NB (22) above indicates the latest post & numerical order
Masks and hypomimia with Parkinson's
During my thirteen years in the theatre, I spent many hours wearing masks, stage makeup and costumes to create characters. With the help of skilled directors and voice coaches I was also able to create fictional characters using mannerisms and accents that were credible. The sophisticated masks we "wore" - either physical or otherwise - encouraged audiences to follow the characters' stories in the context of the play being staged. It is interesting to note that there are similarities as well as differences between the theatrical mask and the expressionless face often associated with a Parkinson's Disease (PD) sufferer. And a mime.
The theatrical mask lasts the duration of the rehearsals and performance, and with each successive performance the character becomes easier to portray. The thing that made a character come alive, for instance a costume, a manner of walking or talking, would make me also believe in the illusion I was creating as that character. A loss of motor control especially in the face of a PD sufferer is referred to as facial masking or hypomimia. It is assumed that the general loss of motor control, where parkinsed persons start walking and talking more slowly, has an impact on their faces. That results in an expressionless or mask-like appearance.
The mask I have started wearing the past few years is for my current role in a tragedy, Days in the Life of a PD Sufferer 😆. It has become my default look when I am not engaging verbally with people. In Shakespeare's comedy, A Midsummer Night's Dream, a character called Nick Bottom has his head transformed into that of a donkey (as illustrated in the picture below). As the classic clown in a traditional Shakespearian comedy, Bottom appears to be unaware of his own ridiculousness. I played the role of Bottom in the Seventies. However, at the end of the performance I could switch back to reality and to Ari.
On rare occasions I do laugh loudly when I watch television, but generally, my expressionless face has become a real mask. I am aware of this and have noticed that I am able to change the default scowl when I am with my grandchildren, who generate a different reality for me. The PD mask or scowl is probably part of my muscle memory whereas smiling has become part of my "muscle forgetory" (SEE Post 6).
Masking the mask
It is clear that my hypomimia is accompanied by poor and slowed movement, (i.e. bradykinesia), freezing (i.e. akinesia), smaller handwriting (i.e. micrographia) and softer speech (i.e. hypophonia). All these symptoms are part of my PD baggage. However, in my opinion - and as one not on PD medication - my facial masking and slowed movement can be changed depending on my state of mind.
Like Bottom, I try to remove the PD mask from time to time by laughing out loud or smiling when watching television. Also, when walking using my walking stick, I am masking the mask when I swing my right arm that has been immobile for many years. Forced swinging is part of my walking action in an attempt to improve my gait and create a semblance of normality. This forced right arm swinging action generates a rhythm and allows me to also concentrate on straightening my back while walking.
Walking is one of my most challenging activities especially when there's a slight incline. For safer and sustained action when walking or climbing stairs, a few years ago I created a set of verbal and auditory cues to sustain an action and for rhythm. In Post 5, I have referred to this as corrective messaging.
OBSERVATION AND TIP FOR ME I have noticed that a bad mood instills and generates a more debilitating bradykinesia in me. For instance, if I'm upset or frustrated when seated, then my right hand immediately goes into a default claw-like shape and rests on my right thigh. If I'm walking and upset, then the claw-like hand also appears and I tend to drag my right foot more obviously. However, once I have registered this unwanted action and I am able to shift my mood, consciously, then I can "unclaw" my right hand and lift my right ankle while walking without dragging that foot. This represents the masking of a mask, or over-riding an action generated by my PD command centre that has high-jacked my nervous system (SEE Post 8).
Masks: to protect me or to hide behind
Unlike Bottom, I am quite conscious of being parkinsed and its impact on me. I do not have a cure that can be mass manufactured but I do have insight into some of the inner workings of my hijacked nervous system. My response is not remediation but rather ongoing negotiations with that damn PD command centre. So, in the context of the sub-heading, Ari is trying to protect Ari while PD has managed to hide behind my accident and traumas described earlier (SEE Post 2) that may have caused my PD.
This form of "protection" is not cheap as it demands a lot of energy. As soon as I notice tension causing my PD symptoms to be kick-started, then I immediately attempt to analyse then reverse the whole hijacking process. This reversal process, when played out a few times every waking hour, is energy-sapping and leaves me drained at the end of the day. Attempting to execute a smooth turn from being on my back to lying on my side at night, keeps me awake long after I have turned over. This results in my generally waking up tired in the morning.
Quite honestly, although I am tired of being tired, I am really grateful for having had ten good years without chronic PD medication. The current challenge on the horizon is my akinesia and balance issues that could result in serious injury if I am careless. Maybe I should consider PD medication, or...
My form of masque
Protecting myself by masking the destructive masks of PD, I suggest, is a natural instinct and a bold but possibly vain attempt to resuscitate what used to be the norm for Ari.
During the 16th century in Europe, "courtly entertainment" with stories presented via singing, dancing and music was referred to as a "masque". Broadway or West End musicals are a sophisticated modern day form of a "masque". Before Covid-19, these "masques" required skilled performers with the energy to repeat performances for years at a stretch.
My "masque" is more of a mime as I concentrate solely on body motions and there is no song and dance. While it has been it has running for ten years, the artist cannot predict the time or duration of the performances. So, don't bother booking a ticket. Till next time, dear reader.
