Antisocial Masking Disorder

It feels good to diagnose, but it's better to understand.

Features of Antisocial Masking Disorder include:

• Violation of the physical or emotional rights of others
• Irritability and aggression
• Lack of remorse
• Consistent irresponsibility
• Recklessness

(Adapted from DSM 5 Antisocial Personality Disorder)

Whew, that was fun. Those guys are crazy.

But let’s be fair and make some distinctions. At one extreme are those who deny reality. A few conspiracy theorists hold that COVID-19 is a hoax, or more narrowly that it is real but overstated by political opponents, in order to hurt Trump’s presidency and re-election bid. It’s a psychological curiosity to maintain such claims in the face of photographic evidence, first-person accounts, a large number of certifiably dead people of all political persuasions, and so on.

Lately the objections have shifted somewhat. Many protesters now argue that masks don’t help: that they don’t stop the virus, or that they even increase risk by leading wearers to touch their faces more often. These claims, too, fail in the face of science as well as common sense. No one normally objects to covering a sneeze or cough.

Then there are subtler objections. It’s true, for example, that Americans valorize risking one’s life in defense of freedom. Shouldn’t we similarly honor those who make the individual decision to be free, of masks and social distancing in this case, at the cost of increased infection risk? Isn’t this akin to taking up a risky sport, or volunteering for hazardous duty?

The difference, of course, is that masking and social distancing aren’t for the individual alone. These acts protect others. Like obeying speed limits and fire codes, the life you save may not be your own. For most of us who wear masks to fight the pandemic, not doing so seems selfish: a conscious choice to maximize one’s own freedom by imperiling others. We’re all in this together, we plead; do it for your neighbors and elderly relatives. New York governor Andrew Cuomo recently argued that wearing a mask shows respect for health care workers risking their lives, and for one’s fellow citizens. Unfortunately, in an age of tribalism, this sort of collectivist argument rubs some the wrong way.

There’s another dynamic at play here too. It may seem minor, but for the protesters it surely isn’t. Cuomo didn’t dwell on the concrete benefits of mask-wearing; he stressed what it symbolizes. A mask shows the wearer is respectful, virtuous. This argument sounds a lot like virtue signaling: a gesture to convey virtuous values without necessarily accomplishing anything.

Here’s another example. I’ve been wearing a cloth mask whenever I walk outside. Yesterday I was strolling several blocks to an outdoor market, where due to the lines and crowd I’d definitely need and want to be masked. But the sidewalks on the way were nearly deserted. I’d face no increased risk by breathing freely, nor would I risk anyone else. I wore the mask partly out of habit, and partly, I realized, to convey my righteous pro-mask stance. The latter is virtue signaling, as wearing a mask outside on a deserted city block offers no practical advantage. It inconvenienced me, and made it a bit harder to breathe, for no reason but symbolism and self-image. I took it off until I neared the market.

My sense is that many mask refusers are enraged by virtue-signaling. The populism that brought Trump to power actively rejects “I know better than you” statements and gestures, especially those laden with moral overtones and real-life costs. Yes, it’s childish in a “cut off your nose to spite your face” way. After all, wearing a mask in markets or stores really matters. One might say that self-defeating behavior is true of Trumpism in general — more about expressing visceral opposition than a considered alternative.

This didn’t arise out of nowhere. For years, the left has taken moral stands that strike the right as precious: saving whales, using the right pronoun, denigrating meat-eating and gasoline use, and so on. Let’s grant that each of these causes would make the world a better place in the long run. However, in the short run these admonitions can come across as scolding, elitist, and out of touch with everyday concerns. People react badly to that. The chiding sounds parental. Emotionally, it invites angry adolescent rebellion. To make matters worse, dismissing such reactions as hopeless or deplorable merely adds dead-dinosaur gasoline to the fire. It’s a bit like a parent telling a teen he’s a loser and won’t amount to anything.

In family therapy, there’s often an “identified patient”: usually a child or teen with overtly pathological behavior who expresses the whole family’s otherwise hidden dysfunction. In larger society, too, playing one type of “sensible” role may invite others to play a complementary role that looks more overtly pathological. Authoritarians breed rebels, codependents invite manipulators, and so forth. If an angry minority fights sensible public health measures using immature, self-defeating behavior, it’s wise to consider what’s provoking them. And to recognize that everyone, not just our political opponents, is influenced by emotional irrationality.

The answers to our sincere questions may be uncomfortable ones that implicate ourselves.

To be clear, no one should use psychiatric diagnosis to critique a political position. It’s a feel-good tactic that inevitably backfires. Some mental health professionals tried with Donald Trump, and only encouraged his defenders to lodge counter-charges of mental illness in more liberal politicians. When it comes to masks, it might be argued that the pro-mask majority are “anti-social” in a colloquial sense: we privilege scientific/medical theory over immediate human connection.

Pandemics have been with us through history. Likewise, resistance to pandemic masks isn’t new. Many arguments used today against masks were used a century ago in the 1918 flu pandemic. We know a lot more about viruses and epidemiology now than we did then, and the scientific rationale for masks and social distancing is stronger than ever. But social dynamics haven’t changed much. People still don’t like being told what to do, especially if there’s a suggestion they are willfully ignorant or morally deficient. It’s incumbent on those advocating pro-social behavior to make it a win-win proposition, and not a moral failing — or a psychiatric disorder — for resisting.

©2020 Steven Reidbord MD. All rights reserved.