Unmasking the debate: A look at the psychology behind mask wearing
By: Kari Harden
STEAMBOAT SPRINGS — There is something unique about the intensity of the debate around mask wearing during a pandemic, and there are strong opinions on both sides about the efficacy of masks, the social responsibility of mask wearing and the role of personal freedom.
Whereas in many other countries mask wearing during a pandemic isn’t given a second thought, in recent months, it has become a trigger point in Routt County and across the U.S. — inciting outrage, and in some instances, even violence between those who are asking others to wear masks and those who refuse.
In Steamboat Springs, there have been confrontations in grocery stores and gas stations over the use of masks, and social media is inundated with the debate.
In Flint, Michigan, a security guard was shot and killed in a dispute over requesting a dollar store customer wear a mask. In California, an elected official resigned because of the death threats she received after instituting a policy requiring masks.
Masks have become a symbol of a political divide, with President Donald Trump telling the Wall Street Journal last week he believes some Americans are wearing masks just to show they disapprove of him and not for protection.
Vincent Atchity, CEO of Mental Health Colorado, gets frustrated by the unwillingness of many Americans to believe in science when it comes to masks and the COVID-19 virus in general.
“As our government consistently points out to us, our odds of returning to some level of functionality of the economy depends on us learning self-preserving behavior,” Atchity said. “Staying 6 feet apart and wearing masks diminishes the rate of droplet spraying.”
There is an element of machismo in not wearing masks, acknowledged Atchity.
“You can be as machismo as you want to be, but when you get the disease, do not present yourself to a health care facility. Don’t reject science and then come and impose on it,” Atchity said. “Be consistent with your machismo. Tough it out. … If you say you are not going to wear a mask, then assume the risk.”
There are also the more nuanced and logistical details of mask wearing being hashed out.
What kind of masks should or shouldn’t we wear, and where should and shouldn’t we wear them? And who should wear them? And how are we wearing them — are they covering our nose? Are they tight enough?
In combatting the spread of COVID-19, Routt County Chief Medical Officer Dr. Brian Harrington said masks are not perfect.
“Masks alone won’t do it,” he said.
He also acknowledges they are inconvenient. However, Harrington said he fully believes masks have a role in reducing the spread of the virus at the source and are one of many tools and strategies in mitigating the public health risk.
“I considerate it clear that masks make a difference,” he said. “Though there is a legitimate debate in how much of a difference do they make?”
Knowing that COVID-19 spreads through respiratory droplets, if there is something in front of your face those droplets from a cough or a sneeze don’t spray as far, Harrington said. Still, there is no guarantee a tiny viral particle cannot escape out of a loosely fitted mask, he noted.
Depending on the circumstances, masks may or may not make a difference, Harrington said.
But they are a “cost-efficient way of putting a dent in disease transmission,” Harrington added. “I’m a little surprised people wouldn’t choose them over some of the other things deployed — like shutting down business or not allowing big groups to gather.”
Dr. Amy Gallagher, a licensed psychologist with Mind Springs Health, noted that changing behavior and assuming new behaviors like wearing masks is hard.
“It’s a new concept for all of us,” she noted.
And behavior change requires a series of stages. It doesn’t happen overnight.
In the research around motivation, Gallagher said only about 10% of people are motivated by information. About 10% aren’t motivated by much of anything. And that leaves 80%, she said, who makes changes within the context of relationships.
Gallagher also notes that trust can be difficult to come by due to the inundation of information and a lot of mixed messages.
“It can be really hard to make a decision,” she said. “The safest thing may feel like not making a change.”
Studies about mask wearing
With more and more studies coming out around the effectiveness of mask wearing against COVID-19, Harrington notes those studies lack the characteristics of being a randomized controlled trial, or a blind trial, as would be required for gold-standard scientific conclusiveness. They are being conducted among different populations in different parts of the world.
But there are still some interesting results and some interesting case studies, Harrington notes.
One came out of Washington State, where among 61 people who attended a two and a half hour choir practice in March, 32 were confirmed positive for COVID-19 cases and 20 additional probable cases were identified. Three people were hospitalized, and two died.
“Transmission was likely facilitated by close proximity (within 6 feet) during practice and augmented by the act of singing,” according to the study.
In Springfield, Missouri, two hair stylists tested positive for COVID-19, but it turned out not a single one of their 140 clients and six coworkers who were potentially exposed tested positive for the virus. The two infected stylists wore cloth masks, and the salon had policies in place like distancing the chairs and staggering appointments.
In terms of expert opinions, Harrington notes that people like Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said wearing masks makes sense. The Centers for Disease Control, the World Health Organization and the Colorado Department of Public Health and Environment also endorse mask wearing as a way to prevent the spread of COVID-19, Harrington noted.
In a study published June 1 in The Lancet, researchers conducted a meta-analysis of 172 studies looked at various interventions in preventing COVID-19 and SARS and MERS transmission from an infected person to other people. The study reported that masks and respirators reduced the risk of infection by 85%.
Arguments against mask wearing
Of course, there are plenty of arguments against masks, including causing people to touch their face more often, which can spread the virus, or giving people a false sense of security.
And Harrington notes there are people who may have medical issues with wearing a mask, especially those with breathing problems.
In terms of the risk of a dangerous carbon dioxide buildup from too much mask wearing in a healthy person, Harrington said a person would have to be wearing a tight mask for a long time, and as a health risk, it would be “quite rare.”
And if you do find yourself adjusting your mask often, that’s just one more reason why hand washing continues to remain very important, he said.
While masks seek to stop transmission at the source, Harrington said, hand washing seeks to stop it “once the horse is out of the barn.”
“Hand washing matters a lot,” Harrington said. “Masks have a role. Social distancing is the most important. All things matter in some degree.”
Mask wearing to protect others
There’s also a social contract element of mask wearing, Atchity noted.
“It’s a social thing in admitting we are part of a community — that we care about each other,” he said. “We are expressing awareness of the potential risk for each other and demonstrating we are members of the same society.”
Atchity said people who refuse to wear masks see themselves as being more independent than others.
“Nobody is independent of others,” he said. “We are creatures that thrive on networks and community.”
Atchity points out some of the funnier and ironic aspects of mask wearing — like a friend of his who loves going into his bank with a bandana covering his face and the ability to make faces or curse others under your breath without detection. And Atchity notes the irony in the development of big push in development for facial recognition software — a useless technology when someone is wearing a mask.
But to Atchity, at the end of the day, it’s deadly serious.
“There’s no justifying not wearing a mask,” he said. “It’s a failure to understand the nature of public health, and it shows contempt for your fellow citizens.
“We can survive this,” Atchity added. “All we need to do is take simple little measures, like as you get in close quarters with people, mask up.”
Gallagher notes that when people feel their freedom is being threatened, many have a tendency to rebel — triggering the adolescent brain. She also noted that, like with adolescents, nagging is rarely effective.
In an article in Psychology Today, psychologist Dr. Seth Gillihan noted the multitude of anxieties brought on by the pandemic.
“In light of these anxieties, masks may trigger our fear that someone is trying to block our pursuit of happiness — either by not wearing a mask and threatening our life, or by making us wear masks and taking away our liberty,” Gillihan wrote.
“If you’re reluctant to wear a mask when required, question any automatic thoughts about others trying to take away your freedom,” he continued. “Most likely their goal is just to keep everyone safe, not to make you buy into a certain worldview or to force you to eat arugula.”