The Symbolic Lives of Masks: Lessons from the role of firearms in the United States

Individual choices play a role in health outcomes and, previously, much of medicine in the United States has focused around education and interventions meant to influence those choices available at the individual locus. However, those individual choices are made within the framework of defined realities, with the limits of a subset of all possible choices. Who gets sick and who does not is largely a structural problem – putting different people and populations in harm's way.  

There is also another powerful force guiding health outcomes – culture. Culture and structure are not mutually exclusive forces even though there has been some debate about the role of culture in a world largely composed of extreme inequalities driven by significant historical political, economic, and religious histories that generate asymmetric power relationships. The role of culture does not always need to be invoked in understanding these power structures but is needed to understand how knowledge is generated in human groups (Culture with big “C” as a human universal for knowledge production and meaning making, culture with a small “c as a local process for a specific group). Symbols are a lens into cultural knowledge and knowledge production, rituals and processes that make up inseparable personal identities. Individual choice is a key cultural concept in America and symbols representing that individuality are deeply engrained in our daily life. 

Masks serve as both a form of identify expression and identity concealment – or identity transformation. Stone masks have been found that likely date back to the Neolithic around 9,000 years ago in Iran (Figure 1) but obviously masks made with decayable material might even be older. Steve Nash, an archaeologist at the Denver Museum who frequently appears on the Sapiens podcast, discusses the possibility that even Neandertals made attempts at facial identity alteration tens of thousands of years ago. Of course, later, masks began to serve functional purposes as well, for example in health and sports (e.g. hockey mask).  

The earliest popular historical appearance of a healthcare provider related mask is probably the bubonic plague outfit worn by the physicians (Figure 2) working during a time before germ therapy. Those physicians in Venice may have simply needed to minimize putrid smells encountered during treatment of plague victims but, perhaps, also realized (recognized or not) protective benefits from the beak like appearance of the mask.  

It is unclear what symbolic structures prior masks have held among the wearers and the human groups of the past. However, we do now that, currently, a seemingly functional mask has also taken on a symbolic life. Our current Covid related mask debate befuddles many who can’t understand why everyone won’t simply apply a harmless and essentially no cost piece of fabric to their face that at best may save a life and at worse may be slightly annoying and smelly. However, we can look to the ongoing debate around firearm policy in the United States to inform the intense reaction many have to government mask ordinances meant to protect vulnerable peoples and allow businesses to stay open when virus has reached a triggering density in the community with concomitant asymptomatic spread.  

 Physician and social scientist Jonathan Metzl writes about the symbolic life of firearms, gleamed through his long-term ethnographic interviewing of, mostly white men, gun owners as well as analysis of gun policy in different states and throughout the history of the United States. Metzl has examined the sociopolitical context surrounding firearms and, specifically worked to uncover “links between guns and larger scripts about identity, bias, racism, nationalism.” 

What do guns mean when they are not shooting bullets? Guns denote strong feelings around protecting home and family, a sense of duty and conviction to make your community safer. There is a disconnect between gun rights advocates and public health models focused on reducing firearm related injuries through more restrictive gun buying and ownership policies. Certainly, this must be a tainted public health model that reduces gun ownership given that gun ownership is associated with duty, conviction and protecting? This disconnect introduces suspicion of bias towards medical groups and public health organizations (who bemoan the NRA led restrictions on public financing of firearm violence research that existed up until very recently). Metzl feels that firearm researchers do not help themselves when they fail to communicate with communities where there are a lot of guns.  

For gun owners, guns are a form of selfhood, representing family heritage, bonds between neighbors, hobbies and activities and ways to bond with children. Taking those guns away takes away the family and those customs – that selfhood is robbed. In themes common with Case and Deaton, the changing economics of white men – challenged by increasing opportunities for women, policies that end racism, real declines in wages when compared to college educated individuals, we observe a remaining sense of identify that becomes increasingly critical to hold.  

As power tilts away from rural communities and less educated urban white areas, deep knowledge around firearms may create a way to “get back”, by carrying guns to “instill fear particularly among urban and educated elites who hold the levers of power and status in society today”. Note also the ability to code white man machismo into identify through imagined pasts of 20th century cowboy inventions of a non-existent 19th century reality (Metzl allows that guns were an important aspect of American westward expansion but not in the John Wayne style way created for Hollywood movies). This leads to racialist thinking (consider a black man holding a gun compared to white man carrying a piece) of “white good guys to protect against racial others” (e.g. carjackers, “thugs” vs. patriots, potential scenarios hinting at blackness instead of actual threats).  

When we take on guns (or masks) symbolically, we are able to get at questions that address these symbols that may seem counter-intuitive, that allow us to get at identify and to better understand stereotypes.   

There were mixed messages around mask wearing early on during the Covid Pandemic when the first cases started to appear in the United States in February 2020 and then increased in prevalence throughout the early spring. Anthony Fauci (a symbol in his own right) stated that mask wearing was probably not necessary on a 60 minutes episode (March 8). However, at that time, the devastating events in NYC had not yet occurred nor had the widespread levels of asymptomatic spread throughout multiple communities in the United States that became apparent in late spring. In the initial phases of this pandemic, the response by most people was largely apolitical. However, as mixed messages propagated and President Donald Trump either grew bored or decided to become biologically resistant to the virus, politics began to creep into the language and identify of facial coverings. By the time that the CDC revised their mask recommendation in April 2020 and Fauci suggested the public should wear facial coverings on April 2, the American public had already begun to split on the importance and acceptance of wearing a facial covering.  

Leadership matters and leaders can be both political and cultural leaders. Imagine for a moment a message from President Trump (and Governor Desantis here in Florida) that suggested individual responsibility for ensuring the economic viability of this country. Stephen Taylor (author of Psychology of Pandemics) writes that if you would have told people mask wearing was patriotic, they would have rushed out to buy a mask. However, early language from the President framed mask wearing as an individual choice, a choice made by liberals who were scared of an unseen, silent threat. This posturing made mask wearing both a political issue and a cultural phenomenon (Figure 3 and Figure 4).  

President Trump identifies with many of those same people concerned with gun restrictions and increased firearm restrictions aimed at protecting public health. Echoes of suspicion regarding public health interventions and models also enter into the discourse with daily discussions surrounding whether the prevalence of cases is really going up, whether the prevalence of cases even matters, whether the virus affects old people or young, whether there is a conspiracy by elites to collect more money by inflating hospital billing amounts, whether the death rate is overestimated secondary to under diagnosis and whether the movement of the virus through our country is really a Democrat electioneering campaign to ensure that President Trump loses the 2020 election.  

Just like carrying a gun identifies manhood and identify, wearing a mask may feminize the wearer playing off those same machismo representations. In addition, ungrounded biophysiological hypotheses have been put forward suggesting that mask wearers have low oxygen levels and may retain exhaled carbon dioxide (even though medical workers often wear masks for hours and careers at a time). Conservative Laura Ingraham furthered suspicion around public health, science and the manliness of mask wearing, stating that “social control over large populations is achieved through fear and intimidation and suppression of free thought” and “conditioning the public through propaganda is also key, new dogmas replace good old common sense.”

Language used by face covering supporters, like Fauci and similar to communication issues between gun owners and firearm safety supporters, has not helped. Fauci stated that he wears a mask “as a symbol for good behavior” – essentially, for Ingraham and her listeners – code for indoctrination into tainted liberal public health models (Figure 5).  

So, now, in this view, wearing a mask invokes images of male indoctrination into a feminine submission, lack of individuality and a following of liberal elite scientific conspiracies – the same conspiracies and the same public health models that threaten to take away guns (or, in reality, to improve firearm safety). These concerns about the image of a man in a mask haven been furthered by the President who apparently did wear a mask when visiting a Ford plant but took it off before being giving photographers the “pleasure” of seeing him in a mask. In addition, both the President and some Republican governors have refused to issue federal or state mask ordinances as Mr. Trump has specifically said that his administration recommends face coverings while downplaying the seriousness of Covid spread and adding numerous times in the past that he would not be following his own recommendation to wear a mask. The President sets the tone of the White House as well (culture with the little ‘c’) as reporters and other visitors to the location have noted that most staffers and secret service agents do not regularly wear any type of face covering.  

Interestingly, symbols of a different America are clashing with epidemiological and clinical reality as Republican governors are facing some of the most concerning recent rises in coronavirus cases during the second half of June until present. Responding to this, trendsetters like Mitch McConnell (you will never see that phrase in any other context) have intentionally been seen in a mask in order to help alter the existing imagery and associated symbolism (Figure 6).  These cues may be too late though as symbols become integrated into ritual and regular cultural behavior quickly growing inseparable from an already developed identity.  

References:

1. Victor Fuchs: Who Shall Live  https://www.amazon.com/Health-Economics-Social-Choice-Expanded/dp/9814354880 
2. National Geographic. 9,000 year old masks. https://www.nationalgeographic.com/culture/2018/11/neolithic-stone-mask-discovery-archaeology-forgery/ 
3. Sapiens Podcast https://www.sapiens.org/podcast-season-3/ 
4. Venice’s Black Death https://www.discovermagazine.com/planet-earth/venices-black-death-and-the-dawn-of-quarantine 
5. Jonathan Metzl. What guns mean: the symbolic lives of firearms https://www.nature.com/articles/s41599-019-0240-y 
6. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html