Mass psychogenic illness


Mass psychogenic illness, 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".

Etiology

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 by involving physical symptoms. Adrenaline is a typical response factor to emotional stress; unfortunately it tightens the capillaries thus degrades one's health. 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:
British psychiatrist Simon Wesseley distinguishes between two forms of MPI:
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:
SymptomPercent reporting
Headache67
Dizziness or light-headedness46
Nausea41
Abdominal cramps or pain39
Cough31
Fatigue, drowsiness or weakness31
Sore or burning throat30
Hyperventilation or difficulty breathing19
Watery or irritated eyes13
Chest tightness/chest pain12
Inability to concentrate/trouble thinking11
Vomiting10
Tingling, numbness or paralysis10
Anxiety or nervousness8
Diarrhea7
Trouble with vision7
Rash4
Loss of consciousness/syncope4
Itching3

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 remain contentious." According to Jones, the effects resulting from MPI "can be difficult to differentiate from 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:
"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 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 hysterical seizures of screaming and general violence, wherein tranquilizers were ineffective trance states, where a worker would claim to be speaking under the influence of a spirit or jinn and 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 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 textile town in the United States south 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:
Kerchoff also links the rapid rate of contagion with the apparent reasonableness of the bug infestation theory 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 university town in the United States mid-west 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:
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.
In August 2019 the BBC reported that schoolgirls at the Ketereh national secondary school in Kelantan, Malaysia, started screaming, with some claiming to have seen 'a face of pure evil'. Dr Simon Wessely of King's College Hospital, London suggested it was a form of 'collective behaviour'. Robert Bartholomew, an American medical sociologist and author, said, "It is no coincidence that Kelantan, the most religiously conservative of all Malaysian states, is also the one most prone to outbreaks." This view is supported by Afiq Noor, an academic, who argues that the stricter implementation of Islamic law in school in states such as Kelantan is linked to the outbreaks. He suggested that the screaming outbreak was caused by the constricted environment. In Malaysian culture burial sites and trees are common settings for supernatural tales about the spirits of dead infants, vampiric ghosts and vengeful female spirits.'' Authorities responded to the Kelantan outbreak by cutting down trees around the school. Outbreaks of mass psychogenic illness have been reported in Catholic convents and monasteries across Mexico, Italy and France, in schools in Kosovo and even among cheerleaders in a rural North Carolina town.
Episodes of mass hysteria has been observed in schools of Nepal frequently, even leading to closure of schools temporarily. A unique phenomenon of “recurrent epidemic of mass hysteria” was reported from a school of Pyuthan district of western Nepal in 2018. After a 9 year old school girl developed crying and shouting episodes, quickly other children of the same school were also affected resulting in 47 affected students in the same day. Since 2016 similar episodes of mass psychogenic illness has been occurring in the same school every year hence it was thought to be a unique case of recurrent mass hysteria.

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 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, 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.