On 15 February 1787, a young woman at a Lancashire cotton mill decided to scare one of her co-workers with a mouse. The prank made medical history. Terrified of the rodent, the woman on the receiving end had a fit that lasted hours. The next day, three more workers suffered violent fits. The day after, six more.
Alarmed and mystified at the epidemic, the owners closed the mill amid rumours of a disease brought in by contaminated cotton. When Dr William St Clare arrived from Preston to investigate, he found 24 people affected. Three worked at another factory five miles down the road. He ended the epidemic swiftly. It was “merely nervous, easily cured, and not introduced by the cotton,” he concluded. Suitably reassured, all recovered and no more workers fell ill.
On Wednesday, more than two centuries later, and 65 miles up the A59 from Lancashire, 40 pupils at the Outwood academy in Ripon had treatment for dizziness and nausea after four fainted in an Armistice Day service. Fire brigade specialists dispatched to the incident found no signs of hazardous materials,but the assembly hall was warm. David Winspear of the North Yorkshire fire service suspects that a handful of children fainted, with the rest developing symptoms driven by anxiety that rippled through the school. One student talked of a “domino effect”.
Like the Lancashire mill incident, the events at Outwood academy bear the hallmarks of what was once called mass hysteria, but which is now called mass psychogenic illness (MPI). Doctors have recorded cases for hundreds of years and fresh incidents crop up around the world most weeks. “This is incredibly common and happens to completely normal people,” says Simon Wessely at the institute of psychiatry, at King’s College London, who wrote his first paper on the subject in 1987. Gatherings on hot days of people who know each other well – marching bands, cheerleaders, school groups – are particularly prone.
“It may be that someone faints, or has a fit, or a medical incident, and what then gets transmitted is anxiety. People get anxious because they don’t quite know what it is, and the thing about anxiety is that it gives you symptoms. You feel frightened, you shake, you get a dry mouth, you get butterflies in your stomach, you might get chest pain. The next thing you know, you’ve keeled over,” says Wessely.
Past cases of MPI reveal women are more likely to be affected than men. It often starts with one individual. People are more affected if the first to fall is someone they know well, and if that person has a high status in the group. A spate of cases in the US have seen cheerleaders faint and send others quickly to the floor. Schools are particularly vulnerable. One of the most potent environmental triggers is smell, so anxiety can be heightened if someone posts rumours of a gas leak on Facebook, as happened during the Outwood academy faintings.
Not all episodes of MPI are benign and easily resolved. Complex cases occur when stress builds up and becomes chronic in a population. In these instances, the effects can be explosive. In regions where people live in fear of being gassed, or bombed with nerve agents, or struck down by witchcraft, mass psychogenic events can affect hundreds, even thousands of people at a time. They can suffer muscular tics, twitching or shaking for weeks and months.
“These things become huge when the rumour explanation is both dangerous and credible,” says Wessely. Evidence is plentiful, from the West Bank, Kosovo, South Africa and Afghanistan. In 2012, Takhar province in Afghanistan was alerted to what was feared to be a mass poisoning of girls at a school in the Taluqan district. Some reported a bad smell. They were dizzy, nauseous and weak. But doctors found no organic cause. The WHO put it down to MPI and said it was the fourth year it had happened. The girls feared the Taliban would poison them.
For all doctors know about MPI, one big uncertainty is how best to handle the aftermath. In June, Saudi authorities moved girls out of their school and into another building after fears of it being haunted led them to suffer fits and convulsions. In bowing to parental pressure, did they solve the problem? In 1999, when schoolchildren in Belgium reported falling ill after drinking Coca-Cola, the company suspected MPI, a diagnosis later confirmed, but recalled the product at a cost of $250m for fear of losing market share.
In Ripon, the fire services and school authorities seem to have handled the event well. But mishandled, an incident that should be brief and harmless, and which affects normal, healthy people, can leave a small number with chronic illness. A person who falls ill because of fear of an invisible gas, rather than from direct exposure, is still ill. But some who have their illness dismissed as “all in the mind” can struggle to rid themselves of the symptoms. They might embrace spurious explanations, suspect a coverup, and, faced with having to prove they are ill, fail to get well.
The challenge for emergency services, schools and public health officials, is how to get the balance right. They must investigate – gas leaks and hazardous chemicals need to be ruled out. But writing in the Journal of the Royal Society of Medicine with Robert Bartholomew, a social scientist in New Zealand, Wessely says this must be done in an atmosphere that allows fear to subside and anxiety to dissipate.
The job may be harder now than in St Clare’s day. Bringing calm to a school, or an entire community, is far more difficult, if not impossible, now social media can spread anxiety further than line of sight. When a group of girls developed facial tics at a high school in Leroy, New York, in 2011, some doctors wondered whether the bizarre movements might have spread by YouTube videos victims posted. As soon as media coverage stopped, they began to recover.
In the Middle Ages, Wessely notes, local priests were called in to exorcise demons, a tough task with so many believing in witchcraft. “They were fortunate in one regard: they did not have to contend with mobile phones, Twitter or Facebook.”
Adapted from https://www.theguardian.com/science/2015/nov/14/was-ripon-school-gripped-by-mass-psychogenic-illness