Face Masks: to wear or not to wear when you are living with psychogenic non-epileptic seizures (PNES) during the Covid-19 pandemic

In recent months, I have been asked by a few patients who have been diagnosed with PNES (dissociative seizures) whether it is safe to wear a mask with PNES.

On one hand, it is becoming obligatory to wear masks in some states.  We have all seen those signs that say: “If you come into this store, you must wear a mask or you will not be served.” On the other, some patients have mentioned that wearing a mask increases their anxiety and they are concerned this could set off a seizure.

I have a few thoughts about this topic. First off, I understand that masks have become associated to many negatives, including:

• Most masks are uncomfortable. We tend to mouth-breathe when we have them on and they quickly get hot and steamy.
• Masks can feel constricting and some report becoming somewhat claustrophobic with them on.
• For someone with an anxiety disorder, breathing may unconsciously become shorter and shallow. Left unchecked this can then trigger an intense anxiety or panic response.
• Some are concerned that masks will expose them to high levels of carbon dioxide and can make them sick. This is not true. Remember, health care providers have been wearing masks for years, sometimes for hours on end and they have not succumbed to carbon dioxide poisoning.
• Masks can also evoke sad and anxious feelings for some. Walking into a store or a restaurant and seeing all the customers and staff wearing masks is an overt reminder that we are living in troubled times. It brings everything to do with COVID-19 to the forefront: all those who are sick or who have passed away, or our own anxieties, etc.
• The mask-wearing mandate can also feel very uncomfortable (“do this or else”), especially for someone who perhaps has experienced someone forcing things on them in the past, especially in childhood.
• And then, let’s not forget that some find seeing others not wearing a mask anxiety or anger-provoking because it feels like this person is not “caring about the spread of the virus.”

But I also understand that masks are being shown in one study after the next as a good way to avoid spreading and catching the virus.  With regards to this, I really liked a Ted Talk I watched a few weeks back because it did a great job of explaining how masks work and gave visual demonstrations through some really good videos.  I also liked the presenter’s tone and attitude: educating and explaining rather than shaming and berating those who are not wearing a mask in public. Here is the link in case you want to watch it: https://ed.ted.com/best_of_web/GsuClwql

So, when asked about masks and PNES, I do recommend trying to wear masks, in particular when in closed (especially crowded) environments.

But how can you wear a mask if some of the issues I mentioned at the beginning are troubling you?  Here are some ideas:

• Make sure your mask is comfortable. I went through several masks, including some that made me look like Darth Vader. Fortunately, I finally found a mask that has adjustable strings so it can be loosened and adjusted. It also doesn’t bend my ears out and it is made of a thick cloth but that I can still breathe through.  Try out a few masks made of different materials and sizes and see if you can find one that you feel comfortable wearing.
• Prepare yourself mentally to wear your mask and make sure you are ready for the excursion (have a shopping list rather than wandering around the store). Remind yourself how long you will probably be wearing the mask and why the mask is useful, and use the next tip:
• Breathing: You must make sure to control your breathing. Before putting the mask on, take the time to practice a breathing exercise.  If you have been in psychotherapy, your therapist may have shown you how to do this.  If you want to know more about this, you can Google “diaphragmatic breathing” and if you want to study it more comprehensively, I recommend a book by Dr. Belisa Vranich called “Breathe”).  So, let’s say you arrive to a store; check in with yourself and how you are breathing.  Focus in on this for a minute or two and modify your breathing rate and depth if needed as this will help decrease anxiety and then you can walk in.  Also, plan your shopping excursion with a list so you can reduce the time you spend in the store.

• If you are still finding wearing a mask next to impossible, you might work on habituating to the mask by first wearing it at home for a minute, and then gradually practice increasing the time you have it on to perhaps half an hour.
• If you feel distressed by being “mandated” to wear the mask, remember, that this is not coming from an abusive person or stance. It is a public health recommendation with science backing it up and you are caring for yourself when you decide to put on the mask. In fact, not wearing the mask might put you at risk of catching this very nasty, potentially deadly virus.  I also think that if you understand the facts behind mask wearing (watch the Ted Talk listed above), you will find that you are deciding for yourself to wear one. You will be wearing it because you choose to, not because an authority figure imposed it on you.
• One way to make masks and mask wearing a bit less stressful is also to wear a mask that fits your personality, maybe a funny one or one that makes a statement (like T-shirts sometimes do).  As Halloween, Thanksgiving, and Christmas approach, we can all try to loosen up and maybe wear a season-themed mask.
• If you are among those who feel anxious when you see someone not wearing a mask, I usually recommend that you keep your distance (perhaps even more than the recommended 6-12 feet).
• Lastly, I will admit that I am among those who feels a twinge of dismay when I put my mask on and encounter others with their face covering because it does remind me that we are dealing with something dangerous and that months later, it is still around! But we need to remind ourselves that humans have survived many plagues and pandemics in the past, and if we are careful and shrewd, we will survive this one too.

One final comment, though not all that scientific, I have not had any patient report so far (6 months) an increase in frequency of psychogenic non-epileptic seizures as a result of wearing a mask.  Like I said, although not that scientific, it is encouraging and something to keep in mind.