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Hello, friends. This is a nice Q&A where I answer a couple really interesting and important questions relating to anxiety from wearing masks, and taking medication to help with your mental health.

Dr Duff! Hello, I’m a veteran and have an issue I feel nobody is talking about. I was not prepared for the white hot rage and panic that consumed me the first time I wore a face covering. I guess that wearing the M17 A1 protective mask and full chemical MOPP Gear (Mission Oriented Protective Posture) for 12 hrs at a time, being made to run a mile and a half in it, and qualifying at the range while wrapped up head to toe has changed me a little. I’ve been avoiding people, social distancing, going on long walks (3-10 miles depending on how my legs feel) at 0400 in the morning and isolated since March.

The thing is, now there are mask mandates, I have spent HUNDREDS finding a mask that didn’t make me feel like pitching myself off a bridge, I’ve tried wearing them for short periods of time, with all the social media posts and ad campaigns telling me I’m a bad person if I don’t wear a mask I feel like a total heel. I was quite literally mocked while picking up a to go order the other day and my panic was such I lost control of my legs in the parking lot. I think I’m not alone and I SUSPECT that most of the anti mask people don’t have the words to articulate what they’re feeling so they fling out the “MURICA” response. Truth is they probably have what I have only not on the same level. I’ve been in contact with the VA about it, they’re talking about mask desensitization courses… I don’t know what to do, NOBODY is willing to acknowledge this issue, everyone also seems to be intolerant of my condition.

I thought this would be an interesting question to take since I can definitely be outspoken about the need for people to wear their masks. I recently went off on a huge Facebook rant about the trail near my house that I run on, and how few people wear masks. This puts me at risk as someone with significant lung disease.

Let me start by saying that I totally take your situation seriously. BUT I don’t think that your statement that most anti-mask people are experiencing something like you, but don’t have the language to express it, is correct. There may be some, and that’s something that’s important to consider, but there are also many people who are citing reasons for not wearing masks that are rooted in false information or personal beliefs. That’s different.

What it sounds like is that you have a traumatic reaction to the presence of a mask. It’s not a physiological change caused by CO2 or lack of oxygen, it’s that the sensory experience of being in a mask and constricted in that way is so intertwined with some harsh memories from your time in the military. I’m not sure if you already have a diagnosis of PTSD, but of course we know that PTSD is very common in veterans, whether they were participants in direct combat or not. Problems with tempter, social isolation, claustrophobia or feelings of being trapped, and suicidality are all common.

As far as what to do about this… it’s tough. If someone has a severe traumatic reaction having to do with seat belts, they can’t just not wear a seat belt right? Masks are a public safety concern, so we need to try to find some way around this. Not because you are a bad person for not wearing one – it’s just what we need to try our best to do. It sounds like you have tried a variety of masks, so I’m assuming you’ve tried some of the more breathable options like neck gaiters. There is also the possibility of a plastic face shield that doesn’t come into contact with your mouth at all. I use this during testing (along with a normal mask at times). I even cut up a stretchy shirt that I’ve used as a face scarf. You are doing a great job distancing from others whenever possible, but something will have to give when you actually need to go do that grocery shopping or you can’t avoid people.

In addition to making sure you’ve explored the different possible types to wear, you are on the right track wearing the mask for short periods of time. If you indeed have a significant anxiety reaction to wearing one, it will likely take a process of systematic desensitization through exposure to make that happen. It sounds like you have a pretty darn strong reaction if you are feeling anxious to the point that your legs are going out on you. So I think it’s important to take it seriously. I’ve talked about exposure recently on the podcast (ep 195) and there are some different ways to go about this. If at all possible, working directly with a therapist, even if it’s remotely, could be a big help. You are going to want to decide on a courage ladder where you are gradually ratcheting up the intensity over time. You might start by wearing your mask indoors. If your tolerance for it is quite low for even a few minutes – start there. Even if you can only use the mask for 5 minutes or so, start there. Then you are going to want to progressively increase the amount of time you are spending. Again if you want more info about how to progressively work through this, check out ep 195 or the kick anxiety’s ass course.

Once you are able to master wearing your mask at home for up to like an hour, you can move on to wearing it outside. Take some walks around the block wearing your mask. Again, increase the intensity and time gradually. Once that is mastered, move on to semi-public spaces and so-on. It’s also a good rule of thumb that you will want to work on your general anxiety skills. Breathing strategies, cognitive strategies etc. If you are experiencing a super intense amount of anxiety overall, you may want to talk with your doctor about options including therapy and medication.

So I hope that these tips are helpful for you. I think it’s important for everyone to recognize that there is a big difference between people that are having a significant psychiatric issue and people that are just being stubborn or trying to prove a point.

I started listening to your podcast, so maybe you’ve covered it already. What do you have to recommend to people thinking of going on medication? I’m at a loss, I’m so overwhelmed all the time. I have depression, PTSD, and quiet a bit more. I have had suicidal thoughts (none I would ever act on) but I’m kind of hoping in a way if I were to get on medication maybe I’d be normal again or at least numb myself to the pain and anxiety I just feel all the time. What can I expect if I go on meds? Questions I should ask? Ect. Thank you for the podcast. You are fantastic.

I’ve probably talked about medication a few times on the podcast, but it’s an important topic that is worth repeating. I think an important aspect of considering mental health issues for everyone is how much it is causing you to suffer. Regardless of your labels and history, if you are suffering significantly, you deserve to get help. If you are struggling with suicidality, depression, PTSD and more, it sounds like you are at a place where you are really struggling. It would be totally reasonable for you to look into the possibility of going on medication.

My opinion about medication is that it doesn’t make any enduring changes for you. It’s not going to solve your history of trauma or restructure the way that you think about the world. BUT it will make the world easier to cope with. Ideally, the medication will lower the burden of your symptoms enough so that you can gain some clarity and mental space. That might allow you to make some changes for yourself through therapy, self-help resources, etc. For some people with crippling symptoms, it can even be hard to find motivation or energy to exercise. Similarly, sometimes people can’t really benefit from therapy because they are struggling too much with their symptoms. Medication can help bring things down to a more manageable level.

In terms of what questions you should ask, I think it’s certainly important to ask about potential side effects and interactions with any medications that you are already on. For most psychiatric medications, they take some time to work. Your body will ramp up to the full effect in a few weeks to a month usually. BUT often people feel an immediate boost and start to actually make some changes for themselves because they have finally given themselves permission to change.

So I think that it is important to consider all options and do what works for you. If a medication or a therapeutic approach doesn’t work, you can always adjust. Sometimes this means changing to another medication within the same class. Sometimes this means adding on another medication to balance things out.

All of this is to say that I think it would probably be a great idea to begin this conversation with your doctor. There is absolutely no shame in psychiatric medication.

Thanks for Listening!

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