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The shadow of your smile - (5/26/2020)

By Dr. Ron Gasbarro  

The sign on the pharmacy door read, “Please wear a mask. It protects you and others.” Jan said to the pharmacist, “I understand why we have to wear a mask. They cut down on droplet exchange and minimize the coronavirus from infecting us. But the masks seem so impersonal. Kind of creepy when you can only see people’s eyes and not their whole faces.” 

COVID-19 is affecting our mental health in ways that are intense and continuously evolving. We face isolation, loneliness, grief without being able to bury the deceased, losing our jobs, interrupting our education, and forfeiting our lives. Never before in recent modern history has a virtually invisible, highly contagious, and deadly terror thoroughly and quickly changed our way of life. The damage to our existence will continue long after either human ingenuity or herd immunity has silenced the pandemic. 

Humans have about 10,000 different facial expressions. The smile you experience when you see your child safely sleeping. The face you make when the cat has vomited on the couch (again). The look you give the pharmacist when you think he has overcharged you. The eyes, mouth, and forehead are integral to facial expressions. But now, the mouth is censored by a mask. 

With a mask over your face, how can people see you smile? A smile is the universal facial expression, transcending all cultures and races. Yet, not all smiles are the same. According to researchers at the Niedenthal Emotions Lab at the University of Wisconsin, various types of smiles are part of our communication toolbox. They may reward behavior, inspire social bonding, or exert dominance and subservience. They can be used to flirt, to deceive, to signal awkwardness, to maintain social norms, to cope with pain, to communicate sarcasm, and to express rushes of sentiment.

American Sign Language (ASL) relies on the mouth being used along with other facial expressions and hand gestures. “Mouthing” modifies the word – usually a noun – that is being gestured with the hands. So if the person using ASL is describing a house, the word “house” is signed with the hands. In contrast, details about the house – size, color, shape – is conveyed with lip movements and other facial cues. Remove the lower half of the face, and the "listener" is missing these vital signs in grasping the exchange. Indeed, hearing-impaired or not, we all use our facial muscles to embellish our speech. 

For the rest of us wearing masks, how would we know what a masked stranger is thinking? Some folks have very expressive eyes. Yet, even though the Mona Lisa has an alluring look, precisely what her smile means has mystified us for centuries. Put a mask over her, and she is just another Renaissance painting, not an icon. Then, there is the practicality of wearing a mask while having a conversation. As stated in a 2020 editorial published in the British Medical Journal, the quality and the volume of speech between two people wearing masks are considerably compromised. Wearing a facemask directs one’s exhaled air go into one’s eyes. This generates an uncomfortable feeling and an impulse to touch the eyes. If one’s hands are contaminated, then one is infecting oneself. Facemasks make breathing more difficult. For people with COPD, facemasks are intolerable to wear as they exacerbate their breathlessness. The harder they breathe, the more distant their exhalations travel, and the farther germs are spread. 

Nevertheless, no real excuse for not wearing a mask exists. Masks are protecting you and others. Yet, they can add to depersonalization. That is where humanity is right now: Detached and afraid, but altogether safer when masks are worn. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.  



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