Margaret McCartney 

Don’t panic!

Could 'mass hysteria' explain why 55 pupils and staff from Collenswood school in Hertfordshire fell mysteriously ill last week? Margaret McCartney investigates.
  
  


Last Thursday, a school in Stevenage, in Hertfordshire, alerted the emergency services to a mysterious event that had taken place at the school. In what was described as a "hazardous incident", 55 people - 42 of them children, mainly aged between 11 and 13 - went to hospital. Some self-referred, others came by ambulance; all were complaining of headaches and sickness. The remaining children at Collenswood school were evacuated; police searched the school. Nothing, it seems, was found. "They were brought in as a precaution," says Peter Gibson, head of public affairs at the Lister hospital in Stevenage, "and it was not believed that anything serious or untoward had happened." None of the children or adults had to be admitted, and all were discharged later that day.

So what had caused quite so many children and adults to become suddenly so unwell? In a statement, the Hertfordshire police concluded: "After detailed examination, environmental and public-health experts have confirmed that the school poses no risk to the health of pupils and staff. Despite detailed investigations, no identifiable cause for the incident has yet been established. It is, however, clear that a number of unrelated incidents involving the health of some pupils could have contributed to a general feeling of concern at the school on Thursday."

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

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

Episodes of mass hysteria occur suddenly, with a dramatic onset and rapid recovery. Often there is a trigger and there are no specific organic causes found. It is supposedly one of the phenomena of collective or group behaviours - well known in incidents such as the Salem witch hunts, where illness among young women was attributed to witches' curses leading to a hunt for the perpetrator, sometimes to the death. Even "Beatlemania", which saw girl fans screaming and fainting in their hundreds, has been claimed as an example of mass hysteria.

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

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

In addition, mass hysteria is a diagnosis of exclusion - meaning that there is no test to diagnose it with certainty. Rather it means that other causes - such as chemical poisoning, or viral infections - have to be excluded as a potential cause first of all.

There have been many episodes of a similar nature. In Hollinwell in 1980, almost 300 Nottinghamshire children who were competing in a brass band competition in a field, collapsed and were taken to hospital. At the time there was little explanation as to why the children may have become so suddenly unwell, and, in the absence of a better explanation, it was thought to have been the product of mass hysteria.

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

In 1992, in the USA, 196 children from an elementary school were evacuated after reports had been made that they had been exposed to an un known - and possibly toxic substance. This operation to evacuate them required more than 100 personnel - firefighters, police officers, paramedics and nurses - and, in the end, no child was diagnosed as being acutely ill.

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

Professor David Ray of the Institute of Neuroscience at Nottingham University has a research interest in pesticides. He says: "Smell can precipitate a strong emotional reaction that can make people ill in a subjective way, just as in the American incident in 1992, where the children could be shown not to have had any measurable exposure." Since the olfactory nerves - those concerned with smell - have deep and close neurological connections to the nausea centre, this may be at least a partial explanation.

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

Ruth Engs, professor of applied life sciences at Indiana University, has written about the effects of mass hysteria on campus when students suddenly become ill. She writes about the importance of recognising such phenomena as they arise: "Lack of recognition of such a phenomena can lead to overextension of medical personnel, costly investigations, increased campus stress and even potential litigation." She describes how there have been incidents of mass hysteria throughout history - "hysterical contagion", where sets of symptoms occur because of alleged toxic fumes, but no toxin can be identified. She describes an incident known as the June Bug where female factory workers were affected by sickness over five days. The illness was supposedly due to a "bug bite" but, despite investigations, there was no evidence of any insect or toxin that could have caused it, and in the end it was thought to have a psychological cause.

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

Dr David Enoch, a psychiatrist and expert on psychiatric syndromes, is the author of Uncommon Psychiatric Syndromes. "There are two major phenomena that can explain these kind of incidents," he says. "One is a mass hysteria, the other is folie à deux , which is a shared delusion held between people. There have been many incidents like this along the years - and it is a primarily unconscious phenomena."

Enoch does not believe that such incidents are increasing. However, he does believe that we are living in an age that makes us susceptible to them. "It is an unconscious thing - but we can transfer tension and stresses into physical symptoms. We are faced with situations of terror. We see things on TV, and we should be aware that there might be more awareness of such experiences," - but not necessarily more experiences themselves.

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

 

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