Mass Sociogenic Illness

PUBLIC HEALTH P RACTICE Mass sociogenic illness

Background and epidemiology: fected building or occupation tion; a spread that moves down Mass sociogenic illness refers to site, which is often closed for the age scale, beginning with the “rapid spread of illness signs days or weeks. older or higher-status people; and symptoms affecting mem- Part of the difficulty in recog- and a preponderance of female bers of a cohesive group, origi- nizing outbreaks of mass socio- participants.1 nating from a nervous system genic illness has to do with its di- When faced with the prospect disturbance involving excitation, verse nature.1 A historical review of an outbreak of mass sociogenic loss or alteration of function, of these events suggests that the illness, physicians should involve whereby physical complaints features of mass sociogenic ill- public health officials in the in- that are exhibited unconsciously nesses tend to mirror popular so- vestigation. A prompt diagnosis The impact of occurrences have no corresponding organic cial and cultural preoccupations is problematic because contro- of epidemic hysteria is un- aetiology.”1 It occurs in the con- that define distinct eras and re- versy often surrounds outbreaks derappreciated and under- text of a credible threat that flect unique social beliefs about and time is needed to analyze en- reported. These events provokes great anxiety, such as a the nature of the world. Before vironmental and medical test re- place significant financial noxious odour in a school amid the 20th century most reports of sults. It is often advisable to close burdens on emergency services, public health and envi- fears of chemical warfare or mass sociogenic illness involved the building or area until negative ronmental agencies. bioterrorism. In standard psy- motor hysteria incubated by ex- results are returned. This action chiatric nomenclature, mass so- posure to long-standing reli- serves to control the outbreak by ciogenic illness is subsumed un- gious, academic or workplace reducing anxiety levels and tem- der the general heading of discipline.1 These produced out- porarily dispersing the group.1,4 somatoform disorder and sub- breaks of convulsions, contrac- Treatment involves identify- categorized as “conversion dis- tures, tremors, paralysis and ing and reducing or eliminating order hysterical neurosis, con- laughing. In the 20th century the stress-related stimulus.4 version type.” In the literature, and on to the present, strange it is synonymously termed mass odours presumed to be an envi- Prevention: No one or group is psychogenic disorder or epi- ronmental contaminant or toxic immune from mass sociogenic demic hysteria and distinguished gas from a bioterrorist or chemi- illness. Attempts to identify pre- from collective delusions by the cal warfare attack have been disposing factors and suscepti- presence of illness symptoms.2 commonly blamed in episodes of bilities have produced conflict- Most physicians, through ex- mass hysteria, producing breathing results.1 Understanding the perience or training in psychia- lessness, nausea, headache, dizzi- historical shifts in the manifesta- try, are aware of individual cases ness and weakness in affected tions of these outbreaks, the of “hysteria” or somatoform dis- people. For instance, during the fears and uncertainties that pre- orders. They are less educated 1990 Gulf War the first missile occupy current cultures and the and knowledgeable about epi- attack on Israel by Iraq was distinctive features of mass so- demic hysteria, even though a widely feared to contain chemi- ciogenic illness that appear to review of the literature reveals cal weapons. Although such fears transcend historical context will over 200 published accounts of were unfounded, about 40% of assist in more rapid recognition mass responses to situations in- civilians in the immediate vicinity and treatment of outbreaks. volving suspected poisonings of the attack reported breathing and other events.3 One example problems.1 Erica Weir in September 1998 involved 800 CMAJ children in Jordan who believed Clinical management: The con- they had suffered from the side fluence of 8 symptoms or condi- References 1. Bartholomew R, Wessley S. Protean effects of tetanus–diphtheria tions typically indicates mass nature of mass sociogenic illness: toxoid vaccine administered at sociogenic illness and permits a from possessed nuns to chemical and school; 122 of the children were presumptive diagnosis while biological terrorism fears. Br J Psychi- atry 2002;180:300-6. admitted to hospital. For the investigations are underway. 2. Bartholomew RE. Epidemic hysteria: vast majority, symptoms re- These include symptoms with a review of the published literature sulted not from the vaccine but no plausible organic basis; [letter]. Am J Epidemiol 2000;151:206- 3 7. from psychogenic illness. symptoms that are transient and 3. KharabshehS, Al-Otoum H, Clements The impact of such events is benign; symptoms with rapid J, Abbas A, Khuri-Bulos N, Belbesi A, et al. Mass psychogenic illness follow- underappreciated and underre- onset and recovery; occurrence ing tetanus–diphtheria toxoid vaccina- ported. They place significant in a segregated group; the pres- tion in Jordan. Bull World Health Or- financial burdens on emergency ence of extraordinary anxiety; gan 2001;79(8):764-70. 4. Jones TF. Mass psychogenic illness: services, public health and envi- symptoms that are spread via role of the individual physician. Am

DOI:10.1503/cmaj.045027 ronmental agencies and the af- sight, sound or oral communica- Fam Physician 2000;62:2649-53,2655-6.

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