These two ideas have long battled one another by pitting individualistic and religious ideas about the certainty of death with a more secular faith in science and expertise. And although fatalistic attitudes toward epidemic disease may have gone dormant in recent decades, the defiance of shutdown orders shows that they never fully faded away.
The progressive approach to public health in America began with efforts to prevent epidemic disease in the increasingly crowded cities of the middle and late 19th century. Newly instituted health departments improved sewage, water systems and milk supplies. The affluent, urban middle class cleaned their homes and bodies, believing that disease came from dirty air emanating from rot and filth. With their Enlightenment faith in science and optimism about worldly progress, they thought that with enough well-placed effort, they ought to be able to take action to preserve their health.
In the 1910s and 1920s, a legion of new public health advocates urged the American masses to adopt a modern attitude about their health and take personal responsibility to proactively prevent disease and disability caused by infectious disease, accidents and childbirth complications. Using modern advertising techniques, health educators taught Americans to boil their drinking water and protect the purity of their milk to prevent diarrheal diseases, isolate sick family members to reduce illness transmission and screen their windows to keep out disease-bearing insects.
These Progressive Era public health advocates needed to do more than just disseminate new scientifically based advice, however; they needed to persuade people to abandon traditional fatalistic attitudes and invest time, money and energy into new and better ways to care for their health.
The fatalism that public health advocates bemoaned was part of a long-entrenched tradition, cultivated by Christianity in the face of unpredictable and unpreventable debility and death. For example, Martha Coit wrote a detailed account in 1688 of her harrowing near-death childbirth experiences, which included several stillbirths. But rather than it being a cautionary tale or a recording of hard-won advice, Coit aimed to encourage “my offspring to trust in the Lord at all times.”
In other words, she was modeling Christian fatalistic acceptance of the possibility of debility and death. Early American Sunday school books and children’s spelling primers, too, routinely addressed the need for spiritual preparation for death in the face of frequent epidemics that typically hit children hardest.
In many regards, this fatalism was simply a kind of realism about what was and wasn’t medically possible through the end of the 19th century. Even in the early 20th century, as medical science and public health made major leaps, many of the most effective new techniques for disease prevention remained impractical and unaffordable for the urban poor in crowded tenements and the rural poor on farmsteads with traditional privies.
But this fatalism came into direct conflict with 20th-century ideas about public health.
Disagreements between spouses, who shared the same household pressures and expenses, vividly illustrated that this was not just about resources, but attitudes. Health reformers often noted a conflict between forward-looking, reform-minded wives and their conservative husbands who were inclined to lean on traditionalist fatalism rather than invest in health-preserving innovations. Martha Van Rensselaer, a health educator with Cornell University’s extension program (which provided education away from its campus), identified a “man problem,” exemplified in a letter from one grieving farm wife. The letter writer’s husband conscientiously cared for their crops and animals but insisted on storing refuse in their house’s cellar and rebuffed her efforts to keep the house hygienic and healthy: “Men, men, mud, mud, and my cellar. I wonder we are alive. Poor me, I know if everything had been kept properly my children would be alive and well.”
In the following decades, individual attitudes toward infectious disease prevention came to matter less. Even without the cooperation of traditionalist farmers, the combination of community-wide public health infrastructure and a rising standard of living dramatically reduced deaths from epidemic disease.
But in the face of the coronavirus, the early-20th-century ideological divide between progressive public health activists and conservative fatalists has resurfaced, though many have misdiagnosed this fracture as mere partisanship.
The public health establishment has called for an extended shutdown to reduce the number of new infections to a manageable level, while getting a testing and contact-tracing regimen up to speed. Liberals almost uniformly support state restrictions, and are aghast at conservatives in the media and politics who demand a hasty end to them for economic reasons, despite acknowledging that it probably will cost American lives. Some even envision shutting down until a medical cure emerges.
On the right, some conservatives have made an explicitly religious argument for such fatalism in the face of the pandemic. R.R. Reno, editor of the conservative religious journal First Things, sees New York’s shutdown as a deal with the devil, allowing fear of death rather than faith in God and commitment to daily work, play and worship to determine the course of our lives.
Other conservatives seem to be thinking primarily in economic terms. Texas Lt. Gov. Dan Patrick (R), who says that he and other grandparents would gladly risk death to open up the economy, sounds like early-20th-century farmers who wanted to run their farms the traditional way, without the expense of hygienic upgrades, regardless of the consequences. These conservatives point to other activities such as driving and ailments like the flu that we regularly risk to go about our lives.
They see liberals as overbearing and unrealistically attempting to control an ultimately uncontrollable situation. A mix of motives is involved, but seen historically, it is a resurfacing of traditional fatalism, driven less by politics than by a far deeper worldview.
In this case, each side might learn from the other’s philosophy:
Resorting to mere fatalism ignores the medical advances of the 20th century that help us understand how to combat such public health challenges and already provide the infrastructure needed to develop testing and a potential vaccine.
But even carefully researched plans to reopen with testing and tracing hinge on accepting that there are costs to sheltering in place indefinitely, too. Fatalism should not be the default response to a public health crisis. But once we reach the limits of what we can do with modern science and governmental action, a bit of traditional fatalism will give us the strength, calm and acceptance we need to find our way forward.