Illustration of a person wearing a mask with full battery beside another person holding their head in fatigue, symbolizing caregiver exhaustion and masking in brain injury

🪶 Borrowed Energy, Borrowed Time

The world sees the mask. Caregivers see what it costs to hold it together.

People often confuse hanging out with caring for.
They’ll spend an afternoon or a weekend with someone who has dementia, Parkinson’s, or a brain injury and come away saying,

“They seemed fine to me.”

But hanging out is a snapshot — the mask phase.
Caregiving is the crash phase that follows.

The Masking Phenomenon

Neurologists refer to this as social masking, a temporary, energy-intensive form of compensation that occurs when the brain activates what remains of its executive function to appear “normal.”

  • This process recruits regions like the prefrontal cortex, which handles self-regulation and social behavior, and the anterior cingulate cortex, which manages emotional control.

  • It’s fueled by stress hormones, mainly adrenaline and cortisol, that heighten alertness and suppress tremors, stuttering, or confusion.

  • But this “borrowed clarity” comes at a cost: once the audience disappears, the body crashes, leaving cognitive fatigue, irritability, and neurological instability.

Caregivers see that crash every day. Outsiders almost never do.

The Energy Debt

Neuropsychologists sometimes describe this cycle using energy envelope theory — originally from chronic illness research but now used in brain-injury recovery.
The brain functions like a battery with reduced capacity. Every conversation, sensory input, or emotional demand drains that limited charge.

When someone says, “He seemed fine for hours,” they’re witnessing borrowed energy — the nervous system running on emergency reserves. Once home, the caregiver inherits the withdrawal symptoms: agitation, headaches, confusion, or what some clinicians call post-exertional neurofatigue.

The Emotional Fallout

For the injured person, those “good” moments feed hope and identity.
For the caregiver, they create a painful dual reality, joy that others see them shine, and grief knowing the crash is coming.

Caregivers often describe feeling invalidated when relatives comment on how “normal” their loved one seemed. It’s a form of secondary gaslighting, where someone’s limited view unintentionally erases the caregiver’s daily truth.

This emotional dissonance compounds what researchers call caregiver burden, a well-documented risk factor for burnout and depression in long-term neurological care.

Behind Closed Doors

A friend of mine recently visited family with her husband, who lives with a traumatic brain injury.
He was animated and sharp for three straight days, recalled stories, cracking jokes, holding conversations that had felt impossible months earlier.
To his family, it looked like recovery.
To her, it looked like overdrive.

By the time they came home, he was restless and agitated — the neurological bill coming due. The next morning, relatives texted, “He looked amazing!” and she felt the quiet sting of erasure.
He wanted to plan the next visit.
She was still recovering from the last one.

Why the World Misreads It

Most people only see the neurotypical façade,  not because they’re unkind, but because the human brain believes what it sees. Without firsthand exposure to fatigue, repetition, or personality shifts, it’s easy to mistake temporary function for permanent improvement.

That gap between perception and reality is where caregivers live.

The Takeaway

Neurological illness is deceptive. It can look fine in public and unravel in private.
Every “good day” the world celebrates often costs a caregiver three days of recovery afterward.

So when someone says, “He seemed fine,” remember:
they saw the performance — you managed the recovery.
They saw the trailer — you live the film.

References & Further Reading

  • Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422.

  • Jason, L. A. et al. (2009). Energy Envelope Theory in Post-Concussion & ME/CFS. Journal of Chronic Fatigue Syndrome, 16(1), 59–72.

  • Vitaliano, P. P., Zhang, J., & Scanlan, J. M. (2003). Is caregiving hazardous to one’s physical health? Psychological Bulletin, 129(6), 946–972.

Back to blog