“You don’t look sick.”

I’ve lost count of how many times I’ve heard that — usually said like it’s a compliment. What people don’t realise is how much effort it takes to not look sick. The hair brushed. Being dressed and not in a bath robe. The smile that hides the pain radiating through my body. For many of us living with chronic illness, looking “fine” isn’t a reflection of wellness — it’s survival. It’s performance. It’s the only way we get through the day.

Pain Scales Are Garbage Without Context

My most recent psych made a really good point: everyone’s pain threshold is different. When they ask, “What’s your pain from 1–10?” it’s kind of a useless question. One person’s “10” might be another’s “4” — especially if the first person’s only real injury was a paper cut. The better question, she said, is:

What painkillers are you on, and how effective are they?

For example, opioids, valium, and nerve meds like gabapentin barely touch my pain. That alone should tell you something. What we need to manage our pain — and how little it works — often says more about severity than any arbitrary number.

The “Good Day” Illusion

Sometimes, people catch you on a good day. You’re out, maybe even laughing, and they assume you must be better. But chronic illness isn’t linear. Good days don’t erase bad days — they just make you look “less believable” to everyone else. And honestly? That can sting more than the pain itself.

The “Presented Well” Bias

Every specialist letter about me seems to say the same thing: “She presented well.” Translation: I looked fine. I smiled. I masked my pain — because that’s what I’ve learned to do. But the problem is, when you look okay, doctors assume you are okay. On my most recent visit, I didn’t bother hiding it — I was exhausted, hurting, and it showed. The letter that came back? Way more serious. Maybe it was a better specialist. But I can’t help thinking it’s because, for once, I looked sick enough to be believed.

Why Your “Sick” Doesn’t Match TV Sick

We’ve all been trained by media to picture sickness as someone pale, bedridden, coughing dramatically into a tissue. So when people see someone who “looks fine,” they can’t compute that illness could exist underneath. But chronic illness often lives in the invisible realm — nerve pain, fatigue, brain fog, circulatory issues. It’s not cinematic. It’s quiet. It’s relentless.

The Emotional Tax of Explaining Yourself

Every “you don’t look sick” comes with a tiny decision: Do I explain? Or do I just smile and swallow it? Constantly justifying your illness is exhausting. You learn to pick your battles — when to educate, when to walk away, and when to just protect your peace. Because sometimes, no amount of explaining can convince someone who’s already decided what “sick” should look like.

If You’re Reading This…

If you’ve ever been told you “look fine,” I see you.

Your pain is real — whether or not it fits into someone else’s definition of “sick.”

You shouldn’t have to prove it to get help.