| Mass psychogenic illness | |
|---|---|
| Synonym | Mass hysteria, epidemic hysteria, mass sociogenic illness, mass psychogenic disorder |
 | |
| Dancing plagues of the Middle Ages are thought to have been caused by mass hysteria | |
| Specialty | Psychiatry |
| Symptoms | Headache, dizziness, nausea, abdominal pain, cough, fatigue, sore throat |
| Risk factors | Childhood or adolescence, intense media coverage. Possibly extraversion, neuroticism or low IQ. |
| Differential diagnosis | Actual diseases, mass delusions, somatic symptom disorder |
Mass psychogenic illness (MPI), also called mass sociogenic illness, mass psychogenic disorder, epidemic hysteria, or mass hysteria, is "the rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system
disturbance involving excitation, loss, or alteration of function,
whereby physical complaints that are exhibited unconsciously have no
corresponding organic aetiology".
Epidemiology
Mass
psychogenic illness involves the spread of illness symptoms through a
population where there is no viral or bacterial agent responsible for
contagion. MPI is distinct from other types of collective delusions in that MPI involves physical symptoms.
According to Balaratnasingam and Janca, "Mass hysteria is to date a
poorly understood condition. Little certainty exists regarding its
etiology". Qualities of MPI outbreaks often include:
- symptoms that have no plausible organic basis;
- symptoms that are transient and benign;
- symptoms with rapid onset and recovery;
- occurrence in a segregated group;
- the presence of extraordinary anxiety;
- symptoms that are spread via sight, sound or oral communication;
- a spread that moves down the age scale, beginning with older or higher-status people;
- a preponderance of female participants.
British psychiatrist Simon Wesseley distinguishes between two forms of MPI:
- Mass anxiety hysteria "consists of episodes of acute anxiety, occurring mainly in schoolchildren. Prior tension is absent and the rapid spread is by visual contact."
- Mass motor hysteria "consists of abnormalities in motor behaviour. It occurs in any age group and prior tension is present. Initial cases can be identified and the spread is gradual. . . . [T]he outbreak may be prolonged."
While his definition is sometimes adhered to,
others such as Ali-Gombe et al. of the University of Maiduguri, Nigeria
contest Wesseley's definition and describe outbreaks with qualities of
both mass motor hysteria and mass anxiety hysteria.
The DSM-IV-TR does not have specific diagnosis for this condition but the text describing conversion disorder
states that "In 'epidemic hysteria', shared symptoms develop in a
circumscribed group of people following 'exposure' to a common
precipitant."
Common symptoms
Timothy
F. Jones of the Tennessee Department of Health compiles the following
symptoms based on their commonality in outbreaks occurring in 1980–1990:
| Symptom | Percent reporting |
|---|---|
| Headache | 67 |
| Dizziness or light-headedness | 46 |
| Nausea | 41 |
| Abdominal cramps or pain | 39 |
| Cough | 31 |
| Fatigue, drowsiness or weakness | 31 |
| Sore or burning throat | 30 |
| Hyperventilation or difficulty breathing | 19 |
| Watery or irritated eyes | 13 |
| Chest tightness/chest pain | 12 |
| Inability to concentrate/trouble thinking | 11 |
| Vomiting | 10 |
| Tingling, numbness or paralysis | 10 |
| Anxiety or nervousness | 8 |
| Diarrhea | 7 |
| Trouble with vision | 7 |
| Rash | 4 |
| Loss of consciousness/syncope | 4 |
| Itching | 3 |
Prevalence and intensity
Adolescents and children are frequently affected in cases of MPI. The hypothesis that those prone to extroversion or neuroticism,
or those with low IQ scores, are more likely to be affected in an
outbreak of hysterical epidemic has not been consistently supported by
research. Bartholomew and Wesseley state that it "seems clear that there
is no particular predisposition to mass sociogenic illness and it is a
behavioural reaction that anyone can show in the right circumstances."
Intense media coverage seems to exacerbate outbreaks. The illness may also recur after the initial outbreak. John Waller advises that once it is determined that the illness is psychogenic, it should not be given credence by authorities.
For example, in the Singapore factory case study, calling in a medicine
man to perform an exorcism seemed to perpetuate the outbreak.
Research
Besides
the difficulties common to all research involving the social sciences,
including a lack of opportunity for controlled experiments, mass
sociogenic illness presents special difficulties to researchers in this
field. Balaratnasingam and Janca report that the methods for "diagnosis
of mass hysteria remains contentious. According to Jones, the effects resulting from MPI "can be difficult to differentiate from [those of] bioterrorism, rapidly spreading infection or acute toxic exposure."
These troubles result from the residual diagnosis of MPI. Singer,
of the Uniformed Schools of Medicine, puts the problems with such a
diagnosis thus:
"[y]ou find a group of people getting sick, you investigate, you measure
everything you can measure . . . and when you still can't find any
physical reason, you say 'well, there's nothing else here, so let's call
it a case of MPI.'" There is a lack of logic in an argument that
proceeds: "There isn't anything, so it must be MPI." It precludes the
notion that an organic factor could have been overlooked. Nevertheless,
running an extensive number of tests extends the probability of false
positives.
In history
Middle Ages
The earliest studied cases linked with epidemic hysteria are the dancing manias of the Middle Ages, including St. John's dance and tarantism.
These were supposed to be associated with spirit possession or the bite
of the tarantula. Those afflicted with dancing mania would dance in
large groups, sometimes for weeks at a time. The dancing was sometimes
accompanied by stripping, howling, the making of obscene gestures, or
even (reportedly) laughing or crying to the point of death. Dancing
mania was widespread over Europe.
Between the 15th and 19th centuries, instances of motor hysteria were common in nunneries. The young ladies that made up these convents were typically forced there by family. Once accepted, they took vows of chastity and poverty.
Their lives were highly regimented and often marked by strict
disciplinary action. The nuns would exhibit a variety of behaviors,
usually attributed to demonic possession.
They would often use crude language and exhibit suggestive behaviors.
One convent's nuns would regularly meow like cats. Priests were often
called in to exorcise demons.
18th to 21st centuries
In factories
MPI outbreaks occurred in factories following the industrial revolution in England, France, Germany, Italy and Russia as well as the United States and Singapore.
W. H. Phoon, Ministry of Labour in Singapore gives a case study of six outbreaks of MPI in Singapore factories between 1973 and 1978.
They were characterized by (1) hysterical seizures of screaming and
general violence, wherein tranquilizers were ineffective (2) trance
states, where a worker would claim to be speaking under the influence of
a spirit or jinn
(or genie) and (3) frightened spells: some workers complained of
unprecedented fear, or of being cold, numb, or dizzy. Outbreaks would
subside in about a week. Often a bomoh
(medicine man) would be called in to do a ritual exorcism. This
technique was not effective and sometimes seemed to exacerbate the MPI
outbreak. Females and Malays were affected disproportionately.
Especially notable is the "June Bug" outbreak: In June 1962, a peak month in factory production, sixty-two workers at a dressmaking factory in a Southern textile town
experienced symptoms including severe nausea and breaking out on the
skin. Most outbreaks occurred during the first shift, where four fifths
of the workers were female. Of 62 total outbreaks, 59 were women, some
of whom believed they were bitten by bugs from a fabric shipment, so entomologists
and others were called in to discover the pathogen, but none was found.
Kerchoff coordinated the interview of affected and unaffected workers
at the factory and summarizes his findings:
- Strain – those affected were more likely to work overtime frequently and provide the majority of the family income. Many were married with children.
- Affected persons tended to deny their difficulties. Kerchoff postulates that such were "less likely to cope successfully under conditions of strain."
- Results seemed consistent with a model of social contagion. Groups of affected persons tended to have strong social ties.
Kerchoff also links the rapid rate of contagion with the apparent
reasonableness of the bug and the credence given to it in accompanying
news stories.
Stahl and Lebedun describe an outbreak of mass sociogenic illness in the data center
of a mid-western university town in 1974. Ten of thirty-nine workers
smelling an unconfirmed "mystery gas" were rushed to a hospital with
symptoms of dizziness, fainting, nausea and vomiting. They report that
most workers were young women either putting their husbands through
school or supplementing the family income. Those affected were found to
have high levels of job dissatisfaction. Those with strong social ties
tended to have similar reactions to the supposed gas, which only one
unaffected woman reported smelling. No gas was detected in subsequent
tests of the data center.
In schools
Thousands were affected by the spread of a supposed illness in a province of Kosovo, exclusively affecting ethnic Albanians, most of whom were young adolescents.
A wide variety of symptoms were manifested, including headache,
dizziness, impeded respiration, weakness/adynamia, burning sensations,
cramps, retrosternal/chest pain, dry mouth and nausea. After the illness
had subsided, a bipartisan Federal Commission released a document,
offering the explanation of psychogenic illness. Radovanovic of the
Department of Community Medicine and Behavioural Sciences Faculty of
Medicine in Safat, Kuwait reports:
This document did not satisfy either of the two ethnic groups. Many Albanian doctors believed that what they had witnessed was an unusual epidemic of poisoning. The majority of their Serbian colleagues also ignored any explanation in terms of psychopathology. They suggested that the incident was faked with the intention of showing Serbs in a bad light but that it failed due to poor organization.
Rodovanovic expects that this reported instance of mass sociogenic
illness was precipitated by the demonstrated volatile and culturally
tense situation in the province.
The Tanganyika laughter epidemic
of 1962 was an outbreak of laughing attacks rumored to have occurred in
or near the village of Kanshasa on the western coast of Lake Victoria in the modern nation of Tanzania, eventually affecting 14 different schools and over 1000 people.
On the morning of Thursday 7 October 1965, at a girls' school in Blackburn in England, several girls complained of dizziness.
Some fainted. Within a couple of hours, 85 girls from the school were
rushed by ambulance to a nearby hospital after fainting. Symptoms
included swooning, moaning, chattering of teeth, hyperpnea, and tetany.
Moss and McEvedy published their analysis of the event about one year
later. Their conclusions follow. Note that their conclusion about the above-average extroversion and neuroticism of those affected is not necessarily typical of MPI.:
- Clinical and laboratory findings were essentially negative.
- Investigations by the public health authorities did not uncover any evidence of pollution of food or air.
- The epidemiology of the outbreak was investigated by means of questionnaires administered to the whole school population. It was established that the outbreaks began among the 14-year-olds, but that the heaviest incidence moved to the youngest age groups.
- By using the Eysenck Personality Inventory, it was established that, in all age groups, the mean E [extroversion] and N [neuroticism] scores of the affected were higher than those of the unaffected.
- The younger girls proved more susceptible, but disturbance was more severe and lasted longer in the older girls.
- It was considered that the epidemic was hysterical, that a previous polio epidemic had rendered the population emotionally vulnerable, and that a three-hour parade, producing 20 faints on the day before the first outbreak, had been the specific trigger.
- The data collected were thought to be incompatible with organic theories and with the compromise theory of an organic nucleus.
Another possible case occurred in Belgium in June 1999 when people, mainly schoolchildren, became ill after drinking Coca-Cola.
In the end, scientists were divided over the scale of the outbreak,
whether it fully explains the many different symptoms and the scale to
which sociogenic illness affected those involved.
A possible outbreak of mass psychogenic illness occurred at Le Roy Junior-Senior High School in upstate New York, United States, in which multiple students began suffering symptoms similar to Tourette syndrome. Various health professionals ruled out such factors as Gardasil,
drinking water contamination, illegal drugs, carbon monoxide poisoning
and various other potential environmental or infectious causes, before
diagnosing the students with a conversion disorder and mass psychogenic illness.
Starting around 2009, a spate of apparent poisonings at girls'
schools across Afghanistan began to be reported; symptoms included
dizziness, fainting and vomiting. The United Nations, World Health Organization and NATO's International Security Assistance Force
carried out investigations of the incidents over multiple years, but
never found any evidence of toxins or poisoning in the hundreds of
blood, urine and water samples they tested. The conclusion of the
investigators was that the girls were suffering from mass psychogenic
illness.
Terrorism and biological warfare
Bartholomew
and Wessely anticipate the "concern that after a chemical, biological
or nuclear attack, public health facilities may be rapidly overwhelmed
by the anxious and not just the medical and psychological casualties."
Additionally, early symptoms of those affected by MPI are difficult to
differentiate from those actually exposed to the dangerous agent.
The first Iraqi missile hitting Israel during the Persian Gulf War
was believed to contain chemical or biological weapons. Though this was
not the case, 40% of those in the vicinity of the blast reported
breathing problems.
Right after the 2001 anthrax attacks
in the first two weeks of October 2001, there were over 2300 false
anthrax alarms in the United States. Some reported physical symptoms of
what they believed to be anthrax.
Also in 2001, a man sprayed what was later found to be a window cleaner into a subway station in Maryland. Thirty-five people were treated for nausea, headaches and sore throats.
In 2017, some employees of the US embassy in Cuba reported symptoms (nicknamed the "Havana syndrome")
attributed to "sonic attacks". The following year, some US government
employees in China reported similar symptoms. Some scientists have
suggested the alleged symptoms were psychogenic in nature.
Children in recent refugee families
Refugee
children in Sweden have been known to fall into coma-like states on
learning their families will be deported. The condition, known as resignation syndrome (Swedish: uppgivenhetssyndrom),
is believed to only exist among the refugee population in the
Scandinavian country, where it has been prevalent since the early part
of the 21st century. Commentators state "a degree of psychological
contagion" is inherent to the condition, by which young friends and
relatives of the afflicted individual can also come to suffer from the
condition.
In a 130 page report on the condition, commissioned by the
government and published in 2006, a team of psychologists, political
scientists, and sociologists hypothesized that it was a culture-bound syndrome, a psychological illness endemic to a specific society.
