Link to Article

Archived Version

Wed, 11 Sep 2013 23:33

Mass psychogenic illness'--historically known as "mass hysteria"'--is making a comeback.

(Wikimedia Commons)''Eerie and remarkable.''

Those are the words that Robert Bartholomew used to describe this past winter's outbreak of mass hysteria in Danvers, Massachusetts, a town also known as ''Old Salem'' and ''Salem Village.''

Bartholomew, a sociologist in New Zealand who has been studying cases of mass hysteria for more than 20 years, was referring to the Salem Witch Trials of 1692-1693, the most widely recognized episode of mass hysteria in history, which ultimately saw the hanging deaths of 20 women.

Fast-forward about 300 years to January 2013, when a bizarre case of mass hysteria again struck Danvers. About two dozen teenagers at the Essex Agricultural and Technical School began having ''mysterious'' hiccups and vocal tics.

''The Massachusetts State Health Department refuses to say publicly,'' Bartholomew wrote in an email in late August, ''but I have heard from some of the parents privately who say that the symptoms are still persisting.''

The location might be eerie, but Bartholomew is not surprised by the outbreak in the slightest. He said that there has been a ''sudden upsurge'' in these types of outbreaks popping up in the U.S. over the past few years. It starts with conversion disorder, when psychological stressors, such as trauma or anxiety, manifest in physical symptoms. The conversion disorder becomes ''contagious'' due to a phenomenon called mass psychogenic illness (MPI), historically known as ''mass hysteria,'' in which exposure to cases of conversion disorder cause other people'--who unconsciously believe they've been exposed to the same harmful toxin'--to experience the same symptoms.

Though the Massachusetts State Health Department still has not declared the Danvers outbreak to be MPI, back in March, Bartholomew said, ''[Danvers] could turn into another Le Roy, if they don't watch their step.''Typically, mass hysteria is confined to a group of girls or young women who share a common physical space for a majority of the time. Bartholomew has studied over 600 cases, dating back to 1566, and said that the gender link is undeniable; it's just a question of why. It is accepted within the psychiatric community that conversion disorders are much more common in females. There are also social, biological, and anthropological theories that have to do with how and why females might cope with stress.

There is ''potential for a far greater or global episode, unless we quickly understand how social media is, for the first time, acting as the primary vector or agent of spread for conversion disorder.''He was referring to an episode of mass hysteria in Le Roy, a small town in western New York, that garnered massive media attention in the winter of 2011 when about 18 girls at the local high school came down with a very dramatic'--and very real'--case of hysteria. Bartholomew said that the Danvers case looks extremely similar to the case in Le Roy and that the lessons from Le Roy have gone ''unheeded.''

One major lesson missed: the power of social media to spread and exacerbate an episode.

According to Bartholomew, there is ''potential for a far greater or global episode, unless we quickly understand how social media is, for the first time, acting as the primary vector or agent of spread for conversion disorder.'' He believes that epidemics spread by social media are ''inevitable'' and that ''it's just a matter of time before we see outbreaks that are not just confined to a single school or factory or even region, but covering a disperse geographical area and causing real social and economic harm.''

Le Roy was the first majorly reported case during the era of social media. But there is another significant, related detail of the Le Roy case that sets it apart from the scores of mass hysteria that had come before it.

Marge Fitzsimmons, a 36-year-old nurse in town, also ''caught'' the disease. Bartholomew said that it's not unheard of for one or two adults to be affected, but he cannot recall any cases like Marge's, in which the adults were not intimately involved with the children suffering from the malady. Marge said that she knew about what was going on in town mainly through Facebook postings.

Catching an illness through Facebook sounds wonky. But the contagion of hysteria relies, among many things, upon the unconscious interpretation of what is suggested to us. Fitzsimmons did not even have to be in physical contact with the other girls to ''catch'' their disease. Marge encapsulates the power of social media to penetrate and trigger actions of the unconscious mind. She marks ''a historical shift in terms of the trigger for people being affected and sucked into these cases,'' Bartholomew said.

Here is her story.

***

It was December 2011, and Marge Fitzsimmons was sick. Marge, a nurse, was familiar with the many ways that the body can betray us, but this was different. It wasn't the flu or cancer or even depression, but an illness more mysterious, fraught with anxiety and fear. Marge was a grown woman with a daughter of her own, but that winter, more than anything, she needed her mom.

Her mother, Margaret, 60, had moved 250 miles south to Mechanicsburg, Pennsylvania, 10 years earlier. It was the first time since that Marge had insisted she visit. Marge was suffering from something she felt was deeply ''private and personal,'' so she wanted Margaret to visit without her husband, Marge's stepfather. It was nothing against him, Marge said, but Margaret took it as an insult.

After several failed entreaties over the phone, Marge hand-wrote a three-page letter. ''I ask you this one time, and you deny me,'' it read. ''I'm really sick, and I just need my mom.''

Weeks passed. It was the first Christmas that the two didn't speak. The problem wasn't only that Margaret was offended by Marge's request. It was also that she hadn't yet grasped the gravity of her daughter's situation. She did not yet realize that Marge was stricken by the mysterious sickness that was spreading through Le Roy, a town of 4,000 near the Canadian border.

The strange illness began that fall, when a few teenage girls at the high school started exhibiting uncontrollable tics and stutters, jerking their heads and limbs, and having verbal outbursts and seizures. The symptoms were likened to those of Tourette syndrome. The specifics of the twitches and tics were particular to each girl, but most of the girls exhibited consistency in their movements.

Related StoryThe Touch-Screen Generation

The outbreak began slowly among girls at Le Roy High School, but in February, CNN reported that 16 girls had symptoms. Panic was building and speculation flew around town. It was the Gardasil vaccine; it was the bad marijuana that had been going around; it was something in the water.

The spreading illness was also beginning to draw attention from around the country. Superintendent of the Le Roy school system Kim Cox reflected in an interview, ''We had trucks parked on Main Street for two weeks. You couldn't get a cup of coffee without having a camera shoved in your face.''

It was as though media attention had been switched on and couldn't be switched off. There were the dramatic scenes, seemingly staged for the cameras: local police escorting the team of celebrity environmental activist Erin Brockovich off school grounds; screaming parents at a community meeting. And the public was getting to know some of the girls, such as Thera Sanchez, cheerleader and town darling, who went on national television with her alarming tics. And, of course, there were mentions of the one adult, the 36-year old nurse, who had also ''caught'' the disease.

There were two factors, seemingly unique to Le Roy, that exacerbated and perpetuated the community's fear that there was an environmental toxin. There had been a nearby toxic spill in 1971, and there was strong speculation that it had never been properly cleaned up. The other factor was that, because of Marge, the symptoms appeared to have spread beyond the walls of the high school.

The tension boiled over at a February 4 press conference and community meeting, where Cox reported that after various tests of the school's air, water, and soil, there was no linkable environmental toxin to blame. To some frustrated parents, it was an inadequate response. One mother yelled, ''You are not doing your job!'' at Cox.

Marge attended that meeting, her verbal and physical tics clearly visible. People ''stopped and stared,'' she said, and the media ''bombarded'' her on her way out.

She wanted to see what was happening in her town, but actually, at that point, she'd already met with doctors and been given a diagnosis that had nothing to do with soil or toxic spills: conversion disorder. Dr. Laszlo Mechtler treated Marge as well as several of the girls, and insisted they were all suffering from the same condition. Mechtler and other doctors agreed it was mass hysteria.

Marge accepted the diagnosis and still deems it accurate, but her case continues to stand out. Bartholomew says that it is not unheard of for there to be one or two adults affected in an outbreak of MPI. But he could not come up with any cases like Marge's, in which those adults were not teachers or exposed constantly to the girls in some way. He says that Marge's case is an example of why MPI is ''becoming more common and making a resurgence.''

More than one year later, a look back at Marge's story reveals a stirring reality about why MPI could be making a comeback and spreading beyond its usual confines.

***

Marge is a licensed practical nurse, working with adults who have developmental disabilities and genetic disorders. Her warm smile is suited to the work; it changes her whole face and creases the corners of her large, almond-shaped brown eyes in a wonderfully calming way.

''Most people underestimate the ability of our brains to generate physical symptoms.''Her Rochester office, on Elmgrove Road off of Route 33, sits in a complex next to a YMCA and behind a coffee shop called ''Jitters.'' On a December 2012 afternoon, her desk was extremely, conspicuously organized, with pens, papers, and office supplies placed either parallel or at right angles to one another. Comics pinned to her bulletin board read: ''I am not crazy, I am mentally unrestricted'' and ''heavily medicated for your protection.'' They were unfortunately appropriate. All told, in the past year, she had seen 32 doctors and tried 27 different medications.

She started from the beginning.

Her motor tics began in August 2011 and became more severe that October. At first, she jerked her head uncontrollably to the right, ''Like I had something in the corner of my eye and had to look,'' she said. She developed a bruise on her right shoulder from where her chin jabbed into it. Mike, 39, her boyfriend of eight years and the father of her three-year-old daughter, Abbie, became increasingly worried about the situation.

Mike and Marge both noted that their friend's daughter, a student at Le Roy High School, was having similar symptoms, and Marge noticed through newspaper articles posted to Facebook that several other girls at the high school were starting to report the same symptoms as well.

Marge's vocal tics came later, in a meeting at work in early December 2011. ''It was like I was trying to say something, but it came out as a stutter,'' she said.

On December 5, 2011, she decided to take long-term leave from work. ''I had gotten so scared because of how my symptoms had progressed, that I couldn't'... I didn't feel like I could do my job at that point,'' she said. She decided later to file for family medical leave instead of disability leave. It would not be paid, as disability is, but it would hold her position for 12 weeks instead of six.

On the day she decided to take the leave of absence, she went to the emergency room at Strong Hospital at the University of Rochester. She waited for 14 hours to be seen, and was isolated, she presumed because her tics were disturbing to other patients. When the doctor came in to see her, he was baffled, and brought in five other doctors. After blood tests, X-rays, and CAT scans, they concluded that her symptoms were anxiety-related and sent her home with a prescription for Valium.

Marge had struggled with anxiety in the past, and felt strongly that this was something more. So the next day, she went to the Dent Neurologic Institute in Buffalo to see a neurologist. Movement disorder specialist Xiuli Li treated Marge for the neck pain her tics caused, but told her that she did not have a movement disorder that would explain the symptoms.

Marge and Li began talking about non-neurological causes for symptoms like this, including psychological ones. One part of their discussion struck a raw nerve for Marge. Li did not ask Marge if she had psychological trauma in her past. She asked when the trauma was.

Throughout December and January, Marge's condition worsened. She hardly ate because the uncontrollable and unpredictable motor and verbal tics made it ''next to impossible'' to chew and swallow. She'd choke even on water, so she couldn't take her pills. She lost 35 pounds.

She desperately wanted her mother to visit, but also had her own daughter to worry about. She told Abbie that the tics were ''Mommy's hiccups,'' but said, ''It's hard to explain to a three-year-old that suddenly Mommy is different.''

By the time Marge tried to explain the severity of the situation to Margaret over the phone, the stuttering was already extreme. She often lost the words and went silent, struggling to get something out. Margaret assumed it was bad cell phone reception, and jumped to fill in her sentences. ''I got so upset with her,'' Marge said. ''She couldn't just stop and listen.''

Just before Christmas, Marge wrote and sent the letter pleading with her mother to come. Margaret posted a Facebook status that suggested she had received her daughter's letter, but still, weeks passed until they spoke. Through Facebook messages, Margaret asked Marge's friend how Marge was doing, and the friend said that Margaret would have to come to Le Roy and see for herself. Marge believes that's what got her mother to Le Roy.

Margaret visited from January 13 to 15, 2012. Two days after Margaret left, Marge went public with her condition, appearing on YNN, a local station. She wanted the town to know that it was not only teenage girls who were affected.

Shortly thereafter, neurologist Lazlo Mechtler from the Dent Neurologic Institute contacted Marge, saying he wanted to take over her case. ''I agreed, and I am so glad that I did,'' she said. ''He listened to what I had to say. He was one of the few people that didn't make me feel crazy, which, at that point, was very important to me. He was the first person that could touch me and my skin didn't crawl.'' She also liked that he was thorough. She could come up with any blood tests that he hadn't already run, she said. They tested for Lyme disease, thyroid dysfunction, genetic disorders, lead and heavy metal poisoning, and illicit drugs. ''At one point, they took 16 vials of blood,'' she said.

Finally, after everything else had been ruled out, Mechtler diagnosed her with conversion disorder, which the National Institutes of Health define as a ''mental health condition in which a person has blindness, paralysis, or other nervous system (neurological) symptoms that cannot be explained by medical evaluation.''

Though the term ''conversion disorder'' may sound unfamiliar, it occurs commonly, in various shades and degrees. Orrin Devinsky, a neurologist at New York University's Langone Medical Center, explains that most people have experienced low-level conversion disorder. Knots in the stomach, sweaty palms, or a fast heartbeat when nervous are examples of overflow in the autonomic nervous system, which controls unconscious bodily activity such as breathing and digestion, caused by stressful conditions.

The sort of ''motor overflow'' that Marge and the girls from Le Roy experienced involves different neural wiring, but has the same basic concept of unconscious activity. It can be as simple as chewing on a pen cap, biting one's nails, or tapping a foot. It can express itself as insomnia or impotence, and in severe cases, it can be as debilitating as Marge's illness was. These reactions are physical expressions of something intangible, something in the brain. Steven Novella, a neurology professor at Yale School of Medicine, writes, ''Most people underestimate the ability of our brains to generate physical symptoms.''

Conversion disorder is three times more likely to occur in females than in males, and often is related to emotionally traumatic events'--hence Li's question to Marge about psychological trauma in her past. Devinsky says classic examples include a woman who was raped and, years later, is on the ground, flailing uncontrollably, or a solider who sees his best friend die and then goes blind years later. However, emotionally traumatic events don't always cause conversion disorder later in life. If anything, emotional environment is more a more significant predictor, says Richard Friedman, a psychiatrist at Weill Cornell Medical College.

In Marge's case, both a traumatic event and a stifling environment were at work. And she knew it. Before she was even diagnosed, she had a feeling that'--in order to get better'--she had to tell her mother a secret that she'd harbored for 22 years.

***

"I would never wish this on anybody, but I am somewhat glad it happened to me. It made me stop and take care of myself.''Marge grew up an only child and Margaret was a single mother who worked three jobs. When Margaret was home, she was verbally and sometimes physically abusive, Marge said. But for the most part, Marge spent a lot of time alone.

Margaret started leaving Marge home alone when she was five years old. Le Roy was different back then, Marge said. Everyone watched everyone else's kids; everyone knew and trusted each other. Kids played outside until the street lamps switched off, the signal to go home.

When Marge was 14 years old, her 19-year-old neighbor and friend said he had something to give her, a t-shirt, Marge thinks, and led her into his room. He forced himself on her, despite her pleas for him to stop. Marge called the rape ''horrific,'' and said that it caused her ''extensive physical damage,'' not only because it was forceful, but also because she was a virgin. She bled enough in the days that followed that she assumed she'd gotten her period for the first time. In fact, she didn't begin menstruating for two more years.

At the time of the rape, she only told one person, a friend, and swore him to secrecy. It was ''never spoken about, never acknowledged,'' Marge said. ''From that point forward, I suppressed everything.''

Devinsky explained that conversion disorder can function as catalyst for a person to seek help. ''Your subconscious mind is as smart as you are. Smarter in certain ways,'' he said.

Marge is an example of that. She said that before her illness, ''I used to just bury, bury, bury. And now I deal. I would never wish this on anybody, but I am somewhat glad it happened to me. It made me stop and take care of myself.''

Marge's latent psychological stress might never have taken the form of severe tics and stutters if not for what was already happening in the town. Dozens of other girls were going through the same thing, and Marge was aware of that. Although she was two decades older, she was, in some ways, not so different from them. Perhaps the timing of the unresolved trauma of Marge's rape froze some part of her unconscious mind at the same age as the other girls, so the processes of ''mass hysteria'' operated the same for Marge as they did for the others.

The question remains: How did she ''catch'' it?

***

MPI is not a new phenomenon. Devinsky hails the 1965 book Hysteria: The History of a Disease as the best historical road map of the illness. In it, author Ilza Veith, who holds a PhD in the history of medicine, writes that hysteria is traced as far back as the ancient Egyptians in 1900 B.C., who believed that it resulted from the ''discontent'' womb of a woman who didn't reproduce soon enough after puberty (hystera is Greek for ''uterus''.) Various outbreaks can be traced through history; there were probably 50 outbreaks in medieval European nunneries during the latter Middles Ages alone, Bartholomew says, when theories of witchcraft were prevalent. The Salem Witch Trials resulted from a well-known example of MPI. Notable outbreaks since then include a 1962 incident at an all-girls boarding school in Kashasha, Tanzania, where there was a ''laughing epidemic,'' and a 1965 incident in Blackburn, England at another girls school, where 85 girls were sent to the hospital with dizziness and convulsions, with no medical or environmental culprits found. More recently, in the winter of 2012, there was an outbreak of MPI that affected more than 1,000 students and five teachers across 15 different schools in Sri Lanka, where people complained that they were having vertigo and uncontrollable coughing.

Bartholomew differentiates MPI into two categories: mass anxiety hysteria and mass motor hysteria. Cases of mass anxiety are often precipitated by a stress-inducing belief'--commonly, that there is a weird smell or noxious gas in the air'--but the belief and the effects dissipate in hours or days. He estimates that there are hundreds of unrecognized outbreaks of this type of hysteria in the U.S. each year.

''Epidemic hysterias that in earlier periods were self-limited in geography now have free and wide access to the globe in seconds.''Cases of mass motor hysteria, on the other hand, take months or years to build, and weeks or months to dissipate, as in the case of Le Roy. Bartholomew says that today, mass motor hysteria outbreaks are very rare in Western societies, but happen monthly in Asia and Africa. Historically, they occur in ''pressure-cooker'' environments, like factories, that have intolerable and inescapable social settings and preexisting tensions. ''People are repressed, and that's when you get the motor symptoms,'' he says. ''The twitching, the shaking, the trance-like states '... and it builds up, over weeks or months, and it does not go away.''

But still, Le Roy was different, and not just because of the 1971 toxic spill, or because of Marge, or because of the media blitz, which, by itself, was unprecedented. But the social media was another critical factor that separates Le Roy from other documented cases of MPI. Bartholomew said that Le Roy was the first case of this magnitude to occur in the U.S. during the social networking era. When a case of MPI occurred in 2002 in a high school in North Carolina, the last major reported case in the U.S. before Le Roy, Facebook and YouTube did not exist yet'--both were introduced in 2004. Some believe that the Le Roy outbreak was a direct result of videos posted to YouTube by Lori Brownell, a girl with severe tics in Corinth, New York, 250 miles east of Le Roy.

Bartholomew said that sometimes, social science is ''more 'social' than 'science.''' While there is no clear pattern or personality trait that makes one person more likely than another to fall victim to MPI, about 98 percent of the subjects in the cases he's studied were female, usually adolescents. He explained that with adolescent girls in particular, interpersonal conflict can be ''very sordid.'' He said, ''With some of these girls, it gets really nasty, and (unlike boys), girls hold it in.''

Facebook allows adolescent girls to more deeply internalize interpersonal conflict, adding to preexisting tension. ''In the past, you have a problem with another girl at school or a group of girls, you go home, you might make a phone call,'' he says. ''Now, you're talking to a whole bunch of people at once. You brood and internalize it more deeply.'' Le Roy Superintendent Kim Cox said that among the high school students, Facebook use ''was happening to a much greater extent than we knew.''

Bartholomew said that mass hysteria spreads through sight and sound, and historically, one person would have to be in the same room as somebody exhibiting symptoms to be at risk of ''catching'' the illness. ''Not anymore,'' he says, noting that social media'--''extensions of our eyes and ears'''--speeds and extends the reach of mass hysteria. In a paper, he wrote, ''Epidemic hysterias that in earlier periods were self-limited in geography now have free and wide access to the globe in seconds.'' He says, ''It's a belief, that's the power here, and the technology just amplifies the belief, and helps it spread more readily.''

Marge, in particular, was a signal that this was true. She was not involved with the school in any way and did not have constant exposure to any of the girls. They were not her peer group or even part of her social environment, previously key ingredients in the MPI recipe.

Facebook was not only increasing the spread of the illness to new people, it was also exacerbating the stress, and therefore the symptoms, of those already suffering. Marge got a Facebook message shortly after she went public that said, ''You should just kill yourself.'' Melisa Phillips, Thera Sanchez's mother, said that Facebook was ''insanity and destroyed the community.'' She says that during the time of Thera's illness, ''I did not have cable or Internet, which was my saving grace. It saved my sanity.''

Thera accessed Facebook through her phone during that time, but said, ''I could not turn my phone on after The Today Show, because it froze. I had over 1,000 Facebook messages. Every two minutes, 30 new messages would pop up.''

Mechtler, Marge's physician, who recommended that Marge avoid Facebook, told the press at the time that the girls staying away from social media were the ones getting better.

***

In a paper titled ''Mass Psychogenic Illness and the Social Network: is it changing the pattern of outbreaks?'' Bartholomew writes, ''Local priests, who were inevitably summoned to exorcise the 'demons', faced a daunting task given the widespread belief in witchcraft, but they were fortunate in one regard: they did not have to contend with mobile phones, Twitter and Facebook.''

However, the old and the new are more intertwined than one might expect. Two separate strangers messaged Thera through Facebook saying she needed an exorcism. One person told her to let God into her life.

MPI itself is born from an intersection between and old and the new. Veith wrote in her 1965 book that MPI is ''a shifting, changing, mist-enshrouded phenomenon,'' whose specifics adapt based on the society in which it takes place, but whose ''predispositions and basic features have remained more or less unchanged.'' The illness is thousands of years old, but some of the new modes of transfer are novel. Marge is an embodiment of how an age-old affliction, in which demons in the brain convert and surface in the body, is itself converting and resurfacing once again.