When you feel bad your mind continues to focus on all the parts of your life that seem to not be working. Then you feel even worse. This all continues until you wake up to the fact that your self-image is just a mental idea. It is just a concept
To me this art is saying that you show one thing but feel another. you can show happiness but still feel caged in with nobody to turn or talk to about your feelings. <--- what this caption says here is so true.