Image: A 15 second CNN ad accompanied by upbeat music and a shifting montage of individualized masks—bearing among other images those of flags, camo markings, Pride rainbows, I heart Fauci declarations, and the superman insignia–states simply that “a mask can say a lot about a person who wears it and even more about a person who doesn’t.” According to this PSA, the mask is a reflection of personality and even more so of the values and ethical systems that determine our actions. Calculated to counter partisan mask refusal in the US, the ad appeals to the very individualist ideals that undergird American (and more generally Western) resistance to the mask in the first place at the same time as it makes a case for collectivism.
Mask refusal is rooted in Western ideas of individualism that took hold in the eighteenth century with the political philosophy of John Locke. Although Locke did not himself employ the term “individualism” (it was coined by the French in the nineteenth century in a pejorative sense) in relation to his theories of natural rights and personal property, his thinking nonetheless lay the groundwork for modern ideas relating to individual freedom and self-determination.
In the last century or so, individualism has come to dominate western medicine’s autonomy-based bioethics. This model isolates the individual from society and renders them a “client”/consumer” of medical services rather than someone implicated in a shared structure that impinges on everyone’s health. Furthermore, if one considers infectious disease, it is clear that this notion of “autonomous agency” simply does not apply; according to Jacquineau Azétsop and Stuart Rennie, “First, as both a victim and a vector, a patient cannot be simply seen as a rational agent who has the final ethical word on his own decisions. Both vulnerability to infection and threat of transmission to others should shape our understanding of patient agency. Second, the concept of choice that shapes our conception of agency in bioethics can no longer be understood in isolation from society. Risk of acquiring and transmitting infectious diseases reflects the patient’s interconnectedness with others and the biological environment, an interconnectedness which is always there even when infectious disease is not present”
More specifically, immunologists like Alfred Tauber have been at the forefront of decoupling the medical idea of immunity from western individualism. Tauber’s work attempts to counter twentieth-century immune theory with an ecological view that deconstructs the self/non self distinction contouring our sense of the immune system since Elie Metchnikoff’s “discovery” in the late nineteenth century. Building on immunological critique, Ed Cohen’s work on immunity, biopolitics and the apotheosis of the modern body explores the ramifications of the rather arbitrary label Metchnikoff applied to the organismic activity he viewed through his microscope. As Cohen concludes rather wistfully,
Imagine what might have happened if he had not been so focused on either the individual organism as milieu interior or the dynamics of aggression and response which underwrote his political ontology, worldview, and laboratory experiments. Imagine what might have happened if ‘community’ had achieved the same biological status that immunity did. How differently might we live in the world imagining that our ‘commune systems’ mediated our living relations with and in the world? How might we experience ourselves as organisms if we imagined that coexistence rather than self-defense provides the basis for our well-being? (281).
Applied to our current situation, how different might our response to mask recommendations be were we to view our immune system through this other lens? Precisely because we are interconnected we must make decisions that take into account other people with whom we come in contact in society. Opting not to wear a mask because it makes us uncomfortable or “we don’t believe in it” involves a failure to recognize on a very basic level that disease is a social process that implicates all of us.
In the context of COVID-19, the mask constitutes a refusal of medical individualism. It becomes a signifier of our responsibilities towards others, a sign that perhaps suspending our individuality is not so great a sacrifice to make if this means ensuring the health of others. And yet it is also a surface on which we project our ideologies and beliefs: some view this strip of cloth or folded paper as a sign of docility, the uniform of those brainwashed by state officials. It represents compliance, restraint, mindless submission. When something has become supercharged in this way as an ideological symbol, it becomes that much more difficult to dismantle, even to the extent that those who have fed these beliefs may not be able to counter them by eventually assuming the mask themselves.
But why does the mask attract such vitriol?
Much of this stigma of mask-wearing has to do with the perception of weakness, it’s so-called emasculating effect. By associating the practice of mask-wearing with fear and the mindless compliance of the far left (while paradoxically casting this same group as lawless anarchists), Trumpism has politicized public health in unprecedented ways. It has also inserted gender into the debate by stigmatizing the mask as effeminate, thereby triggering a counter campaign joined by unlikely Republicans like Dick Cheney who, garbed in cowboy hat, jeans and a paper mask, recently insisted that mask-wearing is actually consonant with masculinity. It’s striking that rather than pointing to how misogynistic this gendering of the mask happens to be, the tendency is to rehabilitate the mask as “manly.” Furthermore, the fact that assurances that wearing a mask won’t undermine one’s gender position are more important than arguments for basic decency speaks to the fragility of a certain kind of masculinity. This is clearly one of those times in which traditional gender norms actually get in the way of social justice, or in this case, public health justice. But neither is this a new phenomenon; as the epidemiologist Julia Marcus has written recently in The Atlantic, the phenomenon of mask refusal is consistent with behaviours in prior pandemics and others public health areas in which “Men—especially those who endorse traditional masculine gender norms—have been less likely than women to engage in protective health behaviors.” Moreover, as Nadja Durbach has shown, in the anti-vaccination movement in England in the second half of the nineteenth century, “male anti-vaccinators constantly affirmed their masculinity, claiming to be ‘Manly men’” (58) and insisting that compulsory vaccination challenged their sovereignty over their households. One need only look to comment threads on Instagram to see similar bravado and rhetoric informing COVID specific anti-vaccination positions and numerous publications have run stories about the gender divide in mask-wearing practices of hetero couples; there is ample visual evidence of men appearing maskless in public while their female partners are covered up. Because there is no getting “outside” of gender, the same publications indicate that a mask mandate is required to sidestep the problem of peer pressure.
When we think of the face, we think of its expressive possibilities. This is how we present ourselves to the world, this is how we connect; some might argue that our humanity is conveyed by the face. Those who struggle with social cues look to the face for assurances, and children in particular who may not understand the language of adults rely on facial expression for clarification. The mask obscures the “universal translator” of the face, muffling the voice and intervening in the communicative process. Viewed through the lens of the ethical philosophy of Emmanuel Levinas, the mask intervenes in the face-to-face encounter that “orders and ordains us,” rendering us responsible to one another. At the same time, the encounter between masked strangers possibly inaugurates a new situation, one in which the mask, viewed as a symbol of empathy, takes on this function of ordering and ordaining. As such, the mask has a compensatory function, and acts as a supplement to the face to convey a shared resolve amongst the vulnerable.
Despite the considerable challenges atomistic individualism poses to public health officials’ attempts to promote mask wearing as widespread practice, one may glean some hope from looking to the younger generation whose early exposure to mask wearing may in fact help shift western perceptions of disease from an individual to a relational affliction. If the children of today may become habituated to wearing a mask when fighting a cold or other illnesses and practicing handwashing, then we may very well see a different paradigm by the time they reach adulthood, one that views illness as “linked to social, spiritual, and environmental determinants (Azétsop and Rennie 27). In the shorter term, the unprecedented donning of the mask, even if not universally accepted, may in fact be a sign of a shift in thinking, and possibly the complete renovation of a generational worldview.
Future blog: what does mask refusal have to do with vaccination debates?
 I am indebted to my student research assistant, Albana Stafa, for this observation.