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Facial protection can trigger those with traumatic experiences

Dawn Nau, of Williamsport, recently went to the grocery store for the first time since wearing a mask became mandatory in her state. For someone with post-traumatic stress disorder and anxiety, this was a huge task.

“To be honest, I thought I was being brave,” she said. “The first time I came up an aisle, there was a man there with a mask on.”

Dawn had to tell herself to breathe. She went into the next aisle and took her mask off.

“I was in the store maybe five minutes before I had to take my mask off,” she said. “It feels like I’m suffocating, like I can’t breathe. It panics me.”

She wasn’t in the store long, but by the time she left, she was soaked from sweat.

“I looked like I had taken a shower,” she said.

Dawn was a bank teller in the early 1990s, when her bank was robbed at gunpoint by a man who used a bandana to conceal his face.

“There were three of us working that day,” Dawn remembered in a recent interview. “This man came in, and it was my turn, but something didn’t look right. You usually know your customers.”

The man passed her a $50 and asked for change. She turned to complete the task.

“When I came back, there was a gun in my face, and he said, ‘Give me all the money in the drawer,'” Dawn reflected.

At one point during the robbery, the man became agitated with Dawn, she said, and “he threatened to blow my brains out.”

“He was wearing a disguise and had a bandana that he pulled up around his face as he was leaving the bank,” Dawn said.

Nearly 30 years later, Dawn’s body remembered its reaction that day and referred to it last week in the grocery store.

Kate Thompson, a licensed professional counselor who specializes in trauma with a private practice in Washington, Pa., said a common saying with folks who work in trauma is, “What wires together, fires together.”

“Something like a face mask or bandana gets wired with a very dangerous situation, so when something comes up again like the mask, those neurons get fired together,” she said. “Anything that the body remembers, that gets triggered. Even though grocery shopping isn’t generally dangerous, someone with a bandana or mask may have fired up that danger reaction.”

Thompson said that, culturally and historically, masks and face coverings often have negative or fearful context, and they haven’t always meant medical protection. Whether through movies, other media or traumatic experiences like what Dawn went through, Thompson said masks are often seen as a means to hide something for negative reasons.

“I think that’s why people go to such lengths to decorate the masks, just to put some creativity in it, because it lightens it a little bit,” Thompson said.

Even before the masks were made mandatory to wear, Nau’s husband of 36 years, James, did much of their shopping for them because of Dawn’s anxiety.

“It’s so much easier to stay home,” she said. “People with anxiety do not like surprises. I need to know what’s going to happen next so that I can prepare. I have to have that sense of stability.”

That day last week, James and Dawn were thinking it may be good for her to get outside, even if it was only to pick up groceries. They had endured weeks of social distancing, not being able to see their granddaughter, family or most people.

“It’s something I didn’t think about when I suggested she get out of the house a bit,” James said. “It didn’t even occur to me about the whole mask thing.”

Dawn’s not alone either. According to Pauline Amaismeier, a licensed professional counselor and psychiatric nurse in Canonsburg, Pa., victims of choking, domestic violence and child abuse might not be able to wear a mask.

“Not just people who may have a reason to be afraid of masks, but anyone who had an attack where their face was covered may have that same reaction,” Amaismeier said. “Your body is just reacting, and you may not have any control over it. Feeling out of control and not being able to control your body response is a horrible feeling.”

That “fight, flight or freeze” reaction has to do with the sympathetic nervous system kick-starting the brain’s survival mode, she said. When a person’s traumatic memory is triggered, a person could experience a body reaction — like labored breathing and nervous sweating — before their mind even realizes what’s going on, Amaismeier said.

“Because the body never forgets,” she said.

Psychologist Michael Crabtree, of Washington, Pa., said masks becoming triggers for people is a topic that’s come up frequently in the last month among his network of counselors, mostly in consideration for people with pre-existing conditions or a history of trauma.

“We’re designed as human beings to recall similarities from past situations to what’s happening presently,” Crabtree said. “The thing that all of us can identify with is we aren’t as comfortable around other people because we can’t see their face or discern what they’re thinking because of the facial expression.”

That is a huge concern for Dawn, who often relies on being able to read people’s facial expressions while coping with anxiety. For her, not seeing people’s faces means less control.

That lack of control, especially at a time of “heightened anxiety” and uncertainty, can be especially difficult for folks who have experienced trauma, according to Michelle Steimer, a licensed professional counselor and trauma specialist in Washington, Pa.

“Masks in general create a mistrust among people with not being able to see somebody’s nonverbal cues,” Steimer said. “We can educate people on how to address those triggers.”

Steimer said people can see therapists and trauma providers through telehealth, as many insurance providers have waived co-pays for mental health services during the COVID-19 pandemic.

“You can still seek treatment, and it’s become more affordable in some cases,” she said.

Steimer’s private practice and others that she knows of in the region have had an uptick in telehealth sessions, as people look for ways to cope with the pandemic and isolation. She also recommended people try practicing breathing exercises, meditation and getting outside for daily walks.

“Anything that makes you more resilient right now will help across the board,” Steimer said.

For now, the Naus decided that James will do the grocery shopping, though that certainly won’t mean an end to Dawn’s anxiety throughout this pandemic. In fact, one of her greatest fears right now is that James will contract the virus and she won’t be able to be with him during quarantine or treatment.

“He is my rock, and I can’t imagine not being with him if he were to get sick,” she said. “That is unfathomable.”

The isolation felt by so many right now during the pandemic, the feeling of uncertainty and lack of control is a point of anxiety for many right now, including Nau.

“I feel for the people who are all alone,” she said. “I wish I could go and give them hugs.”

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