The Masks We Wear: A Major Cause of Misdiagnosis and Lack of Support

Recognizing a common reason for confusion and misdiagnosis related to grief and depression.

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I first became a published author in the 1990s. I’d written a book about my battle with chronic depression. It was my first book, and I hadn’t yet developed my skills as a writer, but the message was on point. I had overcome a clinical depression that persisted for five years, so I wrote the book to give hope to patients and families suffering from the same issue.

After a publisher released the book in 1999, I was invited to speak at hospital support groups around New England, including the prestigious McLean Hospital in Boston.

After these talks, people would approach me privately to explain that none of their family or friends knew about their diagnosis or that they were taking medication to treat their disorder. I was surprised how many people repeated this same story. Due to stigma and fear of being negatively judged, people were choosing to suffer alone rather than risk asking for support from their loved ones.

I had already begun investigating the afterlife before this book was published and recognized a similar occurrence in reference to bereavement. Many people were suffering from deep grief without letting loved ones know what they were going through.

Because I was also giving talks about my discoveries involving evidence of life after death, people would approach me after the lecture admitting that their spouses, siblings, and children had no idea they were interested in the afterlife. Once again, they were afraid of the stigma and how they might be judged as a naïve believer if they had revealed their interest in the subject.

What fascinated me most about these experiences was how the hundreds of people who approached me after my lectures were likely surrounded by loved ones going through similar experiences, yet their secrecy prevented them from identifying one another and, therefore, supporting one another.

Yet, even worse, it became clear to me that many of us hide our challenges from others unconsciously. The fear of stigma and judgment is so prevalent in our society that we protect ourselves from it without even realizing we’re doing it.

Our Masks Confuse Our Family and Friends

A couple years after my book on depression was published, Melissa and I met with a family whose daughter was in a mental health facility due to a suicide attempt. The patient (a young woman in her early thirties) was sitting with her father, mother, and sister in a private visiting room when we arrived. They were friends of Melissa’s family, so we were supporting the family due to my experiences as a former sufferer of depression and Melissa’s experience as a supporter of someone with depression.

My first impression when we walked into the room was revealing. The patient, whom I’ll call Julie, was sitting in a chair talking, smiling, and laughing. If we didn’t have prior knowledge, we never would have been able to tell which of these people was the patient.

Although Julie had experienced prior depressive episodes, as well as prior suicide attempts, this was the first time she had ever stayed overnight at a psychiatric hospital and the first-time clinical depression was ever considered as the cause of her suicide attempts. In other words, both Julie and her family were all quite new to this idea that she suffered from a brain disorder called depression. Previously, her experiences were blamed on outside causes: adolescence, turbulence in the home, or the divorce of her parents. Now the truth had made itself known and the family was lacking in knowledge as to what it meant or how to deal with it.

As the conversation in the visiting room centered on weather and sports, it was obvious to me that Julie hadn’t opened up much to her family. How could she? Julie was dealing with her family’s lack of understanding about clinical depression the easiest way she could, by putting on her happy face and talking about everything but what she needed to talk about—her depression and suicide attempt.

This really hit home for me because I used to be just like Julie. Not everyone is like this. Some people are quite open about the issues they’re dealing with in life. For those who are less forthright, many folks have learned to get through life wearing a mask to hide their true feelings, struggles, and challenges.

When a person lives with grief or depression for years before receiving professional help, they often develop these masks as a tool for coping. And the longer we live with our masks to hide our true feelings, the easier it is to wear them. Before long, we put our masks on unconsciously, and it takes a conscious effort to take them off.

In the first thirty years of my life, I never learned to show my true feelings in front of anyone other than Melissa. If you knew me during my deepest most chronic depression, all you would have seen was an act. I would have appeared happy and full of energy. You would have been very surprised to learn that I was struggling with depression and frequent suicidal thoughts.

For example, if I had attended a birthday or anniversary party during this time, you would have seen a version of Bob who was friendly, charismatic, and sociable. Two hours later, however, when Melissa and I got in the car to go home, I crashed into a deeper depression than before I got there. The effort required to wear my mask for two hours was exhausting. On the ride home, the Bob who Melissa witnessed was excessively sad, irritable, and withdrawn.

This can be radically confusing to people who see the transition. Before Melissa became educated about depression, and certainly before we identified the mask effect, she wondered if my change in mood had something to do with her. Why did I get so irritable and sad around her when I was so different at the party? Was this an expression of my feelings toward her? They weren’t, of course, but it’s understandable why she would question it.

What seems unfair, but is a compliment in its own twisted way, is that the reason we take off our masks with certain people is because we trust them. I took off my mask with Melissa on the ride home after the party because I felt safe expressing how I truly felt to her. Unfortunately, I felt horrendous in this situation because I’d been faking it for two hours. The energy I put out to mask how I was really feeling accentuated my symptoms.

It’s like holding your breath for two minutes and then breathing again. You’re huffing and puffing to make up for the lack of oxygen, which is an exaggerated expression of breathing caused by holding your breath for two minutes. My irritability and sadness after the party was my exaggerated expression of my depression caused by wearing my mask for two hours.

Express Verbally What You Are Hiding Physically

Masks are obstacles that we need to acknowledge in ourselves and explain to other people. The depressed patient who sits in a chair slumped over with her eyes focused nowhere does not have to explain to her family, friends, or doctor that she is depressed. Her body language explains that clearly. But the Julies and Bobs in the world have some explaining to do. We must express verbally what we are not revealing physically.

Doctors understand these masks, but they still have difficulty identifying them. It’s vital that we look deep within ourselves to find our true feelings so we can explain these feelings to our doctors. If we do not, we may eventually become that patient who is slumped over with eyes focused nowhere. It does not have to come to that stage.

If you’re dealing with grief, for instance, but not sharing with your doctor or therapist the deep sorrow you’re feeling or the numbness or detachment you’ve been experiencing since your loved one’s passing, you might be showing up to your doctor appointments with a smile that is making your doctor think you’re doing well.

Sometimes, even we become fooled by our own masks. I remember when I first attended a support group for people with depression, I began comparing myself to the other patients and the way they interacted with others. I realized that I was not like them. There was no moaning, no groaning. My step was quicker and lighter. I was more polite and friendlier. My conclusion was that I didn’t belong there. There must have been a mistake in my diagnosis, I thought. I shouldn’t be wasting everyone’s time.

Thankfully, a talk with my doctor reminded me of all the evidence. Sure, I wasn’t like those other patients, but my life was upside down because of my disorder anyway. I was sleeping eighteen hours a day. I was crying for no apparent reason. I couldn’t focus enough to read a short article. And I believed Melissa and everyone else would be better off if I were dead.

Everyone is unique. We feel many of the same symptoms, but we react to them differently, much the same as we react to pain or being sick in our own unique way. There’s no right or wrong way to grieve or be depressed, which is why we react to these conditions differently. And, as I’ve been illustrating, some people tend to wear a mask when they get around other people.

A Major Cause of Misdiagnosis

One has to wonder if these masks are not a major cause of misdiagnosis regarding mental illness, bereavement, and a heap of other conditions. I can still remember the faces of some friends and family members when I eventually told them of my depression. “Perplexed” is the best word that comes to mind. It was obvious they were having difficulty believing that the person in front of them was severely depressed.

I can only wonder what would have happened if I went to my general practitioner complaining of fatigue, sore muscles, a loss of appetite, and confusion while I wore a smile on my face. He likely would have ordered some blood tests wondering if I had a virus or bacterial infection.

How many depressed people—the bereaved included—who are only able to pinpoint physical symptoms, and do not understand the internal markers of depression and grief, have been misdiagnosed because of the happy masks they wear in the doctor’s office? We will never know.

What I do know is that my relationships improved once I revealed to my friends and family members what I was going through—more accurately, what Melissa and I were both going through. It was the 90s, so people didn’t understand depression the way they do today, but it was still better once I told them. For one, I didn’t need to wear the mask anymore. Not to say I instantly removed it. These changes take time. But even wearing half a mask takes a lot less energy.

Not only did I get more support from those who understood depression, my authenticity prevented friends from misinterpreting my actions, like when I cancelled a dinner invitation or didn’t return their call for days because I was feeling withdrawn and fatigued.

Open the Lines of Communication

To conclude my story about Julie, she did not know how to start communicating with her mom, dad, and sister. Likewise, her family did not know how to talk with her.

Her sister was a little suspicious and confused about the whole situation. She found it difficult to understand how Julie could be depressed to the point of suicide when she appeared so happy and full of life when they got together. Our discussion concerning masks brought it all together for the sister and her parents.

Before long, we were talking about the suicide attempt and Julie opened up right there in front of her family about it, even with her mask still on. Good job, Julie! Now the lines of communication were open, and we learned later that they kept flowing.

Final Thoughts

One important lesson I learned from the many people who approached me after my lectures is that we are surrounded by family and friends who share the same challenges and interests, yet it is our silence and secrecy about these matters that prevent us from supporting one another.

I’ve had many friends and family members approach me about their interest in the afterlife, admitting that they haven’t revealed their interest to anyone they know. Some of these people even know each other, yet they’re meeting for coffee or dinner and avoiding the one subject they’d love to discuss, but they don’t broach it with one another out of fear.

This was true for people treating for depression too. I lost count regarding how many people admitted to me that their spouse, children, and friends did not know that they were taking an antidepressant. Again, I say, some of these people had immediate family members who were also treating for depression, yet their fears stopped them from being able to support one another.

Because I teach about the afterlife, many people who read my articles and books are struggling with grief. The reason I’ve written this article is because when grief is ignored, it can turn into clinical depression. One way grief gets ignored without us realizing it is due to these masks we wear. Yet, awareness of the issue is an important step toward prevention.

Thanks for reading! I’d love to hear from you in the comments.

Warmest wishes,
Bob

PS, Knowing some people will ask: my depression book from the 1990s is no longer available. The publisher closed its doors. But I plan to make it available again in the future. I will announce it here on my Substack account, Bob Olson Connect.

PSS, If you or someone you know is contemplating suicide, call 988 or text 988 in the United States (or visit the 988 Lifeline website) or you can learn helpful information on the International Association for Suicide Prevention website. For international crisis phone lines, visit here.

Bob Olson is the host of Afterlife TV, author of two books, Answers About The Afterlife and The Magic Mala, and creator of the directory of psychics and mediums, BestPsychicDirectory.com. His newest venture is Bob Olson Connect, where you can read Bob’s articles before they become books.

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