Could you share more about that? One of my professors from undergrad was involved in that research and development f the program and he had some strong opinions bout how their research findings were misunderstood and misused.
People can be experiencing significant impairment and/or distress and still mask or downplay their depression to others, though, at least to some degree. Many people experiencing MDEs may have episodes that eventually remit on their own or with self-care, but many may require or benefit from active medical/psychological care, in terms of reducing illness duration and severity and sequalae from untreated illness. Major depression has very high morbidity and non-negligible molarity associated with it, and there are good reasons to treat it or at least have good triage around treatment.
But what is the difference between coping and masking?
I've always made the assumption that masking is a type of coping.
From a cursory overview of this article, I'm interpreting masking as the same thing as suppression. Not sure if there is a distinct difference between the two. My guess is that masking has been adopted by the autism community to describe their specific experiences, but I'm almost entirely unknowledgeable about this topic and providing my initial thoughts. doi: 10.1089/aut.2020.0083
Masking can be coping, but masking is largely about regulating one’s presentation to meet a certain standard. We all mask to some degree—think “work personality,” “customer service voice,” etc. The issues with autism comes with expecting people to do a high degree of masking almost all of the time—like having to be in “work mode” any time you’re around or interacting with other people at all, which can lead to physical and mental exhaustion. With mental illness, people can often mask quite well-they get up, do their job, go to class, maybe even participate in social activities and try not to let their symptoms show. And this can have a degree of behavioral activation that’s helpful for sure—but for a subset of people, that isn’t going to be enough, and they are going to be looking like they are doing pretty well while still having considerable symptoms/internal distress. But because the goal of masking is to “seem normal,” that often gets overlooked, as does the mental energy masking requires. Whereas coping is about finding ways to reduce distress/impairment, masking is about finding ways to keep other people from noticing your distress or impairment—there’s overlap but it’s not 1:1.
1) Symptoms are what one reports. Signs are what can be observed.
Yep, that's what the intro to psych texts state, and it can be a useful distinction. However, your statement- both by itself and combined with your additional list items, does not clearly contradict or support anything that @futureapppsy2 said
See above. Additionally, @futureapppsy2 's use of the forward slash ("/") and conjunction "or" between "distress" and "impairment" suggests that they are aware that "distress" and "impairment" are different concepts and, further, that @futureapppsy2 has purposefully chosen to highlight the effect of masking on both of these concepts, rather than inadvertently conflating the two.
I believe this to be a faulty analogy, but I suppose it really depend on how you view/label what is changed by "assertiveness training." If, like me, you view assertiveness training as means of skill training to address a skills deficits (i.e., poorly developed or absent abilities to be assertive), than the analogy doesn't fit, and the the future assertive behavior of the trainee is not "masking" any ongoing symptoms. If, however, you view assertiveness training and allowing someone to continue to be passive or have an overall perception of themselves being non-worthy of being stood up for or having their needs made know- despite their own behavior to the contrary- then it might be an apt analogy. That does seem to be a bit of a stretch.
1) The numerical thing is mostly because I am a poor writer, who works in a field where everything is numbered.
"Masking" as a term and concept (at least in regards to ASD) has increasingly appeared in the peer-reviewed literature, and thus it probably would now qualify as a professional term. As with many terms/concepts in psychology (especially relatively new areas of focus), definitions of masking are not always consistent and, as you have pointed out, there may be some overlap with other terms/concepts (such as "coping"). There are also "lay" perspectives and definitions that can differ from the professional definition. From a recent research article (The workplace masking experiences of autistic, non-autistic neurodivergent and neurotypical adults in the UK), masking is defined as "hiding or concealing one’s traits during social interactions." Note that the authors do suggest that it may be including a function in the definition (e.g., "in order to fit in" or "in order to avoid ostracization") may be important for future studies and understanding.
This has been a big change in my field- Historically, things like hand flapping were consistently labeled as "pathological behaviors" and thus targets for reduction. It is now increasingly common to not put a default "pathological" label on every characteristic associated with ASD, and thus not- de facto- target them for reduction.
Based on the article in the OP, there does seem to be a different "flavor" to what is going on with affective disorders. For example, with the current criteria for a Major Depressive Episode requiring that the symptoms " represent a change from previous functioning", it kind of goes against the "trait" part of the masking definition I provided above.
If these signs/symptoms are truly causing undue harm or distress to the individual or others in their environment, the individual both desires and consents to interventions to reduce them, and there is empirical evidence that these interventions are not immediately or ultimately harmful in other ways, then I would argue that we are not actually teaching the individual to mask. However, if the signs/symptoms are not causing undue harm or distress to that individual or others and there is at least emerging evidence that our treatments are harmful in other ways, and the end result of the treatment is not an actual reduction in the sign/symptom, but rather a displacement of it to another time and place, it is at least a negative. If the sign/symptom is a relatively common and life-long behavior (e.g., repetitive body movements in individuals with ASD), then I'd say that meets the above definition of masking. If the individual does not have the ability or agency to self-advocate, consent, or clearly report on negative experiences and side effects of the treatment, we should be extra cautious. If many (not all, but at least some) individuals who experienced the treatment when they did not have this ability/agency at the time later- when they do have the ability and agency to do so- describe the treatment as harmful, report that they hid the target behavior despite the extreme distress other negative side effects of doing so, and say that this treatment interfered with their benefitting from other treatments that they actually found somewhat helpful, then we need to be extra extra cautious.
In the case of repetitive body movement and ASD, here's what I and many of my colleagues have done:
I think this discussion also points out why we need to be well trained. The further you get from training (I'm going on 30 years!), the more you realize that you can't just be a technician who blindly implements protocols. Populations change, local and world events impact mental health and how pathology presents or not, diagnostic criteria change, etc. I am continuously thankful that I had some good training and mentorship early on. I've still got a lot of learning to do, and I can thank my early experiences for making sure that I recognize that fact.
Do you think that the relative ease in which young people can create such homogenous groups today, with similar interests, experiences, even appearances, has skewed their perception of "everybody else?" When there is such little variance in the characteristics of who you interact with, any little little difference is significant. Additionally, outgroups are very much more "out", and thus much more mysterious, weird, and uncomfortable.
Most definitely. And we also didn't do a very good job of operationalizing "undistinguishable" in a socially valid way. Using IQ as a metric!?!
"Masking" may not be used widely with mental illness yet, but other, similar terms have been ("concealment", for example). It's not really a new concept, empirically or clinically. If anything, the change that people--including researchers--are more openly starting to question the degree to which concealing symptoms is a desirable outcome and how that differs from actual symptom or distress/impairment reduction.
I'm not able to reconcile that with the CBT, ACT, and 1/4 smile literature.
Here are some sort-of-recent articles. As you'll see, concealment is still a pretty broad topic and the literature covers not only the effects of concealment of mental health symptoms, but also physical disability, medical diagnosis, and -perhaps the most common area in recent literature- the concealment of sexual and gender identity. This is not my clinical area at all, nor are CBT/ACT (I can't get any returns in psychinfo/Eric for "1/4 smile" or "quarter smile", but I assume it's somehow related to the stuff of forcing yourself to make a smile and you end up feeling better than if you didn't), but I'm guessing the outcome research on incorporating concealment issues into treatment is probably equally equivocal/idiosyncratic. The references below include stuff from around the world, so there are likely significant cultural mediators of the relationship between concealment and mental health.
link.springer.com
doi.org
I’m actually referring more to the patients I work with who have severe and chronic mental health diagnoses and the expectations that society and their families place on them. These are kids that are far outside the norm but still deal with the expectation that they can function normally somehow. One of my patients who has been working 2 days a week at the same job for over a year and has not been hospitalized in over two was just talking about her parents communication to her that she needs to work 40 hours a week. She said the last time she tried to work full time she ended up in the hospital and why don’t they get that? Another client with Bipolar Disorder and multiple hospitalizations gets out and goes back to school and work and everyone seems to think that’s a good idea. Except me, of course, but then I’m like the boy pointing out that the emperor has no clothes.
Wow. That's tough work. Thanks for doing it.
Slight tangent, but I've seen/heard of this happening with younger patients with longer-standing histories of epilepsy as well.
Operationally, what's the distinction between 'masking' vs. 'under-reporting' of psychopathology?
The fundamental doctrine of existentialism--that 'existence precedes essence'--is something that the younger folks of this generation are really struggling with...whether they realize it or not. With the erosion of the classical sources of fundamental meaning (religion, extended family structures, institutions that held to their traditional values/principles) and with their day-to-day survival needs taken for granted (by parents or by government), a lot of younger folks are baffled at what to do with this whole 'existence' thing that the universe has bestowed upon them.
@futureapppsy2 may have a different answer, but I'd say it's a matter of function vs. topography. "Under-reporting psychopathology" is a topography of behavior. Doing so with the function of avoiding/escaping stigmatization is masking.
Going back to the original post, I think about psychological flexibility generally predicting outcomes and Hayes work in how verbal thought processes impair psychological flexibility.Many depressed students don't identify as such (opinion)
And that might not be a bad thing, Isaac L. Ahuvia writes.www.insidehighered.com
Thoughts? The author's take away is that we should perhaps not encourage labeling/diagnosis of depression, as that may lead to less engagement in positive coping behaviors.
Parents look for any excuse to "protect" their kids, insert any chronic illness and you start getting the archetypal pathological mothering instincts and modern protectionism. Bringing this back to labeling, it's important to have a discussion with anyone about labels and individuals. I am hoping the pendulum swings back from hashtags and labels to understanding that people are more than their twitter bios and pronouns.
As one (masking) is a subcategory of the other (under-reporting psychopathology), the correlation would be quite high!
A potential problem with that view is that research would indicate that females with ASD are much lees likely to have been referred for an autism evaluation and much less likely to have been diagnosed if they were. Combine that with the literature (not as strong as the ASD stuff, but still compelling) that females are more likely to mask mental health symptoms, and I'd proceed with caution and give clients the benefit of the doubt with this one until evidence proved otherwise. I'm not saying run with the ASD diagnoses and assume masking, but treat it as a real possibility and further assess, investigate (and that's not directly primarily at you @borne_before, but out of recognition that many new and future psychologists read this board).
Kind of cynical view, in my opinion. I do think some feeling bad is normal, and pure bliss certainly isn't the modal state. I also think that people have a difficult time discriminating from unhappiness due to a lack of positive stimuli in their lives AND unhappiness DESPITE positive stimuli in their lives (a la clinical depression). Both are worthy of treatment, but very different types.
I think this is an important area for study in our field. Most of us doing the clinical work (including you "younger" therapists), did not come of age with the same constant contact, feedback, scrutiny, and ability to be so selective with who and how we interact as someone who cam of age in the last decade and a half. While every generation has dramatic differences from the last and next, social media and connectivity have really changed the mental health landscape for for late adolescents/early adults in ways that make some of our old rules and techniques prematurely past their use by date.
It does tend to go from one extreme to the other. It is hard enough to walk that line to help support independence with any kid but when there is mental illness involved it’s even more challenging. It’s easy to blame parents, and at times they are the issue, more often though it is inherent in our societies misconceptions of mental illness and how to treat it. Even AI knows that treatment for severe mental illnesses requires a comprehensive approach as me and a young lady with Bipolar found out yesterday 😁, but the general zeitgeist is that medications and maybe a little therapy thrown in for some reason will make people function normally except for the really sick who will probably just stay that way and can’t really live independently.
It’s kind of fun when it works. Part of my mission is to prevent institutional living and foster autonomy. Love every minute of success. Yesterday was kind of a 50/50 day with that. We’ll see what today brings.
We also need to acknowledge that there are some very bad, very aversive, therapists out there who may be worth avoiding. Many of the treatments treatment are difficult on their own. Pair those with an aversive therapist, and it might be adaptive to say that you feel better rather than dealing with aversiveness of the therapeutic process.
