The Narrative Beneath the Mask

A word that needs no introduction –COVID-19– has been headlining news outlets for years now, addressing issues ranging from the politicization of vaccination to innovative research on new treatment methods. Beyond Dr. Fauci’s numerous televised press conferences, which have effectively ingrained his face into the minds of U.S citizens, the media has neglected to educate the public on the effects COVID-19 has on adolescents– specifically their mental health. Anxieties among youth have spread due to fears of mask-fishing, going against the community's masking social norms and an increased prevalence of acne.

Adolescents have become accustomed to people only seeing the top half of their face, allowing them to hide some of their facial insecurities; however, the lifting of mask mandates has caused adolescents to worry that their peers will now judge their appearance more critically. Studies have identified that “the lower half of the face, and specifically the perioral area…[is] vital for determinations of attractiveness” [1]. Masks concealing the lower half of people’s faces have come to greatly impact the evaluation of someone’s perceived attractiveness, which is also influential when judging a person's interpersonal characteristics. These effects are so great that a study comparing participants’ rating of people with and without masks “found that 100% of the faces in the unattractive group were rated significantly higher after application of a mask” [1]. This research justifies the reason behind adolescents’ fears and anxieties about no longer wearing a mask in public because it will reveal their unattractiveness and facial flaws, subjecting them to ridicule and judgment. The impact masks have on perceived attractiveness caused the phenomenon to be called “mask-fishing,” a term that originally emerged on dating apps but started becoming a trend on Tik Tok late last year [2]. Although taking off the mask does raise concerns about adolescent’s physical health, it additionally impacts their mental health as removing the mask marks a time of social transition with youth becoming increasingly hypersensitive about their appearance and their peers’ opinions [2]. Adolescence is a sensitive time, dominated and defined by insecurities about body image, causing the mask mandate changes to increase rates of social anxiety among youth.

Additionally, adolescents are being shamed for not conforming to the community's mask-wearing expectations and norms. Deciding to either wear or not wear a mask is subjecting individuals to bullying. Students are being judged because “the simple act of wearing a face mask has become highly politicized” [3]. Viewing mask-wearing as a binary that separates people into two groups - paternalists and libertarians - is a polarizing narrative that is causing people to associate other’s mask-wearing decision with the two political parties - democrats and republicans. Correlating people’s political beliefs with their choice of mask-wearing is increasing rates of anxiety among youth who aren’t following their community’s sociopolitically shaped mask-wearing norms as it gives adolescents a means to judge their peers based on their perceived differing belief system. Beyond fears about judgment, bullying is a serious implication of people’s choice in mask-wearing. Bullying can cause physical injury as well as social and emotional problems with those who are bullied being “at increased risk for mental health problems, headaches, and problems adjusting to school” [4]. The association mask-wearing has on people’s perceived character and political beliefs gives people more material to criticize and bully their peers which leads to a detriment in adolescents’ mental health.

Lastly, an increased frequency of acne with mask-wearing has affected students' self-esteem and mental health. The phenomenon that “masks induce microenvironment changes in the skin by dehydration, increased sebum and increased pH” coined the term “maskne,” in which its increased prevalence has even caused skincare companies to specifically release products that address this issue [5]. Acne is not only a physical condition, but has also been shown to have a significant impact on “emotions, daily and social activities, study/work, and also interpersonal relationships” [6]. In a cross-sectional study of 100 patients, 68% of patients reported that acne affected their social activities and 57% of patients reported that acne had negative effects on work/study [6]. The most significant statistic was that “88% of cases reported embarrassment/self-consciousness due to acne” because self-consciousness is directly linked to low self-image and self-esteem, affecting people’s mental health [6]. With masks having a prominent effect on the frequency of acne, it is consequently impacting people’s mood, emotions, and overall well-being. There is increased hesitancy to wear masks because of their correlation to acne, which is becoming a public health issue since the most protective mask –the KN95– has the greatest tendency to cause acne [4]. A conflict arises between staying safe and protecting oneself from the spread of COVID-19 and subjecting oneself to the possibility of getting acne which impacts one’s emotions, self-esteem, and daily activities.

Ultimately, COVID-19 has urged the public to consider both the biological and psychological impacts viral diseases have on society. The pandemic is evidence, once again, that physical illness is not mutually exclusive with mental illness, highlighting the importance of evaluating both with equal fervor and support.

References

1. Patel, V., Mazzaferro, D. M., Sarwer, D. B., & Bartlett, S. P. (2020). Beauty and the Mask. Plastic and Reconstructive Surgery - Global Open, Publish Ahead of Print. https://doi.org/10.1097/gox.0000000000003048

2. Sohn, E. (2022, March 17). For some teens, as masks come off, anxiety sets in. The New York Times. https://www.nytimes.com/2022/03/17/well/family/teenage-student-mask-anxiety.html

3. Lee, B. Y. (2022, August 16). What new CDC COVID-19 school guidelines says about bullying face mask wearers. Forbes. https://www.forbes.com/sites/brucelee/2022/08/14/what-new-cdc-covid-19-school-guidance-says-about-bullying-face-mask-wearers/?sh=5f299f5e5e39

4. Falodun, O., Medugu, N., Sabir, L., Jibril, I., Oyakhire, N., & Adekeye, A. (2022, May 19). An epidemiological study on face masks and acne in a Nigerian population. PloS one. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9119463/

5. Damiani, G., Gironi, L. C., Grada, A., Kridin, K., Finelli, R., Buja, A., Bragazzi, N. L., Pigatto, P. D. M., & Savoia, P. (2021, March). Covid-19 related masks increase severity of both acne (maskne) and rosacea (mask rosacea): Multi-center, real-life, Telemedical, and observational prospective study. Dermatologic therapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995182/

6. Hazarika, N., & Archana, M. (2016). The psychosocial impact of acne vulgaris. Indian journal of dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029236/

7. Miller, K. (2021, July 12). CDC's new mask guidance in schools raises bullying concerns among experts, parents. Yahoo! Retrieved October 25, 2022, from https://www.yahoo.com/lifestyle/cdc-new-mask-guidance-schools-raises-bullying-concerns-experts-parents-153139137.html

8. U.S. Department of Health and Human Services. (2021, January 31). How does bullying affect health and well-being? Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/bullying/conditioninfo/health