Who Was That Masked Man?

What do the Lone Ranger, the Mandalorian, the surgeon who performed my surgery a month ago, and I all have in common?No, I cannot ride a horse, at least not very well, and I don’t think I would want the Mandalorian entering an operating room with The Child in tow, cute as he is. The horse I never ride is not named Silver, and sterile technique was probably not one of The Lone Ranger’s major weapons. So, what is it that binds us all together? We all wear masks. 

Now, this column has never been political, and I see no reason to start down that path now. It is not an extension of the CDCwebsite, which I trust you can search for and read yourself if you are so inclined. I am not writing this week to browbeat you about vaccines or positivity rates or partial vaccination percentages. I am going to talk about masks, but not in the way you might expect. This is after all a column that deals with the mind and mental health, so I’d like to share a few observations with you about mask wearing and its effect on interpersonal interactions, as seen from behind the desk of a psychiatrist. 

Like many of you, I was abruptly sent home to work at home in mid-March of 2020, and there I would stay for the next year, learning to turn a guest bedroom into a functioning office, trying out chairs and tables and bookcases, setting up new printers and laptop stands, attaching clackety keyboards and positioning phone stands at just the proper angle for Zoom or Doximity or Doxy.me calls. I made it work, like a lot of people have, for over a year, when I was then gradually allowed back into the clinic building, and even more gradually allowed to see real live breathing patients back in my office, face to face. Well, sort of. The mask thing, you know. We were and still are under a department directive to wear masks when indoors, in our offices seeing people, or when we are out and about in the building’s public spaces. We are still physically distancing, but we are not as gung ho about cleaning every single surface after every single visit as we were back in the early days of the pandemic. We know a lot more about the virus that causes COVID-19, but we are still diligent, even after vaccinations, even as we feel that the end of this awful pandemic is finally in sight. 

How has mask wearing affected us? I have some thoughts. You may agree or disagree but bear with me, and see if any of this resonates with you in your daily life. 

We wear masks first to protect ourselves and others from the spread of viruses like coronavirus or flu. The science bears this out, that high quality masks worn correctly can indeed slow or virtually eliminate significant transmission of virus particles that can make you sick. That being said, when we wear a mask we can feel pretty confident that we are doing something that helps us protect people. At first this felt very odd, unnatural and even silly. When virtually everyone started to wear a mask in certain situations, it felt much less so, much more normal and much more expected. Like remembering your keys on the way out the back door, you needed to stuff a mask into your pocket or make sure you had a spare one in the car before you got to the store or the restaurant. In places like family homes or even workplaces, where we knew people “B.C.”, or before COVID, we remembered their faces and it was not a great stretch to “see” them smiling or frowning or otherwise emoting behind those cloth coverings, because we knew their facial expressions and reactions so well from before. 

Going into new places or situations was different. If you do not know a person and all you can see and read is his body language and his eyes, it is much harder to gauge what he is really thinking or feeling behind his KN-95. The social dance becomes much more cumbersome, with us straining for physical cues, sounds, or anything else that does not involve a smile or a frown. In my field of psychiatry, being able to see a person’s body language, watch her facial expression, hear her voice and see if all of the above match up in a meaningful way is a big part of what I do every day. A mask, small and unobtrusive as it is, makes this much, much harder to do in a meaningful way. A mask also gives us something to hide behind, for better or worse. I have found that in some ways it is easier to be myself, crack jokes, be more personable with my patients, and they with me, when we are wearing masks. I believe that some patients have found it easier to speak freely when masked than not. Paradoxical, yes indeed. 

When sitting across the table from two accreditation surveyors who were visiting our center last week, we all found it a little odd to be presenting ourselves, our programs and our achievements while masked. Even one of the surveyors commented that we didn’t really know each other, or our features, while interacting in this way, and how odd that was. 

So in summary, masks can be physically protective against pathogens that can harm us. They can quickly be assimilated into everyday life and provide minimal barriers against interactions with those we know well. They can also be barriers, literally and figuratively, that prevent knowing others and assessing their emotions and interactions if we do not know them well. They can be something to hide behind, which might make it easier for some to interact, or harder for others to be themselves. They can make it much harder to get to know someone new. There is also one more thing to consider. Though we are all so tired of the pandemic, the quarantines, the isolation, the distancing, and the mask wearing, it may be harder to give up the latter than we think when the time comes. One previous life experience reminds me of how hard this might be when we are told we really, truly do not have to wear masks any more.

I can remember playing in a staff/patient softball game many years ago. I had just hit a driving single that I was sure I could stretch into a double, so I rounded first base and raced towards second, sliding in a cloud of dust. It was an ill planned slide, and my left leg caught the bag, which decided that it would not move. I heard a snap, felt immediate pain, and looked down to see my lower leg in a weird angle that was certainly not natural.(I was safe, by the way) After a trip to the emergency room, I headed home the proud owner of a new set of crutches and a cast that encased my lower leg to my knee. I hated that cast, though it allowed my broken bone to mend over the next six weeks, because I could not take a shower easily and could certainly not carry my own coffee cup while rocking crutches. However, as my bone healed and strengthened and the muscles of my leg dwindled to half their pre-slide size and power, it soon was time to shed the cast and go back to supporting myself without an exoskeleton. I was afraid to give that cast up. Why? Because I knew that while I wore it, I was relatively steady on my feet, my leg was strong and supported, and I would be able to walk and not fall. Without the cast, as soon as it came off, I felt vulnerable and weak. It took a few more weeks after that to get back to my normal strength, confidence and steadiness. 

When it comes time to shed our masks, how will we feel? Will we smile, timidly at first? Will we avoid others, wondering how vulnerable we are to illness and disease? Will we relish the ability to gauge someone’s delight or anger or sadness from their facial expression, or will we find it hard to open up again? Time will tell. I just know that one day, and soon, we will pass someone in the hallway at work or in the store or at church and we won’t need to ask, “Who was that masked man?” Because we’ll know.