June 26, 2020

More Americans are wearing face masks and coverings when they leave their homes—an effort that's key to curbing the new coronavirus' spread, but also one that, according to the New York Times' Jacey Fortin, hides a "small but important social lubricant: the smile."

How Covid-19 will impact behavioral health services

Can we communicate without smiles?

People usually use their smiles to greet neighbors, reassure people, and make others feel comforted, but conveying these feelings is proving to be more difficult now that people have their mouths hidden behind face coverings, Fortin writes.

Coco Briscoe, 38, who lives in Los Angeles, said she's struggled to be friendly to strangers while wearing a mask. "You're both staring at each other, and you're smiling, but they can't see that you're smiling," she said. "[I]t's just a very awkward interaction … and I think it's going to be that way for a while."

Josh Trebach, a 30-year-old ED physician at Johns Hopkins Medicine in Baltimore, said he's no longer able to fall back on the nonverbal cue to put patients at ease.

"I would want to smile to assuage someone's anxiety, show interest or convey warmth to let a patient know that they could trust me," he said. "Suddenly, all of that was gone."

David Matsumoto, a psychology professor at San Francisco State University and director of the research company Humintell, said we lose our social smile when we wear masks. A Duchenne smile, a smile that reaches the eyes and lights up the face, can sometimes still be seen behind the mask, but the typical social smile, which only engages the corners of the mouth, is almost impossible to read under a face covering, Fortin explains.

And masks hide more than smiles, according to Fortin. They also hide other facial expression that can communicate emotions like discomfort or disdain—which, according to Matsumoto, are critical to the "entire communication package" necessary for human connection. Moreover, masks can muffle speech and make it particularly difficult for deaf people, who often rely on visual cues, to communicate, Fortin notes.

How can you compensate?

According to Matsumoto, "other nonverbal cues" like a wave or nod "can compensate for the lack of a social smile."

Jasmine Gregory, a lawyer focusing on family and juvenile law, said she has had to put in a bit more effort to communicate with her clients, especially when they're testifying in court.

"There's a lot of reassurance on my end," she said. "You just make more of an attempt to laugh, show your emotions and say what you're thinking, rather than just listening and nodding."

Gregory added that she wears her hair back so people can see her eyes. "When you make eye contact with someone and you feel happy or warm toward them on the inside," she said. "I think that creates the true, sincere smile that is more likely to spread across your face."

Similarly, Trebach said he has had to find other ways to communicate those sentiments to his patients. "I'm almost a little bit over-expressive now to try and compensate for the mask."

Trebach said he has been sitting with his patients so they could be at eye level. He also makes more small talk and shares pictures of his cats to put patients at ease.

"Even though we've lost the bottom halves of our faces, other things, I've noticed, have become stronger in terms of communication," he said. "So for the sake of my patients, I had to become attuned to those other things, like body language or eyes" (Fortin, New York Times, 6/23).

How Covid-19 will impact behavioral health services

Covid-19 is rapidly increasing the need for behavioral health services. But there are significant gaps and barriers that stand in the way of people getting the help they need.

Read our take on your highest-priority behavioral health moves amid Covid-19 crisis.

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