Alarms and Contagions: Collective Phantom Ailments
In any emotional situation intellectual functions tend to be disturbed. The more acute the situation the greater the dissolution of the critical faculties of those involved. In extreme situations there is always the danger of a reversion to fearful, 'primitive' or panicky forms of behaviour. This response is always likely to be magnified in a group situation where normal reactions tend to be intensified, making good experiences better and bad ones far worse.
Communal Conversion Disorder
Despite a certain softening of attitudes in more recent times, conventional medical opinion is still somewhat reluctant to admit the extent to which psychological stress can convert into actual physical disorders. That this does occur is well-known; it is not unusual for patients to present with very clear neurological symptoms such as memory loss, sensory disorders, even paralysis, with no obvious physical cause. But there is no generally accepted explanation as to how this happens, and the place of 'conversion disorders' (as they are now labelled) within the corpus of psychiatric classification is unclear. In fact, this remains a distinctly grey area of medicine. .It is thought that as many as 4% of neurological patients are affected by such inexplicable symptoms, but physicians are well aware that a 'mental' diagnosis is usually regarded as pejorative. Interestingly, recent research has discovered that those areas of the brain that are activated by hysterical paralysis are similar to those activated by hypnotic paralysis. From this it is clear that the roles of suggestion (and auto-suggestion) are an important factor in these matters, in individuals and in the group.
It is well-established that intellectual functions tend to be disturbed in any fraught emotional setting, and the more acute the conditions, the greater the dissolution of the critical faculties of those involved. In highly stressful situations there is always the likelihood of a reversion to fearful, 'primitive' or panicky forms of behaviour; a response that may be greatly increased in a group context, where reactions of any kind tend to be intensified. At such times reason is scarcely involved at all. As we have seen, those caught up in an out-and-out panic have little idea at the time why, or from what, they are fleeing; the urgent instinct to 'get away' precludes any kind of rational thought.
Panic is, of course, an extreme manifestation of collective anxiety, but there is another category of anxiety-based hysterical contagions that break out from time to time, in the form of various collective physical disorders. Quite often these outbreaks go unrecognised for what they really are, at least in their initial stages. The symptoms can be real enough though; typically, these might include nausea, dryness of the mouth, throat and stomach cramps, shaking limbs, fainting, and even mild convulsions. Contagions of this kind occur most frequently in larger institutions of various kinds, such as factories or schools – or even hospitals.
The Royal Free and B.M.E.
During the latter part of 1955 London’s Royal Free Hospital was plagued by a mysterious recurring disorder. The symptoms were in line with those described above, but in a few cases were rather more serious, involving muscle spasms and vomiting. The disease ran from mid-July to the end of November, during which time some 300 people were affected, of whom around 250 were admitted as in-patients. Curiously, the great majority of cases were from among the medical and non-medical staff of the hospital itself; only 12 of the victims were existing patients. Most of those affected recovered fairly quickly, although an unfortunate few suffered ill-health for years afterwards.
The outbreak began when a doctor and a ward sister were struck down on the same day with stomach pains. These were serious enough to warrant their admission to the hospital as patients. Within days, a further 70 of the staff, right across the board, from doctors and nurses to cooks and cleaners, were laid out with similar problems. They reported sore throats, headaches, stiff necks and nausea; it was assumed that a mystery virus was sweeping through the building. Over the following weeks there was a steady flow of victims, and the hospital launched an enquiry. The water supply and kitchens were thoroughly examined, as were the laundries, but no infectious viral or bacteriological material was found. And an extensive series of blood-tests and tissue examinations of those affected also drew a blank.
The causes and nature of the disease, which by this time had generated a fair amount of professional interest both inside and outside the hospital, left the investigating team completely baffled. Apart from all other considerations, it was puzzling how any infectious disease could be so selective as to infect previously healthy hospital staff, yet avoid their sick patients. The idea that the epidemic might have a ‘hysterical’ basis was considered, but rapidly dismissed by staff at all levels and by Union representatives, who suspected the hospital authorities of looking for an excuse to avoid their responsibilities as employers. There was a general consensus among the Royal Free staff that the disease was definitely organic in nature, and was not in any way psychological. Eventually, the investigators published their report in the British Medical Journal, in which the disease was attributed to an inflammation of the brain, accompanied by muscle pain. Despite their failure to detect a causative agent of any kind, they designated the condition as benign myalgic encephalomyelitis - and there the matter lay, until 1970.
In that year, two psychiatrists Colin McEvedy and Alfred Beard, reinvestigated the episode, and after a thoroughly examination of all the patient’s records, came to the conclusion that the entire episode was entirely attributable to epidemic hysteria. Their findings, to put it mildly, were not at all well received, particularly by the medico’s involved. Epidemic hysteria was not an unknown diagnosis, but it was one that was associated with schoolchildren, feckless female factory workers or other similar, susceptible groups. The suggestion that highly-educated, responsible medical professionals could be affected in this way, especially the senior male doctors, proved to be very difficult to accept. As in many cases of his sort, the ‘hysterical’ label was felt to be derogatory. The controversy rumbled on inconclusively for a while, but eventually the whole episode was quietly forgotten about (q.f.a.), and consigned to the annuls of medical mysteries.
The Royal Free outbreak was exceptional in that it affected higher-status professionals; phantom illnesses are far more commonly associated with schools, factories and similar closed institutions. In a characteristic example from the 1980’s, environmental officers were called to investigate a leak of 'poison gas' at a London school. On arrival they found that seven children had been rushed to hospital and a further twenty-five taken home by their parents. Forty other pupils were being treated at the school for headaches, stomach cramps, and shortness of breath. Although many of the children were distressed, none of the symptoms actually lasted for very long but, surprisingly, a thorough investigation of the premises failed to find any evidence of a gas leak or other source of toxicity. It later transpired that there had been an unusual smell around the school, which was traced to a harmless adhesive used to fix a new carpet, and it was presumed this that had triggered the scare. There were no long-term effects.
There are, of course, variations in these incidents, but the sequence of events described above is very typical. In most occurrences of this sort the investigators initially assume that there must be a physical cause. More often than not a prolonged examination draws a blank, and no source of contamination is found. It may only be at a much later stage, if at all, that the suggestion of 'hysterical contagion' is made, although in many cases the matter is quietly dropped. Investigators and physicians are reluctant to make a hysterical diagnosis because it leaves them open to the criticism that they have failed to find the real cause. For their part, the parents of affected children usually find it difficult to accept a mental explanation for their child’s afflictions, which at the time seemed all too real. It is also likely that a great many minor incidents go unreported.
Occurrences of this kind are often triggered by some tangible 'nucleic' event. It is frequently found that an initial case of sickness was perfectly genuine, but that the sight of a fellow-pupil (or co-worker, or nurse) being carried away in a stretcher provides an image that deeply impresses the imagination of a few, and sets in train a self-fuelling, group-hysterical pattern of events. There is a well-documented account of collective hysteria that broke out in a 19th century Lancashire cotton mill which was triggered when a mouse was put down a girl's dress. Her hysterical reaction, which culminated in an florid episode of convulsions, then spread to twenty-four other girls, who went on to exhibit similar symptoms. But this sort of sympathetic hysteria can occur on a much larger scale…
In the 1990's Egyptian medical experts were baffled by a nation-wide outbreak of nausea and fainting among schoolgirls. The epidemic, which began in the Nile Delta province, spread rapidly around the country. One outbreak, typical of many, took place at the railway station in Damanhour, where a minor incident lead to a flying rumour that a girl had died after fainting. This triggered a mass-fainting event that went on to affect more than a hundred and fifty girls. The local hospital was besieged by frightened schoolgirls, many of whom were seized by bouts of uncontrollable weeping. In the weeks following, the numbers and severity, of such incidents multiplied. Naturally, this all attracted a great deal of attention, in the press and among the public at large. Rumours and other wild theories as to the cause abounded. Food poisoning and even nuclear contamination were suggested; radon gas was implicated but immediately denied by the Egyptian nuclear power agency. Cairo saw 168 cases in a single day - eventually, thousands were involved all over the country. Stories began to circulate of an attack on the Egyptian nation, centred on the notion that the girls were victims of a sinister plot to make them infertile. Schools were closed and many hospitals were inundated with cases. In Cairo, whole wards were filled with sobbing schoolgirls, accompanied by their bewildered parents. But when blood- and urine-tests failed to detect any trace of an organic cause for the outbreak, the hospital doctors boldly denounced the whole affair as a case of epidemic hysteria. Although this diagnosis was initially resisted, once it was announced publicly and officially the number of new cases rapidly reduced.
A rather more exotic, and sustained, form of collective hysteria occurred over a two-year period in East Africa in the 1980's, during which school activities were constantly interrupted by outbreaks of hysterical laughter. This epidemic seemed to pass from one school to another and from one province to another. It affected all kinds of schools, but girl’s schools were particularly vulnerable; occasionally it involved the parents themselves. The authorities tried to contain the outbreaks, but they were extremely hard to deal with. Many of those caught up in these hysterical outbursts finished up in hospital, suffering from exhaustion brought on by excessive laughing. For the educational establishments involved these continuous disruptions were no joke.
When events of this kind have run their course they usually leave a trail of some confusion, embarrassment and disbelief. They also tend to be erased from official memory. Once a diagnosis of ‘hysteria’ is pronounced interest tends to fall away from these cases, and sympathy for those involved evaporates. The attitude seems to be that the ‘mental’ is not real, that there is no genuine problem, therefore normal service can be resumed - despite the continuation of the underlying causes of the outbreaks.
Bugs and Spiders
Sometimes the focal cause (or believed cause) of a hysterical episode is quite specific; the bites of bugs and spiders are a favourite. There is a well-documented case, dating from the 1920's in the U.S., where women working in a factory claimed that they were being bitten by an unusual bug that made them feel nauseated, nervous and numb, causing several to faint. The number of cases rapidly increased until two hundred out of a total workforce of a thousand were severely affected. The affair lasted for about eleven days. Despite extensive investigations, there was never a convincing explanation for the symptoms. Only one small bug was ever discovered, and in the end this turned out to be quite harmless.
There had been an earlier insect-bite scare in the U.S. when, in the summer of 1899, a 'kissing-bug' hysteria swept the country. The panic had its origins in a Washington Post account which reported the appearance of a new and deadly bug that chose to bite the lips and cheeks of sleeping victims. This was a case of poor journalism; the account had no basis at all in reality - but it was taken up by other more sensationalist newspapers and went nationwide. As a result, ‘kissing-bug’ hysteria was rapidly installed as a fad for the duration. Provincial newspapers all over the States found something to fill their columns in the quiet months and printed lurid stories of citizens who firmly believed that they had been bitten by the poisonous insect. Many victims sent in remains of the offending creatures to newspapers, museums, government departments and anyone else that they thought ought to take an interest. But practically all the specimens turned out to be completely harmless species.
The ‘kissing-bug’ scare, like most crazes, gradually died down, but it has a curious resonance with one of the most enduring of all hysterical epidemics, namely Tarantism These notorious spider-bite epidemics of Southern Italy, were far from being ephemeral, occasional outbreaks though - in fact they became thoroughly institutionalised and endured for centuries. No examination of collective hysteria is complete without at least a passing reference to this curious phenomenon – but it has a history, a mythology and 'explanations' all of its own
Tarantism was centred in the region around the town of Taranto on the heel of Italy, and is associated with a spider native to the area that has a poisonous, and potentially lethal, bite. Traditionally, when somebody was bitten great efforts were made to keep the victim as active as possible for at least 24 hours. The reasons that were given for this were various - that it was necessary to counter the effect of the poison; that it dispelled the deadly depression that followed; or that the bite itself caused spasmodic twitching of the limbs. In any case, a standard remedy to the situation was to encourage the victim to dance. When somebody had been bitten (or had believed hat they had been bitten), musicians were quickly called in, neighbours joined in the efforts to help, and as the sufferer became weary the music got faster and faster. Invariably, it seems, the dancers themselves became possessed, and those that had come to watch also got caught up in the frenzy. Many of these came to believe that they too had been bitten. An orgy of dancing usually ensued, involving most of the neighbourhood, and ended only when everyone was completely exhausted. In some older accounts of this phenomenon there are dark hints that it was associated with immoral activity; it has also been suggested that the whole performance was a remnant of pagan, specifically Bacchante, celebrations
Since there were outbreaks of Tarantism every summer it is clear that versions of this social hysteria, involving dance and music, had, over the centuries, became thoroughly ritualised. The musicians who services were called upon were known as Tarantella players, and they had their own musical style (which became widely imitated). One way of viewing the whole phenomena is that it provided a ready-made excuse for wild partying, a welcome distraction from the hardships of ordinary life. Naturally, these activities always met with official disapproval. The dance and its accompanying ecstasies became fairly notorious, to the extent of becoming a visitor attraction in the 18th and 19th centuries. This popularity provoked suspicions about the authenticity of the events, but they continued, and managed to survive, in an attenuated form, right up to modern times.
Apart from its supposed origin in a spider-bite, there are other points of similarity between Tarantism and other forms of irrational collective possession, namely, the aspect of its being a culture-bound activity (see below), and its expressive form, which are reminiscent of the frenzied outbreaks of ecstatic dancing in the Medieval period (also mentioned below).
Another factor common to many of these cases is the ‘trigger’ event; which in the case of Tarantism was of course the spider-bite itself - but striking, anxiety-inducing occurrences of many kinds can exert a powerful effect on the human imagination. Sometimes these reactions are understandable, even rational in the initial stages, but an irrational, hysterical response can nevertheless develop…
In 1982 seven people died in the Chicago area after taking a proprietary headache tablet that had been deliberately contaminated with cyanide by some deranged individual. Naturally this crime received a great deal of media coverage and the product was rapidly removed from the shelves everywhere. Understandably, customers remained cautious with all related products. But pretty soon reports of poisonings were coming in from casualty wards in every part of the U.S. Most of the sufferers were convinced that they had been poisoned, and a whole range of products became implicated, including mouthwash, eye drops, nasal spray, soft drinks and even hot dogs. The victims typically complained of burning sensations in their mouths and throats and many presented serious symptoms of poisoning. It turned out that the great majority of these were hysterical reactions. Unfortunately the whole affair was compounded by the activities of other crazies who, for their own demented reasons, tampered with a whole range of products, setting off other copycat scares, causing public alarm to spiral into overdrive and creating an even greater hysterical response.
In cases of this kind the initial events that trigger a mass-anxiety reaction is fairly obvious, but there are a class of social epidemics that have no clear, identifiable cause other than older fears and superstitions. In these cases it is usually a build-up of underlying anxieties that contribute to an outbreak. The health-based, hysterical mass-reactions among the so-called 'culture-bound' syndromes fall into this somewhat exotic category…
One of the more bizarre collective disorders, at least to the Western mind, is that of Koro (sometimes known as Shook Yang), variants of which erupt from time to time in parts of South-East Asia. The main symptom of this strange condition, which mainly affects young men, is a morbid fear that the penis is retracting into the abdomen - a process that is feared to be fatal if completed. The fears, which are based in traditional beliefs, have no medical foundation whatsoever, but they produce a state of acute apprehension in the sufferers, who resort to extreme measures to avoid the imagined effects (tying weights to their penis, desperately trying to stay awake, etc.). For much of the time this syndrome only affects particularly susceptible individuals, usually younger men, but occasionally it breaks out in epidemic form.
In Singapore in 1967 there was a health scare concerning pork. A rumour began to go around that the meat from pigs that had been inoculated against swine-fever was being sold, and that this was deleterious to health. The rumours rapidly became more specific, claiming that the meat could cause Koro, which was believed to be fatal. In the ten day period following the first accounts of these rumours no less than 469 cases of this non-existent disease were reported. The Singaporean authorities were forced to use the media to assure the public that the meat was safe, and that any Koro-like symptoms that appeared were entirely the product of their own fears. As a result of their prompt efforts the epidemic, on this occasion, waned fairly quickly. Curiously, in light of the symptoms traditionally associated with Koro, some 5% of the sufferers in this particular outbreak were young women.
It is more usual that those affected are males in their twenties or early thirties. Koro seems to be endemic in particular localities in southern China, where it breaks out at fairly regular intervals, affecting hundreds, or even thousands, of young men at a time. Interestingly, the localities where it strikes are often close to others where it never appears. As might be expected, the stricken areas are those that hold the traditional beliefs that nurture the particular anxieties associated with Koro - an object-lesson in the extent to which different cultural models can affect different, unconscious, aspects of behaviour.
These outbreaks are an intriguing psychosocial phenomenon, not least for their similarities with genuine disease epidemics. Like these, Koro never completely disappears, tending to resurface unexpectedly from time to time, and 'infect' a new generation of victims, before gradually dying out. It seems pretty clear that this is a group-response, triggered by particular mental images that draw on sexual anxiety, which rapidly build up in a self-reinforcing feedback loop. Unlike those panics that evoke a flight response, Koro is inwardly directed and as such is possibly related to those strange forms of group behaviour involving self-inflicted injury.
Koro is not unique; there are many other culture-bound syndromes in different parts of the world. Susto in Latin American countries causes insomnia, palpitations and vomiting, and in acute cases death, in apparently physically fit men. The somewhat similar Lai Tai (Sudden unexplained nocturnal death syndrome) has killed hundreds of Thai and the Philippine men. Both of these syndromes are bound up with traditional beliefs concerning health and moral behaviour, both have an ‘infectious’ element, and neither are entirely explicable in conventional medical terms. Naturally, traditional remedies and preventative measures are often sought for these traditional ailments.
It is not only young and middle-aged men who are affected by these mysterious epidemics. Pibloktoq (‘arctic hysteria’) affects Eskimo women in Greenland. This condition is characterised by a period of frenetic breast-beating, swaying and singing, followed by the tearing off of clothes, running away, and plunging into icy water. In most instances the victim collapses at the end of a seizure, but later returns to full consciousness and resumes normal activity. There is a comparable condition, known as Grisi siknis, that affects village girls in Nicaragua, but the outcomes here are often far less benign. Outbreaks of this malady leave the young women in a coma-like condition for long periods, which, on their coming round, is followed by frenzied attempts to arm themselves with any available weapon against imagined attackers, and then to flee from their communities. During these attacks the girls are said to be possessed of extraordinary strength and are very difficult to restrain. Some, in fact, manage to escape into the forests, and although most are found and eventually recover, occasionally the seizures are fatal.
It would be easy to categorize these dramatic, culture-bound reactions (and there are many more than I have described) as peculiar to specific cultural traditions, based on out-of-date superstitious belies, and are therefore not ‘real’ diseases. But of course for the sufferers and those around them, the subjective experience of the illnesses are absolutely real - which raises the interesting question of the extent to which diseases in general, even those of the modern advanced world, are ‘culture-bound’.
It is certainly the case that some conditions appear to come into, and go out of vogue. Chlorosis was a common disease among young women in Victorian times that left its victims pale and presenting with a range of symptoms, including palpitations, breathlessness and poor digestion. Although it could be very distressing for the sufferers, it was something of a medical mystery. At the time many different organic explanations were put forward, but the disease seemed to disappear spontaneously in the early 20th century. Anorexia nervosa is perhaps the modern equivalent and is equally. Perplexing. These conditions are very real for all involved but, as with the culture-bound syndromes, there seems to be a strong influence of what might be termed a ‘pathological narrative’, i.e. a culturally established model of distressed behaviour. This, of course, is a very grey area, into which all kinds of deviant activities might fall - narcotic addiction, compulsive shoplifting, and even those now sadly familiar episodes of mass-killings in schools and workplaces. But in the strictly medical area, it does seem that a soon as a new condition is detected and given a name, incidences tend to rise, sometimes dramatically - the increase in ADHD (attention-deficit disorder) incidents among young children being a recent case in point. Clearly, Mind and Body are absolutely linked, but so are Mind and Society; cultural tensions (and which culture does not have them?) give rise to individual afflictions.