Altruism, Individualism, and the Science and Psychology of Mask Wearing

Recently it was announced that masks will be mandatory on Metro Vancouver’s public transit system. This is one policy, among a growing list since the start of the coronavirus pandemic, making masks compulsory in countries or metropolitan areas.

Currently, masks are required on public transit throughout Colombia, Argentina, Germany, and South Korea. Many countries have, at some point, made masks mandatory in any public space, and the list is varied, from the United Arab Emirates to Ecuador, from Austria to Morocco, El Salvador to Israel.

In the United States, though there is no federal requirement, 32 States plus Washington D.C. and Puerto Rico all have some sort of mask requirements as of the publication of this article.

Some countries adopted mask-wearing much earlier than others with little controversy or even official communication. While others still have small but vocal groups pushing back at the science, legislation, and apparent symbolism of masks.

Why is this? To get a full picture, we should acknowledge the early lack of agreement among scientists, as well as examine the cultural and psychological factors at play for those pushing back against mask-wearing.

The Science

The word that we got was that we were struggling to make sure we get personal protective equipment, including masks, for the health care workers, so the initial recommendation was: Don’t put masks on, because we’re going to be taking them away from health care workers. That understandably got interpreted as we didn’t think masks were of any benefit.

 Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases

The concern over the availability of PPE for health care workers was reiterated many times, especially in the United States. But it is perhaps understating the mixed messaging at the start of the pandemic to imply this is the cause of public confusion regarding masks.

Traveling in Aerosols

Within the U.S., experts assembled to consult on the pandemic did not include aerosol scientists. And it was aerosol researchers who were sounding the alarm about the potentially more significant role of airborne transmission. 

Wired ran an article in July outlining the about-face on recommending masks. Within it, Lidia Morawska, a leading aerosol researcher at the Queensland University of Technology, states she found the World Health Organization’s insistence that the “evidence was too weak” regarding airborne transmission “exasperating” as any experiment providing definitive proof would have been unethical. 

Morawska was blunt regarding her position as far back as an April 2nd article for Nature, “In the mind of scientists working on this, there’s absolutely no doubt that the virus spreads in the air. This is a no-brainer.”

Physician and health policy researcher Harvey Fineberg is critical of the firmness of WHO’s position regarding transmission from the Wired piece:

“When the WHO said there’s no aerosol spread, that was an utterly misleading statement,” says Fineberg. Granted, he says, public health officials are often called upon to do the difficult work of making black and white declarations and recommendations based on information that’s as gray as it can be. In this case, though, he says, “They were definitive in the wrong direction.”

Culture

In many East Asian nations, the practice of mask-wearing became widespread during the 2003 SARS outbreak. These nations were more greatly affected by SARS than countries in Europe and North America.

Though not significantly affected by SARS, Japan’s adoption of the mask dates back much further. One of the first domestically produced masks was advertised in Japan in 1879. These were primarily for mine, factory, and construction workers. 

It was the Spanish Flu (1918 – 1920), which solidified a culture of mask-wearing in Japan. Educational posters from the period feature slogans such as “reckless are those who don’t wear masks.” And for those who couldn’t afford to buy masks, newspapers began giving instructions on how to make them at home.

Japan is an interesting case study as it did many things wrong at the start of the coronavirus pandemic. It was slow to close businesses (with even karaoke bars staying open) and to switch to teleworking, but considering these factors (and its large elderly population), the rate of infection and death compared to the UK or the United States is small. The one thing which was done correctly from the start was masks. Moreover, there has been less need to implement laws governing behavior as people have largely complied with what has been asked of them.

From a cultural perspective, it is notable that the narrative tends to focus on not spreading the virus versus not catching the virus. It’s an important distinction when examining the psychology of mask-wearing. Masks are effective mainly in keeping those who may be infected but asymptomatic from infecting others. They are, in this sense, an altruistic act. That the most vocal objections to masks have arisen from countries that prioritize individualism is likely not coincidental.

The Psychology

For some people, when their freedoms are violated, or they perceive their freedoms are violated, they respond with something called psychological reactance

Dr. Steven Taylor, clinical psychologist at the University of British Columbia, author of The Psychology of Pandemics.

In a recent interview on CBC’s Day 6, the psychology of those actively pushing back against wearing a mask was discussed. Dr. Steven Taylor stressed that this was a “small but vocal” minority of the population.  

For some people, the implementation of mask mandates or even social pressure to wear masks may trigger reactance. Reactance is “an unpleasant motivational arousal to offers, persons, rules, or regulations that threaten or eliminate specific behavioral freedoms. Reactance occurs when a person feels that someone or something is taking away their choices or limiting the range of alternatives.” 

He also added that there are people who react with fear and moral outrage towards others for not wearing masks.

For those responding with psychological reactance, the effects of the virus itself are often minimized, and for those who have an extreme reaction against masks, it could be that they are a visual cue marking the virus. 

As Taylor points out, “If we look back to the 1918 influenza pandemic, there were coffins piled up in rooms, piled up in the streets. The sight of hearses was a daily occurrence…People got — every day — a very vivid depiction of how serious this was.” Currently, unless you work in a hospital, you do not see dead bodies, making it easier to disassociate and minimize the effects of the virus.

Ingroup/Outgroup And The Politicization of Mask-Wearing

On May 26th at a press conference, President Donald Trump asked a reporter to remove his mask, “I cannot hear you,” he said. The reporter declined, saying he would speak louder. To this, the President responded, “Oh, okay, you want to be politically correct.”

This is a strange response given the rate of infection in the United States and, as pointed out by The Atlantic, “Masks are not empty symbols. Masks are tools of public health.”

We have covered in previous articles humans’ natural tendency towards Ingroup/Outgroup categorization. This bias can increase with social media use and when resulting divisions are exploited. 

An early lack of cohesive messaging from scientists has been exacerbated by a continued lack of cohesive messaging from politicians. This allows for psychological reactance to be validated. And exploitation of divisions could cause problems beyond mask-wearing.

Taylor stresses messaging over regulation and further warns of a need to be prepared for vaccination non-adherence and pushback when there is a vaccine. Masks are a testing ground for how to deal with this.

Mask wearing, says Taylor, should be presented as a patriotic practice or a responsibility to your fellow citizens. 

Championing Unity

COVID-19 is not only a public health crisis but an economic crisis and social crisis.  Civic responsibility can be a powerful motivator, and social norms are often more effective than mandates. Building strong communities and responding to each other with an understanding of the physical, mental, and financial stress we are under will go a long way in forming effective and thoughtful communication and governance.

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Sources From the Article

1. CNN, Breakdown of state mask regulations
2.  Wired, “How Masks Went From Don’t-Wear to Must-Have”,By Megan Molteni and Adam Rogers
3. Nature, “Is the coronavirus airborne? Experts can’t agree”, By Dyani Lewis 
4. The Japan Times, The history behind Japan’s love of face masks,By Alex Martin
5. The New York Times, Is the Secret to Japan’s Virus Success Right in Front of Its Face? By Motoko Rich
6. BBC World, Coronavirus: Japan’s mysteriously low virus death rate, By Rupert Wingfield-Hayes
7. University of California San Francisco: Patient Care, “Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus”, By Nina Bai
8. CBC, Day 6 Podcast

Further Reading About Masks and the Psychology of Mask Wearing

1. The Scientist, On Covid-19 traveling in Aerosols
2. Scientific American, On masculine ideology driving resistance to a public health initiative
3. The Atlantic, On political ideology and refusing to wear masks
4. CBC,  On how we misinterpret meaning when we cannot read facial expressions
5. The Independent, On “vice signaling” in response to “virtue signaling”