It's funny. We look for symptoms and mix and match with diagnoses, but nowhere is it written that wearing make-up matters. Yet it's pretty obvious that make-up does matter for some, generally the types with the double X chromosomes.

This has happened so many times over so many years. I don't even have to ask, "So how ya' doin' today?" with certain patients. I can look across the waiting room and I know how they're doing. If not painted brightly, then not feeling brightly, back in the black hole.

So interesting, isn't it? And we wonder why artists need that certain something to produce. That certain something is serotonin. The best paintings are produced when the artist is feeling best. Literally painting faces is the same.

Sure, the DSM mentions hygiene. We know that if a person is uncharacteristically dirty for an extended period of time that it is withdrawal. That individual is unaware of the situation, can't remember or care to bathe, can't feel the oil on the skin, can't smell that offensive smell that others notice right away. Such withdrawal is characteristic of psychosis, and the most disabling depression is psychotic. The patient does not know or care beyond the limits of his or her thoughts, feelings.

Does one who is not psychotic, however, not wear make-up to deliberately communicate to everyone else, perhaps especially a doctor, that she's not doing well? Or is it the depression talking, period. What we're looking at here is whether or not the behavior, putting on a little lipstick, is functional and can be controlled.

The answer, I think, is that sometimes it can be controlled, but the will isn't always there. The patient doesn't have much energy and conserves what she has. Putting on make-up is just another job, and getting out of bed is hard enough, frankly.

Why bother preening indeed, when a person thinks: I'd rather no one pay attention to me. I haven't the emotional energy to carry on conversations. I feel ugly and useless. What's the point of drawing positive attention to me, especially since it takes me out of my comfort zone? I'd rather be mindless, thank you.

So different from someone in sales who is on all of the time, even under depression. The personality is all smiles, the hair still in place. This is not always the case, of course, when the depression really gets bad, but when it's middle range, certainly it is.

A person who is hard-wired to perform will perform socially as a default, and look the part, then will crash harder when the performance is over. Performance artists and sales people under that depressed influence are at risk for self-medicating with drugs and alchohol as soon as the down-time permits. Even before the down-time permits.

Not unlike the evening martini, except there are three or more.

You know, of course, that we call one or two drinks a night moderate drinking for a reason. It's not always dysfunctional. Some people do this to regulate their moods and it doesn't ruin their nights or days. I would suggest they're not self-actualizing, however. And the reason I rail against this and am always on you about it is because the drinks get stronger, taller. Pretty soon what you're telling me is a drink is not a drink, it's a vessel that could water a rubber tree plant.

But back to make-up. Younger people don't need it, honestly. So this little diagnostic tip is really more applicable to those of us who are aging, who really notice the lines and lack of color. No? Okay, no. Perhaps we should generalize, however, and say,

If a person is ordinarily concerned about how they look, no matter what the age, and all of a sudden is not concerned, then you should consider ruling out depression.

I forgot! It's that season to be jolly!

Even more pressure, right, to feel good!? Act happy? Dress it up?

We'll talk about it again soon. I'm not finished.

To be continued.

Copyright 2oo7, therapydoc


Angelissima said…
One therapist I was seeing a few years ago talked about my "affect" at every visit. He told me right out if he saw I was feeling good or not.

I have to admit that I don't wear makeup if I'm feeling badly. I sort of like to draw attention to the fact that I really don't care about myself.

This is evident with my sudden weight gain. I really don't much care about it and I probably should. Its all about my lack of exercise and obsession with sleep.

I think I need to change my medication, but to what? I need a good swift kick in the pants.
The Goddess G said…
Intresting post. It goes both ways for me though. There are times that I don't wear make-up because I haven't budgeted my time...draggin myself through my daily routine has drained me...and I could care less about one more thing.

But then there are times I feel really good. I put a minimal amount of make-up on...maybe just mascara...maybe nothing...because I feel good. I don't feel that I need it to cover up anything.

I know...go figure, right? lol
PsychoToddler said…
It's so true. I make rounds in the morning, and if that little old lady with pneumonia (LOLWP) is suddenly wearing lipstick, I know it's time for discharge.
linrob63 said…
Is it possible that a painter will elect a naked face on therapy days? The possibility, even likelihood that being all snot and tears by the end of the visit invites will invariably look worse on a painted face than a naked one. Though the image of Tammy Faye Baker's tear soaked face is exaggerated (maybe exponentially), even a well applied cosmetic looks pretty bad after an hour of crying and swiping tissues across it.

Or maybe it is just me...
Scraps said…
I don't usually use clothes and makeup an a direct indicator of my moods. However, I distinctly remember one morning choosing my outfit with particular care, dressing up more than I normally would on a Sunday, because I'd just received some particularly difficult news and I knew that if I didn't dress up and get out of the house, I'd end up a quivering wreck huddled in a puddle of tears on my bed. And I did just that--I dressed up, put on a little makeup (not something I normally do except for Shabbos/weddings/etc), and met up with a friend for a fabulous day of shopping and a Broadway show. It was like I had to be SuperFine in order to make up for the fact that truly I wasn't fine at all. But hey--it worked. And when I got past that first day, even though I wasn't being SuperFine anymore, dealing with the new reality wasn't as hard as it would have been that day.
therapydoc said…
Oh, it's true. Too much make-up could be a BAD idea if you know you're going to cry buckets. And face it, why not cry a few buckets if you have the chance? Unless there are simply too many buckets.
Anonymous said…
My mom OBM always hid behind her "face" - "I have to put on my face" every morning. It's why I wore so little makeup for years. Once DD was born in 1999, I stopped wearing it completely, so I could smooch my new baby to pieces without it rubbing off on her. (And after we'd visit MIL, DD would get a bath and change of clothes right away because the stench of MIL's perfume was too much for me to stomach!)

I still don't wear meakup except on VERY special occasions - IOW, I very, very rarely wear makeup, LOL. I probably still have some dating back to 1999! And yeah, I've done buckets of crying since then...
Anonymous said…
Re: "affect": I'm a terrible liar/actress, and my therapist and I laugh about it. Now, that's not completely the same as being a Diva/drama queen/histrionic, LOL...
therapydoc said…
Angelissima, Please, no swift kicks in the pants. No kicks.

Scraps, this is what we call fake it til you make it and it's an EXCELLENT strategy.

Ima2Oh, thank you, thank you for reminding me that women who think of it this way, do put on their face, and totally MAKE it without even a thought about faking it, because it's not. Such a natural thing, so wonderful.
Anonymous said…
explain more on the hygiene psychoicness...some people just like a fresh face but on the other hand, do you think those who are lackidocical with washing and hygiene and dont really care about it have serious issues? what if they do all the stuff like the oil on the skin etc and withdrawl how do you help them?
Anonymous said…
what is a flat affect and what does that mean?
Anonymous said…
I love this blog. Been surfing around, and there are not many quality psychological blogs out there. Thanks for that! You got a new subscriber!

Albert | UrbanMonk.Net
Modern personal development, entwined with ancient spirituality.
Anonymous said…
Thought provoking post, absolutely dead-on AND I was going to say what linrob63 mentioned:

There are women patients (when I enter into it from the "other" side I, too, am like this) who prefer going make-upless to session in order to feel free to release and wipe with ease. Freedom.

Great blog. Glad someone's out here "doin' that voodoo like you do."


Anonymous said…
I was an acne-infected pre-teen. Does wonders for a young lass who already lacks self-esteem. At the age of 18 I finally attracted a boyfriend, go figure...then we started engaging in sexual intercourse and the monthly scares started: Please God, let me get my period, intensified by the fact that my older sister got "knocked-up" at the age of 17. Oh what shame my dear old Dad endured with that little dalliance. So one day I read an article that mentioned the use of birth control pills to clear up extreme cases of acne. By this time I had terrible reddish/purplish scars on both cheeks of my face (you know, from picking and squeezing, impossible to resist doing that)so I approached dear Mother and told her about the article. Off I went to the local family planning clinic, of course not explaining to her the "primary" reason I was going on the pill. Well, it worked. The awful purple scarring went away and I could stop praying to God every month! Since I never learned how to apply make-up (why some mothers avoid teaching their daughters this I will never know) I went make-up free for many years. I did start wearing make-up a lot more in the late 80's, 90's, don't know what got into me. Oh yes, I was in my thirties by then and twice divorced. You know, foundation, bright blue/aquamarine eye shadow, absolutely hideous by todays standards. By the late 90's I said to hell with this and stopped bothering. Now I just wear a bit of eye liner and mascara. Oh yes, and my Oil of Olay, I've been a faithful fan for years.
Do I have scarring from the acne? Yes, I do. But when I see women who have the same problem I did (terrible scarring from acne) plastering on the heavy foundation and make-up, I want to tell them that give their skin a chance to breathe! I think the heavy make-up, instead of covering up the scarring, brings alot much more attention to it. Of course the fact that I love myself now has alot to do with it, thanks to a wonderful therapist who helped me exorcise that ugly black cancerous core of self-hatred I carried around inside of me for years. Thanks for a wonderful post, as usual!
therapydoc said…
Thanks ANON, GREAT STORY. I considered asking for names of great therapists and posting them so that these folks get an even break, but probably they're busy enough.

Still, with all the therapist bashing on the web, it's great to hear about somebody who really helped.
Anonymous said…
you are brilliant.
excellent post.
therapydoc said…
ANON on FLAT AFFECT. It means emotion-less, not happy, not sad, sort of there. Eyes are a little vacant, disinterested. It's a symptom of many different diagnoses.

ANON on HYGIENE. I actually think most of this is about habit, not feeling too tired or sick to wash. A person who is conditioned at a young age to like the smell of soap, to enjoy that fresh feeling of bathing (nothing else quite cuts it, you know) won't go without showering at least once a day-- except when really sick or depressed.

In the winter, if the heat in the house dries up the skin, it's good to bathe a little less frequently. Tell that to someone who's been socialized differently; it's hard to allow the oil to build up on the skin.
Anonymous said…
thank you ! :)
Anonymous said…
I guess I would be a square peg in this diagnosis. I'm allergic to most makeup. I find I will break out if I use it regularly. So I rarely wear it.

LOL. I only start wearing it if I've been watching to many make-over shows.
Interesting. I think there is a class and age dimension to makeup that has nothing to do with depresssion, however-- if you've been socialized about ladylike behavior from a young age, or grew up in an adamantly feminist "you're beautiful as you are" household, that affects your decision to wear makeup, other issues aside. I find that most of the women lawyers from middle class backgrounds between ages 25-40 tend to wear less/little make up. The older women lawyers do wear makeup, and always have, because it's important to appear feminine, bad enough that you're a lawyer. And younger women, especially from working class families, tend to wear more makeup than women from middle class families. Of course, these are generalizations to which there are always exceptions, but I tend to find that family money and age are big determinants.
therapydoc said…
BPlawyer, This is fascinating stuff, no, how sociological trends affect it, too. I'm so glad that there's less stress on the made-up face, honestly.
therapydoc said…
Just think of all the time we save.
Oh what a great post! So true and so simply reflective of women's relationships with the way we present ourselves. Can't wait to read the next post.
Just Me said…
I choose not to wear make-up. For one thing I have sensory issues/hyperacuity with my bipolar disorder and I can feel makeup all the time it is on my face, no matter how light it is. It doesn't last more than an hour or so. Plus, like someone else, I am allergic to most make-up products. It's not worth it to break out.

Second, I have a big old birthmark. It's on my hand, not my face, but it has affected how I feel about what people see when they look at me. To have something people are going to constantly ask about and look at teaches you a confidence within your own skin.

Third, it is very, very difficult to get out of bed when you take 3000 mg of depakote and 650 mg of seroquel, along with antidepressants and antianxiety pills each night. Some choices are made for you by the need to sleep as much as possible, yet still work.

I also have the kind of curly hair that doesn't do "neat". It is well-maintained and all, it just is wild and if the wind blows or it is humid whatever I did to it in the morning is undone.

My therapist had to fill in some paperwork about my functional skills. I know that these 2 things are why he marked that I am impaired in personal appearance, but I've always been bothered by this as I just don't think my illness has to do with my crazy hair and sensitive skin.
therapydoc said…
SUCH an important observation, JUST ME, about how meds make life difficult in general and fatigue is a seemingly inevitable bi-product of wellness that impairs an already challenged individual.

It's like choose your poison. I'm always in awe of people with bi-polar disorder who go with the program, so not an easy program, to stay well. It's unimaginable for those of you uninitiated who feel this disorder somehow romantic. And to think you have to please other people in the looks department, etc., is an extra burden that just shouldn't happen (shame on the therapist, who does this, adds more to the pathology, "over"-assesses self-care).

Oh, and birthmarks? Don't get me started. Another day.
I never really learned how to do makeup. And now, I've just kind of come to the conclusion that I'll shower and comb my hair and put on (vaguely) appropriate clothes, but other than that, well, I just look how I look. And my face probably isn't my biggest aesthetic sin, anyway.
Just Me said…
Thanks so much Therapy Doc for your statements about how difficult bipolar is, and how not romantic. I wish more people got that. Fighting bipolar is fighting a constant battle against something which wants to take all the good from life.

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