Mass psychogenic illness (MPI), also called mass sociogenic illness, mass psychogenic disorder, epidemic hysteria or mass hysteria, involves the spread of illness symptoms through a population where there is no infectious agent responsible for contagion. It 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 causes that are known.
Signs and symptoms Timothy F. Jones of the Tennessee Department of Health compiled the following symptoms based on their commonality in outbreaks occurring in 1980–1990: Jones, Timothy. "Mass Psychogenic Illness: Role of the Individual Physician." American Family Physician. American Family of Family Physicians: 15 Dec. 2000. Web. 28 Nov. 2009. + Predominant symptoms in nine outbreaks of mass psychogenic illness Symptom Patients 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
Causes and risk factors MPI is distinct from other types of collective or mass delusions by involving physical symptoms. 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;
British psychiatrist Simon Wessely 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 contest Wessely's definition and describe outbreaks with qualities of both mass motor hysteria and mass anxiety hysteria.Ali-Gombe, A. et al. "Mass hysteria: one syndrome or two?" British Journal of Psychiatry 1997; 170 387–88. Web. 17 Dec. 2009.
The DSM-IV-TR does not define a 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."
Prevalence and intensity Cases of MPI frequently involve adolescents and children as the primary affected groups, with females often being disproportionately impacted. The hypothesis that those prone to extraversion 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 Wessely 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.
History
Medieval period 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 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 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 women that made up these convents were sometimes 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.
In the English translation of Hecker's The Epidemics of the Middle Ages (1844), the translator and 18th century epidemiologist Benjamin Guy Babington included a personal note of his in the Hysteria section of The Dancing Mania chapter. Babington's note recalled reading an uncited French medical journal that described a large convent of nuns in France that collectively began to meow like cats one day. The nuns meowed for long periods of time throughout the day, for several hours, until they were beaten with rods to cease the excessive meowing.
Priests were often called in to exorcise demons.
In factories MPI outbreaks occurred in factories following the industrial revolution (1760–1840) in England, France, Germany, Italy, Russia, 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 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 Malay people were affected disproportionately.
Especially notable is the "June Bug" outbreak: In June 1962, a peak month in factory production, 62 workers at a dressmaking factory in a textile town in the Southern United States 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. 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 summarized his findings: Strain – those affected were more likely to work overtime frequently and provided 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 linked the rapid rate of contagion with the apparent reasonableness of the bug infestation theory and the credence given to it in accompanying news stories.
In 1974, Stahl and Lebedun described an outbreak of mass sociogenic illness in the data center of a university town in the United States Midwest. Ten of 39 workers smelling an unconfirmed "mystery gas" were rushed to a hospital with symptoms of dizziness, fainting, nausea and vomiting. They reported 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 tests of the data center.
In schools In 1962, the Tanganyika laughter epidemic 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 what is now Tanzania, eventually affecting 14 different schools and over 1,000 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. Their conclusion about the above-average extraversion 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 [extraversion] 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. In 1974, mass hysteria affected schools in Berry, Alabama, and Miami Beach. In Berry, it took the form of recurring itches. In the episode in Miami Beach initially triggering fears of poison gas. It was traced back to a popular student who happened to be sick with a virus.
In June 1990, thousands were affected by the spread of a supposed illness in a province of Kosovo in March to June 1990, exclusively affecting ethnic Albanians, most of whom were young adolescents.Radovanovic, Z. "On the Origin of Mass Casualty Incidents in Kosovo, Yugoslavia, in 1990." European Journal of Epidemiology 12(1) (1996):101–113. JSTOR. Web. 27 Nov. 2009. Symptoms included headaches, dizziness, impeded respiration, muscle weakness, 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, reported:
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.
Radovanovic stated that this reported instance of mass sociogenic illness was precipitated by the demonstrated volatile and culturally tense situation in the province.