The U.S. is taking mask wearing much more seriously than the U.K., which is striking from a mental health perspective. This isn’t about the rights and wrongs of masks as an appropriate measure against Covid-19. You’ve read enough about that. This is about the implications of mask wearing for those with mental health issues such as post-traumatic stress disorder (PTSD) and how the issue gets buried in the mask debate—or lack thereof.

In the U.K. I was technically exempt from having to wear a mask when it became mandatory in July 2020, due to my PTSD-related moral injury following military tours in Kosovo, Iraq, and Afghanistan. The page on the U.K. government website explaining exemptions stated in confusing terms that a “reasonable excuse” for not wearing a mask was “because of any physical or mental illness or impairment, or disability” or if it caused “severe distress.”

Guess what’s the easiest and fastest technique if a PTSD-symptom flares up—or if you experience any unpleasant emotion? Take a good long deep breath while focusing in particular on the exhalation to activate the parasympathetic nervous system to slow down the heart and help calm you down. It has been advocated since the teachings of the Buddha. It’s not so easy to do when wearing a mask.

Initially, I tried to toe the line on masks, conscious that my moral injury is relatively small-fry on the PTSD spectrum, for which I am grateful—many veterans, as well as civilians who have suffered childhood neglect, or sexual or domestic abuse, are dealing with far darker demons. But the equivocating claims and data about the effectiveness of wearing masks have withered away against the nauseating psychological effect of feeling gagged and being taken back to where I was after Afghanistan.

It hasn’t been such an issue for me since the U.K. lifted mask mandates and largely left it to personal choice. Not so in the U.S., as I discovered upon my recent return, especially in the north eastern area of New York, Washington, D.C., and Boston, where it is mask up and shut up.

This stance strikes me as ironic at various levels. The U.S. is meant to be the land of mental health considerations. The U.S. often gets lampooned for its seemingly obsessive therapy culture. But this also means it is a world leader in parsing the likes of trauma and PTSD, assisted by research spurred by the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, and private foundations that study the efficacy of alternative forms of trauma treatment such as yoga, theater, and psychedelic-assisted talk therapy. Despite all this, masks and mental health rarely gets mentioned as the sledgehammer approach to masks is taken, with everyone expected to mask up regardless.

Explaining the full complexities behind why I struggle to comply with the tannoy’s pronouncement to don a “protective face covering” would take too long here. But, in short: The intensity of my moral injury relates to not talking about events, especially those in Afghanistan, allowing them to fester for a decade until I finally sought counselling in 2020; but that breakthrough moment of literally opening my mouth for the first time to the counsellor, family, and others—which while enormously painful was also hugely necessary and healing—collided with society suddenly embracing covering and inhibiting the essential organ of speech and articulation (and breathing). A conflicting situation.

If that sounds a bit woolly, I’d refer you to The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel Van der Kolk. “These feelings are almost impossible to articulate,” Van der Kolk says. “Trauma by nature drives us to the edge of comprehension, cutting us off from language based on common experience or an imaginable past.”

Oddly enough, often the fiercest mask legalists are the normally mental-health-focused left. These are people who likely read The Body Keeps the Score—it was a number one New York Times bestseller, after all—but they have forgotten its lessons.

Van der Kolk discusses the work of psychiatrist Abram Kardiner, who in 1941 had published his The Traumatic Neuroses of War about his dealings with World War I veterans. In addition to Kardiner identifying how sufferers of traumatic neuroses develop a chronic vigilance for and sensitivity to threat, Van der Kolk highlights how Kardiner was the first to demonstrate that “post-traumatic stress isn’t ‘all in one’s head’, as some people supposed, but has a physiological basis.”

Van der Kolk explains how “Kardiner understood even then that the symptoms have their origin in the entire body’s response to the original trauma.” Hence Kardiner might have had something to say about the very physical act of someone with PTSD enduring a face mask, and how that might intersect with his sensitivity to threat.

Of course, it is not just those with PTSD. In a café, I saw a masked server hand a customer his coffee. The forearm of her left arm was blanketed in lacerations of scar tissue. She sounded cheery enough in the moment—and perhaps she has moved on from darker days of self-harm—but at the same time she had little choice in needing to be perky on the job while wearing a mask, cut off from face to face human connection.

“Deep down many traumatized people are even more haunted by the shame they feel about what they themselves did or did not do under the circumstances,” Van der Kolk says. “We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain and body.”

Dealing with shame and guilt is not helped by slapping a mask on your face—a less than empowering posture that is likely to add to the trust and intimacy issues that trauma sufferers typically struggle with. It’s a finger in the eye of that traumatic imprint.

“We have also begun to understand how overwhelming experiences affect our innermost sensations and our relationship to our physical reality—the core of who we are,” says Van der Kolk, who highlights the importance of such basic activities as breathing, moving, and touching in regulating our own physiology and well-being.

“When we ignore these quintessential dimensions of humanity, we deprive people of ways to heal from trauma and restore their autonomy.”

This is about much more than veterans and masks. Trauma is an unavoidable part of the human condition, which modern society seems set on finding additional ways to accentuate. Through a life lived, eventually everyone carries trauma and must learn how to deal with it.

The psychological implications of mask wearing are only one of innumerable negative consequences of Covid-19 restrictions that typically are left undiscussed. Covid-19 is a serious threat to vulnerable individuals. But honestly weighing that threat against the fallout that restrictions like masks inflict on other vulnerable people still rarely happens.

James Jeffrey is a freelance journalist and writer who splits his time between the US, the UK, and further afield, and writes for various international media. Follow him on Twitter: @jrfjeffrey and at his website: https://jamesjeffreyjournalism.com/ .