Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.
Given that face masks help prevent asymptomatic spread of COVID-19 and may also reduce the chances of anyone contracting the virus, wouldn’t any decent, responsible citizen put up with such a minor inconvenience? Apparently not.
In the midst of a frightening spike in COVID-19 infections in over a dozen states,1 how do we understand those who adamantly refuse to wear protective masks in public? Barring some (very rare) medical contraindication to wearing a mask, I can think of no ethical justification for such a refusal. Given that face masks help prevent asymptomatic spread of COVID-19 and may also reduce the chances of anyone contracting the COVID-19 virus,2 wouldn’t any decent, responsible citizen put up with such a minor inconvenience?
It is tempting to write off the mask refusers as selfish, irresponsible yahoos, or as “COVID deniers”—those who simply don’t believe the pandemic is “real,” or that it represents a serious health threat. There may be some truth to those characterizations. But, in my view, the picture is more complex and provides a window into a cultural archetype that I call the American Man-Child. First, though, we need to deal with mask refusal and machismo.
A recipe for American Machismo
In an earlier essay, I referred to a venerable tradition of tough-minded individualism that has marked this country from its very inception.3 I noted that,
“The image of the self-reliant, iron-willed “loner” is an iconic American archetype, from the days of the lone cowboy, out on the range, to the novels of Ernest Hemingway. The motto, “Don’t Tread on Me”—which arose during the years of the American Revolution—nicely sums up the feisty spirit of American individualism. Indeed, during recent anti-restriction protests, “Don’t Tread on Me” appeared on numerous flags and banners.”
I argued that, up to a point, this rugged individualism serves as a useful counterweight to the communitarian impulse—the belief that the community is a “bearer of rights,” to which an individual’s interests may have to be subordinated in some cases. But carried to an extreme—what I called, “hyper-individualism”—the “Don’t Tread on Me” mentality can become an insidious force for societal disintegration.
In my view, many mask refusers are acting out of a debased form of individualism that some would call “toxic masculinity,” and which I would call machismo. I hasten to add that I am using the latter term in a broad, generic sense, and not as a trait endemic to “Latin” culture or society. A very useful definition of machismo is
“Exaggerated pride in masculinity, perceived as power, often coupled with a minimal sense of responsibility and disregard of consequences.”4
In my view, this brand of American machismo helps explain the behavior of many (though not all) mask refusers. In effect, refusal to wear a mask in public settings has become a mark of being “a man’s man”—someone who won’t be pushed around or “muzzled” by governmental “tyranny.” To be clear: I’m not saying anything new here. In April of this year, social scientist Prof. Peter Glick wrote,
“Why the reluctance to model safe behavior? My research with Jennifer Berdahl and others suggest one critical reason, which is that appearing to play it safe contradicts a core principle of masculinity: show no weakness. In short, wearing a mask emasculates . . . [mask refusers] prove their manhood by showing resistance to experts’ opinions, hypersensitivity to criticism and constant feuding with anyone who seems to disagree with them.”5
But, in my view, machismo is just one piece of the puzzle. We now need to examine an archetype that, in academic circles, is called puer aeternus—Latin for the “eternal boy” or “eternal child”—and which I want to call, “The American Man-Child.”
The eternal child
As Jungian analyst Frith Luton explains, puer aeternus:
“. . . is used in mythology to designate a child-god who is forever young; psychologically, it refers to an older man whose emotional life has remained at an adolescent level . . . He covets independence and freedom, chafes at boundaries and limits, and tends to find any restriction intolerable.”6
In this regard, consider this pronouncement from an Ohio state representative who refuses to wear a mask:
“I will not wear a mask . . . quite frankly, everyone else’s freedom ends at the tip of my nose. You’re not going to tell me what to do.”7
How many frustrated parents have heard, “You can’t make me!” from their petulant, early adolescent child?
One modern version of the puer aeternus archetype was popularized by the psychoanalyst, Dr Dan Kiley, in his 1983 book, The Peter Pan Syndrome: Men Who Have Never Grown Up. Kiley describes men of this type as follows:
"Narcissism locks them inside themselves . . . pursuit of other people's acceptance seems their only way to find self-acceptance. Their temper tantrums are disguised as manly assertion."8
Thus, we find a nexus between machismo and puer aeternus. Now, add in a dollop of magical thinking—as in, “This whole virus thing is a big hoax!”—and we have the makings of the American anti-masker.9 Tragically, we also have the makings of a resurgent American pandemic that threatens to overwhelm us once again.
Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of Psychiatric Times (2007-2010).
1. Knowles H, Wagner J, Shaban H, et al. Seven states report highest coronavirus hospitalizations since pandemic began. Washington Post. June 23, 2020. Accessed June 29, 2020. https://www.washingtonpost.com/nation/2020/06/23/coronavirus-live-updates-us.
2. Texas A&M University. Face masks critical in preventing spread of COVID-19. Science Daily. June 12, 2020. Accessed June 29, 2020. https://www.sciencedaily.com/releases/2020/06/200612172200.htm
3. Glick P. Masks and Emasculation: Why Some Men Refuse to Take Safety Precautions. Scientific American. April 30, 2020. June 29, 2020. https://www.psychiatrictimes.com/view/freedom-does-not-mean-being-loose
4. Encyclopedia Britannica. Machismo. https://www.britannica.com/topic/machismo
5. Glick P. Masks and Emasculation: Why Some Men Refuse to Take Safety Precautions. Scientific American. April 30, 2020. Accessed June 29, 2020. https://blogs.scientificamerican.com/observations/masks-and-emasculation-why-some-men-refuse-to-take-safety-precautions
6. Frith Luton. Puer aeternus. https://frithluton.com/articles/puer-aeternus/
7. Polman D. Refusing to wear a mask is about the most un-American thing to do right now. Pennsylvania Capital-Star. May 11, 2020. Accessed June 29, 2020. https://www.penncapital-star.com/commentary/refusing-to-wear-a-mask-is-america-at-its-worst-dick-polman
8. Kiley D. The Peter Pan Syndrome: Men Who Have Never Grown Up. Avon Books, 1983 (xvi, preface).
9. Lithwick D. Refusing to Wear a Mask Is a Uniquely American Pathology. Slate. May 14, 2020. Accessed June 29, 2020. https://slate.com/news-and-politics/2020/05/masks-coronavirus-america.html
LETTER TO THE EDITOR
Response to Dr. Ronald Pies:
I read with interest Dr. Ronald Pies two articles, “Culture Wars, COVID-19, and Countertransference What America’s Cultural Rifts Might Mean for Psychiatry,” and “Masks, Machismo and the American Man-Child.” Both articles were timely given the expanding cultural rifts exacerbated by the COVID pandemic. My intent is to add further insight into the discussion.
Although Dr. Pies strove for impartiality, the topics are so ripe with undercurrents of economic uncertainty and political nuances that it is often difficult to see the forest from the trees.Although the magnitude of the difference between the liberal versus the conservative prism is great, psychiatrists need to be consistent and nonjudgmental with all patients regardless of political bent. However, the insertion into the mix of COVID has made the delineation between the two sides more apparent as even health care providers have opposing views along with the rest of the population.
Dr. Pies pointed out the underlying rage of conservatives witnessed during the initial protests against the economic shutdown and asked the question as to what psychiatry’s role is in dealing with the rage and resentment underlying the antirestriction protests.Although the worry about the virus spread is valid, the economic devastation caused by the shutdown must be understood to answer Dr. Pies’ question.Blue collar and small business owners suffered disproportionately compared to white collar workers who were able to transition with little change in income.Many small business owners who had used up their savings became dependent for the first time on government assistance.Psychiatrists need to be cognizant of the effect the prolonged shutdown has had on their patient’s health and wellbeing.It is an opportunity for psychiatrists to be aware that the real threat of financial ruin is a contributor to the underlying rage and resentment against the forced economic shutdown observed in some of their patients.
Battle lines according to party affiliations have been drawn around the use of facial coverings.The face mask has become representative of the widening cultural chiasm between those who use and those who don’t. Whatever the reason for mask refusal, Dr. Pies’ negative depiction of the older male mask refuser as a self absorbed, irresponsible, emotionally immature individual does more harm than good and reflects his own internal bias.
Psychiatrists are aware that both acute and chronic stressors lead to both healthy and unhealthy coping mechanisms.In an atmosphere of loss of control in many aspects of life, mask refusal may be the one avenue for some to regain perceived control over body and spirit and feel a connectedness with other like-minded individuals during a time of social isolation and economic stagnation
Despite deep differences in cultural and political ideologies, psychiatrists who are open minded and nonjudgmental can establish therapeutic relationships even with their most culturally misaligned patients and work towards development of mutual respect and COVID safe practices.
Elizabeth A. Varas MD
Response from the author
I thank Dr. Varas for her thoughtful and thought-provoking letter. In the end, I don’t believe our views are very far apart, regarding the psychiatrist’s responsibility toward patients whose political, religious, or other views are at marked variance with our own. At the same time, I stand by the main conclusions of both articles Dr. Varas references.
Specifically: I agree with Dr. Varas that--within a certain range of political views--“psychiatrists need to be consistent and nonjudgmental with all patients regardless of political bent.” Thus, in general, we need to guard against reflexive moral judgments, even when we strongly disagree with the patient’s “politics.” However, I don’t believe we need to be “nonjudgmental” no matter how hateful or bigoted a patient’s political or religious views may be. Guidedbyour own values and those of our profession, we may rightly judge a patient’s political views to be “bigoted” “distorted” or “extremist” in certain limited instances; for example, when a patient’s political views lead him or her to the conclusion that African Americans are “inferior;” or that Jews should be rounded up and put into concentration camps; or that all immigrants should “go back where they came from.” (These, of course, are extreme examples).
But merely “judging” the patient’s views is not sufficient. If we continue to work with the patient, we have the further obligation of self-reflection, introspection, and perhaps consultation with a colleague, as to whether our disapproval (and resultant counter-transference) is of such intensity as to compromise our ability to be of help to the patient. That premise was the foundation of my article on “counter-transference.”
Furthermore, if we continue to work with the patient, we also have a professional obligation to understand how the patient came to develop such extreme views, and—if possible—to develop some degree of empathy for him or her. Indeed, I learned this first-hand in dealing with an extremely anti-Semitic (and quite psychotic) patient in my care—more on that presently.
Dr. Varas opines that the current pandemic provides “…an opportunity for psychiatrists to be aware [that] the real threat of financial ruin is a contributor to the underlying rage and resentment against the establishment observed in some of their patients.”
I certainly agree with this. Indeed, in an earlier article Dr. Varas may not have seen, I stated:
“Many [anti-restriction] protesters voiced perfectly understandable concerns about lost jobs, missed opportunities, and social isolation. These individuals deserve our empathic understanding.” [https://www.psychiatrictimes.com/view/freedom-does-not-mean-being-loose]
Dr. Varas writes that, “Dr. Pies’ negative depiction of the older male mask refuser as a self-absorbed, irresponsible, emotionally immature individual does more harm than good and reflects his own internal bias.”
Indeed, I believe these terms—self-absorbed, irresponsible, emotionally immature--are largely accurate characterizations of the views and behaviors of many, if not most, individuals who adamantly refuse to wear masks during the pandemic. I acknowledge that my conclusion may reflect my own “internal bias”—e.g., as someone who self-identifies as “progressive” politically--but that does not render my conclusion incorrect.
Nevertheless, my claim is, at most, a hypothesis—not a fact—and it ought to be subject to empirical verification or falsification. For example, it would be interesting to see how adamant “mask refusers” score on validated measures of narcissism, sociopathy, and emotional immaturity. [see, e.g., http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.676.3624&rep=rep1&type=pdf]Yes, I could be mistaken—but I’ll wager that most of these individuals will score “high” on one or more of these three personality traits.
None of this is inconsistent with Dr. Varas’s hypothesis—which seems plausible to me—that
“In an atmosphere of loss of control in many aspects of life, mask refusal may be the one avenue for some to regain perceived control over body and spirit and feel a connectedness with other like-minded individuals during a time of social isolation and economic stagnation.”
Consequently, I would agree with Dr. Varas that, if we find ourselves treating such individuals, we have an obligation to “put ourselves in their shoes” and try to find an empathic connection with them, if possible. These individuals are, like all of us, fallible human beings. They deserve our compassion and good-faith efforts to help them. But we are not obligated to withhold the judgment that they are behaving in a self-absorbed, irresponsible, and immature manner.
In this regard, I would distinguish between judging a person’s beliefs and behaviors, on the one hand; and judging the totality of the person, on the other. In the case of the extremely anti-Semitic patient I treated, I judged his views (and still do!) to be thoroughly reprehensible—but I never regarded him as a reprehensible human being [https://www.nytimes.com/2006/01/31/health/psychology/after-polite-sessions-letters-filled-with-antisemitism.html?auth=login-email&login=email]. As the late Dr. Albert Ellis reminded us, “bad acts” do not imply a “bad, wicked, or rotten” person. [Ellis A, Harper RA, A Guide to Rational Living, Melvin Powers, 1975, chapter 12]
Again, I thank Dr. Varas for taking the time to write on this important topic.
Ronald W. Pies, MD