Faith and Disease: Understanding Behaviour During Lockdown

May 3 was a special day in the ongoing war against Covid-19. The army, navy and air force showered flower petals at various hospitals throughout India. While watching these thrilling visuals of gratitude, a stirring thought surfaced in my consciousness.

While one set of warriors saluted the other, what must be going on in the minds of those who were pelting stones on healthcare workers and policemen! Would there be some contemplation?

Many cases of unprecedented behaviour got reported during the three-week lockdown starting March 25 that initially got extended till May 3, then till May 17, and now exists in a revised format. One event of the initial phase that echoed for quite some time was the Tablighi Markaz episode in New Delhi. The congregation of about 2000 people in the Markaz drew everyone’s attention.

Initially our healthcare workers met with a lot of resistance. Many localities here are congested and I thought of taking people out from these localities to spacious quarantine facilities to break the transmission chain but people weren’t willing to leave their homes, especially those who did not have symptoms.

Later, the Delhi police claimed that around 16,500 people visited Nizamuddin headquarters of the Tablighi Jamaat between March 13 and 24. According to the Union health ministry, by mid-April 4,291 jamaatis had tested positive constituting 29.8 percent of the total corona positive cases in India. The health ministry’s press conference of April 18 linked the mid-March Tablighi Jamaat event to the total confirmed cases of Covid-19. The attendees of this congregation spread to 23 states and union territories, thus giving a big jump in the total count. In that press conference, the joint secretary added that 80 per cent of cases in Tamil Nadu, 63 per cent cases in Delhi, 79 per cent cases in Telangana, 59 per cent cases in Uttar Pradesh and 61 per cent cases in Andhra Pradesh are related to the Nizamuddin Markaz in New Delhi.

This outbreak repeatedly flashed in the media creating a perceived association between faith and spread of Corona virus in a section of the society. By the time the attendees were tracked, spotted, and subjected to quarantine, several of them had spread to several states in the country and the focus of the media consolidated the perception.

Today, their contribution percentage has gone down due to the rise in the total number of corona positive cases, but has the perception also weakened?  It is, therefore, important for us to understand the interplay of belief and attitude and how it results into an intended behaviour, especially with respect to the current pandemic.

We had to involve religious leaders, and communicate through them to convince these people. That took a lot of effort and time.

Firstly, how does belief blind us sufficiently enough to mistrust either science or the saviours, or both? Western researchers have shown ample examples of unwarranted public mistrust in science. However, here it seems not only a case of mistrust in science but also a strong anchoring into belief.

Some of us may give the discredit to poor literacy rate and hygiene, but it cannot be denied that sufficient information about Corona was disseminated through media and other virtual alternatives. Thus, the kind of non-cooperative behaviour of some of the corona positive patients we saw, partly seems to be in the mistrust in science. This mistrust did not allow some to visualize the health risk.

According to Camargo and Grant, “A majority of health risks, for instance, are not self-evident, and identifying these risks requires a somewhat sophisticated epidemiological machinery that is fully understood by relatively few, even among health professionals. This means that the issue of what to trust usually becomes an issue of whom to trust.”

So, whom do we trust— the doctors, policemen, bureaucrats, or the lawmakers? Let us focus on the doctors and policemen, the two frontline worriers who have been attacked at some places.

Evolving public policy at crucial times, like COVID-19 pandemic, and convincing people to follow it is a great challenge. People’s belief about the disease is of extreme importance. The classic health belief model in psychology lay importance on the risk perception of people which ultimately affect compliance to precautionary measures. According to Jones and colleagues, six different factors— perceived seriousness, perceived susceptibility, benefits to action, barriers to action, cues to action, and self-efficacy, contribute to our health behaviour. It means that unless one perceives the risk of COVID-19, ensuring compliance to precautionary measures would remain a challenge for the frontline worriers, especially the medical team.

How does belief blind us sufficiently enough to mistrust either science or the saviours, or both? Western researchers have shown ample examples of unwarranted public mistrust in science.

Police has a perception in the eyes of a common man. It represents the State’s agency which has the role in implementing whatever the State instructs irrespective of whether it is popular among the masses or not. There were socio-political developments around the COVID-19 outbreak in India. Who was implementing the law and order during this phase? Of course, the same policemen. Now, there is a role reversal. Thus, assuming an advisory coming from that source to augment risk perception, it is more than what one should expect.

The attack on medical team at Indore and other places is another disturbing development. My previous article talks about these attacks in the light of source credibility and attitude. Let us go little beyond the incident in Indore. Days after this attack, a leading Muslim organization published an apology in the newspaper naming the two doctors who were attacked. The apology read, “Dr Trupti Kataria, Dr Zakia Syed, all doctors, nurses, medical teams, all officers of government administration, all policemen, all Asha-Anganwadis, institutions, and all people are engaged in the rescue of humanity from Corona. We do not have words so that we can apologise to you. Believe us, we are ashamed for that unpleasant incident which has happened due to rumours.” 

It was a pleasant surprise for many. However, one wonders why such an apology came for only one incidence whereas such attacks were reported from many places. It is important to keep in mind that many of the localities where such attacks have taken place have also reported increasing number of Corona positive cases. For instance, in a span of 20 days, Indore saw a jump in Covid-19 positive cases from four on March 24 to more than 900 in early May. Increase in the number of positive cases were also reported from Moradabad and other places.

Let us think how psychologists would analyze it and suggest ways to optimize the outcome of such situations.

However, here it seems not only a case of mistrust in science but also a strong anchoring into belief.

The strong belief of few people has consolidated their attitude in a certain direction and thus their intention and behaviour are being questioned. Several disciplines of study have focused on religion. Psychologists and mental health experts also consider religion and faith as a social determinant of health. Researchers have not only found how it improves one’s health, rather they consider it a social capital. Religious and other faith-based institutions attract human beings seeking solace. In the current times we saw a conflict, at least in the beginning, between faith-based institution, such as Tablighi Jamaat and institutions involved in disease control and prevention. The initial audio clip of their leader endorsing the gathering at the place of congregation and large number of disciples assembling there despite gradual spread of the virus indicates what dominated their decision-making and behaviour.

Did we somewhere miss the trade-off between health-belief talked about by psychologists, micro-planning and implementation of lockdown strategies?

The sources supposed to augment perceived seriousness and susceptibility of Corona, and benefits of recommended actions could not be strong enough as compared to the preaching of a faith-based institution. There are evidence endorsing religion and faith as social capitals; let’s take advantage of this. 

Psychologists talk about different kind of defense people use to safeguard themselves against odds. One such defense is the socio-cultural defense. Maselko and colleagues call it religious social capital and define it as the social resources that is available to people through the social connections within a religious community. Wingood and colleagues say that “the social resources within a religious community include shared values, levels of trust among members, as well as levels of socializing that are specific to that particular religious group. Religious social capital might be an especially significant social determinant of health precisely because the ties within an average religious community are quite strong. Additionally, religious communities tend to be rather homogeneous in terms of health-related beliefs and acceptable behavior, and individuals are more receptive to those unified ideals”.

If the faith-based institutions and religious leaders communicate to their followers and preach them to forbid such practice of violence against the frontline warriers, things might improve. On April 22, a special team from the central government visited select cities in India and a member of the team visiting Indore stated: “Initially our healthcare workers met with a lot of resistance. Many localities here are congested and I thought of taking people out from these localities to spacious quarantine facilities to break the transmission chain but people weren’t willing to leave their homes, especially those who did not have symptoms. We had to involve religious leaders, and communicate through them to convince these people. That took a lot of effort and time.”

This is a testimony of taking advantage that I am referring to.

Fishbein and Ajzen has extensively talked about belief, attitude, behavioural intention, and behaviour itself. Attitude is a learnt “predisposition to respond in a consistently favourable or unfavourable manner with respect to a given object”. So, it is belief that shapes the attitude of the individual yielding intentions that result into a behaviour. While belief remains the building block, attitude remains the epicentre. Modification in the behaviour cannot be achieved until the belief is revisited. The current measures might help as an immediate stop-gap arrangement. However, intended behaviour will be shaped by the favourable or unfavourable attitude one holds and this attitude can be modified only by working on the belief.

This will give the society a relatively stable solution wherein the saviours will not be assaulted in the days to come. It is a slow but definite process. It will allow society to achieve the needed crucial balance, thus making the subconscious realize what is right and what is not.

The writer isShri Deva Raj Chair Professor of Psychology & Head of Department of Humanities & Social Sciences, IIT Kanpur.