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Thursday, Sep 16, 2004

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Understanding mass hysteria

By Margaret McCartney

Could 'mass hysteria' explain why 55 pupils and staff from a U.K. school fell mysteriously ill last week?

ON SEPTEMBER 9, a school in Stevenage, just north of London, England, alerted the emergency services to a mysterious event that had taken place at the school.

In what was described as a "hazardous incident," 55 people — 42 of them children — went to hospital. Some self-referred, others came by ambulance; all were complaining of headaches and sickness. The remaining children at Collenswood School were evacuated; police searched the school. Nothing, it seems, was found.

"They were brought in as a precaution," says Peter Gibson, head of public affairs at the Lister Hospital in Stevenage, "and it was not believed that anything serious or untoward had happened." None of the children or adults had to be admitted, and all were discharged later that day.

So what had caused so many children and adults to become suddenly so unwell?

One of the possible explanations being touted for this curious and — for the children, parents and staff involved — alarming incident, is "mass hysteria." But what is mass hysteria? Does it really exist — and if so, what are its causes?

The accepted definition is "the occurrence in a group of people of a constellation of physical symptoms suggesting an organic illness but resulting from a psychological cause." Supposedly affecting women more than men, especially where grouped together — for example in halls of residence, clubs or schools — the symptoms can be varied, but include nausea, fainting, headaches, abdominal pain and fatigue.

Episodes of mass hysteria occur suddenly, with a dramatic onset and rapid recovery. Often there is a trigger and there are no specific organic causes found. It is supposedly one of the phenomena of collective or group behaviours — well known in incidents such as the Salem witch-hunts, where illness among young women was attributed to witches' curses leading to a hunt for the perpetrator, sometimes to the death.

The history of mass hysteria, however, is a deeply controversial one. Even the naming of it now sounds pejorative — hysteria having been a term given over to any illness supposedly connected with any of the female neuroses.

In 1955, in the U.K., Royal Free Disease was ascribed to more than 300 nurses who were working in the Royal Free Hospital in north London. They complained of paralysis which, in the majority, improved; but many were left with symptoms of fatigue. Two psychiatrists, McEvedy and Beard, wrote a description of events for the British Medical Journal and described it as mass hysteria. Since then, the history of mass hysteria is divisive. Some say that it is all, somehow, "in the mind"; others say that there may yet be an agent — infective or chemical — that could cause such symptoms, but it is still to be found.

In addition, mass hysteria is a diagnosis of exclusion — meaning that there is no test to diagnose it with certainty. Rather it means that other causes — such as chemical poisoning, or viral infections — have to be excluded as a potential cause first of all. There have been many episodes of a similar nature. In 1980, in the English midland county of Nottinghamshire, almost 300 children who were competing in a brass band competition in a field collapsed and were taken to hospital. At the time there was little explanation as to why the children may have become so suddenly unwell, and, in the absence of a better explanation, it was thought to have been the product of mass hysteria.

However, one chemical, tridemorph, had been sprayed on crops nearby where the competition had been held, just days before the incident. There has since been some suspicion that exposure to chemicals may have contributed towards the feelings of illness that the children experienced — all of whom subsequently recovered.

In 1992, in the United States, 196 children from an elementary school were evacuated after reports that they had been exposed to an unknown — and possibly toxic — substance. The operation to evacuate them required over 100 personnel and, in the end, no child was diagnosed as being acutely ill.

The investigation concluded that the insecticide malathion had been used on crops 100 metres from the school, and had drifted on winds towards classrooms. The children taken to hospital, however, had no measurable exposure to the chemical, and investigators concluded that the incident was an example of mass hysteria. However, they did think that it could have been triggered by the malathion — or the stress of the emergency response.

Part of the problem in dealing with episodes like this is the deep uncertainty of knowing what you are dealing with. People in the middle of an incident need to be reassured if there is no toxin to worry about — but often that reassurance is not immediately available.

Yet in the acute situation it can be difficult not to take people — particularly children — to hospital for assessment. It may only become clear in retrospect that there was not an organic cause for an incident. But it may be very hard to give people in the middle of a stressful incident clear reassurance that there is no problem.

While at one level these incidents are fascinating, they must be deeply frightening and disturbing for the individuals involved and their families. They invite endless speculation as to the cause — yet what is needed most by those affected is reassurance.

- Guardian Newspapers Limited 2004

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