Words matter in Combatting COVID-19: Continuing to call for ”Social distancing” can make matters worse

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As my hometown of New York City enters phase 1 of 4 phases in “re-opening for business” and people emerge out of the COVID-19 pandemic isolation, preventing spikes in the infection rates rests gravely on people following practices about masks, hygienics, and distancing.

Distance between people is critical since the coronavirus is transmitted by close contact that exchanges respiratory droplets.

Use of the term “social distancing” is widespread. In the US, it’s spoken publicly by many pundits, reporters, organizations, city and state public service announcements (PSAs), AT&T, TV show promotions like for Marriage Boot Camp, and health experts like U.S. National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci and White House coronavirus response coordinator Dr. Deborah Birx. Even popular TV host Trevor Noah now calls his program the “Daily Social Distancing Show.”

But I urge replacing the term “social distance” with “physical distance.”

In many webinars about the coronavirus that I’ve participated in during this pandemic period, I have made sure to highlight this need to shift terminology. In my segment on mental health on a webinar on April 6, on “COVID-19 in Africa: Stopping the Spread and the Panic,” co-sponsored by the United African Congress and my NGO accredited at the United Nations, the International Association of Applied Psychology, the Ambassador of Sierra Leone to the United States, HE Sidique Wai, who was also on the program, acknowledged the wisdom of my point. Later, he told me he had passed along this rewording advice to all his fellow Ambassadors.

Physical distancing is crucial to stop the spread on the continent of Africa, where people are continually in close quarters in markets and many extended families are crowded into one-room housing. Since social interaction is so much a part of the culture, the concept of “social distancing” is contradictory to the fabric of the community and society that revolves around interpersonal interactions. These facts make terminology matter and can affect Africans responsiveness to this safety practice.

Any preventive measure is critical for the continent as the virus has spread to every country in Africa and communities are vulnerable.

In my view as a psychologist, continued use of the word “social distance” exacerbates the emotional trauma already evoked by the loneliness, frustration and depression caused by self-isolation and quarantines of the lockdowns, making people more desperate for interpersonal connection.  Studies are currently underway to establish the immediate and long-term psychological sequelae from these experiences.

Also, “opening up for business” can make some people newly released from home confinement even more likely to rebel against restrictions of  “social” contact to prevent the virus spread.

Hence, a physical measurement – implicit in “physical distancing” -- is easier to follow, less emotionally-charged, and more likely to sustain compliance.

Further, promoting interpersonal separation through "social distancing" is not healthy. Considerable research proves that social isolation exacerbates emotional trauma and that the opposite -- social connection -- heals psychological stress from crisis. This has been vividly true in all my extensive work providing psychosocial support to people after natural disasters around the world, in Japan, China, Sri Lanka, Iran, Sint Maarten, the USA, as well as in epidemics, like in Hong Kong during SARS and in Sierra Leone during the Ebola outbreak.

Social connection – people keeping in touch without touching -- can still flourish in physical distancing, facilitated by many technological tools available to almost everyone today.

All strata of society need to be aware of their languaging, from governments to civil society, academia, media, and youth. When the pandemic first broke, I immediately reacted negatively to the term “social distancing” being used in wall-to-wall news, and advised replacing it with “physical distancing.” All my associates agreed. I also pointed out this distinction right away to my graduate psychology students at Teachers College, Columbia University, in my class on “Psychology and the United Nations,” emphasizing that this distinction is more consistent with international documents recognizing social connection as fundamental to good physical and mental health.

Words matter.  They determine behavior through neural connections in the brain.  When the brain hears the words “social distancing,” the neurons fire on the word “social” and do not compute a required physical distance.

In days leading up to the official easing the lockdown, I saw groups of people congregating despite continual reminders to “socially distance”and passing closely by each other in the street and supermarket aisles, oblivious to the 6-foot safe space.

This more lax "normal" movement is in stark contrast to months ago during strict lockdown, at times when I gingerly ventured outdoors to the drug store, dodging and zig-zagging with fellow passers-by to avoid getting close to each other. In the rare instances of making eye contact, our glances warned, “Stay out of my space” “You could make me sick.”  Eerily, I felt like a leper.

But now, caution can be thrown to the wind.  Emergence from months of stifling quarantine can unleash defiant disregard of safe distance rules. This is especialyl dangerous for young people, who during the height of the pandemic during the school Spring break vacation week, were shown on TV news programs cavorting in close contact on beaches.

Fortunately, some stores are helping promote the distancing, with separation barricades, broken lines or big circular dots on the ground to indicate how far apart people need to stand. Kudos to CityMD, where I went for my COVID-19 test, for encouraging adherence with impressive quotations inside the dots outside the door for patients waiting to enter.

The quote from revered human rights activist Desmond Tutu says, “Hope is being able to see there is light despite all the darkness.”  

Another wise saying inside another dot, from ancient philosopher Aristotle, says, “It is during our darkest moments that we must focus to see the light.” 

But spaced-apart dots can’t accommodate the long lines accumulating now that shops are opening up. The dots leading up to the cash registers on the floor of Duane Reade drug store have the printed  message, “Thank you for staying 6 feet apart for everyone’s safety.” Wanting to position myself accurately while waiting to pay on one such long line with no remaining dots and customers close together, I noticed the guy behind me looked at least 6 feet tall. “Are you 6’4?” I asked. “No, I’m 6’7”, he answered. He smiled but didn’t budge, nor did the guy close behind him.

Six feet is now the recommended safe space. Interestingly, a systematic review published in the Lancet medical journal of databases from over 200 studies supports physical distancing of 1 meter (approximately 3.3 feet) or more. The researchers say that's the best available guidance to date for models and contact tracing to inform policy about the coronavirus, but warn that more “robust” research is needed.

The once-proposed humorous alternatives to handshakes and hugs, such as bumping fists, elbows, or even feet, don’t even qualify for the required safe distance.

To traverse the divide, one woman joked, “Since we’re not supposed to hug anymore, I’m going to do the Queen of England’s signature royal hand wave.” One man’s solution is more zooming on his iPhone. He also admitted spying on neighbors with binoculars, as he said, “I need to know living bodies are out there besides me.”

“Physical distancing” will impact differently in cultures. Spacing is already built in to greetings in socially conservative countries, evident in the Japanese traditional bowing and the Sanskrit “Namaste.” In contrast, for Americans, Europeans, and Latinos more accustomed to closer contact, bans on hugging and cheek-kissing may meet more resistance, especially when labeled as a “social” rather than “physical” act.

As one New Yorker bemoaned to me, “If I don’t hug people, I’ll feel empty and others will think I’m stand-offish. It’s just not me.”

My psychological advice: Alerting people about a change in your behavior allays complications.  Disclose up front, “I’m usually warm and friendly, but I’m observing physical distance to keep both of us safe; so, no offence if I stand back further now.”

Also, speak in a louder voice to be heard across the space. 

Further: notice and adjust natural personal moves, like moving in closer to show attraction or agreement.

Also, amplify body language, 60% of which normally accounts for communication, but more of which will help get your points across under these contagious circumstances.

Recognize your own and others’ comfort level with PD—a measure of personal distance.  As a relationship therapist, I have always advised daters to respect each other’s PD. Those who require more PD can feel anxious or “invaded” when their boundary is crossed, or sense aggression that someone is "in their face.”

A field of study called proxemics, named by cultural anthropologist Edward Hall in 1963, defines the distance surrounding a person as forming a space. Personal space is the area around a person which s/he regards and values as psychologically theirs. Zones of space are individually defined and reserved for different relations, from intimates and new acquaintances to public groupings. In studies, gender mattered: males needed more personal space than females.

Four zones and ranges of distance were identified.

Social distance – that correlates to the current 6-feet pandemic recommendations – refers to interactions among acquaintances. It  ranges from 4 to 7 feet, and can extend from 7 to 12 feet.

Public distance is even further -- as during speeches in public events-- ranging from 12 to 25 feet or more.

Intimate distance, for close relations, as during touching or embracing, ranges from less than an inch to 6-18 inches.

Personal distance, defined for interactions among family and good friends, ranges from 1.5 to 2.5 feet, or extended to 4 feet.

Social forms of space are defined as territory, referring to areas a person may "lay claim to" or defend against others. These include surrounding spaces (body territory); places a person has continuous control over (home territory); or spaces people can freely enter (public territory) or congregate (interactional territory).

The brain also plays a role, in that proximities stimulate the amygdala part of the brain inside the cerebral hemisphere involved with experiencing emotions. An approach into personal space can be welcome, while violations, as noted above, are perceived as invasive or aggressive, and lead to discomfort, anxiety or anger. The #MeToo movement has made this issue evident, demanding respect for personal space.

Brain chemicals that boost health and mental health get triggered from close bonding.  For example, oxytocin, (the “cuddle chemical”) flows between a mother and her newborn, and between partners. And neurotransmitters boost a positive mood in activities like intimate relations, releasing endorphins (“the pleasure chemical”), dopamine, serotonin and norepinephrine.

Research proves that touch has physical benefits - reducing blood pressure – as well as emotional value. After the terrorist attacks of 9/11 and many other disasters, first responders like myself providing psychosocial support handed out teddy bears to survivors and those who lost loved ones, based on best practices that embracing a soft object creates “contact comfort” that leads to psychological and physical gains.

One of my favorite studies proving the importance of this contact comfort is by noted psychologist Harry Harlow in the 1950s who showed that baby monkeys spent more time clinging to a “mother” figure constructed of wire covered with soft cloth than to a wire figure outfitted with a milk bottle. The close physical contact was coveted more than sustenance.

Once health advisories say it’s safe, recalibrating personal distance while maintaining social contact is crucial in healing from this pandemic, in the US, in Africa, and in the world.

 

Note: this article addresses the personal distance between people, while other distancing measures used to control the spread of the contagious Coronavirus refer to closures of schools, workplaces and other public facilities, and prohibition of certain numbers of people in gatherings.

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