Mass Hysteria

Mass hysteria, most commonly known as mass psychogenic illness (MPI), is a sociological as well as psychological phenomenon. This article explores the history of MPI while posing the question of whether MPI is specific to cultures and societies, or is a universal human trait. Most research shows that MPI is apparently a gender-specific phenomenon. A concise history of recent cases of MPI is presented, and a recent experiment into the causes of MPI is examined. The paper then looks at the role of the media in creating or sustaining mass hysteria, as well as its potential to help a public overcome its inclinations toward mass hysteria. The paper finishes with some journalistic considerations in media propagation.

Keywords Bioterrorism; Mass Sociogenic Illness (MSI); Mass Psychogenic Illness (MPI); Medically unexplained physical symptoms (MUPS); Modeling; Post Traumatic Stress Disorder (PTSD); Response Expectancy; Somatoform Disorder

Mass Hysteria

Overview

Mass Hysteria: A Mysterious Medical Phenomenon

The general meaning for the term mass hysteria is that individuals in a group setting experience collective panic over some occurrence. Mass hysteria is considered a socially contagious frenzy of irrational behavior in a group of people in reaction to some event experienced in common. This definition emphasizes the psychological aspect of mass hysteria, so that the meaning can describe anything from screaming Beatles fans to a theater crowd rushing en masse, after smelling smoke, to the exit doors in a movie theater. Mass hysteria is a phenomenon that very few would deny exists, since many have witnessed it firsthand. However, once we attach a physical aspect to mass hysteria, wherein there is also an inexplicable appearance of physical symptoms of illness, the definition becomes less believed or accepted. Physicians, emergency personnel, psychologists, and sociologists find this physical aspect of mass hysteria to be intriguing and worthy of investigation, which is why much of the academic work that focuses on mass hysteria is actually focused on the curious physical effects. Thus, most researchers—and particularly researchers within the field of sociology— tend to define mass hysteria in the same way Mattoo, Gupta, Lobana, and Bedi (2002) define it, as "a constellation of symptoms suggestive of organic illness but without an identified cause in a group of people with shared beliefs about 'external' cause of the symptoms."

When examining the research and literature around this particular phenomenon, researchers posit very similar definitions as the one above. However, as noted by Weir (2005), the term "mass hysteria" is often synonymously termed, "mass psychogenic disorder" or "epidemic hysteria," and is "distinguished from collective delusions by the presence of illness symptoms." Thus, among researchers, the physical aspect of mass hysteria has been subdivided from the purely psychological aspect, and has been given its own specific term or terms. The individual experiences symptoms that have no external physical cause, which is quite similar to the concept of a psychosomatic disorder. Considering the group setting, this physical form of mass hysteria could be called a sociosomatic disorder rather than a psychosomatic disorder. Other terms for this physical aspect of mass hysteria are "mass sociogenic illness" (MSI) and "mass psychogenic illness" (MPI). As Weir defines it, MPI is a

… rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss or alteration of function, whereby physical complaints that are exhibited unconsciously have no corresponding organic aetiology.

Weir also observes that MPI usually occurs in the context of some believable physical source that causes a feeling of anxiety for a group. This physical source could be a strange odor or some unknown material that is perceived as a toxin.

As Lacy and Benedek (2003) note, such outbreaks of physical mass hysteria always have contagious physical symptoms within a group of people, with the symptoms quickly affecting the entire group. The outbreak is usually spread "by sight and sound whether on-site or via media and are characterized by rapid onset and rapid remission." Lacy and Benedek also describe the symptoms as including "hyperventilation, dyspnea, dizziness, nausea, head ache, syncope, abdominal distress, and agitation," and the symptoms are often identical to whatever are the known symptoms of an infectious or chemical agent. The authors also observe that the most common settings for such outbreaks are "schools, factories, sporting events, and other social groupings."

A Response to Sociopolitical Threats

Mass Psychogenic Illness (MPI) is the most commonly used term for describing a mass hysteria or panic wherein individuals manifest physical symptoms that have no identifiable pathogen as the cause. According to Lorber, Mazzoni and Kirsch (2007), MPI has been chronicled for centuries, and they note that the effects of MPI can cost greatly in an economic as well as social sense. The authors propose that the current sociopolitical climate (i.e., the threat of terrorism) makes it critical that we as a society come to understand more fully this age-old phenomenon. As Lorber et al. note, the possible threat of biochemical weapons, as well as the fact that new infectious diseases can quickly spread from one continent to the next, has created an environment wherein cases of MPI are on the rise. The authors also warn that, "public health providers could be inundated by patients experiencing psychogenic symptoms following an actual biochemical attack or infectious outbreak."

Szegedy-Mazsak (2001) makes the astute comment that while anthrax isn't contagious, fear is. She notes, at the time of the 2001 anthrax scare in the United States, that as Americans learned of new cases of anthrax "an epidemic of vulnerability and panic spread." She observes that this epidemic was an epidemic with real physical symptoms, and that some of those symptoms "even bear a striking resemblance to early anthrax." However, the author concludes that these reported symptoms may actually "portend an outbreak of mass psychogenic or sociogenic illness, more commonly known as mass hysteria." Spinney (2006) observes that, in industrialized nations, environmental contamination is more often the event that causes MPI in groups. Also, after the 9/11 terrorist attacks, some researchers predicted that there would be increased outbreaks of mass hysteria related particularly to bioterrorism. Spinney writes that, "despite the difficulties in spotting outbreaks [of MPI caused by bioterrorism], that now seems to be happening."

As Weir (2005) observes, in recent history (twentieth century to the present), unknown odors have sparked cases of MPI because such odors can be misperceived as a toxic gas from industrial accidents, or perhaps as a consequence of bioterrorism or chemical warfare. Weir notes that such odors have caused episodes of mass hysteria wherein the patients feel breathlessness, nausea, headache, dizziness, and weakness. By way of example, the author cites the 1990 Gulf War, when Iraq sent a SCUD missile into Israel. The missile was widely feared to contain chemical weapons, and even though this proved not to be the case, "about 40% of Israeli civilians in the immediate vicinity of the attack reported breathing problems."

Specific Recent Cases

Mass hysteria is likely part of human nature and is not specific to historical periods or particular cultures. As Lorber, Mazzoni, and Kirsch (2007) have noted, the phenomenon of MPI has been recorded for centuries. Spinney (2006) notes that mass hysteria has been documented since the Middle Ages; the author observes that, in the past, witchcraft was often blamed for mass illness (these were most likely cases of MPI), and in some contemporary societies witchcraft is still blamed for mass illness. By considering the long history of MPI, as well as examining the location of cases, we can gain a clearer understanding on whether or not this physical form of mass hysteria is something universal or culturally specific. If cases occur globally and throughout history, it then becomes quite evident that MPI is some inextricable part of human nature, and that it is not a malady that only affects particular societies, nations, or cultures. For this reason, it is beneficial to summarize some of the recent locations and situations that have given rise to cases of MPI:

• In 1973, a ship that carried 50 barrels of a harmless organophosphate defoliant docked in Auckland, New Zealand. The workers detected a foul odor, saw the word "poison" written on the barrels of defoliant, and some unfortunate miscommunication about the ship's cargo ensued. The workers' concern increased and a crisis developed. Although no one was actually physically affected by the barrels of defoliant, 643 people went for medical attention from typical MPI symptoms. The symptoms were "consistent with anxiety and somatoform reactions."

• In September 1998, eight hundred children in Jordan believed they were suffering the side effects of a tetanus-diphtheria toxoid vaccine that was administered in school. During this epidemic, over one hundred children were admitted to hospital, but for the vast majority the symptoms resulted not from the vaccine but rather from psychogenic illness.

• In November 1998, an American teacher noticed a smell similar to gasoline in her classroom, and soon thereafter felt a headache, nausea, shortness of breath, and dizziness. Officials evacuated the school, and 80 students and 19 staff members went to the emergency room. Of these, 38 persons were hospitalized overnight. When the school reopened five days later, another 71 persons went to the emergency room. The individuals who reported symptoms during the first day were from 36 classrooms scattered throughout the building. The most frequent symptoms for this group—as well as for the group that reported symptoms five days later—were headache, dizziness, nausea, and drowsiness. The hospital carried out blood and urine tests for the presence of carbon monoxide, volatile organic compounds, pesticides, polychlorinated biphenyls, paraquat, and mercury, but nothing was found. An extensive investigation was also performed by several government agencies, but none of the investigators were able to find any medical or environmental cause of the reported illnesses. As Jones et al write, "this illness, attributed to toxic exposure, had features of mass psychogenic illness… notably, widespread subjective symptoms thought to be associated with environmental exposure to a toxic substance in the absence of objective evidence of an environmental cause." An interesting fact that arose from administering a questionnaire a month after the incident is that the affected individuals were predominantly female. As we shall see, other research also clearly indicates this same gender-specific pattern among cases of MPI.

• In 2001, Szegedy-Mazsak reported a few similar cases as the above. In Washington state, paint fumes sent 16 students and a teacher to the emergency room. Several weeks later, in suburban Maryland, 35 people went to the hospital claiming they felt headaches and sore throats after seeing a man spray a glass cleaner in a subway station. As Szegedy-Mazsak observes, these cases occurred before two postal workers died in the Washington, DC, area from anthrax poisoning, and shortly thereafter, "emergency rooms and private doctors' offices have been flooded by worried, coughing, dizzy, feverish people."

• In December 2005, students and staff at a school in Chechnya reported that they felt respiratory difficulties, were experiencing seizures, and were fainting. These symptoms, which quickly spread to other nearby schools, did not respond to medical treatment. Eventually, close to one hundred people were affected, mainly adolescent girls. Investigators never found any evidence of a chemical or biological agent that could have been the cause.

• Between 2011 and 2014, thousands of workers across a number of different Cambodian garment factories fainted while working on the factory floor. Though it would be reasonable to expect fainting in factories where temperatures can reach upwards of 100 degrees Fahrenheit, temperature and difficult working conditions don’t explain the countless other fainting that happen en masse throughout Cambodian society every year. In 2011, at a school in the Kampong Cham Province, 136 students fainted almost simultaneously while gathered to sing the Cambodian national anthem. That year, on thousand factory faintings were reported. In 2012, two thousand were reported. Medical checks have, in some cases, revealed that the factory workers don’t, in fact, faint at all, but simply lose control and lie down, maintaining consciousness throughout the whole ordeal. Some researchers attribute the frequency of fainting in Cambodia to poor nutrition and weather conditions, but others have suggested mass hysteria as a possible cause.

• As Lacy and Benedek note, medically unexplained physical symptoms (MUPS) occurred after World War I, the Vietnam War, the Three Mile Island nuclear catastrophe of 1979, industrial exposures at Love Canal in the 1970s and 1980s, and after the military conflicts in the Balkans and the Persian Gulf.

• Only in cultures where extended family is common do we see cases where specific families appear to suffer from incidents of MPI. This further indicates that the phenomenon is a universal human characteristic, though the particular social organization in a culture influences the specific form of MPI in society. Mattoo et al. (2002) researched a case in India where they believe a culture of extended family caused MPI to arise within a family in rural India. It is also interesting that, even in this case, the authors claim that "this social phenomenon is characterized by preponderance of female cases" and they note that the other characteristics of MPI match cases all around the world. The authors observe that there is "a clustering of cases by time and location, rapid onset and remission of symptoms, and relative paucity of physical findings despite severe subjective complaints."

Further Insights

MPI cases can be found around the world, so that MPI seems to cross all cultural barriers. This indicates that the phenomenon is actually caused by some universal trait existing within the entire human species. Specific social and cultural factors influence people's perception of the cause; thus, in the Middle Ages such cases were thought to be caused by witches, which was also the case in the rural Indian family. In industrial societies, cases are most often attributed to perceived industrial toxin leaks or exposures and, most recently, cases are often attributed to perceived biochemical terrorist attacks. It is also quite interesting that the phenomenon appears to be gender-specific across all cultures. Females appear to be much more prone to experiencing MPI than are males, an observation that is also confirmed by Mattoo et al.'s recent study.

Manifestation by Gender

Lorber, Mazzoni and Kirsch (2007) carried out one of the few scientific tests to investigate the cause and effects of MPI. The experimenters asked students to inhale a harmless spray that they explained was a suspected environmental toxin that had been linked to various specific adverse physical effects. Half of the students observed a second person inhale the substance and subsequently display the specified symptoms. The person displaying the symptoms was a "confederate," whom the research team instructed to exhibit symptoms. There was a statistically significant increase in psychosomatic symptoms among all students who inhaled the placebo, but there was an even larger increase among the group that observed the confederate displaying symptoms; this increase of specified symptoms significantly increased among women, but not among men.

The authors note that the hypothesized causes of MPI include response expectancy and modeling. Response expectancy is "the anticipation of an automatic subjective response," whereas modeling refers to a participant observing another person exhibiting a behavior. The authors note that "in everyday life, for example, direct contagion by observation seems common with vomiting, coughing, yawning, and laughter, but prior to this study, the influence of modeling on psychogenic symptoms does not appear to have been examined in a controlled experimental setting." The study supports the hypothesis that response expectancy and modeling are the most probable causes of MPI, and another conclusion the study supports is that "symptoms of MPI are more commonly reported among women than among men." However, the authors also write, "the reason for this gender difference in the epidemiology of MPI is unknown."

This is not to say that mass hysteria does not affect men. In fact, mass hysteria has occurred in which men have believed that their genitalia were shrinking or disappearing. The first well-documented episode of such a panic, also known as koro, occurred in Singapore in 1967. Similar panics have also occurred in southern China. Some episodes of koro have affected both men and women, such as that which occurred in northeast Thailand in late 1976, northeastern India in 1982, and Nigeria in 1990.

Mass Hysteria & the Media

Another interesting aspect of mass hysteria is the effect of the mass media on the creation of mass hysteria. As we have seen above, several of the cited authors note that there was a significant increase in cases of MPI after the terrorist attacks of September 11, and after the anthrax scare. However, when we consider this, it is quite easy to overlook the ubiquitous medium that carried this information, thus instilling a sense of fear into nearly every American home. As Ross (2004) observes, news coverage wherein Americans receive many "details of death, destruction, and hatred" is a destabilizing factor that is "terrifying and enraging to the public," which also means that the media is capable of creating mass hysteria that is likely unnecessary and quite avoidable. Other studies and evidence indicate that the media can indeed heighten the public's sense of fear and thereby create higher levels of stress and other physical effects on the public. Research has also looked at the role social media can play in heightening public fear and causing instances of mass hysteria.

Cohen, Kasen, Henian, Gordon, Berenson, Brook, and White (2006) not only cite a study indicating that the September 11, 2001, news coverage caused an increase in various physical symptoms of mass hysteria, but the researchers also carried out their own study that confirms the power of the media in creating public stress and other adverse physical effects. As the authors note, "Television, radio and newspaper coverage of 9/11 was extensive, graphic, and far-reaching" and the authors cite a study that found a higher prevalence of adverse physical symptoms such as post-traumatic stress disorder (PTSD) and depression among New York City residents who watched more TV coverage of the 9/11 terrorist attacks. The authors cite yet another study that indicates that TV viewing—especially of very graphic images—was associated with higher estimates of PTSD and other symptoms. The authors argue that, "because vicarious traumatization occurs at a significantly lower intensity than direct trauma, those who suffer from its effects may not be aware of being affected and are at risk of developing further impairment."

The authors' own research was on whether they could find a correlation between increased PTSD and depression from increased media coverage of a traumatic event. The authors found an interesting correlation that demonstrated the power of the media. They discovered that there was consistently a significant increase in physical symptoms every year when the media replays, as anniversary coverage, a lot of the 9/11 disaster footage, etc. Cohen et al. carried out extensive research into this phenomenon, and collected an impressive body of research data. They conclude in their study, "These data suggest that effects on psychiatric symptoms were again visible as media and political coverage of the 9/11 attacks peaked around the anniversaries of these events." This is a clear indication that the media influences the psychological state of the public, and it becomes then quite obvious that an "anthrax scare" may be generated more by the media than the actual circumstances merit.

Media sources know that drama and sensational news have a tendency to increase their ratings—though it may be that this drive to increase ratings is at times inadvertently increasing some viewers' feelings of stress or depression. Ross (2004) makes this same observation, and concludes that the media can also be used to "help reassure and promote hope and meaning" so that the media can help the public transition "from the trauma vortex into the healing vortex." Under the heading, "Protecting the Public from Secondhand Trauma," Ross offers some good advice to journalists so that they limit the amount of unnecessary trauma inflicted upon the public. Ross advises that frontline media professionals "monitor their own levels of traumatic stress, learning how to release safely and discharge traumatic energies," and the author advises journalists to ask the following questions:

• Have we balanced the coverage of the trauma vortex with coverage of the healing vortex? Is caring for the victims obvious?

• Has secondhand trauma determined the pull for repeated trauma-driven coverage?

• Are ratings indicators of public opinion or simply indicators of secondhand trauma-driven attention?

Ross also offers some other practical advice to avoid creating mass hysteria among viewers:

• Warn viewers of upcoming disturbing sounds/images.

• Recognize the impact of language (i.e., predictions of doom) on a public in shock.

• Encouraging viewers to watch the news in small doses. They need to be informed, but also "resourced" in between viewing.

• Avoid excessive use of gory details.

• Avoid repetitive showing of the same traumatic images. Repetition drives traumatic images deeper, putting people at risk for flashbacks and panic.

• Heavy focus on negative news reinforces fears and desires for revenge.

As to whether media professionals currently consider the above points, we as viewers should consider this and hold them accountable to an ethical form of journalism that does not use the lurid or sensational—and perhaps viewers should take a look outside their front windows. This can dampen the sense of mass hysteria and impending doom that is so often generated on living-room television and smartphone screens.

Terms & Concepts

Bioterrorism: The use of living organisms, such as viruses, bacteria, and other biological toxins, to attack or intimidate a society or nation for political or ideological reasons.

Mass Psychogenic Illness (MPI): The rapid spread of the symptoms of an illness within a cohesive group of people. These symptoms arise from a disturbance in the nervous system caused by an unusual level of psychic excitation, and there is no physical or environmental cause for the symptoms.

Mass Sociogenic Illness (MSI): See Mass Psychogenic Illness.

Modeling: The process through which individuals demonstrate behavior for others to imitate. The term is most commonly used in discussions of children’s developmental psychology, but it also applies to any human behavior that is fundamentally an imitation of another's behavior.

Medically Unexplained Physical Symptoms (MUPS): Physical symptoms of illness for which healthcare providers can find no physical cause.

Post Traumatic Stress Disorder (PTSD): An anxiety disorder caused by exposure to one or more traumatic events. A person with PTSD may experience intrusive and frightening thoughts or memories, have difficulty feeling close to others, and have difficulty sleeping.

Response Expectancy: The theory that a subject's expectations will influence the response or outcome of the subject's behavior. Response expectancy is the same process which is thought to create the placebo effect (the measurable, observable, or felt change in physical condition or behavior not attributable to a medication or treatment that has been administered).

Somatoform Disorder: A condition characterized by physical symptoms that mimic illness or injury but that have no identifiable physical cause. Physical symptoms such as pain, nausea, depression, and dizziness are typical of somatoform disorders.

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Suggested Reading

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