the ‘disclosure hoop’-Should I or shouldn’t I tell about my condition? What will they think of me? Will they believe me? The dilemma of disclosing for the sufferer is about having control or losing control. The stakes are high. With disclosure comes possible judgment, possible rejection. If one is looking calm, serene, healthy and happy on the outside- who is going to believe it is all an illusion- a well-rehearsed performance used to hide the debilitating and painful depression or anxiety symptoms lurking from within? On the other hand, disclosure, especially with inter-personal relationships can be a positive step. Disclosure can help those who want to be in your life to understand or empathize with the disorder and your needs, while not feeling helpless themselves or wrongfully personalizing the times when the depressed individual is feeling a ‘lack of interest due to illness’ as opposed to a lack of interest in them. Disclosure can also help family and friends better understand those difficult times when a depressed individual turns inward, preoccupied and distant.

For many, the stigma of having a mood or anxiety disorder is beyond the pale of acceptable and they dread anyone finding out. Because of the long list of myths and misunderstandings that surround mood and anxiety disorders, society still views them as something that can be willed away- ignored and pushed through, if the person suffering is willing to help themselves. Nothing could be further from the truth. Psychological pain can be described as one of the most intense and significant types of pain any human being can possibly endure. It cannot be willed away, wished away or ignored into submission. Attempting to do so with clinical depression is impossible. President Clinton recently summed it up perfectly when he said, “ Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”

But times are changing and there are many reasons to feel hopeful, as awareness grows so does the amount of resources and help available. There are support groups for specific mood and anxiety disorders now that meet regularly- in person or online. Information and education is readily accessible, most of time only a phone calls or click of the computer away. Research is underway to help find cures and treatments that can better control the severity of the episodes and the symptoms, while healthcare providers are becoming more astute at recognizing what lays hidden behind the well-worn masks of their patients. Below are a few coping tools to make the healing journey just a little bit easier-

  • Learn as much as possible about your disorder.

  • Locate a considerate and knowledgeable mental health-care team.

  • Realize that you are more than your mood or anxiety disorder.

  • Use what you have learned about your disorder to assist others if you are able.

  • Pay attention to your limitations and honor them.

Behind every face is a story and behind every story is a person with a life-tale to tell. And while looks can be deceiving even to the best trained eye, we must never think for one minute that a smile or a calm exterior can make everything just fine from within when coping with a mood or anxiety disorder.

“People want to believe that life is either impossible or easy, but not that a good life is both difficult and possible.”

--- Jean-Paul Sartre

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