Most days, I don’t think about how I look to others. I go to meetings, run errands, and talk to people, and my body is just... my body. It works well enough, and I feel relatively normal.
But fibromyalgia and ME/CFS are unpredictable. There are days when symptoms flare, or when energy runs low, and suddenly, appearing "normal" is no longer automatic. It becomes a conscious effort.
That’s when the performance starts.
The Hidden Labors of Masking
When you have a visible injury—like a broken leg—people can see the cast. They adjust their pace to match yours. But when your symptoms are invisible, the burden of adjustment falls entirely on you.
On a hard day, looking fine is an active project. You adjust your posture so you don't look like you're dragging. You control your facial expressions so a sudden spike of nerve pain doesn't register as a wince. You nod and smile while your mind is sorting through cognitive fog, trying to find the thread of the conversation.
We do this because it keeps the interaction smooth. It avoids the exhausting explanations of why we are tired or why we need to sit down. But performing "fine" when you aren't has a distinct price tag.
The Cognitive Overhead of Suppression
Here’s the thing about suppressing symptoms: it’s not neutral. It is neurologically expensive.
Research on pain modulation suggests that actively masking pain or fatigue uses the same cognitive resources we need for focus, memory, and decision-making. When you are forcing your brain to suppress distress signals so you can sound pleasant, you have fewer processing resources left for the actual conversation.
For people with ME/CFS, this cognitive suppression can actually trigger post-exertional malaise (PEM). It’s not just the physical movement that drains you; it’s the mental effort of pretending everything is normal. The exhaustion you feel afterward isn't just physical—it's the cognitive receipt for a performance you had to pay for in advance.
Auditing Your Performance
Because these hard days only happen sometimes, it's easy to treat masking as an automatic habit rather than a conscious choice. We get so used to putting on the "fine" face that we do it even when we don't need to.
But we can choose when to run this script.
The next time you're having a difficult day and find yourself performing, stop and run a quick audit:
- Is this performance mandatory right now? (e.g., in a client meeting or a job interview).
- Or am I doing it out of habit for friends or family who would actually be fine seeing me a little tired?
We don't have to throw away the mask completely. Sometimes it’s a useful shield. But recognizing that it is an expensive tool—one that we only need to use when it truly serves us—lets us save our energy for the things that actually matter.
What would happen if you let the performance drop just a little today?
