Viewpoint

The sociological eye means looking at things for what they are, as best we can given the blinders of interest and ideology, of cliché and ritualized belief. It is not an individual enterprise. Chaining our efforts together as a long-term network of theorists and researchers improves one’s own sociological vision, provided we make the effort. The sociological eye holds up a periscope above the tides of political and intellectual partisanship, spying out the patterns of social life in every direction.

Thursday, July 2, 2020

SOCIOLOGY OF MASKS AND SOCIAL DISTANCING


Throughout human history, people have generated almost all of their solidarity face-to-face, by physical co-presence. This has been disrupted by a world-wide natural experiment: making people stay home, avoid public gatherings, avoid interacting with strangers except when wearing masks and staying six feet apart.

Since the publication of Interaction Ritual Chains (Collins 2004), the issue has been discussed whether mediated forms of interaction, especially electronic communication in real time,  substitute effectively for face-to-face (F2F) interaction. On the whole, this literature has found that electronic media do not substitute for it, but instead supplement it. Studying cell-phone use, Ling (2008) found that persons tend to call the same people that they normally interact with, and much of what they communicate is where they are and how they can meet. He also found there is some feeling of social solidarity-- personal belonging-- in talking over a mobile phone, but that it is a weaker feeling than F2F. This may explain why cell-phone users spend much more time telephoning than traditional land-line users did; in this respect similar to drug addicts who increase their dose as its effects decline.

Are humans are infinitely malleable, entirely determined by social construction, so that we become acclimated to whatever is “the new normal” (perhaps with a measurable time-lag)?  Or is it that technologies become increasingly better at ferreting out what kinds of things happen in F2F interaction, that can be mimicked electronically? My review of currently availble evidence is carried out with these questions in mind, along with a third possibility: that some features of F2F interaction are deeply engrained in the human genome, and that eliminating them leads to resistance and new forms of social conflict.

The Ingredients of Interaction Ritual (IR)

[1] Co-presence:  people are physically near to each other where they can see, hear, and otherwise sense which each other is doing.

[2] Mutual focus of attention: they focus their attention on the same thing, and become aware that they are doing so.

[3] Shared mood or emotion: they feel the same emotion, whether excitement, joy, fear, sadness, anger, boredom or any other.

[4] Rhythmic entrainment: they get into the same rhythm, with voice or body.

Feedback processes take place among these ingredients. As people pay more attention to each other, they tend to converge on a shared emotion and intensify it; conversely shared emotion intensifies mutual focus. As these increase, rhythmic entrainment increases.

Successful interaction rituals (in contrast to failed rituals where these ingredients are missing or weak) have the following outcomes:

[5] Social solidarity. Individuals feel like members of a group, and recognize others as co-members.

[6] Emotional energy (EE). Individuals feel pumped up by a successful interaction ritual; persons with high EE are confident, proactive, and enthusiastic. Persons with low EE are the opposite: they are depressed, passive, alienated. These are the results of failed interaction rituals.

[7] Collective symbols. Durkheim called these “sacred objects”, referring to the emblems, places, books, etc. that are the focus of religious worship; and he extended this to political symbols like flags. Collective symbols include all our ideals and strong beliefs.

[8] Moralities of right and wrong. For any group with successful rituals, the fundamental standard of morality is whether people respect its rituals and sacred objects. The worst offense is disrespect for its emblems; attacking its symbols creates moral outrage. This results in the most heated forms of social conflict, and rituals of public punishment for the enemy group and their symbols. We can see this process in the conflicts that arose during the coronavirus emergency, and in the public demonstrations that spread across the US in June 2020.

In sum, successful interaction rituals are the micro-process that generates almost everything that we refer to as “social order.”  If we  get rid of interaction rituals, or weaken them considerably, what would happen?

How important is physical co-presence?

Co-presence [1], in the scheme as developed by Durkheim and Goffman, is the point of departure. It is when people come together that the other ritual ingredients [2-4] can be brought into action. Can we say, though, that as media become more ubiquitous and mimic more aspects of F2F interaction, social connections become increasingly transferred to media connections while the bodily interactional basis fades away?

Co-presence is important because it facilitates mutual focus, shared emotion, and rhythmic entraiment.  By seeing another person’s eyes and face, and the orientation of their body, you know what they are paying attention to. An exchange of glances communicates, I-see-you-seeing-me, and also I-recognize-what-we-are-both-looking-at. Looking at the other person’s facial expressions and bodily gestures, as well as hearing their tone of voice and its loudness or softness, communicates what emotions are being felt. The James-Lange principle applies here: moving the muscles of one’s face, eyes, and body intensify the felt emotion; also it is triggered and intensified by closely monitoring the other person’s emotional expressions. Not only does running away with the rest of a crowd make you feel more afraid, but shouting happily, or angrily, with others makes one more happy or angry. Rhythmic entrainment is most strongly felt when it is in all bodily channels: not only seeing and hearing, but the proprioceptive feelings in muscles, breathing, heart rate, and bodily chemicals that make an emotional mood a felt experience, not merely a detached cognition. These kinds of embodied experiences are the glue that creates moments of social solidarity.

What happens when people are prevented from bodily F2F encounters, or are restricted to a small number of sensory channels?


Masked social distancing in public

Here we have a partial restriction of the ingredients of IR: people are bodily co-present, but the F2F aspect is greatly reduced. Masks cover the mouth and lower face, making it harder to recognize emotions, as well as harder to hear what the other person is saying. Thus we would expect shared emotion and mutual focus of attention would be harder to attain, IRs would weaken, and solidarity decline.

Nevertheless, what we find in observing people on the streets was the opposite, at least for a period of time. Simmel’s theory of solidarity through conflict says that when a group is shocked by a enemy-- we can widen this to a natural disaster or other shared emergency-- solidarity goes up. I tested this immediately after the 9.11.2001 attacks [Collins 2004a], and found that it has a time-pattern: using the display of American flags as an indicator, the pattern looked like this. After the first few days of hushed uncertainty, people started putting up flags on windows and cars; this reached its maximum within two weeks. It stayed at a plateau for 3 months, a period during which there were also repeated displays of flags and ceremonies honoring police and firefighters killed in the attacks. After 3 months, articles starting appearing discussing “can we take our flags down now?” Political controversy, which was almost entirely stifled during this period, started up again. By 6 months, the level of flag-display had declined by more than half, with a long diminishing tail thereafter.

In the US, public alarm over the coronavirus surged about March 16, when schools and gyms were shut down. By March 20, many states had ordered people to stay indoors. Wearing masks away from home became a requirement in the next two weeks, delayed because of shortage of supplies and controversies over effectiveness. Effective or not, wearing masks now became a social marker of joining the effort against the epidemic, along with keeping 6 feet away from other people. I anticipated that this period of solidarity would last no more than 3 months. Since the period after 9.11.01 had many public assemblies, often highly emotional, honoring the heroes of the attacks, whereas in 2020 public assemblies were prohibited as dangerous incubators of the epidemic, I expected the period of public solidarity would be shorter, probably 1 or 2 months.

For several years I was in the habit of walking or running for a half hour or more almost daily in my neighbourhood or public parks, and thus have a baseline for normal street behavior. By early April (about 2 weeks after the lockdown began), I noted that the number of people out walking was up by a factor of two or three from the pre-epidemic period; people deprived of exercize had found something they could do. Soon almost all walkers were now wearing masks, and when meeting others on the sidewalk, one or the other would step out into the street to maintain distance. When doing so, almost everyone waved or called out a friendly greeting. The main motivation would be that deliberately avoiding someone would be a mark of fear or an insult; so we countered that by a friendly wave or greeting. This is also Simmelian solidarity. It is clearly related to the onset of the shared emergency; in my walks in previous months and years, I would estimate the proportion of F2F encounters on the street where there was a greeting was less than 20% (chiefly among older people; noticably absent among the young). 

The time-pattern of decline in Simmelian solidarity was the following: By late April (one month after the lockdown), the number of people out walking had noticably increased. The proportion of people greeting each other declined; this was particularly true in areas along the harbor or ocean-front (the beaches and parks being closed and patroled by guards); perhaps there was the beginning of a tone of defiance. Younger adults in particular were ignoring social distancing; and friendly waves or greetings were absent (including towards each other).

I began to make systematic counts of how many people were wearing face masks, distancing, and greeting. My focus was on adults who were walking on sidewalks or streets (children at this point rarely wore masks). I did not count runners or bicyclists, since they almost never wore masks-- a constant pattern from this point onwards. This may be due partly to decreased lateral visibility, but especially to difficulty breathing when doing heavy exercise. I did not count gardeners or other outdoor workers or delivery persons: the latter usually wore masks (as they worked for bureaucratic organizations that demanded it); manual workers usually did not, nor did they practice social distancing among themselves. One can see here a social class divide in the observence of social distancing etiquette. For walkers, the height of symbolic solidarity (mask-wearing and greetings) was in April; during May the proportion wearing masks gradually declined, as did greetings when social distancing (very noticable around May 22-23).  For this period, a Gallup poll reported 1/3 each said they always, sometimes, or never work masks outdoors (New York Times June 3, 2020); given the desirability bias in surveys, the mask-compliant numbers are probably exaggerated.

A sharp break occurred in the first week of June, as Black Lives Matter protests and marches broke out. This was 10 weeks after the lockdown began. During the most militant period (the first 4-5 days), when many protest demonstrations were accompanied by burning, property destruction, or violence, photos indicate that few protestors wore masks, and participants massed close together. This happened despite official warnings that big assemblies, especially when shouting and chanting together, broadcast the virus. A rival source of Simmelian solidarity had been created, and it overrode the already-declining solidarity rituals of the social distancing etiquette. Most of the participants in the protests were young (as one can see in news photos); young people already were largely ignoring social distancing, and signs of solidarity among the young in ordinary public street behavior had been low. They were further IR-starved by the banning of sports and concert participation as audiences, or even as performers. The predominant participation of white youth in the protests (in most photos far outnumbering minority participants) were at least in part the response to the sudden opportunity to regain experiences of mass solidarity. Police violence and other grievances have been long-standing [https://sociological-eye.blogspot.com/2020/06/seven-reasons-why-police-are-disliked.html, but why have protests mushroomed now?  The timing of these unprecedentedly widespread protests throughout the youth cohort is also connected to their intensified alienation in the social distancing regime, as I will document in the next section.

In subsequent weeks, as protests became smaller, photos show participants more often spread out, maintaining social distancing (also no big crowds) and at least half wearing masks. This is probably the effect of being more deliberately organized rather than spontaneous, with organizers and (mostly white middle-class) participants making a conscious effort to present a good appearance by following official coronavirus etiquette.

In California, parks and beaches were opened up again around June 10, along with reiterated regulations on masking and social distancing. My observations for pedestrians June 10-27:

Totals for public parks: 54 of 267 wore masks (20%); 3 greetings (6% of mask-wearers, 0% of unmasked).
for neighbourhoods: 23 of 91 wore masks (25%); 15 greetings (43% of mask-wearers, 9% of unmasked).

Those who continued to wear masks showed some solidarity (although declining over time) by greetings; this was more likely in residential neighborhoods (at least middle class) than in public parks, where greetings had largely disappeared.

Occasional conflicts were observed, in the following pattern (mid-June):  middle-aged woman says to an unmasked woman approaching her closely: “Could you please stand back? Where is your mask?” Reply: “Don’t be rude!”  It appears that both sides felt collective morality is on their side: a formula for intense social conflict. News reports a month earlier  noted an upsurge of confrontations between maskless shoppers who grew angry when retail store employees who told them to wear masks; violent incidents however were rare. (Wall Street Journal, May 18, 2020) We have no trend data on conflicts over masking, so we don’t know whether this was just a transitional pattern.

When everyone is wearing masks, it becomes more difficult to hear what people are saying; also some of the cues that we use to fill in likely words are missing because we cannot see their mouth and facial gestures, nor can one use facial feedback from the listener to correct one’s articulation. Thus masked interactions even in ordinary utilitarian situations give rise to misunderstandings, raised voices usually associated with anger, and sometimes gestures of annoyance. I have observed this frequently in grocery stories. Anything that limits multi-modal interaction takes it toll, even in situations where solidarity mainly takes the form of routine civility.

Family Solidarity

Also on the positive side, it appears that at first solidarity increased, at least for some family members. Children of elementary school age and younger seemed happy, as they had more time with parents and attention from them. I observed a large increase in families bicycling together on neighbourhood streets (seldom seen before the epidemic); since bicyclists rarely wear masks, and children at this time never did, one could see that their expressions were on the whole happy. It is unlikely that teenagers were similarly affected; I almost never saw them bicycling or walking with adults in neighbourhoods or parks. Not surprisingly, as teen culture is mostly concerned with being independent of adults, and being seen with parents is a status loss except on formal occasions (Milner 2016). Given that teens were prevented from gathering (I only occasionally saw teens out together, and hardly any male-female young couples other than parents), I would predict that data on the level of alienation and anxiety among teenagers would increase for this period. Even though teens are the most media-connected and media-obsessed of all age groups, they are the ones least likely to find it a compensation for a further drop in F2F experience.

On the negative side, doctors report an increase in child-abuse cases, although official statistics show a decline (all attention being focused on COVID-19). [San Diego Union-Tribune June 5, 2020] A national child-abuse hotline reported a 20% increase in calls and 440% increase in text messages over the prior year [Wall Street Journal, May 19, 2020]  The stay-at-home situation is favourable to some, perhaps most families with adequate space and resources; where there is family tension, isolation increases abuse, as has long been established [Collins 2008: 137].  Psychiatrists interviewed generally regard remote video counseling as less effective than F2F, especially the difficulty in reading emotions and conveying empathy [San Diego Union-Tribune May 18, 2020]. A national survey carried out in May found that reports of clinical symptoms of depression had doubled (compared to a 2014 baseline) to 24% of the US population; depression was especially high among young adults and women, even though they were less vulnerable to COVID-19 [Washington Post, May 27, 2020]. But embodied social interaction in the smartphone generation was already in decline, especially among teenage girls [Wall Street Journal, August 17, 2019]. By 2018, American teens were spending 6-to-9 hours daily on-line. Since 2007, time spent on seeing friends or going out in public had fallen sharply, as did dating. In 2019,  36% of girls said they were extremely anxious every day.

We have no data on sexual behavior during this period. Likely the birth rate will spike 9 months after the onset of the epidemic. On the other hand, monthly marriage rates must surely drop, as will the frequency of sexual behavior among couples of all kinds; casual hookups as well as commercial sex likely will be found to drop drastically. (I have very occasionally seen an unmasked male/female couple necking in the park; formerly active gay pick-up areas look deserted.) Sexual activity had already declined in the Internet generation; in 2018, 23% of Americans age 18-29 had no sex in the previous year, doubling the percentage of sex-less lives in the pre-social-media 1990s [Wall Street Journal, May 18, 2019]. Looking for a bright side in the coronavirus shutdown, The Wall Street Journal (May 30, 2020) touted “Distancing Revives Courtship,” an interview-based story of how dating has gone on-line, returning to almost Victorian manners, at best watching each other on-line drinking a glass of wine (definitely no touching). If sex is a form of solidarity, it must surely decline among those who do not already have intimate live-in partners. The same would be true of ordinary fun involving any kind of physical activity together. Research may well find that social distancing makes little difference to upper-middle class professionals whose social gatherings consist entirely of conversation or playing cards, but more active persons would likely feel deprived. This is one reason why after bars re-opened in late June 2020, these suddenly crowded venues (photos showed an absence of social distancing and mask-wearing) became hotspots for coronavirus infections. In the tradeoff between lively sociability and risk of sickness, many choose the former.

Remote Schooling

By all accounts, this has not been very successful. Leaving aside issues such as the extent of the school population who lack internet access; and schools adopting a no-grading policy; we find that on-line schooling has a negative effect on student motivation.  On-line daily absences of students who don’t log in are 30% or more; surveys find there is little interaction with teachers; 50% of students said they don’t feel motivated to complete on-line assignments. [Wall Street Journal, June 6, 2020] Teachers complain they can’t read the body language of students and can’t pick out cues for whom to engage with at what opportune moment. I have watched my 8-year-old grandson during on-line classes; these usually last less than half an hour, while the teacher goes over the assignment in a pleasant voice, talking to no one in particular. He spent the time playing with a slinky held beneath the level of the screen.  Posts on Reddit by college students showed: students complained about noise from parents or siblings while they were trying to hear a lecture or take an exam. [San Diego Union-Tribune May 23, 2020] Some students said they liked not having to go to campus, since they did not need to find a place to hang around between classes; apparently these were students who did not live near campus, or who had jobs. One student said he liked being able to watch a lecture while doing his homework in bed; on-line viewing reduced the need to pay attention. But we have no baseline of how much students normally pay attention in class (usually they pretend to, but often their laptops are not being used for taking notes, as any teacher can observe by walking around the classroom). We cannot assume that F2F classrooms are automatically successful Interaction Rituals.

Some college students complained about the anti-cheating protocol during a virtual exam, where they were required to keep their face and hands visible on the webcam at all times. Other Reddit posts said they felt isolated at home, missed their school friends, and were generally apathetic and unmotivated. This suggests a divide between students who are entirely utilitarian in their orientation, and those for whom school is a social experience. Hypothesis: grinds like on-line learning, party animals don’t; those who value networks, whether intellectual or career, also miss personal contact even though it consists in more than fun.

Besides passive feelings of alienation and deprivation, some students actively took the opportunity to counter-attack. Some coordinated on-line pranks with fellow-students, such as simultaneously switching off their cameras so that the teacher finds oneself suddenly alone surrounded by blank rectangles. Others organized campaigns to destroy the ratings of apps such as Google Classroom. [Wall Street Journal, June 2, 2020] Others hacked into Zoom conference calls, playing loud pop music, shouting insults and obscenities, or inserting pornographic images on the screen. [Washington Post April 5, 2020; Associated Press April 8, 2020] Mass rebellions by students in classrooms against unpopular teachers are not unknown in the past; but they were rare. On-line hacking may be a mixture of pranks, fun, alienation, or hostility. The comparison shows that interactions in person result in more conformity, a  Goffmanian front-stage show of respect for the situation, and thus at least a mild form of solidarity. This social pressure or entrainment disappears at a distance; violence, too, is difficult to carry out F2F, and much easier at a distance, above all when there is no reciprocal view of each others’ eyes. (See Collins 2008, especially pp. 381-87 on snipers, whose mode of killing hinges on seeing their target through a telescopic lens but cannot be seen by them.) It is reciprocal eye contact that generates intersubjectivity and its constraints.

Working Remotely

There is disagreement whether working remotely is effective. Some people prefer working from home. What they like about it are: no commuting; reduced meetings which they feel are a waste of time; and fewer distractions in the workplace. Some dislike working at home; what they dislike are more distractions in the household; less team cohesion; and technical and communication difficulties. (Wall Street Journal, May 28, 2020: based on a survey of hiring managers) Similar points were made by the head of a state judicial unit, who emphasized that much additional time by management personnel was now spent on meetings, and attempts to keep up morale by remote contact; meetings were often frustrating because considerable time was wasted trying to get the communications technology working for all participants. (repeated interviews during March-June 2020)  She sometimes went  to her office in order to use secure communications, and found it refreshing whenever encountering a colleague in person. Efforts to re-open court business, with social distancing and masking precautions, were welcomed by part of the staff and opposed by others. The characteristics of one group or the other are unknown; a hypothesis is that the those more committed to their career and professional identity want to return to their customary work setting; those for whom work is more of a routine prefer to stay home.

Hollywood film professionals said they liked spending less time on planes flying around the country; and less high-level meetings which they considered more habitual than necessary. [Los Angeles Times May 3, 2020] One producer said: “I don’t think video conferencing is a substitute for being in a room with someone, but it is better than just talking on the phone. There are so many ways you communicate with your expression... when it’s delayed and small, you just lose all that. My feeling is it’s 50% as good as an in-person meeting.” [p.E6] In the actual work of making movies, most emphasized that it is a collective process, and some insisted that spontaneous adjustments on-set were the key site for creativity. They also reiterated the point that live audiences are the only way to reliably tell whether a film is coming across, and larger audiences amplify both comedy and drama (i.e. via emotional contagion).

Some businesses have tried to compensate by having “virtual water-cooler” sessions several times a week, where any employee can log in and chat. It is unclear what proportion took part,  how enthusiastically, or with what pattern over time. Some managers reported that company-wide “town-hall meetings” to reassure employees lost interest over time [Wall Street Journal, June 6, 2020]. DiMaggio et al. (2019) however, found that on-line “brainstorming events” for employees in a huge international company were consonant with some patterns of interaction rituals; this research was carried out in 2003-4, long before the epidemic. The degree of involvement and solidaritly in town-hall meetings is a matter of scale; the court administrator reported that feedback about morale was positive after on-line sessions involving group of around 10; but in larger groups it was hard to get a Q&A discussion going. This is similar to what any speaker can observe in ordinary lecture presentations and panel discussions; even with physical presence, most people are reluctant to “break the ice” after the speakers have been the sole center of attention; but once someone (usually a high-status person in the audience) sizes up the situation and says something, it turns out that many others find they also have comments to make. This is a process of micro-interactional attention, which is especially difficult to handle on remote media.

Many managers said that innovativeness was lost without serendipitous, unscheduled encounters among individuals. [Wall Street Journal, June 6, 2020] In a PricewaterhouseCoopers survey, half of employers reported a dip in productivity with on-line work. Longer trends, going back before the coronavirus epidemic, indicate that the promise of on-line work was not highly successful. During 2005-15, the era of the high-speed Internet, the percentage of persons in the US regularly working from home increased slowly;  those working from home at least half-time reached a pre-epidemic peak of only 4%. [www.npr.org/sections/money/2020/04/28/846671375/why-remote-work-sucks] 
During this period several big corporations, initially enthusiastic, tried to shift to primarily on-line work but abandoned it after concluding it was less effective. In the market-dominating I-T companies, the trend instead was to provide more break rooms, food, play and gym services to keep their workers happy on site. This was abruptly reversed in the coronavirus period.

Zoom fatigue

Popular video-conferencing tools such as Zoom attempt to reproduce F2F interaction by showing an array of participants’ faces on the screen, along with one’s own face for feedback in positioning the camera. Reports on how well it works in generating IR-type rhythm and solidarity are mixed. CEOs of high-tech companies tend to claim that it works well. Among rank-and-file participants, however, complaints are widespread and it even acquired a slang term, ‘Zoom fatigue.’ [Wall Street Journal, May 28 and June 17, 2020]  Achieving synchrony with others is hard to do with a screen full of faces, delayed real-time feedback, and lack of full body language. Since there is a limit to how many individual faces can be shown, in larger meetings some persons are seen only occasionally, and leaders looking for responses often find they get none. Some of the ingredients of IR (not necessarily under that name) are now being recognized by communications specialists; these include fine-grained synchrony and eye movements. In ordinary F2F conversation, persons do not stare continuously at others’ eyes, but look and look away (Tom Scheff made this point to me in a personal communication during the 1980s; for detailed transcripts of multi-modal interaction see Scheff and Retzinger 1991). Thus seeing a row of faces staring directly at you is artificial or even disconcerting. Some readers responded with advice: cut off the video to reduce zoom fatigue, go audio-only. Some found hidden benefits in zoom conferencing: once the round of social greetings is over, turn off the video and your mic and do your own work while the boss goes through their agenda.

Continuously seeing one’s own face on the screen is another source of strain. Of course, as Goffman pointed out, everyone is concerned with the presentation of their self, in terms of status as well as appropriateness for the situation. But one does not have one’s image constantly in a mirror; and when interaction starts to flow, one loses self-consciousness and throws oneself into the activity, focusing more on others’ reactions than on oneself. Those who cannot do this find social interaction embarassing and painful.  But enforced viewing of one's own image feels unnatural.

Prolonged video conferencing as a whole seems to have about the same effects as telephone conference calls. In my experience on the national board of a professional association, our mid-year meeting was canceled by a snowstorm, and a 2-day conference call was substituted. The next time I saw the board in person, I polled everyone as to whether they liked the conference call: 18 of 20 did not. Lack of shared emotion was apparent during the event; for example, when it was announced that we had received a large grant, there was no response. No wonder: applause and cheers are coordinated by looking at others, and it is embarassing to be the only person applauding. [Clayman 1993] Work gets done remotely, after a fashion; it just lacks moments of shared enthusiasm.

Assemblies and Audiences

Participating in large audiences or collective-action groups is intrinsically appealing, when it amplifies shared emotions around a mutual focus of attention. This is a main attraction of sports and other spectacles, concerts, and religious congregations; and it is what creates and sustains enthusiasm in political groups and social movements. Thus the ban on large participatory gatherings should be expected to reduce commitment.  Especially vulnerable is the practice of singing together, because it spreads aerial germs more than any other form of social contact. We lack current data on these effects; but the prediction of Durkheimian theory is that religious commitment and belief will fall off as the group is prevented from assembling. How long will this take? Judging from patterns of religious conversion, my hypothesis is that beliefs fall off drastically if there is no participation for 1-to-2 years. When the epidemic finally ends, the level of church attendance will give an answer; during the epidemic, surveys of religious belief on a monthly basis should show a trend-- although allowing for desirability bias (which makes religious surveys overstate religious practice) [Hardaway et al. 1998].

Can technology substitute for collective practices like singing together in a congregation? Some Christian organizations have created virtual choirs, where individuals sing their parts alone and their recordings are compiled by sound engineers; the resulting performance is presented on-line, either showing a series of faces of individual singers, or several faces simultaneously on screen. [interview with international religious organization staff]  Such videos have been widely viewed, and convey the singers’ enthusiasm. It remains to be seen, over a period of time beyond the onset of the world epidemic, whether participation and commitment levels change.

Similar techniques have been attempted for performances of operas and orchestras. [Wall Street Journal, April 27, 2020]  Achieving good sound quality is difficult, since this depends on minute timing and adjustments of volume. (Sound quality of amateur efforts by church congregations is admittedly poor.) Making music together works best when there is a strong beat and repeated musical motifs--- i.e. when there is a pronounced rhythmic coordination, as in successful conversational IRs. More complex music is more difficult to produce by remote coordination. No doubt it will be possible to compare such recordings with conventionally produced ones over the coming year.

When sports events are played without live audiences, can crowd enthusiasm be supplied by canned cheers? There is, in fact, considerable experience over the years with TV broadcasts, including the long-standing practice of laugh tracks in comedy shows. Most listeners find these artificial; research is needed, however, comparing the sounds and laughs audiences make when they are at a live show or when watching it with a sound track. We also know that important games attract enthusiastic fans even when ticket prices are high-- and here TV viewers can actually hear the sound of a live crowd reacting to the action.

What is the extra ingredient of group emotional contagion needed? A natural experiment occurred in March 2013 when a Tunisian soccer match banned fans because of political tensions. [Wall Street Journal, May 27, 2020]  Fans were able to download an app that connected to loudspeakers in the stadium, producing recorded cheering that got louder as more people tapped on their smart phones more frequently. Fans could thus could hear the effect of their own remote “cheering”, and presumably so could the players on the field (although there are no interviews about the players’ experiences). Audience enthusiasm was high, and much local publicity was given to the experiment. The key ingredient is feedback, from one individual fan to another; they were able to monitor how their own action fit into the dynamics of making collective sounds. This feeling of collective participation should be highest, not when sound is kept at a maximum, but when participants can perceive rising and falling levels in accordance with their own actions. This is what happens in real audiences, who can monitor each other in all perceptual channels (such as recognizing when doing the wave is going around the stadium and when it is fading out). If remote-communications technology is to generate the solidarity and energy of embodied gatherings, it is such details of the IR mechanism that must be reproduced.

Summing Up

We can now provisionally answer the questions posed at the outset. Theory of interaction rituals does not disappear; we do not need to invent a new sociology and psychology for the IT era (at least not until robots start replacing human beings entirely, and even then the issue remains to what degree such autonomous robots would incorporate current human qualities). As far as human beings are concerned, political authorities and technological developments may force people to forego much embodied interaction. People are culturally quite malleable, but if that means that after a period of acclimation, we can get used to anything, it does not follow that we can do so without paying a price. If people are deprived of embodied interactions, it is a likely hypothesis that they will be more depressed, less energetic, feel less solidarity with other people, become more anxious, distrustful, and perhaps hostile.


References

Clayman, Stephen E. 1993. “Booing: the anatomy of a disaffiliative response.” American Sociological Review 58: 110-130.

Collins, Randall. 2004.  Interaction Ritual Chains.  Princeton Univ. Press.

Collins, Randall. 2004a.  “Rituals of solidarity and security in the wake of terrorist attack.”  Sociological Theory 22:  53-87.

Collins, Randall. 2004.  Violence: A Micro-sociological Theory.  Princeton Univ. Press.

DiMaggio, Paul, Clark Bernier, Charles Heckscher, and David Mimno. 2019. “Interaction Ritual Threads: Does IRC Theory Apply Online?” in Elliot B. Weininger, Annette Lareau, and Omar Lizardo, Ritual, Emotion and Violence: Studies in the Micro-sociology of Randall Collins. New York: Routledge.

Durkheim, Emile. 1912/1964. The Elementary Forms of Religious Life. New York: Free Press.

Goffman, Erving. 1967. Interaction Ritual. New York: Doubleday.

Hardaway, C. Kirk, Penny Marler, and Mark Chaves. 1998. “Overreporting Church Attendance in America.” American Sociological Review 63: 123-130.

Ling, Rich. 2008. New Tech, New Ties. How Mobile Communication is Reshaping Social Cohesion. Cambridge MA: M.I.T. Press.

Milner, Murray, Jr. 2016. Freaks, Geeks, and Cool Kids: Teenagers in an Era of Consumerism, Standardized  Tests, and Social Media. New York: Routledge.

Scheff, Thomas J. and Suzanne Retzinger. 1991. Emotions and Violence: Shame and Rage in Destructive Conflicts. Lexington Mass: Lexington Books.

Friday, June 5, 2020

SEVEN REASONS WHY POLICE ARE DISLIKED


A theme of protest demonstrations since late May 2020 is that police violence persists despite previous episodes of public outrage and efforts at reform. The problem has not been solved, including by the protests themselves.

Police violence was prominent in triggering the uprisings of the 1960s. The two most destructive riots were both started by police arrests: Newark in June 1967 (26  dead); Detroit in July 1967 (43 dead). In Newark 5 days of riots began after a taxi driver was arrested; in Detroit, when police attempted to raid a popular after-hours club, patrons fought back by attacking police cars; backup was called and eventually the National Guard; fighting with snipers, arson and looting lasted 4 days. The pattern continued in riots over the acquittal verdict in the Rodney King beating by the LAPD in 1992, and a long series of highly publicized cases through the Ferguson Missouri protests of 2014 and down to today.

There have been occasions where police have been adulated; notably in the public ceremonies so prominent in the months after the 9/11/2001 attacks, when police and firefighters were repeatedly honored for their sacrifices at the Twin Towers. On the other side of the ledger, there are a series of reasons why large portions of the public -- not just African-Americans-- dislike the police, and will join in protests against them.

[1] Police are used for collecting fines for municipal budgets. This has been a long-standing practice in speed traps, where heavy fines are levied on drivers, usually on highways outside of town; since locals know where the speed traps are, it falls mostly on strangers (similar to resting your budget on hotel taxes in popular tourist destinations). Cities where there is strong resistance to tax increases, or which have serious budget short-falls, often explicitly adopt the policy of increasing fines for all sorts of infractions. It then becomes the police duty to seek out offenses, however trivial; they are expected to produce at high rates, sometimes with quotas set by police officials (Moskos 2008). This was a notorious practice in Ferguson, where the protests began after police shot a young man who defied an order about walking in the street.

In Philadelphia, Alice Goffman (2014) showed how computerization of court records and police communications has intensified pressure on persons (mostly minorities in the ghetto) who have some kind of previous record. Offenses may range from drugs to violence to gang association; police stops on the street immediately run a computer check in their car, above all for outstanding warrants. These often involve failure to appear for a court hearing, or failure to pay fines, since the penalties for everything include fines. It becomes a vicious cycle as fines mount up. The courts are overburdened, and this combined with attempts to reduce over-sentencing to prison, results in most offenders being released but required to make future appearances and pay fines which they can’t afford. Persons caught up in the system no longer can get a bank account, a legitimate job, or driver’s license -- which generates further fines. Police, as the front-line enforcers of the system, are understandably unpopular. On their side, police also regard the criminal justice system as a revolving door.

[2] Police are used for enforcing unpopular regulations. A long history includes prohibition on alcohol (now mostly passé except for prohibitions on young people); prohibitions on marijuana (ditto). All of these promote counter-cultures of defiance. There have been many examples during the stay-at-home lockdowns during the coronavirus plague. Public parks have been closed, playing ball prohibited, beaches and/or their adjacent parking lots are closed; children’s playgrounds roped off. In many instances, ordinary people find these prohibitions inconsistent or irrational-- areas closed even if people maintain their distance; young people who have heard the statistics and know that their chances of surviving the coronavirus are above 99 percent. It appears that another counter-culture of defiance is building up today, likely to become exacerbated during the phase of opening up public activities under a regime of masking and social distancing. To a considerable degree, this coincides with conflict between age groups.

What many people regard as trivial offenses can escalate when officials enforce the rules. In San Diego, a black man walking his dog in a state park (actually the old Spanish settlement) was accosted by park rangers; when he refused to leave, they called police backup, who arrested the man; when exiting the police car downtown, he slipped his handcuffs, ran away, and was shot and killed. His mother said he was schizophrenic and did not understand the order to wear a face mask.  (San Diego Union-Tribune, May 6, 2020)  This is the archetype of many such events: one damn thing leads to another.

[2a] Police hypocrisy and cynicism. In both [1] and [2] police are required to carry out the dirty work of government. When this becomes the primary part of their job, it makes them cynical and hardened. They know that it doesn’t necessarily make sense to punish harmless violations, or that they are lying when they say their city-mandated increase in traffic stops are purely in the interest of public safety. In their own work lives, they are under a regime that demands hypocrisy; after a while, this unpleasant feeling turns into a bitter that’s-the-way-it-is.  Like prison guards who have to play the role of the bad guy, they embrace the tough-cop image. (Striking descriptions of this are in Jennifer Hunt’s 2010 close-up ethnography of the NYPD.)  Citizens who argue with cops about these things  increase the tension; one reaction is to be more aggressive. Taking videos of the police is felt as threatening them; and this can lead to attempts at retaliation.

[3]  Police dislike defiance. Jonathan Rubinstein (1973), a sociologist who joined the Philadelphia police in order to study their everyday life (similar to Peter Moskos in the Baltimore PD 30 years later), found that their number-one priority is to be the person in control in all encounters with civilians. For the most part, a cop is out there alone, or with a single partner; they are almost always outnumbered by civilians. Particularly in areas where they know they are unpopular, they feel it is imperative to not let things get out of control. They want to be the one who starts and ends the encounter, who sets the speaking turns (micro-sociology of conversation), who sets the rhythm of the interaction. Acts of defiance, whether micro-actions on the level of voice and gesture, or more blatant words and body movements, will cause a cop to increase their own aggressiveness in order to maintain dominance (Alpert and Dunham 2004). This a reason why trivial encounters with the police can escalate to violence far beyond what seems called for by the original issue.

[3a] Inner-city black code of the street emphasizes defiance. Elijah Anderson’s ethnography of black street life (1999; also Krupnick and Winship 2015) point out that in dangerous areas, where the police are distrusted, most people adopt a stance of being hyper-vigilant about threats and disrespect, and portray themselves as ready to use violence. Anderson says this is mostly a Goffmanian frontstage, a pretence at being tough designed to avoid being victimized. When dealing with the police, this leads to another vicious circle. Black people, particularly on their home turf, are more defiant of police than are whites; often this is no more than a confrontational way of talking, but these are micro-interactions that arouse police aggressiveness. Anderson notes that one reason people in the ghetto are wary of calling police is that they themselves may end up being arrested, because of the tone of these micro-interactions. Donald Black (1980), who pioneered observer ride-alongs in police cars, found that police arrested black suspects more than whites, but this happened when black people were defiant, which was more often than whites. Martín Sánchez-Jankowski (1991) in his gang ethnographies (including black, hispanic, and white) describes the culture of gang members as “defiant individualism.”  The pervasiveness of the street code in black lower-class areas, even among the majority who are not sympathetic with a gang life-style, hardens mutual hostility between citizens and police.

[4] Police dislike property destruction.  Anne Nassauer [2019] who studied protest demonstrations in the US and Germany by compiling videos of these events, was able to pin-point the conditions that led to a turning point where violence broke out. One of the major conditions was when police could see protestors destroying property, but were unable to do anything about it; this happened if they were under orders not to respond, or when they had relatively limited forces compared to the numbers of protestors. Normally police are concerned to prevent robbery and vandalism; it is one of their more favored duties, since they get to be the heroes protecting people. But now they are in a situation where they have to stand by and let it happen. This builds up their frustration. Although they may perceive that only a small part of the crowd is doing the destruction, they dislike the crowd for providing the opportunity to get away with it. Given further trigger events during the protest-- more on this in [5]--  police will take out their tension and anger on whoever is nearby in the crowd.

Property destruction in a mass demonstration puts police in a damned-if-you-do, damned-if-you-don’t dilemma. If they take action against looters and arsonists, they get accused of whatever violence they use and casualties they cause. If they stand by and let the destruction happen, they are accused of neglecting their duty and not caring. Eye-witnesses to such scenes are particularly likely to be outraged (see letters to the editor in recent days).

[5]  Adrenaline overload and forward-panic attacks on unresisting targets. When tension builds up, humans experience rising heart rate, driven by adrenaline. At a high level, perception narrows in, time becomes distorted, fine motor control is lost. Nassauer found that the level of tension is visible in videos: whether the police are in relaxed or tense postures, and similarly with the crowd. When tension builds up, from escalating gestures of confrontation, unexpected movements by crowd or police units, police getting surrounded and cut off, a trigger point sets both sides in action. Adrenaline is the fight-or-fight hormone; it produces generalized arousal of the large muscles of the body, but in what direction will it go? Police, like soldiers, are trained to respond to high adrenaline arousal by attacking. Most civilians, of the other hand, will run. But the one reaction feeds back on the other. The crowd suddenly running away is felt by the police as a release of their own tension into action.

In interviews (reported by Nassauer and others), police say they can see the crowd is divided between peaceful demonstrators and a small number of trouble-makers; but when the situation boils over, the crowd is infected by the violent ones. --This is how the police perceive it; what happens is that the panic of the crowd running away puts the police in an over-the-top rush of adrenaline in which their own perception is narrowed. When police rush forward, they become likely to strike those who have fallen down, or are screaming uncontrollably. The content of what people are saying is lost; all that is heard is the sounds and sights of out-of-control people. Since the police are trained to operate as a unit, officers who rush forward with their comrades tend to imitate what they do; if they are striking someone on the ground, it must be for good reason, and they will join in or protect them.

I have called this “forward panic” because it is like a panic flight where the overwhelming emotion of the crowd increases individuals’ adrenaline level; but in this case, the adrenaline is driving them forward, towards an easy target who have their backs turned, running away or falling down. 

Police who have been in shoot-outs generally report that their senses are blurred, they have tunnel-vision, can’t hear the sounds of their own guns, don’t know how much time is passing (Artwohl and Christensen 1997). They also tend to fire wildly, with poor aim, and with an overkill of bullets as they empty their magazines. It is similar with those who deliver a large number of blows with their batons, or put their full weight on a captured suspect’s neck.  It is the same in military massacres (with a higher level of casualties because of more weapons).  There is the same time-sequence: a period during which tension has built up on both sides; a sudden tipping point when the tension is released; one side becomes incapable of resisting (because they are caught in a traffic jam, fallen in the mud, turning their back, running away); the result is  hot rush, piling on, overkill.

In real-life situations, violence is usually incompetent-- in the sense that it often fails to hit its intended target, or hits the wrong target, or is disproportional to what is necessacry to prevail.  Soldiers and police are much more accurate shooters on firing ranges than they are in the emotional conditions of real-life confrontation.The clichés of military and police officials refer to “surgical strikes” and proportionate response. But the military is all too aware of “collateral damage”, especially in counter-insurgency warfare, where violent enemies hide in the civilian population.  This is a close analogy to confronting peaceful protests in which aggressive militants cover themselves.

[6] Police training for extreme situations.  Police training tends to emphasize the worst-case scenarios. Knowing that firing in real-life situations is encumbered by high adrenaline, weapons instructors tell them to aim middle-mass-- the center of the body; don’t try to shoot for extremities like arms or legs (the cowboy movie myth of shooting a gun out of someone’s hand never happens). The result is, police shootings tend to be deadly. Emphasis also is on rapid reaction; in the worst-case scenario, the suspect is armed and dangerous; you have to train your muscle memory to react as quickly as possible.

There is sometimes training in how to calm dangerous situations, but this tends to be overshadowed by the quick reaction scenario: your life or someone else’s life is in danger; train yourself to react automatically.

Another process that enhances the atmosphere of worst-case scenarios is police communications. When police call for backup, they tend to emphasize the danger of the situation. When the call is propagated more widely, the message is propagated just as rumors are: the distinctive elements are dropped out as the message is repeated. A man on a highway overpass threatening suicide by jumping, will get transformed into the cliché-- suicidal and threatening to take someone else with him --  into armed and dangerous. This is how individuals end up getting shot dozens of times by an aroused network of converging cop cars. The distortion may start when a civilian calls in, starting with an ambiguous situation, which the police dispatcher (a civilian employee), transforms into the more conventional warning. This was the case with the famous incident in 2009 when a Harvard professor, a black man, arrived home and had difficulty getting his front door open, getting the taxi driver to help un-jam it. A well-meaning Harvard secretary passing on the street phoned to say a possible burglary might taking place, but did not mention anyone’s race on the 911 recording and said: “I don’t know if they live here and they just had a hard time with their keys”. The dispatcher transformed this into a house-breaking by two black men; the cop who showed up was restrained at first but reacted to the irate professor by arresting him.

Lesson: police training needs to be drastically reformed. And training for police dispatchers, as well as from one police car to another, needs to be instructed on how rumors are formed; and procedures to avoid inflammatory worst-case clichés.

[7] Racism among police. Some cops are racists. How many are there, and what kind of racists they are, needs better analysis. What kind? There is a difference between white supremacists of the pre-1960s period; stereotyping racists who think most black people are potential criminals; situational racists who react to black people in confrontational situations with fear and hostility; casual racists who make jokes. These aren’t insoluble questions; if ethnographers followed people around in everyday life and observed what they talked about and how they behaved in different situations, we would have a good picture.  And there still remains the further question, does one or another degree of racism explain when police violence happens?

My estimate is that racism among police is less important a factor than the social conflicts and situational stresses outlined in points [1-6]. To put it another way, if we got rid of racist attitudes, but left [1-6] in place, how much would police violence be reduced? Very little, I would predict.

What can be done? And how likely is it to have effects?

Let’s go through the list.

[1] Collecting fines for municipal budgets. Getting rid of this corrupt practice would be important for reducing hostility between police and citizens; especially since it is a version of color-blind racism insofar as it targets poor black areas. But how to get municipal officials to forego money that can raised without taxpayer consent?

[2]  Enforcing unpopular regulations. A solution would be to legalize more prohibited substances. It does raise a problem of trade-offs, such as deaths from fentanyl. And there are other kinds of prohibitions being invented from time to time, as in the coronavirus period. Some conflict of this sort is going to be with us for a long time.

[2a] If police don’t have to do the dirty work enforcing unpopular policies, they’d be a lot less cynical and hard-assed, and we’d get along better with each other. This depends on what we do about [1] and [2].

[3] The code of the street, ostentatious defiance. I think this is declining already, with the growth of a black middle class. On the whole, recent protest demonstrations are more civil than those of the late 1960s.

[4] Police anger at property destruction. This is a genuine dilemma; either way, bad feelings are created. If we had fewer riots -- if some of the other conditions get better-- this would be less of a problem. Caveat: racism and police violence are not the only things riots can be about; for example, the anti-globalization riots of the past decade in the US and Europe. We may well be headed towards increased class division in the future, among other things between the computerized elite (now riding out the coronavirus working from their nice homes) and the other two-thirds of the population whose jobs are steadily being replaced by computerized robots.

[5] Forward panic violence in policing demonstrations. There are ways that police (as well as everyone else) can learn techniques to monitor their adrenaline level, and to not rush into action until they have a clear perception of the situation and have reduced their heart rate by breathing exercises. This one is solvable. http://sociological-eye.blogspot.com/2016/10/cool-headed-cops-needed-heart-rate.html

This could go along in tandem with:

[6] Reforming police training. More than reforming police departments, we need full-scale investigation and reform of police academies. They need to get away from the emphasis on worst-case scenarios and the quick-trigger, muscle-memory approach to weapons training. As noted, civilian dispatchers as well as cops need better training about rumor propagation and its tendency to revert to stereotypes as messages pass along the chain.

[7]  Police racism.  If we have enough of these kind of reforms, this will take care of itself.

As of now, most calls for reforms reiterate long-standing demands for independent review boards and stronger penalties for police misconduct. Having a reform-oriented black police chief in Minneapolis did not solve the problem. It is dubious that the top-down approach would solve it, as long as the everyday conditions of police work go unchanged.

References

Alexis Artwohl and  Loren Christensen. 1997. Deadly Force Encounters.
Geoffrey Alpert and Roger Dunham. 2004. Understanding Police Use of Force.
Elijah Anderson. 1999. Code of the Street.
Donald Black. 1980. The Manners and Customs of the Police.
Donald Black. 1989. Sociological Justice.
Randall Collins. 2008. Violence: A Micro-sociological Theory.
Randall Collins. "Cool-headed Cops Needed: Heart Rate Monitors can Help." [posted 10.05.16]
http://sociological-eye.blogspot.com/2016/10/cool-headed-cops-needed-heart-rate.html
Alice Goffman. 2014. On the Run: Fugitive Life in an American City.
Jennifer Hunt. 2010.  Seven Shots: An NYPD Raid on a Terrorist Cell and its Aftermath.
Dave Klinger. 2004. Into the Kill Zone. A Cop’s Eye View of Deadly Force.
Joseph Krupnick and Christopher Winship. 2015. “Keeping up the front: how disadvantaged black youth avoid street violence in the inner city.” in Orlando Patterson (ed.), The Cultural Matrix.
Peter Moskos. 2008. Cop in the Hood.
Anne Nassauer. 2019. Situational Breakdowns: Understanding Protest Violence.
Jonathan Rubinstein. 1973. City Police.
Martín Sánchez Jankowski. 1991. Islands in the Street.

Wednesday, April 15, 2020

DOCTORS AT WAR: THE PSYCHOLOGICAL COST


Mark de Rond’s book Doctors at War (Cornell Univ. Press, 2017) is one the most painful books you’ll ever read. De Rond, a organizational ethnographer at Cambridge University, was embedded in a field hospital in Afghanistan, where a team of medical personnel from the U.K. and U.S. waited to operate on wounded flown in by helicopter-- allied soldiers, captured enemies, and injured civilians alike. Like Conrad’s Heart of Darkness, the horror is not so much in the gruesome physical scenes (although that is part of it), but more in the psychological costs of trying to do something about it. It is about feeling your failure in a terrible situation beyond your control; and how the things that members of the group do to cope with their feelings circle back to make things worse.

Each kind of patient delivered to this desolate outpost by a clattering helicopter creates its own kind of strains.

Wounded warriors: This is largely a war of home-made bombs on the insurgent side-- improvised explosive devices hidden under rubble at the side of the road or anywhere an allied patrol might go. This means wounds are often horrible, not bullets penetrating the body but limbs torn off, extensive burns, all kinds of fragments. Surgeons have to extract, patch, amputate and sew back up. It is not the kind of scene that one reads about from battlefield hospitals in the U.S. Civil War or the Napoleonic wars, where in the absence of sedatives there were anguished sounds of screaming, and doctors had to decide which ones to triage. Now the wounded are brought in already sedated by battlefield medics. And triage is not really necessary, this being a counter-insurgency war-- low-intensity if endless-- the doctors are not overwhelmed by numbers but instead have a steady drip of casualties to be patched up and flown out to medical facilities far from the war zone.

No, the strain is in the minds and emotions of the doctors, nurses, and auxiliary personnel as the same kinds of cases repeat themselves, day after day, with their endless variations.

            A surgeon “had been operating for forty-one consequtive days, the last seven of which he said had consisted mostly of chucking dead or dying limbs into bins. Homemade explosives left few options other than lopping off the dying bits and dropping them in one of several buttercup-yellow buckets destined for the incinerator.” [p.31]

            “I wandered into a waft of freshly burned bacon, its source soon obvious: two badly burned Afghans occupied opposite tables, attended to by emergency staff. The first registered at 53% burns, the second at 48%, both readings the result of a standard calculation using the ‘rule of nine’: divide the body into multiples of 9, with the head, chest and abdomen accounting for 9% each if completely burned, the back and buttocks for 18%, 9% for each arm and 18% for each leg, 9% for the front, 9% for the back. Anything over 35% isn’t considered survivable in Afghanistan... so such patients are given palliative care from the word go. The first of the two died within the hour. The second would follow soon after but insisted on seeing an interpretor.... ‘He wants you to take him and his friend back to the valley where the helicopter found them.’ ‘His friend’s dead.’ ‘Yes he says he knows. He wants you to organize a car to take them both back.’ ‘Right. So where does he think we’re going to get a taxi from?’ ... ‘Tell ‘em we will see what we can do.’... The Afghan slowly moved his blackened hand over his left upper chest and looked grateful.” [117]

            “A US marine had called earlier to report the discovery of two partial legs belonging to Billy, one of the troops in his charge, and would it be all right if he dropped them off at the hospital? He and his troops had been told that if limbs could be reattached within six hours of an explosion, they’d have a chance of surviving. The legs had been cold too long, Smitty told him, and were probably too badly damaged to be reattached in any event, but the marine was not to be dissauded and made his appearance soon after.
            ‘I gather you’ve got something for me?’ Smitty said.
            ‘Billy’s legs,’ he said and handed Smitty a floppy carton box that once upon a time held US army rations.
            ‘You be sure to fix him up, won’t you?’
            ‘Leave it with us.’
            ‘Billy’s a quarterback, you know, when we get time to play. Has one hell of an arm.’
            ‘His arm’s fine.’
            ‘You look after him now.’
            “As soon as the marine took off, Smitty got hold of Ginger, a scrub nurse on his first-ever tour.
            ‘What’s this?’
            ‘Legs. Used to belong to the guy in theater three.’
            ‘Well what the fuck am I supposed to do with them?’
            ‘Walk them over to the incinerator, that’s what.’
            ‘...’
            ‘Sure whoever gave you this is gone?’” [52-3]

Captive enemies: Doctors operate under the rules of war, which stipulate that wounded enemies are entitled to medical treatment. At the forward hospital, surgeons do their best, although they know-- and openly say to each other-- that when they are fixed up and released into custody of Afghan troops, they will probably be killed.

            “By the time I returned to the hospital the next morning, late and weary for lack of sleep, the early morning casualties had already been dispatched to the ward or the morgue, the youngest of the still warm only ten. Matching sets of double and triple amputees underlined the war’s agonizing ambiguities: which is the crueler, to prop up Afghans with quick fixes and the sort of sophisticated analgesics not available locally for the handful of hours they’d spend in Bastion, or let them cash in on their convictions pronto and meet their Maker? Ingenuity, after all, can render death quick nowadays and pretty much pain-free. All had been Afghans this morning, peeled off the desert floor by a helicopter crew after 106 pounds of AGM-114 air-to-surface missile did precisely what it said on the tin. The absurdity of the situation was plain for all to see: one budget is used to save those a different budget tried to kill only moments ago.” [11]

De Rond accompanies the transfer of three Afghan army casualties to their own hospital:
            “ ‘This guy is high on opium,’ my escort said, having wrestled back one of our oxygen canisters [from a driver]. ‘These things fetch a fair bit of money on the black market, so we want to hang onto them if at all possible.’ He crouched down next to the most serious of the three casualties. The man had already been relieved of his 60% oxygen supply and now was cut loose from his morphine drip and antibiotics...       
            ‘And the first thing these drivers do is look into the bags to see what drugs we’ve sent along. Anything morphine goes directly to the driver and never even gets to the patient. And so we leave them here to a slow and painful death. This guy here will die of pneumonia.’ ”  Doctors argue about what they should do. “ ‘If  you keep him here and treat him, he’ll ultimately die. If you take him to Kandahar, he will die too, but a little more quickly.’ ” [101]

Injured civilians: The situation with patching up civilians was much the same, with some additional twists.

            0400, four a.m. “Two local women had arrived with bullet holes in their legs. Someone who identified himself as a brother stood idly by, insisting, as they did too, that they should be treated by a female attendant. Weegee, the attending emergency department coordinator, ignored the request, saying they have no such luxury in Afghan hospitals so why give them that option here?
            “After a quiet day, at around 1900, nine casualties arrived within thirty minutes of each other, including five girls with gunshot wounds: two to the chest, the rest through the arms, legs, and belly. The girls had long eyelashes and olive complexions, their hands covered with henna tattoos. There wasn’t a tear in sight. The emergency and surgical teams were brilliant to watch. When the proverbial shit hit the fan, they salvaged what war destroyed, giddy for being productive. The curse in Bastion was never that of too much work but rather the insufficiency of it. Once the casualties had received emergency treatment and the surgeons had repaired for near beers in the Doctors’ Room, it turned out the girls might have been shot by our own helicopters in error. Their thirty-millimeter cannon rounds were designed to fragment upon impact such that anyone within ten meters of an exploding round risked serious injury, and tonight’s GSW’s looked far more like fragments, the docs said, than the usual bullets.” [125-6]

Friendly fire and collateral damage, as the jargon goes, are endemic in a counter-insurgency war where the guerrillas hide in the civilian population. The civilians in the middle get treated if allied medivacs bring them in. But there are no hospitals to release them to, and back in their villages, care is poor and many will probably not survive. But release them we must.

Sometimes the borderline between civilians and enemies disappears, green-on-blue attacks where Taliban sympathizers among Afghan army troops turn their weapons on American soldiers-- or perhaps suddenly snap under their own pressure, as indeed some American troops have done.

De Rond observed doctors talking about such incidents with the medical staff.

            One doctor “told of a British nurse who had arrived in the hospital with severe burns. She had befriended a young boy, plying him with candies, until one day he threw a plastic bucket at her, dousing her in petrol and setting her alight. The Taliban, he said, are not shy about using children to advance their interests, whether by forcing them to walk donkeys heavy with explosives toward the infidel or by leaving injured kids by the roadside as bait to attract a medivac helicopter.” [52] 

This, at any rate, is the conversational culture of the forward hospital. It does not stop them from treating everyone who comes in, to a high medical standard, in the brief time they are there. And this adds to the incongruities that make up the psychological dissonance of the place.

Isolation, boredom and surreal disconnect

In traditional wars, on the whole, the psychological pressure on doctors in battlefield hospitals was severe but not so complex. Of the three kinds of patients treated-- allied soldiers, enemy captives, injured civilians-- such doctors mainly dealt with the first. If they treated wounded enemies, they at any rate were not handed over to others who were going to kill them. In traditional battles with high casualties in a short period of time, the problem for doctors was being overwhelmed, and having to pick out those most likely to survive. This was not a problem in the Afghanistan field hospital, where there were plenty of medical staff to handle the daily influx of casualties. Their problem was that they practiced good medicine, then felt much of it went to waste. And unlike traditional battles, they didn’t even have the consolation of winning a battle or the war.

And they were isolated and bored. Their base was a fort in a hot desert, dangerous to go outside the perimeter, and nowhere to go if they did go out. They were stuck with the same people, who worked, slept, ate together, and tried to amuse themselves in the down times between the hours when the emergency alarms sounded and the helicopters unloaded. It was a total institution, in the sociological sense of the term, but not one in the Goffmanian sense of a hierarchy where a staff guarded a lower class of inmates. The wounded were in a sense like inmates, except that they were so badly incapacitated that they remained passive-- at least de Rond never noted any acts of defiance. And the medical staff were idealists and committed professionals; they didn’t pull rank on each other, and their culture was one of “we’re all in this thing together”, a common task and a common malaise. They all had the same problem and they couldn’t get away from each other.

            “Boredom hung in the air like a peasouper that wouldn’t lift except for the briefest of periods. In principle, this should have been good news-- after all, no one was getting hurt-- except that it left the docs with nothing meaningful to do. There was the occasional bit of exercise in a muggy gym to provide a temporary lift, or reading or daytime television, but little to take pride in, to feel productive about. And so they found themselves pining for work to come in, even if this invariably came at the expense of someone else getting hurt.
            “But boredom extracts its pound of flesh in other ways, too. Left with little or nothing to do, [the doctors] have begun to criticize each other’s handling of patients and discharge decisions... Left to their own devices these docs became broody and aware of the relative futility of some of what they do here, particularly when it comes to providing emergency treatment for Afghans whose chances of recovery were badly compromised as soon as they were transferred to local hospitals, or so they think.... Periods of great intensity followed periods of boredom in which it was nevertheless impossible to relax.” [70-72]

They tried to keep up a semblance of normal life. They celebrated the holidays as best the could. A Christmas party wearing Hawaiian shorts, tee-shirts and Santa Claus hats, although no one felt very jovial.

            “ ‘Sometimes I try telling my family some of these things, but they don’t understand,’ Smitty said... He went on to tell me about a double amputee who had come in over Easter weekend. One of his legs had been attached by only a skin flap and came off during the usual logroll. The attending nurse, who’d been left standing with a leg in her arms, asked one of Smitty’s team to please take it away for disposal. As the lad made his way to the morgue, crossing the ambulance bay en route, he was met by Solesky and a nurse walking the other way, sporting bunny ears and carrying Easter eggs.” [85]

            The early morning helicopter patrol brought in an American, but the tourniquets had come off as he was carried to the helicopter under fire, and he had already bled to death: “A glum band of brothers, the docs trundled back to their lair to feast on Apocalypse Now. A famous scene shows a swarm of American helicopters advancing like locusts on a Vietnamese settlement to the tones of Wagner’s ‘Ride of the Valkyries.’ It didn’t seem to strike any of those glued to the telly as ironic that less than klick away their own Apaches were taking off on similar missions... It would quite literally have taken no more than stepping outside the Doctors’ Room and onto the wooden patio to fast-forward to a similar scene. Alas, the patio door was closed shut, and the telly on, and they around it in a half circle, ‘near beer’ and homemade cookies and ginger cake and chocolate to hand.
            “ ‘My favorite line’s coming up,’ Southwark said excitedly. ‘Wait for it...ah, “I love the smell of napalm in the morning.” Absolutely first class that is.’ ”  [64-5]

Obviously they appreciate the irony of it all, but they have gone beyond that. Gallows humour, but nobody was laughing, not even sardonically. The doctors wallowed in escapist Hollywood war films. M*A*S*H was another favorite, about a similar forward hospital in the Korean War, supplied by helicopters with wounded soldiers. Except this, like all war films, did not show the medical gore these doctors faced everyday. Their lives were not censored for the screen and there was no rollicking good fun, even when they had time away. Why didn’t they escape to something else, films that had nothing to do with war? They were obsessed, perhaps with distancing themselves from their lives by viewing the Hollywood version. But it didn’t help, only cycled through the day.

            “At the onset of sunset, just as Sloppy Joe called for volunteeers to help him lug around the weekly pile of pizzas... [the beeping of pagers carried by the on-duty medicals] heralded the arrival of a Cat A [severely wounded]. The whiteboard listed it as a US marine who’d been hit by a rocket-propelled grenade... We made our way from reception into the black hot night to where the light pollution was, signposting the makeshift square with its crude KFC-Pizza Hut combo and games room. A short queue had already formed at the shipping container’s window. The scent they gave off was unmistakable, evoking a lazy day topped off with fast food and soda and feet-up television. Stacked up on one of the two ovens were twenty-one pizzas, hot to the touch, though there’s always a risk they’ll be stone cold by the time the casualty is dispatched with. To my surprise, this happened more quickly than I expected.
            ‘Casualty’s a hero,’ Joe said.
            ‘Right,’ I replied. ‘Gone to Camp Hero.’..
            ‘The guy is dead.’
            “It was right about then and there that I became aware of a nauseating feeling ascending from my gut: a rotten-to-the-core sense of relief, less at a merciful end to years of pain and rehabilitation than at the prospect of hot pizza and companionship. The sense of shame I felt then I’ve not felt since. After all, what was a pizza compared to the life of a soldier? What the fuck was wrong with me?
            “We sat down to watch Lock, Stock and Two Smoking Barrels.” [118-19]

            The doctors were becoming querulous as their beepers sound, calling them to surgery, only to return abruptly to the TV room when they find the new arrival is dead. “They sunk back into the spots they had vacated only moments before, to resume their involuntary stupor, only to be told that a fresh hail of casualties was on the way: a gunshot wound to the neck, a gunshot wound to the thigh and yet another unlucky victor in the roadside bomb lottery.” The most experienced surgeon griped to no one in particular that today he is supposed to be in charge but the other doctors are going ahead of him. No one pays attention.
            “Southwark and Fernsby, in the meantime, were taking bets (to be paid off in pizza purchases) on whether the incoming amputee would turn out to be a single or double, left or right leg. ‘A pepperoni on the left,’ Southwark said. ‘I’d say a double. If it is you’re buying Friday,’ Fernsby replied. [123]

This is beyond gallows humor, beyond cynicism. It is a way of passing the time, living in a surreal disconnect. They disconnect even from their cynicism. It is one more layer of psychological distress, piled up and revolved by the hour.

De Rond winds up: back in England, his battlefield tour over, he can’t get over the pain, and the guilt. The doctors he corresponded with say the same.

Meanwhile, back Home

A medical sociologist who reviewed de Rond’s book in an American journal was horrified. He denounced publication of the book, calling it a pornography of pain, voyeurism of medical horrors for its own sake. He saw the book as pointless, no hypotheses, no theory, no take-away. As a reader, I thought this the most unprofessional review that I can recall. No doubt the reviewer missed the standard academic formalities, reviews of the literature, and writing in bland abstractions. Perhaps de Rond writing about his own emotions in the field set off the reviewer into ranting about his own emotions as a reviewer.

Before concluding that this closes the circle of absurdities mingled with (academic and military-medical) realities, it is well to remind ourselves that de Rond’s ethnography is about surreal experiences, but the report is not surreal. It is tell-it-like-it-is, you-are-there participant observation, focusing in on micro-sociological moments in the verbatim conversations of daily life and their bodily context.

It is about the psychological costs of working in an endlessly prolonged artificial situation, without adequate social support. Does it say anything to us about doctors and medical personnel in the COVID-19 epidemic?

Obviously the kind of medical treatment is quite different-- traumatic injuries for quick surgery, vs. prolonged treatment of agonized patients gasping to breathe. One similarity, in hospitals where there are many severe virus cases, may be the stresses of social isolation. Medical personnel constantly masked and keeping physical distance from each other may experience more isolation stress than at the battlefield hospital, where medical teams are constantly hanging around together. Medicals repeatedly exposed to the virus, some of whom themselves become sick and die, are presumably isolated from their families and friends. Of course they can make contact by phone and on-line, but this was true in Afghanistan as well: the social isolation there was intensified by inability to explain to their families the emotions they were going through. In both cases, a kind of total institution may be created, cut off from the normal supports of social life. Witnessing the social isolation of the bereaved, who cannot be at bedside nor take part in funeral rituals, must create a bleak atmosphere somewhat resembling the battlefield hospital.

Such stresses build up over time. Most people can handle extreme situations for a short period of time; there is a rallying-around burst of solidarity at the outset of any public crisis. In the immediate aftermath of the 9/11/01 attacks,* this period of public solidarity lasted 3 months-- but that was a period where mass ceremonies honoring firefighters and police took place at every public gathering. In the absence of this kind of ritual support, the uplifting period of shared dedication may be shorter, under a regime of enforced social distancing. The field unit in Afghanistan had been operating for six years when de Rond studied it, and some surgeons had served ten or more tours of duty. If anything like this kind of endlessness comes out of the struggle with COVID-19, the experience of doctors at war may start to converge.

---------

https://www.indiebound.org/book/9781543989083

---------

* Randall Collins. 2004. “Rituals of Solidarity and Security in the Wake of Terrorist Attack.” Sociological Theory 22: 53-87.

For a more formal social-science presentation of the battlefield hospital study, see:

Mark De Rond and Jaco Lok. 2016. “Some Things Can Never Be Unseen: The Role of Context in Psychological Injury at War.” Academy of Management Journal 59: 1965-1993.