FACT SHEET
What is facial masking?
Facial masking is a problem for some people with Parkinson’s.
WHAT IS FACIAL MASKING?
There are 43 muscles in the human face that enable us to
smile, frown and express subtle feelings. The lack of the
neurotransmitter, dopamine, in the Parkinson’s brain that
diminishes people’s ability to walk, run, move their hands and
carry out other movements in a co-ordinated way, sometimes
also reduces their ability to control their own facial movements
and expressions.
IS FACIAL MASKING SOMETHING YOU
EXPERIENCE IF YOU HAVE PARKINSON’S?
No, like other Parkinson’s symptoms, facial masking is a problem
for some people and not others.
WHAT DOES FACIAL MASKING LOOK LIKE?
This very much depends on the person. Your expressions
may look muted, distorted or become almost absent. Muted
expression is when you still have a facial expression, but
it appears like a “watered down” equivalent of your facial
expressions before you had facial masking, or appears slower
or delayed. Distorted expressions occur when you want to smile,
for example, but instead it looks like a grimace or pout.
Your facial masking may mean you show very little expression in
your face or may appear (to some people) unhappy, bored, angry,
or sad or any number of other negative emotions despite feeling
quite differently behind your “mask.” An expressionless look may
be perceived by some people as just “lat”, while other people
may perceive it as conveying a negative emotion or attitude.
WHAT SOCIAL AND PSYCHOLOGICAL
CHALLENGES DOES FACIAL MASKING PRESENT?
Maintaining satisfying interactions in our important
relationships is an essential component of wellbeing.
If you have problems with facial masking, communicating with
others, socialising and maintaining warm, satisfying and close
relationships can be a challenge. You may feel frustrated and
misunderstood. This can contribute to feeling alienated from
others, including your partner. Your partner may also feel like
you have grown distant. (But there are a number of things you
can do to help reduce the effects of facial masking, see below.)
It is important to note that facial masking’s negative effects
vary greatly. In one study, a third of participating couples (one
of whom had Parkinson’s facial masking) reported substantial
negative effects on their relationship and sense of wellbeing,
another third reported some effects and a third segment
reported minimal or no effect.
The vast majority of in-person human communication is nonverbal and people tend to believe non-verbal communication
signals over what a person says when the two are in
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THE MASK OF PARKINSON’S BY KAYE HUBNER, TAURANGA
disagreement. Therefore although you may feel happy, for
example, and tell someone this, an expressionless or less
expressive than usual face may suggest otherwise and the
person that you are talking to will not believe you.
The partners of people with Parkinson’s sometimes report that
the masking puts a burden on their relationship because they
feel that their partner is angry or unhappy, even when the
person is saying otherwise. Partners can even feel the person
with Parkinson’s is uncaring or unsupportive. They may become
less inclined spend time with their loved one or withdraw from
them, which can lead to both the partner and person with
masking becoming isolated or distant from one another. Some
couples ind these feelings are minimised when they come
to realise masking is a symptom of Parkinson’s, rather than a
relection of feeling.
Reading people’s facial expressions normally plays a central role
in the way we communicate as humans but may in some cases
be maladaptive (not the most useful approach). However, there is
ongoing research into how we can better read other non-verbal
signals to reduce the negative impact of facial masking.
MARCH 2016
FACT SHEET – CONTINUED FROM PREVIOUS PAGE
MANAGING THE CHALLENGES
OF FACIAL MASKING
First of all, there is hope and things people can do. Whether it is
you, your partner, a health professional or whomever, it’s essential
that facial masking is identiied and any negative effects on your
life and relationships are recognised. Many people with masking
and their partners often do not realise they have problems with
facial masking. For example, you may be asked to smile for a
photograph, think you are, and it’s only when you see the photo
that you realise that you were not in fact smiling.
There are many success stories to show that people may gain
comfort from coming to terms with the fact that masking means
their loved one may come across differently to what they are
thinking. It helps put things in perspective.
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MANAGING FACIAL MASKING
People with facial masking and their carers have reported a number of things are helpful in managing this symptom:
• Speaking aloud thoughts or emotions and describing
how you feel
• Undertaking physical exercises that preserve your ability
to express yourself
• Making a conscious effort to be kind to one another,
which can be good for any partnership where there are
stresses and strains.
• Consciously expressing your thoughts, preferences
and emotions
• You can be mindful the person with masking may look in
a bad mood, but probably doesn’t always feel that way
on the inside.
• You or your partner can educate close friends and family
about facial masking.
• You can pay attention to what the person with masking
says and does, rather than how they look.
• You can use touch or speech to reinforce communication,
show affection, and indicate care or support to a loved one.
• You can challenge unhelpful worries about the person
with masking’s attitude or mood by asking yourself
whether they have actually said or done anything to
conirm this.
• If your partner has facial masking, you can ask questions
and check in with them more regularly.
Source: Adrienne Wootton, Clinical Psychology PhD candidate, Waikato University, Parkinson’s UK
THE PARKINSONIAN