Masters of Disguise No More

The Canadian Mental Health Association’s Mental Health Week runs from May 5-11. This year’s theme is #UnmaskingMentalHealth and encourages people across Canada to look beyond the surface to see the whole person.

Perhaps you know the tune – about Eleanor Rigby.

“Wearing the face that she keeps in a jar by the door. Who is it for?”

In their classic song about loneliness, The Beatles sum up beautifully what it is like to live with a “high-functioning” mental illness. The song comes to mind, at times, like when I am in a bipolar mood episode, I always leave the house with my mask on. Often, this is literal. I painstakingly put on make-up, painting a face that denotes coping and professionalism (wing tips for bright eyes! Blush for pink cheeks to denote good health!). When I leave the house, I match the attitude and tone of the people I interact with, putting in enormous mental effort to calculate the actions that will make me appear “normal.”

This mask broadcasts a message of “I’m fine,” when inside, I am often anything but. When I arrive home in the evening, I wash off the painted face and watch it circle the drain, as a kind of illustration of how depleted I feel, before I fall into bed exhausted from the effort.

For me, this year’s Mental Health Week theme is a call to action. When we unmask mental health, we create the conditions for reducing stigma by promoting understanding and eliminating discrimination against people with mental illness.

Masking – what is it, who does it, and why?

Masking, also known as “camouflaging,” is precisely that – trying to blend in with societal expectations by suppressing symptoms or traits, according to Autism Canada. It is a concept that has been most studied in the context autism and attention-deficit/hyperactivity disorder and is linked to the concept of “smiling depression,” a colloquial term for those who may slap on a smile to disguise their inner feelings.

Zachary Houle lives with autism and schizophrenia. He notes that autism has become more celebrated in the media (“autism chic” is even a thing), but he notes that the media portrayals can remove the reality and complexity of illnesses.

“I find with schizophrenia, people immediately think I’m an axe murderer or I’m dangerous and violent,” he says. “It takes less energy to pretend to be normal than going into an office knowing that I’m going to get hazed, which has happened in the past.”

Houle notes that a lot has changed in the 20 years since his diagnosis and that he is in a very progressive and understanding workplace now, but he still masks daily as it has become his second nature.

He is not alone. According to a 2023 poll from Benefits Canada, 45 percent of Canadian employees with autism feel that they have to mask their autistic traits at work.

Tanya Lepine-Darwiche, a woman who identifies as being on the autism spectrum and who lives with anxiety, agrees. “Masking is about the world accepting me being able to walk into a room and have my opinion heard without them placing judgments on me because I’m neurodivergent,” she says. “It’s putting on a performance.” She notes that it is harder to maintain social relationships when she doesn’t mask. “It’s what I need to do to be socially acceptable.”

As Houle and Lepine-Darwiche both note, masking is very useful in promoting social interaction and protecting oneself, but it also comes with costs, primarily burnout and isolation.

“I’d like to be vulnerable with people, to show them how much I trust them, but at least in the workplace I feel like I can’t do that,” Houle says. Lepine-Darwiche shared about the effects of a day of masking on her personal life, when she would come home and need a three- or four-hour nap just to recoup her energy. “It was really difficult on me and my relationship with my wife and family before I understood that all of my energy was going to masking,” she confided.

How masking affects treatment

If you are “good” at masking and continue to function, this can lead to downplaying how much you are affected by your symptoms. You, essentially, mask to yourself, and your healthcare practitioner, thus contributing to underdiagnosis and a lack of mental health supports, something both Houle and Lepine-Darwiche have experienced.

Masking also affects the level of social support that one receives. For example, when your reply is, “I’m fine,” those in your social circle cannot know that you might need extra support.

In a 2019 Ipsos study of working Canadians, 76 percent of respondents stated that they would be completely comfortable with and supportive of a colleague with a mental illness, but first they would need to know that support was needed.

The descriptor “high functioning” is not part of any diagnosis, but it is a term that captures of the reality of many. If someone imagines those with serious mental illnesses as not being able to get out of bed or go to work, that might be the case. However, for others, such as Houle, Lepine-Darwiche, and myself, we can attest to functioning adequately even when our symptoms are quite severe. Even my psychiatrist has had to learn that seeing me with my makeup done and my work clothes on, doesn’t mean that I am doing well.