Not All Illness is Visible

Let's just get right into it: mental health issues are not stomach aches. You're not going to fix it with a burp or a fart, or even a quality pooping session.

Though the relief might be palpable.

If someone is feeling off on Tuesday, odds are they haven’t been cured by Friday. Or the following Friday. And on and on. Mental health issues tend to be chronic, folks. I'm not talking about someone being “sad.” Depression, when talking about mental health issues, is not “sadness,” and sad people are not depressed. Sadness can be overcome in time with, for example, a change of circumstance, positive affirmations, or even ten hours of sleep. Depression is a chronic illness that can only be mitigated with therapy and medication.

People with Depression usually have to make excuses to people who do not have these issues, as the bulk of the population equates Depression with sadness.

If a person suffering from a physical ailment isn't feeling up to going out into a social setting, they are usually given a pass, and generally don't even have to explain beyond the cursory turning-down of plans. However, if a person suffering from mental health issues doesn't want to go out into a social setting, they will generally have to make up some physical ailment to get out of it. The irony here of course is that often the person with the mental illness issue is sicker than the person with the physical ailment.

Think twice before you judge.

You cannot look at someone and decide they are "fine." We see this charming behavior a lot regarding handicapped parking spots. Who isn't guilty of judging someone who "looks" fine of parking in a handicapped spot when it appears to us that they don't need to? Yeah, we all are. Unfortunately, a lot of the more serious illnesses (cancer, multiple sclerosis, Crone's Disease, and on) don't always have "outward" signs. A person with cancer might look okay, but maybe they just had treatment and are completely exhausted. Maybe someone who looks good to you has peripheral artery disease and can't walk fifty feet with debilitating pain. Point is, think twice before you judge a stranger's actions-- you have no idea what's going on with them.

The onus should never have to be on a sick person to convince a healthy person of their situation. Beyond a simple, "Sorry, I'm not feeling it today," there should be no need for elaboration. Ever.

Below are responses from people who have a chronic illness, regarding that time-tested adage, "You don't look sick to me:"

1. “Hair, makeup, clothing choice and attitude all aid me and help to make me a good actress; it doesn’t mean I’m not sick. The pain underneath the surface is only ever a few bad moments away from breaking through.”

2. “Even on a ‘good’ day where I manage to get stuff done, I’m still in pain — it’s just less pain than when I’m stuck in bed. I literally am in pain 24/7, the only variable is the severity.”

3. “Most of us should win an Oscar for our acting skills. Putting on a smile, even putting effort into our appearance so we look decent, is usually just a mask to hide how we really feel. Get educated about invisible illnesses. The more awareness there is for things like multiple sclerosis, Crohn’s disease, fibromyalgia, etc., the less judgment there will [hopefully] be for us living with these invisible illnesses.”

4. “I have pain 24/7. There is no minute where I am not in discomfort. Some days are worse, some are bearable. But I am never pain-free. You don’t see it because I’m strong. I avoid company on my bad days, so you have no idea what pain looks like when it’s written on my face and I’m ready to give up.”

5. “It’s rude to point out if someone doesn’t ‘look sick!’ It’s such an incredibly private thing to share and if I don’t know you, I’m not going to have a heart-to-heart with you about the guilt that plagues me because I’m not the mother to my kids I’ve always wanted to be, nor the wife I feel I should be. I feel a deep sadness from feeling more than twice my age and feeling as if there is never a break in my pain. If I haven’t shared this with you yet, I probably won’t! Be kind, just because you can’t see my pain doesn’t mean it’s not there.”

6. “An ER doc once told me, ‘Wow, you’re my healthiest looking patient here tonight.’ After my scan, we learned I had another intestinal blockage from my Crohn’s. He then said, ‘Wow, I guess looks really can be deceiving.’ So while I may not fit someone’s definition of ‘looking sick,’ I always remind them I am a great faker… great faker of being well!”

7. “I do, actually, look sick. Under these sweatpants and hoodies I use to hide it are IV lines, sub-cue injection lines, pain patches, surgical scars, protruding bones from malnourishment. Under this makeup are sunken eyes with dark circles, sunken cheeks. This hair is in a top knot to cover where it’s falling out and dull and unhealthy.”

8. “Being sick doesn’t mean you have to look a particular way. It’s easier to wear makeup (if you’re on a good day and have enough energy), wear a smile and hide how you feel than to be told you don’t look good.”

9. “If people could see the internal battle, the daily fight, they would probably be shocked. The lack of a visible impairment makes it difficult for others to comprehend, especially if they have never experienced a chronic illness. Others not having knowledge and awareness is the biggest detriment to someone struggling silently. Everyone deserves to feel supported in what ails them, visible or not.”

10. “My smile, cheerful positive personality and a good face full of makeup can hide a million aches, pains, struggles and negative thoughts. The outside world only judges what they see in front of them at that moment in time — a healthy, fit and well young woman. Oh, if they knew!”

11. “Just because I’m laughing and cracking jokes now does not prove that just an hour ago I wasn’t bawling my eyes out as I was getting out of bed to get ready for work because I’m so worn out… People think because you can smile and laugh and walk around, ‘you’re fine.’”

12. “I’ve just stopped responding to comments like that. The people closest to me know how I’m feeling by the look in my eyes. They just hug me, love me and tell me how great I look… they know. The others with their ignorant, uninformed opinions really don’t matter at the end of the day.”

13. “Every day I’m fighting through pain to get out of bed, to get dressed, to even make it into work. And on days when I can’t leave the house it’s because the pain plus the frequent bathroom breaks have won that day. I hate when people say, ‘Well you don’t look sick,’ because they have no idea that my insides always feel like they’re on fire.”

14. “I put on makeup to cover up the bags under my eyes, my pale skin… I got three hours of sleep because the pain was so unbearable last night. It’s so easy to put a smile on my face and pretend I’m OK just so people won’t think I’m searching for attention. This is my reality every day. I may not ‘look it,’ but I most certainly feel sick.”

15. “I think there are two ways to take that ‘you don’t look sick’ thing. You can take it as people think you are overreacting or want some additional attention. The other way is to take it as a compliment, that your fake smile looks real and that you did an awesome work with your makeup. I take it the second way!”

16. “How is ‘sick’ supposed to look? I put on makeup, which hides a lot. There’s a lot of pain behind the smile. And I don’t go out on my worst days. You’re not seeing the whole picture.”

17. “When I look my best and laugh the loudest is probably when I feel I need to hide a health issue. I secretly wish someone would see through me and tell me it’s OK.”

(Migdol, Erin. "17 Things to Know About Someone Who 'Doesn't look Sick." The Mighty, March 28, 2017, https://themighty.com/2017/03/responses-to-you-dont-look-sick. Accessed June 11, 2022.)

© Ray Cattie