Understanding the Choice Not to Mask

by Alexandra Brewis and Amber Wutich

Currently around the U.S., fewer and fewer people are wearing face masks in their everyday lives. Many schools, public events, and businesses already have—or very soon will be—mask-optional. Overall, the fear of coronavirus is declining, in the wake of the Omicron surge. Feelings of fear around coronavirus and mask use are closely related: The former certainly sustains people’s willingness to mask up when asked to.

A new book released this week provides a cogent and detailed case study of how people navigate the complexities of what they should fear and try to avoid. And it shows how social judgment can sometimes prove a more powerful tool in shaping health behavior, at least when balanced against public health recommendations.

Okoboji is a popular warm-weather getaway location on the Iowa Great Lakes. The town’s population peaks in summer, when boating and nightclubs combine to create a party atmosphere. Before Memorial Day holiday weekend in 2020, county residents had eight reported cases of coronavirus infections. After the boating and unmasked partying along the lakeshore that long weekend, cases spiked. Many of the resulting county cases seemed to have been passed along in packed bars and restaurants to unmasked staff—who themselves partied together on their Tuesday off-day after the tourist influx. The further wave of out-of-town visitors on July 4, in the middle of summer, also certainly brought many more cases in the county, and many of those cases traveled around the state after the holiday weekend.

Georgetown University medical anthropologist Emily Mendenhall has spent a career doing detailed studies that examine why people react to disease as they do. Much of her prior attention has been focused on how people respond to chronic diseases like diabetes in places like India and South Africa. But Okoboji is Mendenhall’s hometown, and her annual summer stay in mid-2020 spurred her to investigate health behaviors closer to home: Why were so many people in the tourist town—in the middle of a serious wave of coronavirus infection—deciding that the health threat wasn’t real? More particularly: Even though many people took COVID seriously that first pandemic summer, what drove so many long-term residents to never mask against COVID, even in frontline jobs that placed them and others at the likely front line of infections?

Mendenhall interviewed people from all different walks of life: restaurant workers, churchgoers, lawyers, business owners, and medical professionals, all of them working to understand what was happening and balancing the best way to respond. The interviews included her own brother-in-law, who was the physician managing the town’s public health response.

Many residents explained how they believed strongly in individual responsibility and rights, a deeply held set of values embedded in contemporary myths about the midwest frontier. Iowa’s motto—adopted in 1847—also concurs: “Our liberties we prize and our rights we will maintain.”

For many of those Mendenhall interviewed, scientists and other medical experts were viewed as “outsiders” telling them what to do. Mask-wearers were described as “blueberries in a can of tomato soup”—obviously sticking out. Being told what to do by outsiders just didn’t sit well with many residents; the very act of wearing a mask was seen by many as choosing outsiders over their own neighbors or fellow churchgoers.

For anthropologists like Mendenhall, who seek to understand people’s actions in their own terms, masking in Okoboji was experienced as a matter of fear, but not in the life-or-death sense due to embedded public health messages promoting masks as a means to reduce harm from COVID-19. People feared not fitting in with the group and therefore becoming an outsider in a community that was very much focused on the economy as opposed to the pandemic. One friend told her that she rarely left her home during the summer of 2020 because some people would shame her for wearing a mask and others would shame her for not wearing one. In Okoboji that chaotic summer, being unmasked (or unvaccinated, too) felt safer for many residents.

Such detailed studies as discussed in this new book, Unmasked, exemplify the ways that seemingly contradictory health behaviors can be explained through how people live with others in their everyday lives. Although the risks of COVID-19 are currently waning in Okoboji as elsewhere, it also provides a cogent explanation and reminder as to why fear is never a straightforward emotion when it comes to how people manage their health decisions.