Conscientiousness in a pandemic: a howto guide

Rachel Miller writes for Vox:

my guess is that if you are experiencing the sort of emergency or unique circumstances where the only solution involves leaving your home or interacting with others, you wouldn’t be asking for permission.

The Answer to All of Your Social Distancing Loophole Questions Is No

Captain Awkward picks this up and adds:

Every time I say [not to call the police on neighbours if it’s avoidable] somewhere publicly, someone tells me about how they had to call 911 b/c of a fire or accident or some emergency, which goes back to the original point: If you needed to, then you needed to, it was an emergency, so why are you telling me about it, Edge-Case Bob?

Link: The Answer To All Your Social Distancing Loophole Questions is “No.”

Here’s the thing: Miller is wrong to guess that everyone knows what emergencies and unique circumstances trump public health right now. We know this, both because people are not seeking hospital care for life-threatening emergencies and because abusers are successfully telling their victims that one of them for sure has the virus, or that they will surely die if they go outside, etc.

I have a bunch of experience with being conscientious to a degree that is sometimes dysfunctional. (Hot tip by the way: never phrase something this way to your boss, because while you may think you’re helping them understand you better, they are thinking “wow, ‘conscientious to a degree that is sometimes dysfunctional’ is such a neat way of phrasing things in a performance review!”)

I’m fine making rules. I’m fine following rules.

What I’m not good at is breaking rules. I definitely do not personally come equipped with good intuitions about which emergencies or unique circumstances should cause me to break rules and if someone finally talks me into following their intuitions I have a huge struggle with it.

Chidi Anagonye is having a really hard time right now.

I have a specific and dramatic illustration of this. One day several years ago, in fact the 1st September 2012, I was starting to feel “fluey” while trying to fit my toddler son for shoes (he kept running away screaming and I was soooo tired). I asked my husband to walk home, I admired the new baby spring leaves on the trees in the park as I walked past them and said suddenly “you know, I think I’m about to get really sick, let’s get home now.”

Reader, I did indeed get really sick. I spent the next week in bed drinking apple juice and watching the shadows of leaves dance on my windows. I didn’t bathe because I was too tired and sore. I cried all the time because my all muscles hurt so much.

And there was this spot on my inner left thigh that was especially painful to the touch, like a really bad bruise. Weird.

We didn’t have a thermometer, but if we had, we probably would have found that my temperature was stable at around 40°C for much of that week.

I get ill fairly often, and had a kid in daycare so it was especially true at that time. The preceding year, I’d gone to the doctor to report that I’d been dry coughing until I vomited and that I couldn’t breathe for coughing.

It’s interesting that COVID survivors often call this out as a really abnormal and alarming thing, because my GP told me that day that “it’s just a widdle viwwwwwus, Mama!” and that it was really normal and I should wait it out. (Doctors often address mothers accompanied by young children as “Mum”, or “Mama”, and often baby talk to them.) After that, I inferred that, among my many existing rules about not bothering people, that “coughing until you’re choking” and any symptoms of similar severity are not a sufficient reason to bother doctors.

So, I wasn’t coughing, but I was similarly uncomfortable. Every day on the phone, my mother begged me to see a doctor. Every few hours, my husband begged me, increasingly in tears, to see a doctor. But I didn’t, because that was my rule: doctors don’t like viruses and don’t want to hear about them (Mama).

To be clear I’m not normally remotely that dysfunctional about rules. I assume being in terrible pain and running a fever that was much higher than we realised had pushed me to my absolutely most irrational degree of rule following. But these are the emergencies and unique situations that people will need to navigate.

Finally I reluctantly agreed to call a triage line, and they told me that high fevers and muscle aches are non-specific signs of severe illness, are not specific to viral infections, and also that having a really tender spot on my leg did not suggest influenza. They very strongly recommended I find out more specifically what severe illness it was that I had.

And so I went to the GP at around the point where the spot on my leg became so painful I couldn’t stand to walk far. I had an ultrasound that showed that it was a massively swollen lymph node, and also that my entire left leg was filled with other swollen lymph nodes. I went to another GP the following day to review the results, I asked if I could maybe lie down to talk to her, and she told me to immediately go to hospital. By that point my leg hurt so much I needed a wheelchair and I was so dehydrated that they ran an IV immediately.

I spent 6 days in hospital running a fever that was closer to 41°C while a couple of layers of skin peeled off my entire inner thigh due to the incredibly aggressive bacterial skin infection that it turned out I had. (It was never cultured, they assumed it was staph.) I refused to eat for almost all that time and for several days I also refused to drink at all and needed IV fluids and painkillers (along with antibiotics).

When my temperature finally went down, the infectious diseases specialist, who tended to address me at all times as a rather dim medical student, dropped by (on a Sunday, in his civvies) and said conversationally “it’s cases like this that really remind us that, even with antibiotics, these things can be very serious, and sometimes even fatal!”

So, it’s indeed safe to say that I’m in the group of people who need to do some work around identifying the emergencies and unique situations where we should take care of ourselves! It is not safe to rely on me recognising my needs and not asking for permission.

But I do have some tips for being slightly safer about this.

Are you a conscientious person? The first step is know this about yourself. Do you:

  • believe that rules usually have a good reason for existing?
  • feel safer knowing and following the rules?
  • tend to reduce ambiguity or make yourself or others feel secure by making rules or otherwise systematising things?
  • prefer to be led by rules?
  • prefer to lead other people with rules?
  • have at least one dramatic story in your personal history that goes something like “and that’s why I didn’t call a doctor for a week” or “and so I was the one who ended up pleading guilty” or “and then I paid back her debt for her” where you’re still sort of slightly proud that you followed the rules right into hell?

You might be a conscientious person! And it might not always be an entirely helpful way to be.

Understand that not everyone is like you. Quite a lot of people don’t like doing what they’re told, don’t believe that rules are generally a good idea or that rules are usually abusive, believe that they are a smart person who does the right thing naturally and that rules are only for those other losers, or use rules as means of having power over other people.

Many of those folks have their own excellent reasons for being that way; if you’ve been abused by rule-making a lot, you likely won’t end up in the “rules make me safer” camp, for example. (I think it’s also worth noting that conscientious types aren’t all good people either.)

Rules are often written to allow for all these responses. Rules are thus often very absolute and strict, because the framers assume that everyone will do 50% more than the rules allow (often recursively so). Rules are backed by the power of the state both because some people won’t respond to anything less, and because the state loves power. Etc.

And so if you’re highly conscientious, statements along the lines of “you wouldn’t be asking for permission [if this was actually bad]” may not apply to you. Those statements are aimed at another group of people. If you always need to ask for permission to take care of yourself, that won’t have suddenly changed since February.

Reflect on the purpose of rules. Pandemic rules are a tool for public health and safety. Know that there are other serious threats to health and safety and they may also happen to you.

If you’re a conscientious type, it could be a good time to engage with civil liberties organisations to make sure framing of the rules is proportionate to risk, and makes clear exemptions for, eg, escaping abuse, seeking treatment for other medical conditions, and getting fed. Help your community out against the abusive or unimaginative conscientious or power-hungry types!

Make a plan. Depending on your relationship with anxiety, extensive worst-case scenarios can be a bit risky to play with. But you can cover the major bases and use your affinity for rules to save yourself some decisions later on:

  • if you’re in an endemic COVID area, familiarise yourself with
    • the typical onset symptoms
    • the current testing criteria in your area, and where you would go for a test if eligible
    • the difference between “care at home” and “go to hospital” symptoms
  • have a plan for spending 14 days entirely inside your front door, eg an appropriate stock of food and painkillers, in Australia learn about Woolworths Priority Assistance and Basics Box etc
  • if you have a known health condition (including mental health!), have a guide to when you are sick enough that you need medical attention for it, and know where you would get such medical attention
  • find an authority you trust (in the best case some level of your government, but perhaps your personal doctor, a different country with a better government, etc) and follow their public health guidelines, not the strictest intersection of every guideline posited by every single epidemiologist, infectious disease physician, and random individual on Twitter
  • if you’re required to work outside the house, see previous point for specific precautions and also remember that physical distancing is a societal measure to slow disease spread that does not require the same thing of every individual person
  • consider #StayAtHome an excellent rule for most people for current circumstances (hopefully eventually in specific regions, very widespread at present!), not the new official way to be a good person forever

Be generous to others. You can’t save the entire world by calling the cops on folks’ parties. Captain Awkward’s post, for all that I’m using it as a jumping off point for “it’s not about you”, has some great tips for more sustainable interventions.

There’s plenty of stories about of people screaming “I see you out there every day! Stay at home! Murderer!” out their windows to people who are on their way to work, at a hospital, because they are a nurse, in a COVID ward. Make a rule to not be that person!

Do something good. Many conscientious people struggle with beliefs they are a bad person. Some of the policing is because people want to actively be good and the only way they can think of is to yell out their window at nurses.

Do some real good: donate some money, or become a civil liberties activist, or let nurses stay in your AirBnb for free, or start working on your plan to go to med school, or send a thank you postcard to hospitals, or join a mutual aid group, or phone a friend.

Work on your dysfunctions. Some of these patterns revolve around overfunctioning and anxiety disorders. Consider therapy or other management techniques.

Manage your own conscience. This is some of where Captain Awkward’s “why are you telling me about it, Edge-Case Bob?” comes from. Some Bobs: “haha, I trumped you in an argument, alleged Internet expert, gotcha!” Other Bobs: “please please, apparent authority figure, reassure me that I’m a good person even though I did a bad thing that was against the rules.”

You have to have better boundaries than this, and a more functional conscience. The rules can’t tell you if you’re a good person or did a good thing, and neither can advice columnists. (I guess I just outed myself as not a deontologist, huh?)

You need to figure it out case by case, and stand by it, and manage your own guilt. Much rule-following is about outsourcing your conscience and self-esteem and you need to stop doing that.

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