Individualism and Affliction: Cultural Responses to Disease

Abstract

This review essay proposes that the influence of individualism, the tendency to prefer individual freedoms over collective obligations, in American society impacted the manner in which the US population responded to the recent global COVID-19 pandemic. During the pandemic, societal rifts were exposed that questioned the infringement on personal freedoms by governmental authority in the effort to protect public health. The essay traces the development of individualism from the Enlightenment through the emergence of the United States, during which individualism entwined with American identity. A review of social science research in the fields sociology, psychology, and anthropology demonstrates the ways in which individualism, in varying degrees from self-centered to collectivist tendencies, can be observed to affect social interaction and perception. With that background, it is possible to use individualism as a lens to investigate cultural responses to affliction. Societal responses to leprosy, syphilis, and COVID-19 are examined, and it is argued that the influence of degrees of individualism greatly impacted the social responses, and the extent to which individual freedoms were lost was notably varied in each case.

US House of Representatives COVID-19 Select Subcommittee hearing exchange between Rep. Brian McCormick (2024) and Dr. Anthony Fauci, 17 June 2024:

Dr. Fauci: And, it’s been proven that when you make it difficult for people in their lives they lose their ideological bullshit and they get vaccinated.

Rep. McCormick: Thank you. Are all objections to COVID vaccinations ideological bullshit Dr. Fauci?

1. Introduction

The recent COVID-19 pandemic exposed deep rifts in Western societies, the US in particular, that questioned the extent of government authority to infringe on individual liberties with the justification of protecting public health. Those tensions infiltrated all aspects of society, revealing the centrality of individualism, even in the face of a virulent, highly contagious, global pandemic. That fallout left the US with the paradoxical outcome of having disproportionate morbidity and mortality during the COVID-19 pandemic despite being the source nation of both the vaccine and an efficacious treatment (Mueller & Lutz, 2022). The political fallout of those tensions continues, with a reduction in the rate of standard, recommended childhood vaccinations administered (Hill et al., 2024), an alarming measles outbreak, and the election of a US government that stands to privilege individualism even further. The above exchange between Rep. McCormick and Dr. Fauci, in fact, demonstrates the ongoing debate on the tensions between individual rights and government authority. A question for this essay is to understand the role that individualism plays in times of a widespread threat of affliction, especially with regard to possible loss of liberties to government authority. If individualism plays a role in cultural response to disease, what are the characteristics of those dynamics? To address these issues, we propose that “individualism” underlies the source of conflict between infringements upon civil liberties and mandates to protect public health. It is argued that significant segments of an individualistic society will reject heavy-handed mandates that impinge on freedoms, especially when alternate explanations are available and evidence of governmental suppression and cover-ups is conspicuous (Martin, 2025; Shir-Raz et al., 2023). The essay presents a review of individualism in Western society and uses the concept as a unit of analysis in reference to diseases that had an unusually imbalanced cultural response.

Reviews of the history of “individualism” and research on the topic in the social sciences, with a particular focus on the United States, are presented below. In addition, the cultural responses to leprosy, syphilis, and COVID-19 are closely examined using the notion of individualism as an analytical lens to contrast the differing social responses. It is argued that the significant transition to individualism during the Enlightenment accompanied social characteristics that transformed how individuals could conceive of themselves in relation to government authority. And, important to this study, that transition impacted the ways in which individuals might respond to public health crises. We suggest three specific factors that accompanied the Enlightenment in this transformative process as significant in the interpretation of a health threat:

(1)

Individuals can select their sources of information.

(2)

Information is not static; since it is subject to change, it is subject to suspicion.

(3)

Individuals can question government authority in relation to their autonomy.

In the context of a severe health threat, those three characteristics trigger predictable cultural responses, which include the following:

(1)

Privilege of individual choices over imposed mandates.

(2)

Viewing any disease exposure outcome, positive or otherwise, as a result of one’s own successful freewill.

(3)

Nurturing mistrust through selection of information choices which justified one’s own conceptions.

Such reasoning patterns were observed countless times during the COVID-19 pandemic, in which individuals made choices against their own best interests, often with fatal consequences (Buelow et al., 2024; Fischhoff, 2020). Given those realities, missteps by governmental public health authorities in their messaging, secrecy, inconsistency, apparent gaslighting, and, in some cases, suppression, exacerbated the morbid and mortal consequences of the pandemic (Cascini et al., 2022; Jennings et al., 2021; Martin, 2025; Shir-Raz et al., 2023). Public health leaders, such as Dr. Anthony Fauci, suppressed discussions of vaccine risks or other public health options such as the Swedish approach while dismissing dissenting opinions as “misinformation.” The Swedish approach, also known as “herd immunity,” was a laissez faire governmental public health response that focused on individual responsibility to assess recommendations in lieu of lockdowns. Individuals with compromised health were encouraged to be vaccinated while the general population acquired immunity through natural infection. Using this approach, Sweden had a 40% lower mortality rate than the US (Miltimore, 2024; Mueller & Lutz, 2022; WHO, 2025). Such missteps, especially in the debate between what was “information” versus “misinformation,” flamed conspiracy theories, allowed for competing, politicized narratives, and generated needless fear and suspicions of efficacious treatments (Gabarron et al., 2021; Gisondi et al., 2022; Martin, 2024; Shir-Raz et al., 2023; Skafle et al., 2022). Furthermore, as the opening quotation demonstrates, both sides continue to talk past one another with no acknowledgement of grey areas or potential for common ground.

2. History of Individualism

Any discussion of individualism in the West must begin with the transition from the late Middle Ages to the rise of the Enlightenment, the 17th-century movement associated with rationalism, constitutional government, and liberty, among other fundamental societal upheavals (Conrad, 2012; Foucault, 1984; Khan, 1987). Central to this discussion is Rousseau’s (1762) introduction of the “social contract,” with which he theorized the then novel ideas of individual freedoms in relation to legitimate political authority. Enlightenment ideals stand in stark contrast to Europe’s prior feudal society, which embodied a collectivist mindset under papal influence (Conrad, 2012; M. Fischer, 1992; Pelz, 2016). The feudal system of serfdom was characterized by a hierarchy that corralled serfs to exist within the boundaries of stratified rule and justified through unquestioned religious interpretation (M. Fischer, 1992; Pelz, 2016). The abrupt transition into the Enlightenment forged the path to a new Western ideology that underpinned concomitant entitlements that accompanied biased assumptions of imperialistic colonialism (Khan, 1987). Within that context, individualism arose in tandem with the tenets of Enlightenment thought and the promise of capitalistic benefits. The entwinement of individualism, freedom, and new forms of representative government, especially in America, infiltrated all aspects of life in the form of a new citizen habitus (C. S. Fischer, 2008; Greeson, 2013; Kerber, 1989; Mennell, 2020). Hence, individualism came to embody the thoughts and actions of a citizen to an extent not possible during the medieval period (M. Fischer, 1992).

Individualism, as the concept is used here, is succinctly defined by intellectual historian Lukes (1971). Most simplistically, individualism “has been used to mean the absence or minimum of state intervention in the economic and other spheres” (Lukes: p. 18). More specifically, Lukes outlines five ideas of individualism:

(1)

The dignity of man, a biblical endowment of natural rights bestowed on the individual. Notably, these were downplayed during the feudal, papal Middle Ages but emphasized in Enlightenment-period Protestant Calvinism.

(2)

Autonomy, the empowering notion that each individual is their own master, free to empirically select the information in decision making.

(3)

Privacy, the separation of public/private, is significant in that the private is free from any social interference.

(4)

Self-development, the freedom to make choices untethered by social determination.

(5)

Abstract individualism, recognition of the dynamic that the state is an instrument to the fulfillment of the individual. (Lukes, 1971; Steinfels, 1974)

Lukes takes these five ideas of individualism to underpin doctrines such as political and economic individualism, which require a laissez faire government so that individualistic pursuits are freely possible (Lukes, 1971; Steinfels, 1974).

Questions of the relationship between governmental authority and individual freedoms sparked tensions between colonial America and the British Crown, leading to the subsequent embrace of individuality, and revolution, in the formation of the new American democracy (Mennell, 2020; J. Turner, 2008). At a time when some bristled at the suggestion of hierarchical disruptions to past collectivist practices implied in the social contract—in England, Germany, and France, for example (Pelz, 2016)—the ideals were fully adopted in the new, post-colonial, American society, creating a virtual laboratory for Enlightenment thought (C. S. Fischer, 2008; Greeson, 2013; Kerber, 1989). Tocqueville’s (1832/2003) describes, in fascinated awe, the uniqueness of American individualism, even providing no less than 73 chapters on daily life, demonstrating the inculcation of individualism into the American habitus (Greeson, 2013; Kerber, 1989; Mennell, 2020). A paradox of the newfound individual freedoms is the implicit inequality simultaneously evident throughout the new society (C. S. Fischer, 2008; Greeson, 2013; Kerber, 1989; J. Turner, 2008). Greeson (2013), for example, questions, “How is it that during the era that gives rise to the most cherished modern Western values—equal human dignity, freedom, the rule of law, and representative accountable government—carry out the most massive crimes in recorded history?” (p. 8). Glaring inequities such as the Atlantic slave trade, women’s societal position, and countless examples of atrocities suffered by indigenous peoples reveal that the values entwined with individualism were limited not only to white males but also in a manner that permitted the commodification of those not included in the pursuits of happiness (C. S. Fischer, 2008; Greeson, 2013; Kerber, 1989; J. Turner, 2008). The inequities permitted to exist in plain sight at the origin of the US foretold the potential for individualism to have the capacity to elevate the freedoms of some while, in the process, restricting the freedoms of others into the future as well.

2.1. Individualism and the Social Sciences

From the mid-19th century to the early decades of the 20th century, the social sciences formed from the writings and debates of its founding figures, Emile Durkheim (1893, 1897), Karl Marx (1909), and Max Weber (1905/2002), among others, in which they placed individualism central to the study and understanding of Western society. Influenced by social evolutionists, such as Herbert Spencer (1873), Durkheim saw individualism as a key aspect of social order. Taking an “atomist” position, whereby society is made of independent, self-interested, self-sufficient agents, Durkheim posed his “Cult of the Individual” perspective in which he argued that individualism, in the new capitalist society, replaced Christianity, in that it was the individual now that was sacred to society, making the priorities of the two mutually exclusive (Durkheim, 1893, 1897). Karl Marx (1909), like Herbert Spencer, viewed individualism as pathological in that it undermined the natural progression of social evolution ending in communism; he argued that a self-interested atomist society hindered the necessary collective action required for social revolution. Max Weber (1905/2002), in contrast, proposed “methodological individualism,” a theory operationalized by the study of society and institutions through the atomist actions of individual agents. While Marx’s work on collectivism has continued to have a salient influence in the research of fields such as labor studies, anthropology, unionism, risk analysis, and others that examine the dynamic tensions of collectivism vs. individualism, Weber’s methodological individualism persists in contemporary sociological and psychological research on social behavior, corporate culture, and policy issues (Udehn, 2002).

The influence of methodological individualism continued through the 20th century, especially in the writings of Karl Popper in the 1940s (Udehn, 2002). Psychologism, a parallel theory to methodological individualism in the field of psychology, was recognized by practitioners with efforts to identify differences between the perspectives. A concession in that debate was that all general laws of the social sciences were psychological laws, given the atomist view that individuals are the independent operating units within society, and thus their drives, biases, and decision making originate from mental states (Udehn, 2002). During the early to mid-20th century various versions of methodological individualism emerged, with the social theory of exchange, perhaps, being the most broadly applied. Social exchange theory, in sociology, psychology, and anthropology, involves cost–benefit analysis by individuals as they assess the costs incurred and benefits gained in various interactions (Malinowski, 1922; Mauss, 1926/2016). Similar in some ways to game theory, social exchange theory considers the factors individuals weigh during interactions. This theory entwines well within a competitive, capitalist society in many layers of social interaction. For example, some of the core concepts include individual assessments of reciprocity, cost–benefit comparison of past interactions, and even how current relationships compare with other potential relationships. The facility of this approach to the study of American culture demonstrates the extent to which individuality is embedded within it (Mennell, 2020). That degree of embedded individuality has, in itself, become a topic of research due to the societal issues linked with individualism.

The sociological study of American individualism in the 21st century has taken on issues of structural violence, paradoxes of a mixture of individualist/collectivist tendencies, and macro/micro dynamics that have shaped the habitus formation that imbues individualism (Mennell, 2020). American individualism, it is argued, exists in a dynamic that can be largely blind to structural violence. It, for example, preserves faith that one’s fate lies entirely in one’s own hands. Moreover, American individualism can ignore the ways social structure constrains the personal freedom and independence of some groups, while simultaneously, individualism can permit the acceptance of unjust benefits of social privilege as products of earned success. These factors, thus, illuminate the dual existence of individualism and structural injustice. In this frame of selfish interests, sociologists and historians have pointed to the paradoxical contradictions of American individualism (Kerber, 1989; Mennell, 2020).

To understand such contradictions, contemporary social psychologists have researched how individualism uniquely affects the way Americans process others’ emotional states and contextual cues (Arceneaux, 2017; Lindquist & Barrett, 2008; Stanley et al., 2013; J. R. Turner & Stanley, 2020). In a series of cross-cultural studies, the researchers Stanley et al. (2013) and J. R. Turner and Stanley (2020) showed American and Chinese participants an image of a central person with a distinct expression of fear, happiness, disgust, anger, surprise, or sadness who was surrounded by a group of other people with either similar or contrasting expressions. The results of the study found that differences in the cultures the participants were raised in, individualist for Americans versus collectivist for Chinese, impacted not only their worldview but also how they perceived others’ emotions. The American participants interpreted the images by their defining features, or the central person, while the Chinese participants tended toward a more holistic interpretation of the image and perceived the central person in terms of their relation to the surrounding faces. This caused the Chinese participants to incorrectly identify the emotion of the central person more often when the surrounding faces displayed conflicting emotions as compared to the Americans, who took into account only the central person’s expression. It can be inferred from this study that while those raised in collectivist cultures take into account the entirety of a group of people when assessing the emotion of a single person, those raised in individualistic cultures focus only on that person and do not perceive the group as being relevant to that person’s emotional state. In other words, one result of an individualistic perspective is a tendency to see people as being independent from the social context to which they belong. Instead, people are more often perceived as operating with their own independent emotional states, which are not related to or influenced by those around them (Arceneaux, 2017; Lindquist & Barrett, 2008; Stanley et al., 2013; J. R. Turner & Stanley, 2020). This aspect of individualism accentuates the apathetic and isolating effect it can have on members of a highly individualistic society, which is important to understanding the influence that it can have on a culture’s disease response. Through its encouragement of perceiving people as being separate, to a degree, from those that they are surrounded by, individualism also keeps highly individualistic people from seeing themselves as being connected to a community of others and keeps them in a state of apathy, both of which are necessary parts of advocating for their own individual freedoms. Thus, when faced with a national crisis such as a disease outbreak, members of highly individualistic societies may tend toward being more concerned with their own self-protection, preservation, and individual freedoms than with the well-being of their society.

Furthermore, contemporary social science researchers have also investigated the impact of individualism on “self-concept,” a fundamental aspect of identity (Triandis, 2001). Social psychologists (Ma & Schoeneman, 1997; Sedikides & Brewer, 2015; Vignoles et al., 2016) measured rates of individualism and collectivism in relation to self-concept in a variety of contexts. Among American college students, rural Kenyans, and urban Kenyans, for example, researchers found that self-concepts among rural Kenyans were distinctly more collective than those of American college students. The self-concepts of urban Kenyans, including college students and day workers, tended slightly more toward individualism but not to as great of an extent as the Americans (Ma & Schoeneman, 1997). It was hypothesized that the urban Kenyans were more individualistic than their rural counterparts as a result of acculturation. Urban Kenyans, particularly college students, had more exposure to Western ideals and values as a result of living in the city of Nairobi, which has been influenced by Western culture and technology. Exposure to Western ideals, then, according to Ma and Schoeneman (1997), contributes to the development of an individualist self-concept. The researchers infer from the results of this study that, based on prior research on the nature of individualistic personalities, the higher rates of individualism apparent in the self-concepts of Americans may mean that they are motivated primarily by their own desires. Americans may also be more emotionally detached from people who are not within their immediate social circle, prioritize their individual freedom, and cultivate and express their uniqueness compared to others (Ma & Schoeneman, 1997; Sedikides & Brewer, 2015; Vignoles et al., 2016; Triandis, 2001). Ma and Schoeneman’s (1997) inferences about individualism and its impact on one’s self-concept is in agreement with Tocqueville’s perspective on individualism. Both characterizations of individualism assert that it primarily works to isolate citizens as individuals, emphasize their uniqueness and freedom from others, and de-emphasize their belonging to society at large. Such features of individualism can impact societal responses to disease threat.

In addition to the complexities of the diverse effects of individualism on self-concept and emotional states, Mary Douglas’ Grid/Group Cultural Theory (GG-CT) has proven applicable in the assessment of variable rates of individualism within a society, especially with regard to the analysis of individualism and decision-making patterns in public policy, corporate, environmental, and public health research (Davidson, 2024; Docter et al., 2011; Johnson & Swedlow, 2021; Langford et al., 2000; Mamadouh, 1999). This anthropological theory has a simple elegance in that it categorizes a culture or an individual, as applied in contemporary research, along two dimensions, “grid” and “group”, and places them along the axis that best fits with their specific bias. The GG-CT chart maps out distinct culture “types” that include Fatalist, Individualist, Collectivist, and Egalitarian. The various culture types that are ascertained differ in key characteristics such as hierarchy, individualism, group orientation, disaffection, etc. (Johnson & Swedlow, 2021; Mamadouh, 1999). The labels and other elements may vary by practitioner, but the basic concept and structure of the theory have remained intact as it has been applied. GG-CT, as a theory, is quite robust and has been operationalized to ascertain tensions and social responses to contentious issues such as climate change, pollution, and the biases of elected officials in relation to public health crises.

The utility of GG-CT is demonstrated in the manner in which it permits investigators to delve into contradictions embedded within the individualism/governmental dynamic. Scholars researching social responses to climate change, for example, tease out the individualistic reasoning behind rejection of science that explains the ongoing global threats (Davidson, 2024; Jones, 2011; Langford et al., 2000). The imposition of expensive public policies, especially those that may work to the benefit of another community, remains an anathema to individualistic ideology. Likewise, individuals can choose where they obtain their information. An Achilles heel for science in this regard is that, unlike the unchanging biblical views of the papal Middle Ages, it is an ongoing, self-correcting accumulation of knowledge. Thus, as new data and interpretations emerge, it is too easy to point to the flawed previous interpretation and the inevitable likelihood of a new interpretation to emerge in short order. Rather than looking to an ever-changing science and propositions for expensive tax-supported policies, GG-CT shows that the American individualist bias favors the assumptions that serve their immediate interests (Davidson, 2024; Jones, 2011; Langford et al., 2000). Those include the following:

(1)

Nature is self-correcting (don’t tax me to fix it).

(2)

If a real issue emerges there is confidence that future technology will resolve it (no need to try and fix a future problem that may never develop).

(3)

Freedom from governmental rule includes freedom to pursue capitalistic gains (the government does not have the authority to restrict my freedoms).

Governmentally imposed environmental restrictions to address climate change, for example, run against those basic foundations of American individualism.

2.2. Individualism and Affliction

The history of past disease responses (Fox, 1989) is important to consider in an examination of how individualism might be a factor. The US, in particular, has had a shifting record on when and why it chooses to exert authority over individual freedoms to protect public health. Moral arguments have been used when an affliction is perceived to be limited to marginalized groups. The AIDS epidemic, for example, was met with a laissez faire approach (Mack, 1991). In that case, the perceived threat, at least in the 1980s, was limited to the gay community and did not trigger an aggressive governmental intervention (Mack, 1991). Likewise, the threat of tuberculosis in the early decades of the 20th century was linked to behavioral characteristics associated with poverty and cleanliness—so much so that the US rejected the WHO-recommended BCG vaccine in favor of heavy-handed public-health social-control initiatives to affect individual behaviors in poor communities (Feldberg, 1995). In contrast, communicable diseases that threatened the greater population, such as the 1918 influenza pandemic and smallpox outbreaks, triggered public health mandates such as masking, isolation, and compulsory vaccinations (Leavitt, 2003; Navarro & Markel, 2021). In both cases, citizen protests—and sometimes riots—erupted at the perceived infringement of individual freedoms (Leavitt, 2003; Navarro & Markel, 2021). Below, discussions of leprosy and syphilis are presented as the extremes of individualistic vs. collectivistic disease responses. The COVID-19 social response is then presented and investigated under the lens of the impacts of individualism.

2.2.1. The Example of Leprosy

Leprosy, the only disease specifically named in the Bible, has a central place in the history of medicine and remains part of modern discourse, with colloquialisms such as “treated like a leper” used when one feels excluded from social interaction (Douglas, 1991; Miller & Smith-Savage, 2006; Shinall, 2018). Medical historians report widespread outbreaks of leprosy during the Middle Ages, which culminated in the “Great Leper Hunt” from 1120 to 1366. During that near-250-year period, hundreds of thousands of individuals were identified as lepers and treated according to social standards and church doctrine. Scholars debate the underpinnings of the leprosy epidemic, not so much in terms of the actual treatment of lepers and their experience as in terms of how their affliction was rendered through social judgement and papal authority. Some of the points of agreement include the following (Douglas, 1991; Magner, 1992; Miller & Smith-Savage, 2006; Shinall, 2018; Watts, 1997):

Leprosy was seen as divine punishment for sin.

Physicians did not treat leprosy since it would be an attempt to subvert God’s will.

Lepers were stripped of all money and possessions.

Lepers dug and stood in their own grave in attendance at their own funeral.

Lepers were stripped of their former identity and only identified themselves as “unclean.”

Lepers lived in Leper Houses, separated from society.

Leper Houses were run by the church, having spartan accommodation.

It is important to distinguish medieval leprosy from the modern form of the condition, known as Hansen’s disease. Hansen’s disease is a slow-acting bacterial disease caused by Mycobacterium leprae. It is a degenerative, lytic disease most famously known for its horrific disfiguring progression. Diagnosis in contemporary medical practice is confirmed using a blood test. In medieval Europe, priests identified a suspected leper through a visual inspection of their skin. Thus, as medical historians have noted, it is impossible that the actual Hansen’s disease bacterium was the infectious agent involved in most leper condemnations (Douglas, 1991; Magner, 1992; Watts, 1997). Instead, any number of skin lesions could result in one being identified as a leper through a priest’s visual inspection. Possible skin conditions misdiagnosed as leprosy include eczema (and the various forms of dermatitis), erysipelas, skin cancer, and syphilis, among others (Douglas, 1991; Magner, 1992; Watts, 1997). What is important to this essay is why this phenomenon took place, the cultural response that ensued, and if this can be interpreted through the lens of individualism.

Historian Sheldon Watts (1997) interprets the phenomenon of the leprosy epidemic as a reflection of the power of the church in medieval papal Europe. In his view, leprosy was a “construct,” rather than a real disease, through which the church could identify, cull, and control the populace. Indeed, due to favorable environmental conditions, the European population grew to 100 million for the first time in this period due to the bumper crop yields that accompanied the Medieval Warm, circa 950 to 1300 (Pretty, 1990; Watts, 1997). Historians point out the pattern of removal of societal outcasts, rarely lords or clergy, in the identification of lepers (Douglas, 1991; Miller & Smith-Savage, 2006; Shinall, 2018; Watts, 1997). A question, however, is why did the population accept the church’s seemingly omnipotent power over individuals and the course of their lives? Two factors are important for this unilateral acceptance. First, in pre-Enlightenment Europe, there was a single source for information and interpretation, the church and its biblical teachings (M. Fischer, 1992; Watts, 1997). That interpretation was consistent and, backed by divine power, was unquestioned. The lives of medieval peoples were highly religious and guided by practices of accepted virtues (Douglas, 1991; Shinall, 2018; Watts, 1997). Of course, in this consciousness, it is understood that no one is without sin; thus, all carried the guilt and fear of potential identification as a leper. The second factor was the collective nature of the hierarchical feudal system. In such a system, trust in authority is not only entrenched but backed by divine power (M. Fischer, 1992; Watts, 1997). Furthermore, a distinct difference between the Orthodox Church and the Roman Catholic Church, after the Great Schism of 1066, was that the Roman Catholic Church emphasized the recognition of God’s presence on earth (Watts, 1997). The presence of many lepers and leprosaria during the Great Hunt was a self-reinforcing system that strengthened the church’s authority. Seeing a leper was a reminder of one’s own sins and of God’s presence and power, and it affirmed further unquestioned adherence to social norms.

2.2.2. The Example of Syphilis

Syphilis, first recognized as a distinct disease in Europe during the late 15th century, has left a prodigious mark on the history of medicine and disease. The early syphilis epidemics took place in ports and, thus, began the disease’s association with debauchery, prostitutes, soldiers, and the decadence of aristocrats (Magner, 1992; Watts, 1997). The bulk of the research on syphilis has focused on its origin and subsequent consequences for colonialism and indigenous peoples. A yawning chasm in the research on syphilis exists, particularly in relation to its threat to public health (Phillips, 2024). Along with smallpox and tuberculosis, syphilis was considered one of the greatest killers of the 18th and 19th centuries (Magner, 1992). Given its prevalence, the omission of research on the threat syphilis posed is notably odd (Phillips, 2024; Watts, 1997). From what is known, the treatment of syphilitics included the following:

Syphilis was seen as divine punishment for sin;

Syphilitics were treated by physicians, most commonly with mercury;

Numerous cottage industries arose for the attempted cure of syphilis;

Syphilitics’ condition was kept confidential;

Syphilitics were free to live their lives as they chose;

The onset of tertiary syphilis resulted in exclusion from society;

Penicillin transitioned syphilis to public health reporting;

Syphilis was commercialized.

Treponema palladium is the bacterium that causes syphilis. Syphilis, a sexually transmitted disease, is a slow-acting chronic infectious disease that passes through three distinct phases. Stage one involves a lesion at the site of infection that clears up within a few months. Stage two manifests as a rash of lesions over the body. The rash does not usually appear until 6 months after the initial infection but can be intermittent for several years. Stage three, tertiary syphilis, can onset 10 to 30 years after the initial infection. This last stage can affect any part of the body, in various ways, but the external symptoms are large lytic lesions and even resorption of cartilage and bone. These can occur on the skull and face, with features such as the nose being resorbed. Syphilis was known as a great mimic, since its various stages had overlapping symptoms with other diseases (Magner, 1992). For example, Stage one was often confused with gonorrhea, and Stage two could be mistaken for smallpox, measles, or any number of rash-inducing conditions. Finally, Stage three mimicked diseases such as leprosy and some cancers. A complication to treating syphilis was that Stages one and two cleared up on their own in the natural progression of the disease. Thus, treatments administered when lesions cleared up, and the disease returned to a latent state, were mistakenly thought to have cured the ailment.

Syphilis, despite its threat to public health, was a “hidden” epidemic until the discovery and wide availability of penicillin in 1944. Prior to that, it appears that physicians treated syphilitic patients and maintained their confidentiality. Phillips (2024) reports an internal debate among physicians in colonial America that persisted until the 20th century on the threats of the “secret disease”. In fact, syphilis was omitted from the historical record in a number of manners, such as physicians falsifying death certificates, and in other ways, like remaining silent when a syphilitic man married an unsuspecting bride. Those occurrences divided the medical community, yet the privacy of the individual patient was privileged throughout that period (Parascandola, 2008; Phillips, 2024; Watts, 1997). A parallel practice occurred simultaneously in England. Mark (2019) discusses a detailed biography in which a syphilitic’s infectious status was protected even after death. Apparently, England had laws to protect patients and punish physicians who revealed a patient’s condition even after death. Thus, not only were doctors at risk of losing clients if they exposed a patient’s infectious status, they could be charged with libel and lose their license if they, even correctly, listed syphilis as a cause of death. Thus, syphilitics were free to participate in society.

Treatment as a patient and consumer opened the door for the commercialization of syphilis. Scholars have noted that numerous cottage industries developed around the treatment of syphilis (Parascandola, 2008, 2009; Watts, 1997). Early examples include cures such as sassafras, which was thought to be a possible treatment for syphilis (Manning & Moore, 1936; Willard et al., 2009), and a wide range of other ineffective tonics and elixirs (Parascandola, 2008, 2009). The primary vein of the syphilis economy was the need for lifelong physician care. As detailed in various texts (Mark, 2019; Parascandola, 2008; Paugh, 2014), patients required regular treatments and counted on physician confidentiality. Thomas Thistlewood, for example, recorded in his 18th-century diary that physician treatments sometimes persisted for 22 consecutive days. Benefits to syphilitics were that they could continue their lives with the protection of secrecy from the medical community. The protection, however, tended to favor white males in particular. Zipf (2016) details how adolescent girls and young women had their rights stripped from them on the basis of national security. Circa World War I in the US, prompted by fear of losing soldiers to hospitalization due to syphilis, the US government rounded up over 100,000 young women, dubbed “Charity Girls,” who were suspected of poor morals, and incarcerated them in institutions such as the Samarcand Home, to train them in acceptable virtues on pain of further disenfranchisement through forced sterilization. The irony of stripping some individuals of their freedoms for a condition for whom others’ freedoms were protected is difficult to overstate.

2.2.3. The Example of COVID-19

In late 2019 to early 2020, the world heard the first calls for alarm regarding a respiratory infection in China that might pose a global threat. COVID-19 became the first pandemic to fulfill Laurie Garrett’s prophetic prediction in her book The Coming Plague (Garrett, 1995). As the disease swept across nations, public health preparedness became daily headline news. The public soon became educated in protocols for disease response. Hopes of a vaccine were dim considering it generally takes 10 years, if ever, for an efficacious vaccine to be developed. Likewise, unlike bacterial diseases, which are mostly treated with antibiotics, COVID-19 was caused by a virus, for which there are limited treatments. For most viral diseases, the prognosis is to let the disease run its course and nurse the symptoms to comfort the patient. In this context, public health measures became frontline:

Masks recommended, mandated in some settings;

Social distancing recommended, mandated in some settings;

Vaccine recommended, mandated in some settings;

School closings, remote learning;

Remote work mandated in some settings;

Paxlovid, preferred treatment;

Some drugs, such as Hydroxychloroquine, were rejected by the medical community.

Although the actual mortality rate is low, ~1 to 0.05% in comparison to more virulent diseases such as measles or smallpox, 7 million still perished from the disease globally, and 1.2 million in the US alone, a notably higher rate for the US in comparison to other countries (Mueller & Lutz, 2022). The elderly, obese, diabetics, and, especially, individuals with a compromised immune system accounted for the bulk of the mortality due to COVID-19 in the US. As the disease ravaged the US population from 2020 through 2022, the US sank into unrest over the contested issues of government authority, individual rights, and conspiracy theories that divided the nation and politicized a public health crisis. And, as with syphilis, a lucrative industry emerged around COVID-19 treatment, earning the pharmaceutical industry an estimated $90 billion annually (Haan, 2023).

Social media played an unprecedented role in the public response to the COVID-19 pandemic (Aggarwal et al., 2022). Central to public interests were infringements on individual freedoms by government authorities. Perceived violation of freedoms ranged from mask mandates to choice of medicinal treatments. Social media enabled individuals to pick and choose their sources of information on topics pertaining to the pandemic. Algorithms that tailored newsfeeds to users’ interests created rabbit holes for conspiracy theorists to be nurtured with misinformation. The situation was made worse as it became apparent public health officials suppressed information that contradicted their messaging and that they downplayed obvious vaccine risks (Jennings et al., 2021; Martin, 2025; Shir-Raz et al., 2023). The vaccine itself, though a medical miracle due to its speedy development because of President Trump’s “Warp Speed” initiative, was rejected by large segments of the population as a poison that likely actually caused COVID-19. In the end, confusion, self-selected information, and mistrust of the government led to individuals making choices out of their own best interests and, even upon death, believing the conspiracy theory when the reality of their own experiences contradicted the frame through which they preferred to understand their situation (Cascini et al., 2022; Jennings et al., 2021; Martin, 2024).

3. Discussion

Central tenets of individualistic behavior in American society strongly impacted the cultural response to the COVID-19 pandemic. Those tenets include the following:

(1)

Individuals can select their sources of information.

(2)

Information is not static; since it is subject to change, it is subject to suspicion.

(3)

Individuals can question government authority in relation to their autonomy.

The history of individualism shows that the emergence of American society developed around Enlightenment ideals which separated the US from most other nations that had some degree of a collectivist past still embedded within their social fabric (C. S. Fischer, 2008; Greeson, 2013; Kerber, 1989; Mennell, 2020; J. Turner, 2008). In response to the pandemic, American citizens were fully prepared to select their sources of information on the threat, assess both changes and contradictions in information, and question how and why their rights might be infringed upon by government-imposed mandates. As Tocqueville first commented, the habitus of individualism is evident in all daily aspects of American life (Mennell, 2020). That basis of enculturation materialized in differing degrees of compliance with mandates, ranging from full compliance to rejection and protests. In the context of a severe health threat, those three characteristics triggered predictable cultural responses, which included the following:

(1)

Privilege of individual choices over imposed mandates.

(2)

Viewing any disease exposure outcome, positive or otherwise, as a result of one’s own successful freewill.

(3)

Nurturing mistrust through selection of information choices that justified one’s own conceptions.

Another aspect of American individualism evident in pandemic-era behavior was an advocation for freedoms even when those freedoms might intrude on the freedoms of others (C. S. Fischer, 2008; Greeson, 2013; Kerber, 1989; J. Turner, 2008). An iconic example of this took place among the Supreme Court Justices when Justice Gorsuch refused to wear a mask during deliberations (Totenberg, 2022). By upholding his freedom and rejecting the mask mandate, he flagrantly stripped Justice Sotomayor of her freedoms to fully participate in her job. At the time Sotomayor was elderly and a diabetic, two factors that put her at greater risk of a poor outcome from COVID-19. Furthermore, this action took place when the Omicron variant, a novel strain not hindered by the vaccine, was surging, which significantly increased Justice Sotomayor’s risk of a potentially fatal exposure. In this context, the choice of one to privilege individualism and their own freedoms in a specific situation, while simultaneously being blind to how such action impeded on the freedom of another, parallels the social detachment reported in social psychological studies on individualism (Ma & Schoeneman, 1997; Stanley et al., 2013).

How might things have gone differently? The examples of leprosy and syphilis, when examined under the lens of individualism, demonstrate, perhaps, the extremes of social responses to the introduction of a novel affliction. A diagnosis of leprosy stripped one of all rights and relegated them to a life of ostracism. There was no challenge to church authority in that decision and consequence. During the nearly 250 years of the Great Leper Hunt, there were no leper revolts or protests; divine judgement was apparent, unquestioned, and final. In contrast, the emergence of syphilis in tandem with the Enlightenment and incipient ideals of individualism created an opportunity, as with COVID-19, for capitalistic advantage. Not only did cottage industries develop around the treatment of syphilis, but, as consumers, patients could expect physicians to maintain secrecy concerning their condition. Even when other diseases, such as smallpox and tuberculosis, had ambitious public health campaigns waged against them, imposing mandates that stripped individual freedoms, the medical community privileged syphilitic patients’ privacy over public health due to the stigma of the disease and how that would damage their patient/consumer’s reputation. This near opposite social response to syphilis in comparison to leprosy, for two diseases both understood to originate as divine punishment for sin, underscores, we argue, the significance of individualism to a culture’s response to a novel affliction. The cultural response to COVID-19 reflects an individualistic society that bristled at government mandates, shifting messages, an opportunity for economic gain, and, at key times, an absence of transparency. As members of an individualistic society, US citizens were permitted a multitude of options on the degree to which one could adhere to suggested protocols. Within those options, division was amplified by varied messaging via alternate sources such as social media venues. Even after the pandemic subsided, there was little to no recognition of the individualistic sources of the cultural conflict.

Social science research reveals the dynamics of how individualism might have impacted social response(s), with investigations into social concept, social detachment, and other global threats such as climate change and pollution (Jones, 2011; Langford et al., 2000; Ma & Schoeneman, 1997). The “atomistic” foundation of social science research has remained intact, and its influence is evident in current research such as the social theory of exchange, social psychology investigations of self-conception and emotional detachment (Ma & Schoeneman, 1997), and GG-CT (Davidson, 2024; Drake, 2023; Johnson & Swedlow, 2021; Jones, 2011) studies into individual reaction along gradients of individualism or collectivism. Such research demonstrates the ability of individuals to weigh situations and respond in such a manner as to ensure the maximum benefit to their own self interests while maintaining emotional detachment from those experiencing the consequences. The GG-CT studies of climate change and pollution, perhaps, reveal the closest parallel social reactions to those of the COVID-19 pandemic (Davidson, 2024; Jones, 2011; Langford et al., 2000). In relation to those broad threats that potentially affect everyone, an individualistic reaction is to bristle at expensive policies and even more so when the benefits might serve to aid another community. The individualistic arguments behind such reasoning include the following (Davidson, 2024; Jones, 2011; Langford et al., 2000):

(1)

Nature is self-correcting.

(2)

If a real issue emerges, there is confidence that future technology will resolve it.

(3)

Freedom from governmental rule includes freedom to pursue capitalistic gain.

While US society was divided along a gradient of individualism to collectivism during the COVID-19 pandemic, strong movements touted the significance of freedoms in the face of governmental authority.

The persistence of the individualistic rejection of government impingement on freedoms in tandem with a blindness for the basis of that rejection is evident in a recent exchange during a US House of Representatives hearing between Rep. Brian McCormick and Dr. Anthony Fauci. During the exchange, both talk past each other while simultaneously espousing the competing interests of individualism and public health. See the following:

House COVID-19 Select Subcommittee hearing transcript, 17 June 2024.

Rep. McCormick:

Chairman [Fauci] it’s been insinuated that politicians only politicians only bloggers only conspiracy theorists are disagreeing with you. I want to point out that I’m probably the only member of Congress that actually saw patients during the pandemic from the very beginning to the very end of the pandemic, during night shifts in the ER, thousands of patients. During that time and in 2020 I was censored, my medical license was threatened because I disagreed with bureaucrats literally taken off the Internet as a person who is treating patients leading edge technologies developing theories but doing my very best but being censored by the United States government for the first time stepping in and taking the place of medical professionals as the experts in healthcare. Any dissent surrounding COVID-19 treatments, mask mandates, any public policy surrounding the pandemic was immediately labeled as anti-science. I watched as public health officials and politicians told my patients what treatment options were best for them, regardless of their comorbidities or their medical history. Despite my education and my training and my experience my opinions were relegated to conspiracy misinformation by so-called healthcare experts who had never treated a patient throughout the entire pandemic. This has been a black eye in medicine and has highlighted why government should never, never insert itself in between patients and their healthcare providers. The American people deserve to make medical decisions through conversations with their physicians rather than politically motivated mandates. Dr. Fauci did you ever treat a patient for COVID during the pandemic?

Dr. Fauci:

I was part of a team that was at the NIH that took care, we didn’t take care of many of them because I’m not hands on.

Rep. McCormick:

Got it thank you. Why would I be criticized by a bureaucrat for doing my very best as a healthcare professional? This is a rhetorical question but why, why would the government who’s never treated a patient for COVID? You can read all the things you want but you’re not there, you’re not seeing patients. You’re not watching people die, intubating patients right there with that disease in your face, watching it happen, watching the development of this disease and actually learning from it but I’m being told by bureaucrats what’s right and wrong. And, what’s funny is everything I was censored on I was proven to be right, pretty crazy isn’t it? You said in an interview that you gave as part of an audio book written by Michael Specter that you believed institutions should make it hard for people to live their lives so they feel pressure to get vaccinated can we run the audio clip on that please.

Michael Specter (audio):

What do you think can be done about it?

Dr. Fauci (audio):

I have to say that I don’t see a big solution other than some sort of mandatory vaccination. I know federal officials don’t like to use that term once people feel empowered and protected. Legally you were gonna have schools universities and colleges, and just say you wanna come to this college buddy you’re gonna get vaccinated, lady you’re gonna get vaccinated, yeah big corporations like Amazon and Facebook and and and all of those others are going to say you want to work for us you get vaccinated. And, it’s been proven that when you make it difficult for people in their lives they lose their ideological bullshit and they get vaccinated.

Rep. McCormick:

Thank you. Are all objections to COVID vaccinations ideological bullshit Dr. Fauci?

Dr. Fauci:

No they’re not and that’s not what I was referring to.

Rep. McCormick:

Well, in reference to making it hard for people to get education, traveling, working I’d say it very much was in context and I take great offense to this. Miss Allison Williams testified before this committee about losing her job because she sought an exemption for ESPN’s vaccine mandate which came from recommendations from bureaucrats like yourself. She and her husband were actively working with a fertility expert, a physician on how to get pregnant, and agreed with the premise that she was young healthy wanting to get pregnant and shouldn’t get the vaccination for medical purposes. But, she was fired because you made it hard. Just like you said in your statement because you wanted to make sure that the ideological bullshit got in the way of her working, living her life, and making a medical decision with her health care professional. I think America should take great offense to this, that’s exactly what you meant when you said making it hard for people to live without getting the vaccination. You affected people’s ability to work, travel, be educated, to actually flourish in American, decide to self determine as we’re all given God-given rights. Shame on you. Watch out, you become Dr. Fear. Americans do not hate science, I don’t hate science, the American people hate having their freedoms taken from them. You inspired and created fear through mass mandates, school closures, vaccine mandates that have destroyed the American people’s trust in our public health institutions. This spirit you created will continue to have ripple effects over generations to come. You have already seen its effects in education and the economy and everything else. Quite frankly you said if you’re a doctor if you disagree with me you disagree with science Dr. Fauci. I disagree with you because I disagree with fear, and with that I yield. (McCormick .gov website)

This exchange demonstrates a lack of recognition by public health authorities of the significance of individualism in American society. Rep. McCormick gives no consideration to the potential benefits of the public health recommendations advanced by Dr. Fauci, and Dr. Fauci, citing “ideological bullshit”, is disrespectfully dismissive of the pushback to the, at times, flawed approach taken by his public health administrative approach.

A misstep for the US Public Health Administration messaging was the assumption that when scientific information is presented in a rational framework it will be widely accepted. In the absence of that acceptance, leading figures such as Dr. Fauci resorted to tactics that have been characterized as secrecy, censorship, and suppression (Martin, 2025; Shir-Raz et al., 2023). Under direct questioning in a US House of Representatives hearing, Dr. Fauci acknowledges valid concerns associated with the COVID-19 vaccine. That statement—confession ?—flies in the face of mandates that hindered civil liberties and harmed the lives of some as a result of the imposed restrictions. Furthermore, in the short time since the pandemic, scholars have documented governmental strategies that entailed methods that included flooding, ignoring, censoring, and attacking information that contradicted the central public-health statement (Jennings et al., 2021; Martin, 2025; Shir-Raz et al., 2023). Given the tenets of an individualistic society having full access to varied information sources, such an approach is unlikely to work. Citizens are free to choose their information sources, contradictions in messaging fuel conspiracy theories, and rhetorical disdain as expressed in “ideological bullshit” is immediately recognized as dismissive and disrespectful. Within this ideological fog is a fight over the competing interests of what is “information” and “misinformation” (Martin, 2024; Shir-Raz et al., 2023).

A significant player in the dynamics of the COVID-19 pandemic was the emergence of social media and the struggle to disentangle information from misinformation (Aggarwal et al., 2022; Jennings et al., 2021; Martin, 2024). It is important to note that social media did not cause individualistic tendencies, but, instead, provided avenues of descension given individuals are free to choose their own sources of information. In the context of the pandemic, social media helped to spur debates and created cauldrons of divisiveness and mistrust of public health authorities. For example, scholars critique the current public health approach as a paradigm that is intolerant to alternative suggestions to the point that testing such ideas is suppressed (Martin, 2025; Shir-Raz et al., 2023). Since such examples are visible to the public, the veracity of the public health authorities’ positions easily becomes suspect and motives are questioned. Prominent conspiracies generated from doubts include the contention that policies are set to benefit pharmaceutical companies through monetary gain and suspicions on the origin of the virus, natural or lab-created. Rather than allow a healthy, upfront debate, government authorities suppressed opposing views, and social media algorithms pulled countless information-seekers into rabbit holes of paranoia. As shown in the text exchange above, even years after the pandemic ended, figures from differing sides of the issues such as Rep. McCormick and Dr. Fauci continue to talk past one another with little resolution and continued abrasive self-righteousness. A problem that emerges from a lack of direct communication is a continued battle over what is “information” and what is “misinformation” (Jennings et al., 2021; Martin, 2024).

4. Conclusions

This review essay has examined the ways in which individualism can impact the cultural response to the threat of an affliction. The US response to the COVID-19 pandemic, for example, was divided, ranging from a rejection of governmental mandates that infringed on personal freedoms to an acceptance of infringements in favor of the public’s health. As the societal debates ensued, social media flamed conspiracy theories and the US experienced mortality outcomes out of proportion with the rest of the world. The US had, for example, nearly 16% of the global pandemic mortality, when the US population is only about 4% of the global population. The essay has detailed the ways in which individualism emerged in Western societies, how individualism affects behavior through social science research, and how degrees of individualism have influenced responses to diseases such as leprosy and syphilis, and, comparatively, the COVID-19 pandemic.

The history of individualism shows how the concept developed with Enlightenment thought and uniquely entwined with the emergence of the United States. Social scientists in sociology, psychology, and anthropology demonstrate how varying degrees of individualism can affect behavior, the weighing of costs and benefits, and empathizing (or not) with others. When individualism is used as a lens to assess cultural responses to afflictions, such as leprosy and syphilis, it is argued that the extreme responses to those diseases were strongly tied to the degree of individualism in the given societies. There were key differences between the two societies, where one was collectivist (feudal Europe) and the other was individualistic (post-Enlightenment Europe and America). Likewise, the debates in the US during the COVID-19 pandemic largely surrounded collectivist/individualistic interpretations of whether to protect individual freedoms or public health.

Governmental missteps during the pandemic further fueled social debate and conspiracy theories. The initial assumption that “if the public was presented with rational public health measures meant to protect lives, the measures would be widely accepted” was, perhaps, a naïve mistake, especially in retrospect. What emerged were debates over what was “information” versus “misinformation”, with government figures associated with cover-ups and suppression of information to minimize obvious contradictions. Tenets of an individualistic society include the ability to select one’s source of information and to question governmental authority. In the context of dispute and the search for information, social media played an unprecedented role as a conduit to divide the US into silos where those on differing sides talked past each other, even when speaking face to face, as the exchange between Rep. McCormick and Dr. Fauci demonstrates.