Op-Ed: Quarantine Fatigue Is Overtaking Us. We Could Have Done Better.
People are getting bored and longing for human contact. We should have guidelines that recognize this.
I’ve spent the majority of the last decade lecturing and consulting on the motivational factors that drive human behavior through the prism of behavioral design and gamification. Most of this work has been in service of industry, civic engagement, and health.
One of my consistent observations has been the terrible way most “hard” scientists communicate with the public, and how their lack of grounding in behavioral science undermines their efforts. This is particularly apparent in the discourse around environmental behavior change, where well-intentioned experts have fostered a culture of nihilism in the populace. They don’t seem to understand that saying “the world is going to end in 12 years” will cause a substantial percentage of people to respond with “might as well get while the getting is good.” This idea, closely related to The Tragedy of the Commons, is taught in first-year psychology and sociology university courses, but seems to be routinely ignored by climate scientists and advocates.
We see this tension playing out now in our approach to the coronavirus. This time, however, politicians and the social media mob have joined the fray — with a marked lack of insight about how people behave.
I thought it might be instructive to look at some of those issues, as they will only increase in seriousness over time. Most of what ails the world today is driven by human behavior. There will be more calamities, more crises, more panic. Science must learn how to persuade if it is going to be a force for good.
The need for physical touch is ingrained in most humans from an early age, and there is a lot of research to back up the deleterious effect of an absence of it in social-emotional development. One-hundred twenty million Americans went into quarantine alone, and many of them are starved for minimal necessary physical affection. Most public health messaging has reinforced “absolute social distancing” without any consideration for the human need for touch. Only a few weeks in, a backlash began to emerge.
Hookup culture — which took a brief holiday at the outset of the crisis — is making a comeback, and people seem shocked and outraged by this inevitability. Unfortunately, public officials have pushed people’s need for sex and affection underground through their high-anxiety, “don’t touch anyone” approach. We learned in the early AIDS crisis (and indeed during Prohibition) that this strategy backfires spectacularly, so why are we repeating this mistake now?
The human sexual/affective drive is so powerful that it easily overrides people’s willpower and best intentions. It is also triggered and heightened by stress or anxiety in many of us. Consider the number of unplanned pregnancies, HIV infections, and STI rates as prima facie examples of both conditions. You cannot reason or rationalize with it, and stigmatizing it just makes it hotter, further driving the behavior. This Forbidden Fruit Effect (or Prohibition Paradox) is undoubtedly not in the public interest and must be addressed in the future.
Do Over: Sex and affection should be included in any future social distancing or pandemic protocols. Specific suggestions or instructions for users would be helpful (for example, do this, avoid that) and guidance on how to “contour” risk (for example, serosorting in HIV) would be best for harm reduction. Moreover, single and dating people should be encouraged to practice “monogamy” with one partner, even if not a spouse. Others should be given concrete advice about how to meet affective needs while minimizing risk (for example, how to hug safely versus not hugging at all).
Most public health messaging has reinforced “absolute social distancing” without any consideration for the human need for touch.
Shame and stigma
Leaders, such as Los Angeles’ feckless mayor Eric Garcetti, have encouraged the use of stigma, snitching, and shame to change behavior in this pandemic. On social media, individuals and influencers seem outraged by people going to farmers markets, jogging, or gathering in small groups even if these behaviors are not explicitly prohibited where they are taking place.
I have personally been a part of a number of (appropriately socially distanced) small gatherings since this pandemic began. In every case, we have been compliant with the current guidance of our county. One consistent thing about these meetings is the general agreement not to post about them on social media. People don’t want to be shamed or have to explain themselves, even though they are making an appropriate personal risk calculation with eyes wide open.
Some amount of shame and social stigma can be highly effective at ensuring group norms are met. However, if society adopts a more absolutist and judgy posture about such activities, the likely response from people will be to do it but keep it on the DL. Many personally risky strategies — such as eating fast food, having group sex, doing hard drugs, or voting Republican — are frowned upon to the point that people obviously lie about their behavior. But ask yourself this simple question: When was the last time someone posted positively about their meth use on social media, and how does that correlate with a reduction in meth use? Spoiler: It doesn’t.
There is a large gap between people’s presentation of themselves and what they actually think and feel. The more structured and prohibitive a society, the wider this chasm becomes. Self-Enhancing Transmission Bias is one cognitive framework for thinking about this yawning space between intent and reality. Another might be the Curatorial Effect, an observation that people selectively post on social media to make their lives seem better, happier, wealthier, and more polished.
And just as we learned in 2016, people will often say one thing to a pollster, and do another thing entirely in the privacy of a voting booth. Make no mistake, this reality has major negative implications for public health.
Do Over: Next pandemic, more specific guidance about acceptable and unacceptable social gatherings would provide a better framework than an outright prohibition. Officials should be more explicit about the need to not criticize others and must provide a mitigation framework that people can work with. Encouraging honesty and transparency — rather than just compliance — will make it easier to shape behavior and improve outcomes.
A common mistake that scientists make is to underestimate the propensity for boredom.
Boredom and restlessness
The first few weeks of quarantine probably felt like a holiday for most working folks. And then, reality began to creep in, and confinement only heightens ennui. Trapped with the same people, doing the same things, over and over again, will provoke any person to reach their wits’ end. And while some amount of distracting entertainment — such as Netflix or multiplayer games — can temporarily alleviate this issue, they are no substitute for meaningful social and professional challenges rooted in mastery and intrinsic interest.
Eventually, social distancing norms run the risk of being undermined simply because people are too bored at home. A common mistake that scientists make is to underestimate the propensity for boredom. This is reflected in the fact that most behavioral studies are brief, rather than long term. Humans are novelty-seekers, and the evidence abounds that we are bad at short-term sacrifice for long-term gain. No matter how negative the consequences, sufficient boredom and disconnection can drive people to madness and/or outrageous behavior. And no matter how distractive an activity, eventually you will want a distraction from the distraction to stay engaged. Think about it: We use multiple screens during TV viewing, or pick up our phone while having a fun dinner with friends. Consider why some people cheat on their spouses, and what prompts others to leave secure, stable, and predictable jobs?
Do Over: The government should have a list of activities at the ready to disseminate to individuals and families for quarantine times. These could include volunteering, research, or other learning and civic engagement opportunities that parents and kids could both do during their time social distancing. We should not solely rely on the private sector or individuals to provide meaning here, and we must acknowledge both boredom and restlessness in any protocols we attempt to enforce.
Anxiety and mental health
Events like a pandemic or large-scale terror attack, particularly when there’s little clarity about the scope, tend to cause anxiety. People don’t like unknown durations, risks, and consequences. Over time, our anxiety around not knowing leads to raised cortisol levels, which pose a well-established health risk.
And for those on the front lines, or dealing with the loss of a loved one, career, or critical social outlet, this kind of event can even contribute to PTSD. Many in this situation will require major support after the crisis has subsided, and probably for years to come.
But the damage may have more far-reaching effects. If people primarily remember the discomfort of the 2020 Covid pandemic in future crises, they may be more unwilling to make similar sacrifices again. If social distancing and other protocols are effective, one would expect people to act rationally and repeat these behaviors as necessary. However, humans are more fearful of loss than desirous of gain — a phenomenon known as Loss Aversion. If the psychological toll is too large this year, it will make it more difficult to get people to quarantine again.
Do Over: Governments should include mental health and anxiety in the list of things that need bailouts and support, and form a national strategy for dealing with these issues in light of potential future crises. Additionally, it would be better to speak of time horizons in manageable chunks so people can see a “light at the end of the tunnel” following their sacrifices. States appear to be quickly glomming onto this idea, with “phased” reopening plans — but these should be further rooted in timelines.
Ultimately, public health lives at the intersection of the behavioral and epidemiological sciences. As we’ve learned from the Covid crisis, it also involves a(n unhealthy) dose of political science. These three (somewhat) disparate groups should really get together and adjust protocols and messaging to maximize positive mental health outcomes and adherence to necessary measures.
Our current way of dealing with these crises should have improved after the early days of the AIDS, crack, and opioid epidemics. But many of the histrionics we’re seeing on display now — as then — didn’t serve to “flatten the curve” because long-term behavioral adherence was elusive. Let’s learn from this experience and use behavioral science to uncover what actually works. Instead of reacting out of panic, let’s have a plan.
And let’s ensure that plan can be followed by the citizens it purports to protect. Unless we design protocols that honestly account for human behaviors, we are doomed for a repeat.