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Next entry: Why contraception is scary, and why it’s not Previous entry: We Need Vaginal Ultrasounds So That Mothers Can Remember What Pregnancy Was Like

It’s okay to admit that mass hysteria is real

For some reason, this week's Newsweek was really great, with an interesting story about how sports wives and girlfriends are an easy target for fan rage and Andrew Sullivan's pretty good article on the contraception debacle, where he rehashes my theory that Obama set it up this way. (However, he still insists that abortion is different, even though anti-choicers have shown their true colors with the attacks on contraception.) But one article I found really fascinating was this brave one by Nancy Hass decrying the intense media indulgence of parental delusions attached to a bout of mass hysteria in LeRoy, New York. For those who haven't heard, a bunch of teenage girls have been overcome with a series of uncontrollable tics, much like Tourette's syndrome, and---this is critical to understanding what's going on---it's spreading. It's an open and shut case of mass hysteria: localized, no physical cause, contagious, and concentrated in teenage girls. While mass hysteria can occur in other groups, it most commonly occurs in teenage girls, probably because the stresses unique to being a teenage girl create the perfect situation for this. But the parents don't want to hear it. They want the answer to be roughly "anything else". And, according to Hass, a number of media sources are giving them a sympathetic audience to make their understandable but still deluded claims that it's something other than mass hysteria. 

There's three major issues with indulging these delusions, beyond just the obvious problem of indulging delusions. 

1) It contributes to the stigma around mental illness. What comes across loud in clear in the parents' reactions is that they can't accept the diagnosis of mental illness, because in their minds, mental illness is not "real" illness. Which is a common misconception, and I'm not especially mad at the parents for having it. They probably haven't really been educated on this or had experiences that would help fix their prejudices about mental illness. Where I am mad is at the media that treats their prejudice like it's a legitimate opinion that needs airing. I'm mad at self-styled environmentalists who are eager to use these girls' distress to raise awareness of fracking, which while certainly a bad thing, is just not the cause of this problem. The parents would probably be more willing to listen to the actual experts if there weren't so many other people---environmentalists, journalists---that also seem like authorities confusing the issue. 

Mental illness is real illness. To say that these girls are hysterical doesn't mean that their suffering isn't real, or that they don't need help. Insisting that it has to be something other than a mental illness issue simply means creating obstacles to care. It's as if someone has a sinus infection and you insist that it's actually a twisted ankle. You're not going to help them by putting a bandage on their ankle. They need antibiotics. Mental illness is the same; treating it like it's physical means you're not treating it at all. 

2) It makes concerns about fracking look like woo. Fracking is a legtimately serious concern. Sober, pro-science environmentalists agree that it's a real concern, and that there's real dangers to it. But when you attach false dangers to it, attributing problems to fracking that obviously have nothing to do with fracking, you open up your movement---for good reason!---to accusations that you're anti-science and no better than anti-vaccination idiots. Which could be used to discredit the whole thing. Which makes me wonder, as I have in the past, if Erin Brockovich is secretly working for the other side. After all, she sent an aide to test the soil in response to this mass hysteria, which ends up bringing attention to the anti-science bent of the environmentalist movement, and makes everyone involved look like an idiot. 

3) It's sexist. There's two ways to interpret the fact that mass hysterias tend to take off amongst teenage girls and young women (see: Salem witch trials, multiple personality disorder) more than anyone else. You could go with the sexist explanation, that women are inherently unstable and hysterical. Or you could go with the more nuanced, anti-sexist explanation, which is that young women are under a specific set of stresses that make this sort of thing happen. From Hass's article, it's clear that the experts in this situation are opening door #2, pointing out how hard the lives of many victims are and suggesting they cracked under pressure. I would point out that the transition from childhood to adulthood is particularly difficult for women. You go from being an adored child who lives in a sea of mother-love to being, frankly, a second class citizen whose sexuality is considered the most important and often only relevant aspect of your personality. You're expected to start stifling yourself, accept being talked down to (often by men who know less than you do about a subject), and to constantly monitor your body to make sure you're striking that perfect and impossible balance between sexually alluring and "slutty". This is especially difficult if you're a teenager, with all the attendant awkwardness and raging hormones that implies. That's the baseline of stress for basically all young women. Add to that any more stress, and no wonder teenage girls crack. 

By insisting that the symptoms must be physical and not mental, the parents and the media and everyone else involved in making this a "mystery" instead of an open-and-shut case of mass hysteria are basically engaging in a cover-up. They're ignoring the patriarchy and the damage it does to young women, probably in no small part because they're not really interested in actually challenging the social structures that caused this problem. But in doing so, as Hass suggests, they're just making it worse. They're signaling to the girls---to be clear, this is mostly subconscious---that the continued ticcing is the path to returning to that state of childhood, where you're an object of love and concern, instead of returning to your new life as a sex object. Hysterical ticcing is basically the only way for teenage girls end up getting media attention that isn't about sex, after all, and that kind of prejudice goes all the way down to the ground. What needs to happen is that teenage girls need love and support and, yes, attention for things other than what they do with their vaginas or if they're acting all crazy. Again, to be clear, I doubt very much that the girls want this. Their distress is real. Pointing out that the cause is mass hysteria---and that patriachy plays a role in mass hysteria---doesn't mean downplaying their distress. It just gives us a clear view of how to fix this and how to prevent it in the future.

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Posted by Amanda Marcotte on 11:46 AM • (92) Comments

Maybe it would help if we didn’t use a word like word like “hysteria”. How about calling it a small scale culture-bound syndrome?

There are some such syndromes that almost exclusively affect men, like Koro. Latah, is almost entirely a women’s syndrome.

I am also reminded of Ian Hacking’s history of the “fugue plague” of the late 19th century as discussed in his book Mad Travelers which is about one of the coolest books I have ever read.

BTW, I think Amanda’s analysis of the LeRoy case is spot-on. Just suggesting some alternatives to using a word like “hysteria”, and providing some cross-cultural context.

Comment #1: Bacopa  on  02/20  at  12:49 PM

Jeebus, I can’t believe the one girl’s mother who is just chalking it up to a mystery and not seeking any treatment. That girl’s life is being majorly derailed all because her mother can’t accept that mental illness is a real thing.

Comment #2: Livi  on  02/20  at  12:54 PM

As a person with multiple personality disorder, which you mention, I must admit I still fall for the stereotype that hysteria and related phenomena are either not real, or not related to patriarchy. You make an excellent point of the fact that oppression causes hysteria. This should be clear from the example of MPD, which in most cases is caused by child sexual abuse (which by the way boys can suffer too, but that’s oppression too), but I still feel uncomfortable with the term “mass hysteria”. However, changing its name would not solve the problem of stigma and prejudice, of course.

Comment #3: Astrid  on  02/20  at  01:12 PM

Isn’t is something like “conversion disorder”?

This is one area where, I think, modern pharmababble can have its use in judicious doses. If it’s not about mental illness, which everyone naturally parses as “wrong thinking”, but rather about excesses or deficits of certain neurotransmitters that upregulate or downregulate other bodily systems, leading to physical symptoms (cue Miss Adelaide) then it may be possible to get away from the choice between “mystery ailment” and “those lily-livered teenage girls”.

And of course the fact that there are cognitive and lifestyle therapies that can do wonders with those neurotransmitter levels, rather than just bashing on them with psychoactive drugs…

Comment #4: paul  on  02/20  at  01:43 PM

Since I was a kid, I’ve had recurring problems with depression and anxiety.  And always, when things got really bad, I would desperately wish for something to happen - a car wreck, a freak accident, a serious diagnosis - so that I could escape for a little while, so the pressure would be released and I could have a break and everyone would take care of me.  Of course, if something that serious had actually happened, it would have been devastating, but that’s how it always feels, that fierce desire for an ‘out’.  Because simply saying “I’m depressed, and depression is a real illness” has never felt like enough, even once I was old enough to understand what was going on.  (It did happen almost perfectly once, when I had mono in high school.  It exactly coincided with a really bad episode of depression, and I was out of school for 6 weeks despite not being all that physically uncomfortable.  I’m still really grateful for how that worked out.)

So I can very easily see myself, in a different social setting and with different options available to me, ending up in a situation like these girls.  And I feel so bad for them.

Comment #5: burgundy  on  02/20  at  01:49 PM

Amanda, can you give your definition of “mass hysteria”?  When I hear it, all I think of is those scenes in old sci-fi movies where everyone is running down the street screaming.

Comment #6: Jake  on  02/20  at  01:49 PM

Jake, you can start here for some good info.  (Hint: it’s not an Amanda-specific definition.)

Comment #7: burgundy  on  02/20  at  01:57 PM

The patriarchy is causing young women in the northeast to experience psychological problems?  Well, I guess it could be worse.  We could be a couple of Republican presidencies away from hanging people in response.

Comment #8: prufrock  on  02/20  at  02:23 PM

And always, when things got really bad, I would desperately wish for something to happen - a car wreck, a freak accident, a serious diagnosis - so that I could escape for a little while, so the pressure would be released and I could have a break and everyone would take care of me.  Of course, if something that serious had actually happened, it would have been devastating, but that’s how it always feels, that fierce desire for an ‘out’.

I’ve felt this way on multiple occasions myself.

Comment #9: Linnaeus  on  02/20  at  02:26 PM

It’s actually scarier than that, Jake:

The year was 1374. In dozens of medieval towns scattered along the valley of the River Rhine hundreds of people were seized by an agonising compulsion to dance. Scarcely pausing to rest or eat, they danced for hours or even days in succession. They were victims of one of the strangest afflictions in Western history. Within weeks the mania had engulfed large areas of north-eastern France and the Netherlands, and only after several months did the epidemic subside. In the following century there were only a few isolated outbreaks of compulsive dancing. Then it reappeared, explosively, in the city of Strasbourg in 1518. Chronicles indicate that it then consumed about 400 men, women and children, causing dozens of deaths (Waller, 2008).

As for your specific inquiry:

BOX: Modern hysterias

Even if dancing plagues are things of the past, mass psychogenic illness (MPI) remains a part of the human condition. MPI has been defined as the ‘collective occurrence of physical symptoms and related beliefs among two or more persons in the absence of an identifiable pathogen’ (Colligan & Murphy, 1982). Simon Wessely (1987) has usefully separated outbreaks of MPI into two different kinds: ‘mass anxiety hysteria’ and ‘mass motor hysteria’.

Mass anxiety hysteria usually involves the sudden expression of intense anxiety in response to a false threat. In Western settings, plausible fears of poisoning or exposure to toxic chemicals have been known to trigger classic stress-reactions such as fainting, nausea, weakness and hyperventilation. In a school in Blackburn in 1965, for instance, as many as 141 pupils were affected by psychogenic dizziness, nausea, spasms and shortness of breath after several girls had publicly fainted (Bartholomew & Wessely, 2002). Unless the initial fear is given credibility by the media or authorities, cases of mass anxiety hysteria seldom last more than a few days.

Mass motor hysteria, in contrast, typically requires a prolonged build-up of psychological tension which then manifests itself in dissociative states, conversion symptoms and other psychomotor abnormalities. These can persist for weeks or months. Such outbreaks are often shaped by the kinds of supernaturalist beliefs that were responsible for the dancing mania and the possession crises of European nunneries. In modern-day Malaysia and Singapore, for example, factory workers are often drawn from rural communities steeped in beliefs about the spirit world. Those who find it hard to adjust to the regimentation of factory life sometimes enter a dissociative state in which they behave in a manner shaped by their culture’s understanding of spirit possession. MPI may arise where fellow-workers share the same beliefs and are also experiencing severe psychological strain. These outbreaks are often brought to an end with a religious ritual involving the slaughter of a goat (Phoon, 1982).
In both Western and non-Western settings, mass motor hysteria usually occurs in schools. In 1962, for example, several girls at a mission school near Lake Tanganyika developed a compulsion to laugh and cry by turns. The affliction soon spread to neighbouring populations (Rankin & Philip, 1963). Similar outbreaks of laughing have been recorded in both Zambia and Uganda. In fact, schools in central Africa are especially prone to outbreaks of mass motor hysteria. Late in 2008 several girls in a Tanzanian school responded to the pressure of taking important exams by dissociating: some fainted, while other sobbed, yelled or ran around the school.

Mass Psychogenic Illness sounds so much like a grundge band grin

Comment #10: Dark Avenger Guardian Chow Mein  on  02/20  at  02:39 PM

It’s unlikely that there’s anything neurologically wrong with these girls. These involuntary behaviors are spreading by social suggestion among people whose brains are working just fine, taking cues from other people, like they’re supposed to.

There are all kinds of things we do reflexively because we’ve learned them from other people. (Saying “excuse me” or “sorry” can be almost tic-like for some people. It just comes out in certain contexts, whether they believe they need to excuse themselves or not.) Usually, it’s good that we have this capacity to learn from other people without even thinking about it. Sometimes, undesirable behaviors and habits spread, too. It’s a normal, fixable glitch. Nothing to get scared about or ashamed of. We’re sensitive, perceptive, social animals.

It might be helpful to think of these outbreaks as interesting quirks of the human mind, rather than as a disease that needs a psychobiological explanation.

Comment #11: Lindsay Beyerstein  on  02/20  at  02:44 PM

I am completely unfamiliar with this phenomenon. Can anyone provide a link to some peer-reviewers psychiatric or psychological literature that explains mass hysteria and postulates causes? Thanks!

Comment #12: JonE  on  02/20  at  02:53 PM

Mental illness is real illness. To say that these girls are hysterical doesn’t mean that their suffering isn’t real, or that they don’t need help. Insisting that it has to be something other than a mental illness issue simply means creating obstacles to care.

Thank you.  I have bipolar disorder and I am sick to death of people telling me that my illness isn’t legitimate. Not to derail, but it is infuriating to be told by a person who’s never experienced a day of severe depression or a panic attack or psychosis in their life that I ‘don’t need medication.’

Comment #13: coldestcaress  on  02/20  at  02:54 PM

JonE: like this? http://bjp.rcpsych.org/content/180/4/300.full

Comment #14: burgundy  on  02/20  at  03:04 PM

thanks burgundy!

Comment #15: JonE  on  02/20  at  03:06 PM

people telling me that my illness isn’t legitimate.

I’m reminded of a conversation my husband once had with a mutual acquaintance:

“Depression is all in your head.”
“And diabetes is all in your pancreas.”

And yeah, this kind of mentality is dangerous, as it makes it harder for people to access the help they need, if only because we become so resistant to acknowledging that we need outside help. I had to hit a state of complete burnout before I would see a doctor, despite there being signs for years that something was going on. The ‘just try harder’ mentality only made me feel worse about myself, as I kept failing and slipping.

Comment #16: Jayn Newell  on  02/20  at  03:08 PM

Lindsay—or itching. The last major “mass hysteria among teenage girls” episode that I’m aware of was after September 11th. A number of high school age girls suddenly complained of serious skin irritation. The problem is that “feeling itchy” is about as contagious through suggestion as yawning, maybe moreso. There are people who are going to read this paragraph and feel the need to scratch themselves.  And no one could argue that the period after 9/11 wasn’t really stressful for people.

The problem is that when people think of mass hysteria in teenage girls, they generally think about reading The Crucible in high school lit class and imagine that the girls are consciously working an angle (getting back at some boy who didn’t take them to the prom, those treacherous bitches!) rather than subconsciously manifesting psychosomatic symptoms from a particularly fucked up set of circumstances and stresses. And since an important bullet in the partiarchy’s arsenal is denial of the subconscious… that anyone, anywhere, might exhibit thoughts and behaviors that they aren’t 100% in conscious control of makes status-quo defenders scoff with derision.

Comment #17: Mighty Ponygirl  on  02/20  at  03:10 PM

I lay good odds good ol’ Erin Brockovich will find something in the ground and recommend a lawsuit, which will be just full of crap science. After all, worked for her once, didn’t it?

Comment #18: KeithM  on  02/20  at  03:53 PM

Dark Avenger @ 2:39,
Grunge bands never grinned.

Comment #19: witless chum  on  02/20  at  04:06 PM

This is obviously witchcraft. Occam’s Razor, people!

Comment #20: typist  on  02/20  at  04:36 PM

This is what comes of you silly libruls rejecting tradition.  We’ve had the solution to these problems for at least six hundred years.  Just burn about twenty of these witches at the stake and it will stop spreading.

I’m sure Santorum, the Nazi Pope, and Christine O’Donnell would agree.

Comment #21: msobel  on  02/20  at  04:44 PM

Actually, Chet, there is is some proof that Morgellon’s is a mass psychogenic illness.

Additionally, however, there are good epidemiological reasons to suspect psychogenic causes, so it’s not true to say that “the only basis for the diagnosis” is that no other cause can be found. Conversion disorders and especially mass psychogneic illnesses follow a fairly historically similar pattern, and the existence of those patterns are a good reason (besides “gee, I dunno” as you imply) to suspect “mass hysteria.”

Comment #22: Auguste  on  02/20  at  04:54 PM

I guess if I want to be fair (which I do), I should say “there is some evidence that suggests” that Morgellon’s etc. etc.

Comment #23: Auguste  on  02/20  at  04:55 PM

Is there a list somewhere of these so-called “environmentalists”?

Comment #24: bomberE  on  02/20  at  04:56 PM

This is about inference to the best explanation, not proof. These girls have been examined and found to be physically healthy. Experts have checked their environment and failed to find any organic cause for their symptoms. Sure, it’s logically possible that they’ve all been poisoned by some magic substance that doesn’t fit with any well-established principles of epidemiology or medicine. I guess it’s also logically possible that magic is real and these girls are really possessed. Can you prove otherwise? I can’t. What I can do is make an inference to the most likely explanation based on the available evidence. At this point, it’s overwhelmingly likely that we’re dealing with a mass psychogenic illness. 

Mass psychogenic illness is a well-documented phenomenon. We know people can develop it after being exposed to something totally harmless. There was an incident of on a public bus in Vancouver involving spilled baking powder a couple years ago. People developed symptoms to what they thought was anthrax or cocaine or whatever—but there was never any harmful chemical present. Their symptoms didn’t fit the pattern of a real chemical exposure. For example, people who were closer to the spill were no more likely to get sick than people who were further away—which you’d expect if it were a straightforward poisoning.

Comment #25: Lindsay Beyerstein  on  02/20  at  04:59 PM

It’s not OK to stigmatize mental illness. Except when it comes to criticizing (perceived) conservatives.

See also: IQ tests prove nothing. Except that Republicans and racists are stupid.

There’s two ways to interpret the fact that mass hysterias tend to take off amongst teenage girls and young women (see: Salem witch trials, multiple personality disorder) more than anyone else. You could go with the sexist explanation, that women are inherently unstable and hysterical.

The question is why you think the outcomes of scientific inquiry should be politically correct.

Or you could go with the more nuanced, anti-sexist explanation, which is that young women are under a specific set of stresses that make this sort of thing happen.

I wonder why psychotic disorders (which can be exacerbated or triggered by various stressors, mostly social stressors) are more common among men.

Way to cherry pick.

Comment #26: cataphract  on  02/20  at  05:29 PM

This is one area where, I think, modern pharmababble can have its use in judicious doses. If it’s not about mental illness, which everyone naturally parses as “wrong thinking”, but rather about excesses or deficits of certain neurotransmitters that upregulate or downregulate other bodily systems

That is a form of mental illness.

And of course the fact that there are cognitive and lifestyle therapies that can do wonders with those neurotransmitter levels, rather than just bashing on them with psychoactive drugs…

The most serious mental disorders pretty much all have to be treated with pharmaceuticals, at least in part. And your characterization of them as necessarily crude, blunt mechanisms betrays an ignorance of modern psychopharmacology.

Comment #27: cataphract  on  02/20  at  05:33 PM

Wait. One girl was abused by her father, another was secretly filmed getting undressed by her mom’s boyfriend and the mom doesn’t understand the stress issues because the girl didn’t have a test in school that day? Are you fucking kidding me?

Comment #28: shakahi  on  02/20  at  05:45 PM

This is unfair. It’s the diagnosis of mass psychogenic illness that is little better than a suspicion of black magic. Can you explain how mass psychogenic illnesses work? How they spread?

No, of course you can’t, because nobody knows. Calling something a “mass psychogenic illness” is just saying “it must be all in your head, because we don’t know what else it could be.” How is that not magical thinking?

Seems to me just from the links that these events seem to follow a common pattern of one person doing Thing X and then people copying them. That’s not a satisfactory explanation by any means, but it’s more than, “Gee, we dunno.” Burgundy’s link also picks up a bunch of newer examples, where we can have some confidence that environmental factors were adequetely checked for.

 

Comment #29: witless chum  on  02/20  at  06:02 PM

@shakahi: that’s pretty standard parental insane blindness.  My friends and I dealt with it more or less continuously at our (pressure cooker) academic high school.  Once the kids pass a certain age, the parents become completely disinterested in their welfare and only in control. 

Sure, but again the “evidence” is exclusion.

Isn’t the evidence the fact that the little boxes which contain the stuff which their bodies are supposedly producing are full of whatever carpets and cloth are in their vicinity?  I mean, that’s pretty open-and-shut.  It’s only our insistence on treating mental illness as somehow distinct from physical illness which is keeping these people from getting the help they need.

 

Comment #30: Punditus Maximus  on  02/20  at  06:14 PM

while i’m not a fan of brockovich, who is a media whore and loves to get out in front of big environmental cases, i think having soil samples taken is real, not fake, science.

the le roy case has a high media profile and allegations of an environmental cause - perfect for brockovich to hitch her wagon to. but it would be wrong to assume that the conclusion is preordained. i’ve litigated against her firm and know that they don’t pursue it unless they think they can win. after all, the PG&E case was a real environmental disaster.

Comment #31: astro  on  02/20  at  06:27 PM

And, let me be clear—the people with Morgellon’s are suffering terribly, and deserve our compassion, our support, and the best care we can possibly give them.

Comment #32: Punditus Maximus  on  02/20  at  06:31 PM

I find the same hysteria over GMO, too.  People will go nuts assigning dangers or saying because one example was dangerous, that all are dangerous, and it’s just not true.  There’s lots of things to be scared of, but just being irradiated or GMO’d or hybridized isn’t one of them.

Comment #33: Crissa  on  02/20  at  06:35 PM

We’re talking about a pattern of involuntary muscle spasms in a number of teenage girls. If this was just a function of copycat behavior, none of them would go to the doctor - they’d just stop copycatting.

This is such a categorical misunderstanding of what mass hysterias and copycat behavior is that I have to assume you’re either being willfully obtuse or you just walked in here, guns blazing without any idea of what you were talking about.

Comment #34: Tyro  on  02/20  at  06:52 PM

Maybe the reason that women seem to be particularly prone to diagnoses of Mass Psychogenic Illness is the cultural stereotype that women are hypochondriacs who frequently experience symptoms that are all in their head.

It seems perfectly plausible that this is mass hysteria. From Amanda’s summary here, it seems likely.

But yeah, the fact that hysteria has been used to dismiss some horrible disease that are more likely to happen to women, such MS and fibromyalgia, does give a bitter taste to hysteria claims.

Historically, was neuralgia just a symptom of lazy, bored women? There are so many undiagnosed chronic diseases that the women could have had. I’m also suspicious of “hysterical blindness” where people would be temporarily blind, the temporariness of it being used to prove that it was hysterical—there are diseases that cause temporary blindness.

Comment #35: Mandolin  on  02/20  at  07:06 PM

It’s a diagnosis of last resort based primarily on post-hoc explication of various historical mysteries, like Europe’s “dancing plagues”, that occurred so conveniently in the past that no physical evidence could possibly exist to refute the conclusion of mass hysteria, buoyed by real examples of things like mass laughter that hardly rise to the level of illness, certainly nothing on par with the neurological symptoms being experienced, here.

Are you saying that you think that psychosomatic illnesses are over-diagnosed because doctors are likely to overlook potential physical causes for a disease? Or are you denying the existence of psychosomatic illnesses altogether?

Lindsay Beyerstein already mentioned an example that doesn’t seem to follow your characterization of psychosomatic illnesses. She mentioned a case where people exposed to spilled baking powder on a public bus started to develop symptoms as they believed the powder to be anthrax or a harmful chemical of some sort.

That seems like a fairly recent case to me. It also seems easy to refute. As far as I can tell, there are three possible causes for the symptoms: 1.) the baking powder itself caused them, 2.) all of the victims had been exposed to something else which caused the symptoms, and 3.) the symptoms were caused by a psychosomatic illness.

I suppose that if you were to re-examine the baking powder and find a dangerous chemical, then that would falsify the psychosomatic illness hypothesis. The same would be true if you were to find something else that all of the victims had been exposed to that same day, particularly if others who were exposed to the same substance and didn’t use public transport that day developed similar symptoms.

Lindsay Beyerstein also noted that the illness didn’t follow the patterns one would expect it to if it were actually caused by a chemical spill. That seems to make the idea that these symptoms were caused by something chemical even more unlikely.

It seems to me that it would be possible to find evidence that the symptoms developed by those exposed to the powder weren’t caused by psychosomatic illnesses.

Comment #36: Anathema  on  02/20  at  07:14 PM

Chet, nobody is alleging that they are consciously copying each other. If they were, they could stop whenever they got tired of it. That’s trivial. The question is whether the mind can create involuntary, persistent patterns of abnormal behavior without an organic disease or illness. The evidence is that it can, and regularly does. Cf. conversion disorder. I’ve spent some time with patients with conversion disorder. They are really paralyzed and/or numbed, but often in ways that can’t possibly be caused by nerve or brain injuries because it flies in the face of our knowledge of anatomy. Cf. glove anesthesia. Their minds are creating this paralysis. They can’t call it off at will. But they get better with psychiatric treatment and nothing else works.

Social contagion of “neurological” symptoms isn’t some obscure thing that only happened in the Middle Ages. It’s part of everyday life. Every day in churches all over the U.S. people speak in tongues and fall down “taken by the Holy Spirit.” They’re not faking. They really feel like they’re swooning and being overtaken by a force outside of their control. This kind of social contagion is considered good in these churches, so we quite rightly resist defining it as an illness in that context. But when the ticking and babbling is mediated by a belief in toxins rather than a belief in spirits, and it happens at school instead of church, and it interferes with people’s ability to function, we rightly call it mass psychogenic illness.

Logically, in any given case, there might be a real poison or contagious disease that we just don’t know about. But insisting that there must be something in the face of all available evidence is just as irrational as positing demonic possession.

If the circumstances don’t fit the usual epidemiological patterns, it makes more sense to assume that the symptoms are psychogenic. For example, there’s no tight physical link between exposure (any plausible candidate) and symptoms. It’s not like the victims all sat in the same classroom, or lived on the same block, or ate the same batch of frozen hamburger. Some credulous media accounts are blaming the symptoms on a spill that happened 40 years ago. Well, if the toxins have been around for 40 years, why are the symptoms only cropping up in a handful of high school kids and a 36-year-old woman today? If it’s fraking, consider that fraking is going on all over the country. Why doesn’t fraking cause Tourettes in other towns?

Comment #37: Lindsay Beyerstein  on  02/20  at  07:25 PM

Great job, Amanda, at getting to the heart of the matter: the stigma still so frequently and unjustly associated with mental illness.

I didn’t fully understand how serious the issue is myself until I fell in love with a woman with bipolar disorder, but even with several years of experience in watching her deal with it and trying to be supportive any way I can, I still can’t help but flinch in horror that someone could suggest that someone with bipolar disorder doesn’t need medication, as coldestcaress mentions. I can’t imagine the rage and frustration something like that would engender. Even as someone fortunate enough to only have to observe and try to support someone with bipolar disorder, it makes ME mad.

Comment #38: Epsilon82  on  02/20  at  07:31 PM

What’s with all the Erin Brockovich hate in the original post and the comments? What’s wrong with taking a soil sample? I could see if she sued without taking a sample, but I can’t comprehend the argument that it’s somehow anti-science to inquire into something. The inquiry might have a shaky basis, but it’s not like taking a soil sample has any negative ramifications. It’s not like she’s investigating something invasively or creating a legal nuisance (at least not yet).

Comment #39: curiouscliche  on  02/20  at  07:37 PM

I disagree that some people who are unwilling to accept a diagnosis of mental illness are doing so out of stigma.  I have OCD and I have never been ashamed of it.  I also have hypothyroidism which went undiagnosed for years because if you’re a woman and tell certain doctors that you’re overwhelmingly tired, the first conclusion they will jump to is depression.  I don’t have depression and never had.  But of course when I insisted that that diagnosis was wrong, they insisted right back that I was simply ashamed of such diagnosis and that’s why I was denying it.  Of course doctors are people and so some are better than others, and I found one who finally diagnosed me with hypothyroidism.  Sometimes I am resentful that years of my life were stolen from me when I could have felt normal with a little daily pill.  If they hadn’t been so insistent that it was “just” depression, maybe I could have had the correct diagnosis sooner.  And those years without treatment were during college, so my GPA was lower than it could be, which will follow me for the rest of my life.  I was denied jobs because I didn’t quite make 3.0 and some places have a sharp cut-off.  And because I couldn’t get those prestigious jobs that I was otherwise qualified for, I won’t have them on my resume when I’m old enough that work experience matters more than college GPA.  I haven’t even tried to apply for grad schools yet, but again I think I would be denied entry to the best programs.  I’ll already make far less in my life because I’m a woman, and now this wrong diagnosis will me haunt me forever.

So anyway, I do think this particular case is mass hysteria, but I’m not a psychologist or a psychiatrist.  Until they get a diagnosis from a qualified mental health professional, then I won’t assume what their diagnoses are.  One thing I have learned is that physicians can be really great at what they do, but they simply aren’t as qualified as a psychiatrist to make diagnoses when it comes to mental health.  And when someone doesn’t accept a certain mental health diagnosis, it’s not always because they are ashamed of it.

Comment #40: bananacat  on  02/20  at  07:44 PM

Chet, if you had used my link, you’d have found the following:

Mass anxiety hysteria and mass motor hysteria can be hard to distinguish from the effects of actual exposure to environmental hazards. Experts have therefore identified several features that are indicative of a psychogenic origin for a sudden outbreak of illness symptoms in a group of people. These include the lack of a plausible organic basis, their occurrence in a relatively closed group, and the prior existence of high levels of stress. It is always necessary, however, to test fully for potential toxic or pathogenic exposures. This point is underscored by a case in 1990 when several children at a London primary school fell sick with typical symptoms of MPI: nausea, vomiting and abdominal pain and over-breathing. It looked like a classic case of hysteria. However, it turned out that they were actually suffering from poisoning from pesticides used on cucumbers (Bartholomew, 2001).

Falsifiability, Chet, if you can falsify the hypothesis that some pathogenic agent or chemical(s) are to blame( or, made impossible) what’s left? 

 

Comment #41: Dark Avenger Guardian Chow Mein  on  02/20  at  07:48 PM

Oh, I would also like to add that it’s a bad idea to mass diagnose these girls.  It’s quite possible that one or some of them have a tic disorder (again mental but not psychogenic) and that started off the symptoms in the other girls.  I really hate to see them all lumped together, and they need to each see a mental health expert individually for individual diagnoses.  Tics can be caused by Tourette’s, but they’re also frequently comorbid with OCD.  I would hate to see a health care professional miss out on an underlying diagnosis for one or some of the girls because the others don’t have them.  I’m also not a big fan of lay people diagnosing strangers in the first place.

Comment #42: bananacat  on  02/20  at  07:49 PM

I want to clarify that I think this is overall a great post, and I agree with Amanda’s overall argument. I just think Erin Brockovich shouldn’t be tarred as working for the other side, or labeled as anti-science (I’m maybe a little biased, because I consider her a personal hero, and she’s probably the biggest reason why I wanted to be a lawyer, ever since I was in high school). She’s probably wrong about a toxic origin to this situation, but there’s no harm in taking soil samples. The results will speak for themselves and most likely establish that even if the soil is toxic, the toxicity isn’t distributed in a way that could cause this phenomenon.

Comment #43: curiouscliche  on  02/20  at  07:56 PM

You can induce social contagion very rapidly and consistently by hot-housing people in evangelical churches and artificially stressing them with sensory overload, stirring evangelism, etc.

It’s not surprising that social contagion is much rarer in the larger community when people are not self-selected to believe they can be overtaken by spirits/toxins, not artificially stressed/hyperstimulated by ceremonies, etc. However, most of the cases of social contagion have been observed in relatively closely knit communities, like schools and factories. The town of LeRoy has fewer than 8000 residents, IIRC. That makes sense if you think of this as contagion in terms of beliefs, but not in terms of germs or chemicals. Why haven’t people caught it from the media? Presumably because the syndrome is a MUCH bigger deal in LeRoy right now than we can even imagine based on media reports. I wouldn’t be surprised if we start seeing outbreaks of tics in other communities that are concerned about fraking now that the narrative is out there.

Once you accept that the mind can produce these symptoms in the absence of physical disease, and the evidence is incontrovertible that it can, then it becomes an inference to the best explanation. It is simply more likely that we’re seeing a rare, but well-documented, psychosocial phenomenon than that we’re dealing with a disease or toxin that violates everything we know about epidemiology and toxicology.

Comment #44: Lindsay Beyerstein  on  02/20  at  08:17 PM

Wouldn’t it be relatively easy to extrapolate based on response to treatment?  That is, if the girls who are kept away from the limelight and given psychological and/or psychiatric treatment get better, and the girls who receive no treatment do not, then there are some conclusions about etiology that can reasonably be drawn.

Comment #45: burgundy  on  02/20  at  08:22 PM

What still remains unsettled is why scientific inquiry should be politically correct or why Amanda Marcotte ignores disconfirmations of her theory that adolescence is uniquely stressful for young women, such as the fact that, e.g., schizophrenia, whose environmental component appears to consist largely in (social) stressors, strikes men earlier and far harder.

Comment #46: cataphract  on  02/20  at  11:17 PM

of her theory that adolescence is uniquely stressful for young women,

And where did she make that claim, troll?

This is what she wrote, not what you think she wrote:

From Hass’s article, it’s clear that the experts in this situation are opening door #2, pointing out how hard the lives of many victims are and suggesting they cracked under pressure. I would point out that the transition from childhood to adulthood is particularly difficult for women. You go from being an adored child who lives in a sea of mother-love to being, frankly, a second class citizen whose sexuality is considered the most important and often only relevant aspect of your personality. You’re expected to start stifling yourself, accept being talked down to (often by men who know less than you do about a subject), and to constantly monitor your body to make sure you’re striking that perfect and impossible balance between sexually alluring and “slutty”. This is especially difficult if you’re a teenager, with all the attendant awkwardness and raging hormones that implies. That’s the baseline of stress for basically all young women. Add to that any more stress, and no wonder teenage girls crack.


schizophrenia, whose environmental component appears to consist largely in (social) stressors, strikes men earlier and far harder.

Heredity and the Genetics of Schizophrenia

The current belief is that there are a number of genes that contribute to susceptibility or pathology of schizophrenia, but none exhibit full responsibility for the disease. It is believed that schizophrenia is much like diabetes, which is caused by a number of genetic and environmental factors. Research also increasingly suggests that - like diabetes - many cases of schizophrenia may be preventable. See “Schizophrenia Prevention” for more information.

..................................................................................................................

Family statistics
As can be seen from the graph below, schizophrenia definitely has a very significant genetic component. Those who have a third degree relative with schizophrenia are twice as likely to develop schizophrenia as those in the general population. Those with a second degree relative have a several-fold higher incidence of schizophrenia than the general population, and first degree relatives have an incidence of schizophrenia an order of magnitude higher than the general populace. Following are two images that summarize the average risks for developing schizophrenia for different groups of people. (The statistics in the two images vary slightly due to inclusion of different study data).

Begone, troll, haven’t you learned from your past experiences here?

 

Comment #47: Dark Avenger Guardian Chow Mein  on  02/21  at  12:09 AM

I don’t remember denying that schizophrenia has genetic components.

“Schizophrenia, whose environmental component appears to consist largely in (social) stressors”

Which implies that there is a component that isn’t environmental.

Man, you are dumber than a box of hair.

Comment #48: cataphract  on  02/21  at  01:06 AM

And where did she make that claim, troll?

I would point out that the transition from childhood to adulthood is particularly difficult for women.

Is English your first language?

Comment #49: cataphract  on  02/21  at  01:11 AM

Cataphract, you have no point.

Comment #50: curiouscliche  on  02/21  at  01:16 AM

I have two points.

Amanda expects the outcomes of scientific studies to be politically correct. I still don’t see why. She also claims that hysteria is more common among young women because growing up is more stressful for them. Why then, for example, is schizotypal personality disorder, which can also be precipitated by stress, more common among men?

I only have no point if you completely ignored everything I just said (which wouldn’t surprise me).

Comment #51: cataphract  on  02/21  at  01:20 AM

I would point out that the transition from childhood to adulthood is particularly difficult for women.

The trolls’ paraphrase:

her theory that adolescence isuniquely stressful</b > for young women

<b>Amanda expects the outcomes of scientific studies to be politically correct. I still don’t see why.

Nope, not at all.

She also claims that hysteria is more common among young women because growing up is more stressful for them

There’s two ways to interpret the fact that mass hysterias tend to take off amongst teenage girls and young women (see: Salem witch trials, multiple personality disorder) more than anyone else. You could go with the sexist explanation, that women are inherently unstable and hysterical. Or you could go with the more nuanced, anti-sexist explanation, which is that young women are under a specific set of stresses that make this sort of thing happen.From Hass’s article, it’s clear that the experts in this situation are opening door #2, pointing out how hard the lives of many victims are and suggesting they cracked under pressure. I would point out that the transition from childhood to adulthood is particularly difficult for women. You go from being an adored child who lives in a sea of mother-love to being, frankly, a second class citizen whose sexuality is considered the most important and often only relevant aspect of your personality. You’re expected to start stifling yourself, accept being talked down to (often by men who know less than you do about a subject), and to constantly monitor your body to make sure you’re striking that perfect and impossible balance between sexually alluring and “slutty”. This is especially difficult if you’re a teenager, with all the attendant awkwardness and raging hormones that implies. That’s the baseline of stress for basically all young women. Add to that any more stress, and no wonder teenage girls crack.


You don’t even have any kind of link or scientific authority to back up your assertions troll.

Quit feeling sorry for yourself, and us.

Comment #52: Dark Avenger Guardian Chow Mein  on  02/21  at  01:35 AM

Nope, not at all.

Why should one care whether a theory is “sexist”?

You don’t even have any kind of link or scientific authority to back up your assertions troll.

Does she?

Schizophrenia ... strikes men earlier and far harder

http://psycnet.apa.org/psycinfo/1996-93350-001

What I’m saying is common knowledge. Also: you’re a bozo.

Comment #53: cataphract  on  02/21  at  01:47 AM

her theory that adolescence isuniquely stressful for young women

And what’s wrong with this paraphrase?

BTW - as long as you’re trying to look like an intellectual elite, you might do well to lrn2html.

Comment #54: cataphract  on  02/21  at  01:50 AM

as long as you’re trying to look like an intellectual elite

I’ll leave that to you.

Schizophrenia ... strikes men earlier and far harder

But nothing she’s written on this thread or anywhere else has gone against that AFAIK, unless you’re coflating hysteria with schizophrenia.

 

Comment #55: Dark Avenger Guardian Chow Mein  on  02/21  at  02:11 AM

I’ll leave that to you.

Likewise, I’ll leave being a hot-headed bozo who blathers on about subjects he has no clue about to you.

But nothing she’s written on this thread or anywhere else has gone against that AFAIK

Nah not really, just the world’s smallest violin solo about how much harder it is to be an adolescent girl.

Comment #56: cataphract  on  02/21  at  02:13 AM

Cataphract, it takes a particularly insecure individual to stew in resentment at teenage girls. Was middle school really that bad for you? Does trolling feminist blogs make you feel any better about it?

Comment #57: curiouscliche  on  02/21  at  02:21 AM

Cataphract, it takes a particularly insecure individual to stew in resentment at teenage girls.

I’m not “stewing in resentment”. I’m taking a dubious epistemic claim to task. That’s science. Deal with it.

Was middle school really that bad for you?

Middle school was bad for anyone with an IQ higher than room temperature. That may not include you.

Comment #58: cataphract  on  02/21  at  02:25 AM

Now, lay off cataphract, he’s suffered more than any adolescent girl because he’s SMART!

Comment #59: Dark Avenger Guardian Chow Mein  on  02/21  at  02:25 AM

This is what happens when people aren’t competent enough to hold a serious discussion with me.

Comment #60: cataphract  on  02/21  at  02:27 AM

Yep, it’s funny how spurious claims blow up in your face when you subject them to the light of day.

You’re not serious, you’re resentful.  Amanda didn’t make any claims about young men re Schizophrenia, she tried to point out the obvious factors that would make teenaged girls more liable to fall victim to hysterical behavior, but you showed her and us, didn’t you, catafrack?

Comment #61: Dark Avenger Guardian Chow Mein  on  02/21  at  02:31 AM

Amanda didn’t make any claims about young men re Schizophrenia, she tried to point out the obvious factors that would make teenaged girls more liable to fall victim to hysterical behavior

And did this in an entirely conformation biasing manner. With “no links or scientific authorities”.

Comment #62: cataphract  on  02/21  at  02:34 AM

*confirmation

But yeah, that’s some nice armchair psychology you got there.

Comment #63: cataphract  on  02/21  at  02:34 AM

And did this in an entirely conformation biasing manner. With “no links or scientific authorities”.

From Hass’s article, it’s clear that the experts in this situation are opening door #2, pointing out how hard the lives of many victims are and suggesting they cracked under pressure.

Even worse than that, on no authority whatsoever.

Comment #64: Dark Avenger Guardian Chow Mein  on  02/21  at  02:40 AM

Even worse than that, on no authority whatsoever.

No peer-reviewed research. If a NYT editorial doesn’t pass muster, neither does a brief blurb from an epidemiologist.

Amanda Marcotte gets to armchair theorize out of her ass. But I don’t get to post peer-reviewed research.

It contributes to the stigma around mental illness.

You seem to have no problem with this BTW.

Comment #65: cataphract  on  02/21  at  02:45 AM

Oh cataphract, you’re so smart, with your using “epistemic” incorrectly, and conceding my point that your misogyny is rooted in an inability to move past middle school.

But just to give your “argument” a minimal response that it doesn’t even deserve, at no point did Amanda suggest that scientific results have to conform to anything, much less some ill-defined category of whatever doesn’t satisfy your sexism. Your bullshit about “political correctness” seems to refer to this quote from comment #27. “You could go with the sexist explanation, that women are inherently unstable and hysterical.” So basically, your argument is that women are inherently unstable and hysterical, because you think the “science” indicates that. The reason you have no point is because Amanda provided an argument and backed it up with evidence. You, on the other hand, are arguing that a medical condition can best be explained by a political belief, known as misogyny.

Your repeated harping about schizophrenia is worthless. The average age of onset for men coincides with adulthood, not adolescence. http://www.schizophrenia.com/szfacts.htm There’s also no genetic component to conversion disorder as DAGCM pointed out, but you failed to understand that with your super HOT IQ.

Comment #66: curiouscliche  on  02/21  at  02:51 AM

Oh cataphract, you’re so smart, with your using “epistemic” incorrectly

How so.

conceding my point that your misogyny is rooted in an inability to move past middle school

#1) Did not.
#2) Irrelevant.

at no point did Amanda suggest that scientific results have to conform to anything

She merely strongly implies that the outcomes of scientific investigation should not be sexist.

So basically, your argument is that women are inherently unstable and hysterical, because you think the “science” indicates that.

Where did I say this? I just it shouldn’t be ruled out. The book Affective Neuroscience, which, unlike Marcotte’s armchair bullshitting, is actual scientific literature, suggests that there is a neuroscientific reason women cry more. So maybe some of these stereotypes exist for a reason.

ou, on the other hand, are arguing that a medical condition can best be explained by a political belief, known as misogyny.

Quote me saying this.

The average age of onset for men coincides with adulthood, not adolescence.

Onset isn’t a discrete event. Prodromal symptoms can often extend well into early childhood. To take a classic example: mathematician John Forbes Nash Jr exhibited weird and antisocial schizotypal behavior yeeeeaars before his first psychotic break.

If, like me, you had actually read any research about schizophrenia before the fact, rather than just frantically Googling something to support your position, you’d know this.

Comment #67: cataphract  on  02/21  at  02:58 AM

She merely strongly implies that the outcomes of scientific investigation should not be sexist.

Wrong, she shot down the sexist explanation. That’s not the same thing.

Where did I say this? I just it shouldn’t be ruled out. The book Affective Neuroscience, which, unlike Marcotte’s armchair bullshitting, is actual scientific literature, suggests that there is a neuroscientific reason women cry more. So maybe some of these stereotypes exist for a reason.

Sure, a book 14 years old has the research and data to demonstrate that women cry more than men for scientific reasons, the difference couldn’t be due to the fact that males in Mainstream American society aren’t expected to cry to show their feelings….....................................

Comment #68: Dark Avenger Guardian Chow Mein  on  02/21  at  03:10 AM

Sure, a book 14 years old has the research and data to demonstrate that women cry more than men for scientific reasons

Do you have it? Did you read it? If not, you are being a partisan by dismissing his work out of hand.

Age of a paper or book is immaterial to its truth.

Comment #69: cataphract  on  02/21  at  03:12 AM

Furthermore, the new edition is from 2004.

Comment #70: cataphract  on  02/21  at  03:13 AM

The only thing I’ve seen take off as fast and make so much sense to people as soon as it was available was text messaging.

I think Facebook grew much faster.

SMS was first commercially available in the mid-1990s, and it became widely available in the United States in 2000. It’s completely ubiquitous today, but so is Facebook, which is on track to have 1 billion users by the end of the year (currently at 845MM users). On top of that, FB is very likely about to have the largest IPO in the history of publicly traded companies.

The difference between the rise in use of SMS and Facebook is that the latter has only been around since 2004, and has only been available outside of colleges since 2006. It’s user base has grown at a significantly faster rate than SMS when that gets taken into consideration.

Comment #71: DTGslu2K  on  02/21  at  04:56 AM

Given that we’re talking about something completely subconscious in origin, it’s probably worth pointing out that it is socially more acceptable for females to be ‘weak’, so I’d imagine that they’re more likely to ‘allow’ themselves to act this way.

Middle school was bad for anyone with an IQ higher than room temperature.

So if your middle school years were fine, what’s your problem?

Comment #72: Jayn Newell  on  02/21  at  08:31 AM

Age of a paper or book is immaterial to its truth.

I have a Chemistry textbook from the 1850s with the formula for water being HO, you were saying?

And, of course, nothing significant has taken place or discovered in neurobiology in the 7 years since the 2nd edition was published is that what you’re saying?

if your middle school years were fine, what’s your problem?

He’s right, goddamn it, even if the rest of us and Amanda fail to recognize the strength of his arguments.

Comment #73: Dark Avenger Guardian Chow Mein  on  02/21  at  08:47 AM

Why should one care whether a theory is “sexist”?

When a theory leads to a conclusion that is contrary to evidence, i.e. sexism, you might want to review it.

Comment #74: BlackBloc  on  02/21  at  09:19 AM

I have an idea.  If you want to have an article and a comment thread talking about men and schizophrenia, why not start your own blog and write the article?

This particular article is talking girls and mass hysteria.  So, yeah, there will probably be little to no reason to talk about teh menz in this particular thread or article.  Sad face!

Comment #75: speedbudget  on  02/21  at  09:43 AM

I hate to continue discussing cataphract has to say, but it’s decidedly politically incorrect to suggest that sexism is to blame for something. Even among leftwingers, there’s always pushback to the notion. I see no reason to let people define “politically correct” to mean “leftwing” when it’s a perfectly useful term.

Ask Jeremiah Wright if rightwingers don’t engage in screaming fits at violations of political correctness.

Comment #76: witless chum  on  02/21  at  10:46 AM

I’m not misunderstanding anything, I’m explaining to witless chum that “one person doing Thing X and then people copying them” is exactly not what’s going on in LeRoy. My remarks were not meant to characterize mass psychogenic illness.

I didn’t mean they were consciously copying them.

I don’t find the theory being mass pyschogenic illness all that strange, either. We all experience small scale varieties of this. Contagious yawning, for example. I don’t experience that as choosing to yawn, but that seems like the only plausible explanation of what’s going on. Or itchyness.

Comment #77: witless chum  on  02/21  at  10:53 AM

What still remains unsettled is why scientific inquiry should be politically correct or why Amanda Marcotte ignores disconfirmations of her theory that adolescence is uniquely stressful for young women, such as the fact that, e.g., schizophrenia, whose environmental component appears to consist largely in (social) stressors, strikes men earlier and far harder.

Quick question. Did this chucklefuck actually whip out “WHAT ABOUT THE MENZ?!?”

Comment #78: StarStorm  on  02/21  at  11:52 AM

Sexist troll happily believes women cry more because women are inherently unstable. He’s too cowardly and pathetic to actually own it, but it “shouldn’t be ruled out.” But when men are violently emotional and irrational, it’s because they’re not getting laid enough, and certainly not because they’re inherently irrational or unstable. This problem, and therefore every problem of any import in sexist troll’s life, would be solved if women would agree to have more sex with unpleasant, unattractive, resentful men like himself.

Comment #79: junk science  on  02/21  at  12:57 PM

Oh man, the whole idea of psychogenic illnesses not being legitimate frustrates me to no end. It keeps patients away from successful treatment on multiple fronts. I used to work for a neurologist who specialized in movement disorders, and I once saw him treat a woman who suffered from psychogenic seizures. She reported that she’d overheard previous doctors and nurses make remarks like, “Gee, that must be a good way to get out of work”. The good thing about a diagnosis of psychogenic seizures is that ~90% of patients fully recover with proper treatment. The bad thing is that psychogenic illness is so stigmatized that you have to be super-careful and super-skillful in explaining the diagnosis, or your patient might hear, once more, “you’re doing this on purpose” or “you’re making this up”. And then, they will leave you and go visit doctor after doctor to find one who will give them a diagnosis that society considers legitimate, but they won’t get proper treatment and they’ll continue to suffer from a debilitating condition. It’s awful.

Comment #80: lucidanne  on  02/21  at  12:59 PM

I was really hoping no one would feed cataphract. He’s the same troll that keeps posting on every thread under different names, normally ones with military/German origins. Ignore him and he’ll eventually get the message that he’s boring.

Comment #81: Treefinger  on  02/21  at  01:08 PM

a mind-control disease that gives you spasms.

Can you point to where someone on this thread defined Mass Psychogenic Illness in those terms, Chet?

lucidanne, don’t confuse Chet with the facts and your own experience with a trained medical professional, his mind is already made up, based on his superior logic and knowledge of SCIENCE!

Google Scholar on examples of mass psychogenic illness examples:

Results 1 - 10 of about 11,600. (0.10 sec)

An increased awareness of MPIs on the part of organisers of future mass vaccination campaigns seems appropriate. Immunisation managers should be aware that mass immunisation campaigns could generate such mass reactions. It is therefore essential that surveillance/reporting systems for reporting adverse events be improved before such campaigns. A mass campaign using a smallpox vaccine should be accompanied by a surveillance system capable of distinguishing between multiple cases of conventionally understood vaccine reactions and outbreaks of mass psychogenic illness.

Discussion

This outbreak has many of the features classically associated with mass psychogenic illness. Mass psychogenic illness has been defined as a constellation of symptoms suggestive of organic illness but without an identified cause in a group of people with shared beliefs about the cause of the symptoms. It is a social phenomenon, often occurring among otherwise healthy people who suddenly believe they have been made ill by some external factor. Outbreaks of mass psychogenic illness affect girls and women more frequently than boys and men. The incidents often occur after an environmental event or trigger, such as an odor, and are frequently preceded by an index patient’s illness and a prominent response by emergency personnel to the event or illness. Contagion is increased by the proximity of affected and unaffected persons, reassembly of the group, and “line of sight” transmission. Although symptoms may suggest an environmental cause, none can be identified quickly, and other persons who are putatively exposed do not become ill.

Such outbreaks often involve a very rapid spread of symptoms (frequently including hyperventilation or syncope), with minimal physical findings, and often occur in groups under physical or psychological stress. Dramatic and prolonged media coverage frequently enhances such outbreaks.7,11,13-16 Many of these factors appear to have played a part in the outbreak at the high school in Tennessee. Intensive media attention probably heightened the collective anxiety and may have contributed to the second cluster of cases.

Despite an exhaustive evaluation, no environmental cause of the reported illnesses was identified. The normal laboratory findings and reassurances about the safety of the school were widely publicized. Nonetheless, more than one month after the outbreak, local media continued to report on persons with persistent headaches that they believed were related to exposure to a toxic substance at the school, and rumors of incompetence and coverup on the part of the government persisted. Some people believed that the investigation had simply failed to find the real cause of the illness. Paradoxically, in such circumstances, the observation of vigorous investigative activities may reinforce the suspicion that a genuine problem is being covered up. Persistent investigation also increases the likelihood of false positive results, which must then be explained to an apprehensive community.

In this case, many ill persons noted a smell at the school on the first day of the epidemic. There was no consistency in the reported quality or location of the odor. Many persons who did not become ill, including school administrators and emergency personnel, also noted an odor on the first day of the outbreak, though it was not consistently described by this group either. The pattern of illness in the school did not reflect a particular route of air distribution. It is difficult to conceive of any toxic gas or other toxic substance in the environment that would account for such variations in the description and location of the odor and for such a wide range of self-limited symptoms in persons scattered throughout a large building, with no evidence of abnormalities in any environmental or laboratory tests.

Those are from the third and second link in the Google Scholar search results.

Comment #82: Dark Avenger Guardian Chow Mein  on  02/21  at  01:27 PM

Chet - psychological treatment decidedly does not make you feel better if that isn’t what the problem is.  Agreed on the staying out of the limelight though.  The chicken soup effect also decidedly not entirely placebo as it gets something warm/hot and easily digestable into a sick person with less chance of stomach upset then most foods while it pumps up liquid and soluble vitamin intake.

Comment #83: helen w. h.  on  02/21  at  01:31 PM

But the people in LeRoy don’t share a belief about the cause of the symptoms: some think it’s a result of fracking toxin exposure, some think it’s a communicable disease, and so on.

There can be subgroups of the original group who believe in different causes of their symptoms, that doesn’t negate the fact that they are behaving in the classic manner of others in groups manifesting PMI.

,simply the notion that it can be widely contagious. I just don’t see how that’s not magical thinking, and a case or two of the infectious giggles is insufficient to support such a counterintuitive and surprising conclusion.

Contagion is increased by the proximity of affected and unaffected persons, reassembly of the group, and “line of sight” transmission

Monkey see, monkey do, Chet, why is that such a difficult concept that you label it ‘magical thinking’?

But, hey, you know more than the researchers, editors, etc., who have written and published their studies of this phenomenon because why?

Here it is explained for you, Chet:

The Le Roy Teen Mystery: How to Treat Mass Psychogenic Illness

A psychologist talks about how “contagious” psychological disorders may be fanned by fear, anxiety and the media.


State health officials recently added three more people to the list of people diagnosed with a mysterious tic-like illness that has affected more than a dozen students — mostly high school girls — in Le Roy, N.Y., since last fall.

............................................................................................................................

Healthland spoke with Joan Broderick, associate professor of psychiatry at Stony Brook University, who has conducted research on psychogenic illness and treated many patients suffering from it. Broderick is a senior consultant to the Red Cross in disaster mental health, and recently published a paper [PDF] about the role of the media in outbreaks of disorders like the one in Le Roy.

What are the most important factors in dealing with cases like Le Roy?

I think that it is very important that the health department and those agencies responsible for the environmental safety of communities engage in a responsible and thorough investigation. That investigation needs to be transparent. The outcomes need to be communicated very effectively to the affected community that feels that they are under threat. Their message is not going to be effective unless there is a trusting relationship between the community of impacted individuals and those agencies.

At the same time, the individuals who are exhibiting symptoms need to be protected. The best advice in terms of managing this would be that impacted individuals should probably be kept apart from one another to reduce the contagion aspect. They should be shielded from media and the investigation that is going on, so that they can let their sense of alarm and threat start calming down.

(cont)

 

 

Comment #84: Dark Avenger Guardian Chow Mein  on  02/22  at  11:14 AM

What other concerns arise when treating psychogenic illness?

It varies by situation. The important thing is to reduce the sense of threat, reduce the opportunity for contagion and continued inflammation, and create conditions in which the illness is fully validated, while at same time supporting the ability to recover. Affected people need to believe that they don’t lose face by recovering. They should be given tools that allow them to reconceptualize what happened to them and to let the physiology calm down so that the symptoms can subside.

The worst thing you can do in treating these individuals is to confront them directly with ideas about it being ‘all in your head.’ That does not do justice to the mind/body interaction going on.

They really are experiencing symptoms. The symptoms are real. If you keep talking to them only about reducing stress, that will be insulting. It is a mistake to imply that they’re hysterical. It’s not the right approach.

There has to be a complete sense of respect of for the patient, validating that they are having a difficult time and very troublesome symptoms. The focus should be on how are we going to help you get better.

There’s nothing worse than feeling like you are ill because of some agent, yet people are saying, ‘Oh you’re stressed’ and patting you on the head in a condescending manner. That will understandably provoke, ‘I have to prove that I am ill.’ That’s the last thing you want patients to have to put more energy into. In fact, it is difficult for people to recover from psychogenic illness when the belief persists by the patient and those around them that there is a real threat that has not been detected or is being covered up.

You have to address the threat and start working on deconstructing the threat. As in a lot of psychotherapy, you have guiding principles that you are applying, but the specifics of the situation and the patient guide the implementation. Cognitive behavioral therapy [a type of psychotherapy shown to help with pain, depression and many other disorders] is an approach that is helpful for psychogenic illness.

Will the students’ doctors or therapists talk to them about how long-term stress can contribute to very real physical illnesses like heart disease and stroke?

At some point in treatment, you might introduce those concepts as a way of helping the patient reconceptualize the illness and understand the mind/body connection. But I wouldn’t make that the first discussion.

If stress and anxiety are part of the problem, would anti-anxiety drugs like Valium help?

A lot of people think that, but it’s not that simple. I’m not familiar with what treatment is being provided for these young people. Sedatives might or might not be part of treatment. Cognitive beliefs become established about one’s illness, and sedatives don’t address that.

What is the impact of media attention?

When you think about the process that we believe underlies the onset of psychogenic illness, it is a sense of threat. The most common trigger for psychogenic illness is perceived detection of a noxious odor. An odor is perceived. People think, What is it? Is this dangerous? They may start getting anxious. Those anxiety symptoms may include nausea and faintness due to hyperventilation.

We’re always attributing what we’re feeling to something. We feel sick and think, Oh, I wonder if the food was bad. This is not an atypical process; it’s about the attribution that gets made. So people notice something unusual, they label the event as threatening, [the media reports it widely], that increases anxiety, which increases physical symptoms, which then are attributed to the threat. It becomes a rapidly spiraling mind/body process.

Link

Follow the link(It would take me several comments to copy the complete article out here), read and learn, Chet, if you’re capable of doing so without preconceived notions.

Comment #85: Dark Avenger Guardian Chow Mein  on  02/22  at  11:18 AM

False positives and false negatives

Nothing in medicine is 100%, and all diagnoses have false positives and false negatives. Physicians learn to deal practically with this uncertainty. For example, even though we may have made a confident diagnosis, we will still rule out alternatives we cannot afford to miss. The diagnosis of a psychogenic disorder is no different.

The public tends to focus on the risks of the false positive – diagnosing a symptom as psychogenic when there was a missed underlying physiological disorder. While this happens, it is again no different than any form of misdiagnosis. This is, admittedly, the worst-case-scenario. But to put it in perspective, this often occurs after a thorough workup that has failed to reveal the diagnosis. So the failure to make the underlying diagnosis occurs whether or not the alternate diagnosis of psychogenic is entertained.

Putting the notion of a psychogenic cause aside, physicians often face the situation in which patients have symptoms that cannot be diagnosed. The body is complex, and we cannot always explain every symptom. Workups are designed, in fact, to look for entities which can be treated, not necessarily to explain symptoms at all costs. So when we say we don’t know what is causing a symptom what we really mean is that we have ruled out anything that we could treat. What we are left with are all the subtle biochemical or physiological causes that we either cannot rule out, or are simply not worth investigating because they will not change management.

Sometimes patients are simply uncomfortable with this situation (perhaps because it was not communicated to them well). They may seek a diagnosis until they find someone willing to make one, and then they will blame their previous doctors for “missing” the real diagnosis. Sometimes the actual diagnosis is missed, and patients were right to seek other opinions. But at other times the new diagnosis is the fake, but it is more acceptable to the patient than the stigma of stress or anxiety induced symptoms.

It should also be pointed out that sometimes there is an underlying disorder causing psychogenic symptoms – serious anxiety or depression. These are just as much “real” disorders as anything else.

In short, we see every permutation of diagnostic misadventure because the human body is complex, our knowledge and technology are limited, and the doctor-patient relationship is increasingly complex.

There are also risks to the false negative, however – missing a psychogenic disorder when that is the proper diagnosis. Patients who have disturbing symptoms due to psychological stress or anxiety will often seek multiple opinions. They will get what we call “the million dollar workup” – sometimes over and over again. There are real risks associated with so many tests. Sometimes the tests themselves are invasive and contain risks. But even safe tests, if you get enough of them, are bound to result in false positives, which could lead to a misdiagnosis, further invasive testing, and improper treatment with risks and side effects.

I have seen this scenario play out as well. I have had a few patients who, in my opinion, had entirely psychogenic symptoms, but through their tireless seeking of medical attention ended up being on numerous medications they did not need, and being subjected to many invasive procedures which then led to complications. In the end the patients had physiological and anatomical disorders and symptoms, but all ultimately resulting from the failure to properly diagnose their original symptoms as psychogenic. They would have been much better served if they were aggressively reassured that they did not have the diseases they feared, and if they were directed toward gentle quality of life interventions, as well as psychological attention for their underlying disorder. In one case the patient had what can only be called mental illness, and needed to be aggressively redirected toward psychiatric treatment.

The point is – there are risks both ways (like in all of medicine). There are risks to prematurely making the diagnosis of a psychogenic disorder or missing an additional underlying trigger, and there are risks to missing the diagnosis of a psychogenic disorder.

Conclusion

In a perfect world the unfortunate stigma attached to the psychogenic diagnosis would disappear. It is very counterproductive. We need broader understanding that the brain is also an organ and can manifest symptoms in a variety of ways. Psychogenic causes are just another item on the differential diagnosis.

Physicians, for their part, should likewise remove any stigma attached to patients with psychogenic symptoms and need to approach the diagnosis as if it were any other – with positive and negative signs, and risks to false positives and false negatives.

Link

Comment #86: Dark Avenger Guardian Chow Mein  on  02/22  at  11:24 AM

You’ve never heard of conversion disorder, Chet?

Mass psychogenic illness
The DSM-IV-TR does not have specific diagnosis for mass psychogenic illness 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.”

Diagnosis

The diagnosis of conversion disorder involves three elements: the exclusion of neurological disease, the exclusion of feigning, and the determination of a psychological mechanism. Each of these has difficulties.

Exclusion of neurological disease

Conversion disorder presents with symptoms that typically resemble a neurological disorder such as stroke, multiple sclerosis, epilepsy or hypokalemic periodic paralysis. The neurologist must carefully exclude neurological disease, through examination and appropriate investigations.[9] However, it is not uncommon for patients with neurological disease to also have conversion disorder[10].

In excluding neurological disease, the neurologist has traditionally relied partly on the presence of positive signs of conversion disorder — certain aspects of the presentation that were thought to be rare in neurological disease, but common in conversion. The validity of many of these signs has been questioned, however, by a study showing that they also occurred in neurological disease.[11] One such symptom, for example, is La belle indifférence, described in DSM-IV as “a relative lack of concern about the nature or implications of the symptoms”. In a later study no evidence was found that patients with “functional” symptoms are any more likely to exhibit this than patients with a confirmed organic disease.[12]

Another feature thought to be important was that symptoms would tend to be more severe on the non-dominant (usually left) side; there were a variety of theories such as the relative involvement of cerebral hemispheres in emotional processing, or more simply just that it was “easier” to live with a functional deficit on the non-dominant side. However, a literature review of 121 studies established that this was not true, with publication bias the most likely explanation for this commonly held view.[13] Although agitation is often assumed to be a positive sign of conversion disorder, release of epinephrine is a well-demonstrated cause of paralysis from hypokalemic periodic paralysis[14].

The process of exclusion is not perfect, so misdiagnoses will occur. However, in a highly influential[15] study from the 1960s, Eliot Slater demonstrated that misdiagnoses had occurred in one third of his 112 patients with conversion disorder.[16] Later authors have argued that the paper was flawed, however,[6][17] and a meta-analysis has shown that misdiagnosis rates since that paper are around 4%, the same as for other neurological diseases.[18]

Exclusion of feigning

Conversion disorder is unique in DSM-IV in explicitly requiring the exclusion of deliberate feigning. Unfortunately, this is only likely to be demonstrable where the patient confesses, or is “caught out” in a broader deception, such as a false identity.[19] One neuroimaging study suggested that feigning may be distinguished from conversion by the pattern of frontal lobe activation;[20] however this is a research, rather than a clinical technique. True rates of feigning in medicine remain unknown, though neurological presentations of feigning may be among the more common.[21]

 

Comment #87: Dark Avenger Guardian Chow Mein  on  02/22  at  05:15 PM

If you can’t see the relationship between CD and MPI, Chet, I’m not going to hold your hand and explicate it for you.

Comment #88: Dark Avenger Guardian Chow Mein  on  02/22  at  09:32 PM

I shouldn’t feed the troll, but I’d just like to point out:

There are, in fact, known syndromes that are much more likely to hit men than women. For example, alcoholism. Men are actually under considerably more peer pressure to drink than women are, and women in the past were under some social pressure to *not* drink (I think this is much less common), so men experience a specific social stressor that is not shared by women, and this causes them to develop a mental disorder more often (mainly because the disorder of alcoholism, which appears to be at least partially genetic, can only be triggered by drinking alcohol. A lifelong teetotaller who has the genes for alcoholism will never become an alcoholic.)

The fact that a certain syndrome is more likely to affect women because women are under stresses that men are not is not a refutation of the idea that other syndromes may affect men and not women because men are under stresses that women are not. Patriarchy hurts men too; there are actually more than a few disorders that are more likely to affect men, and if they’re not infant-onset, it’s quite plausible that they’re caused by the specific stresses suffered by men in our culture. This does not mean women don’t suffer specific stresses that men don’t.

Given that men are under great pressure to pretend that they do not have physical weaknesses, we would not expect the strain of being a teenage boy to manifest as psychosomatic weakness, since teenage boys are actually stressed *further* by being seen as weak. One would, however, expect that rates of suicide would be higher (true… teen girls make more attempts, but teen boys are more likely to succeed), that rates of substance abuse would be higher (true), and that outlets considered permissible to men would be more frequently seen, such as amok behavior (people picking up weapons and going on killing sprees until they are shot… almost invariably men or boys), or uncontrollable rage (almost invariably men and boys), or engaging in violent behavior in general (more frequently men and boys than girls and women.) We would also expect the death rate from preventable illness to be higher across the board for men (true), as they are culturally inhibited from seeking medical treatment.

So saying that teen girls suffer from unique stresses that teen boys do not, and that this can be an explanation for MPI, does *not* say that boys do not suffer from unique stresses and end up with mental illnesses as a result. Although we have a bad habit of defining weird shit that women do as mental illness and weird shit that men do as something perfectly normal that any guy might do if he’s pushed far enough, which does reduce the rate at which we can *identify* male sufferers of mental illness. (Again… patriarchy hurts men too. We pathologize female behavior and make excuses for male behavior that tries to present what is plainly abnormal as something normal and understandable, and as a result, men don’t get treatment for mental illnesses and end up dead at higher rates than women. Good going, patriarchy; it was so important to define men as never weak that it ends up killing actual men. You guys buy into this system why?)

Comment #89: Alara J Rogers  on  02/22  at  09:50 PM

But the people in LeRoy don’t share a belief about the cause of the symptoms: some think it’s a result of fracking toxin exposure, some think it’s a communicable disease, and so on.

So? They all think that something is causing these symptoms, and they all think they’re exposed to whatever they believe is the cause. Or maybe they have no idea what’s causing this, but the suspicion that it’s something they are exposed to is still there.

Good going, patriarchy; it was so important to define men as never weak that it ends up killing actual men. You guys buy into this system why?

Ego. It makes them feel better about themselves.

Comment #90: Jayn Newell  on  02/23  at  08:58 AM

What’s with all the Erin Brockovich hate in the original post and the comments?

Masry & Vititoe, the law firm she’s the publicity darling for, has had a history of running in, making claims about how their tests have shown that something is dangerous and people should sue only to quietly withdraw and go away when tests carried out by others show that either the levels don’t exceed standards or are no different from some other areas which aren’t exhibiting a supposed outbreak of sick people, or when their own tests are subpoenaed and show they don’t support their claims, or when they make their claims without doing any tests at all.

But because it’s Erin Brockovich coming in (especially after that damn movie), people automatically leap to the assumption that there must be something wrong even if there’s no evidence uncovered of anything being wrong because hey, such a good and noble person such as Brockovich wouldn’t show up otherwise, right?

She’s like Paul fucking Watson: the goal people associate them with may be laudable (preserving the whales/ensuring those responsible for pollution are forced to deal with it) but when you look closer, there’s the not-quite-sneaking suspicion they care more about the publicity and the TV shows/movie deals while pulling a Mother Theresa-like Karma Houdini trick in insisting people overlook their flws because surely people working for such noble causes can’t be subject to criticism or questioning.

Comment #91: KeithM  on  02/23  at  04:50 PM

Yes, how unreasonable for them not to think they’re sick for no reason at all. Why, it’s downright craaAAAAaazyy!

Which is why the commentator above was so eloquent about the problems a neurologist had treating a psychogenic illness, and why only, ONLY after environmental/infectious causes can be eliminated, is a diagnosis of MPI appropriate in such cases.

But you know more than any psychologist who ever lived Chet, what an accomplishment at such an early age!

What Is Mass Psychogenic Illness?

Am Fam Physician. 2000 Dec 15;62(12):2655-2656.

See related article on mass psychogenic illness.

Sometimes people in a group start to think they might have been exposed to something dangerous, like a germ or a toxin (poison). They might get signs of sickness like headache, dizziness, faintness, weakness or a choking feeling. If many people in the group start to feel sick at about the same time, we might think they have mass psychogenic illness. The group might be a class in a school or workers in an office. Mass psychogenic illness is sometimes called mass hysteria or epidemic hysteria.

Is mass psychogenic illness common?

Mass psychogenic illness has been talked about and written about for hundreds of years, all around the world and in many different social settings. No one keeps track of these outbreaks, but they are probably a lot more common than we realize.

How do these outbreaks start?

Many outbreaks of mass psychogenic illness start with an environmental “trigger,” like a bad smell or a rumor of exposure to a poison. When one person gets sick, others in the group also start feeling sick. The first person who got sick might have had a real illness, but it might not have been related to the “trigger.”

How do the symptoms spread?

An outbreak of mass psychogenic illness is a time of anxiety and worry. Reporters are paying attention to the situation, and rumors are spreading. Ambulances and emergency workers are making people think a serious epidemic is happening. At such a time, if you hear about someone getting sick or if you see someone get sick, it may be enough to make you feel sick too.

Does this mean that the sickness is “all in my head”?

No, it doesn’t. The people who are in these outbreaks have real signs of sickness that are not “imagined.” They really do have headaches, or they really do feel dizzy. But their illness is not caused by a poison or a germ.

Then why did I feel sick?

Outbreaks of mass psychogenic illness show us the powerful effect of stress and other people on the way we feel. Think of how “stage fright” can cause nausea, shortness of breath, headache, dizziness, a racing heart, a stomachache or even diarrhea. Your body can have a similar strong reaction to the stressful situations involved in mass psychogenic illness.

Does this mean there is something wrong with my mind?

No. These outbreaks happen to normal, healthy people. Just because you reacted this way to a mass illness does not mean there is something wrong with your mind.

How do we know an outbreak of sickness is caused by “mass psychogenic illness”?

We might think a group sickness is caused by mass psychogenic illness if:

  Physical exams and tests are normal.

  Doctors can’t find anything wrong with the group’s classroom or office, like some kind of poison in the air.

  Many people get sick.

If we look at the patterns of the outbreak (like the kinds of illnesses that are reported, the kinds of people who are affected, the way the illness spread) we might think mass psychogenic illness is the reason.

How can we stop these outbreaks?

Most of these outbreaks stop when people get away from the place where the illness started. The illness tends to go away once people are examined and doctors tell them that they do not have a dangerous illness. Keeping the people who feel sick away from all the commotion and stress is important.

After experts check out the place where the outbreak started, they can reassure people that it is safe to go back to that place. You should see your doctor to be checked for a different reason for your health problem if:

  Your illness seems to last several days.

  You have a fever.

  Your muscles are twitching.

  Tears keep coming from your eyes.

  Your skin feels like it has been burned.

Link

Comment #92: Dark Avenger Guardian Chow Mein  on  02/24  at  10:53 AM
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