Protean Nature of Mass Sociogenic Illness from Possessed Nuns To

BRITISH JOURNAL OF PSYCHIATRY %2002), 180, 300^306 REVIEW ARTICLE

Protean nature of mass sociogenic illness each era and reflect unique social beliefs about the nature of the world. From possessed nuns to chemical and biological terrorism fears Wessely 1987) identifies two types of mass sociogenic illness ± `mass anxiety hysteria' and `mass motor hysteria'. The ROBERT E. BARTHOLOMEW and SIMON WESSELY former is of shorter duration, typically one day, and involves sudden, extreme anxiety following the perception of a false threat. The second category is typified by the slow accumulation of pent-up stress, is confined to an intolerable social setting and is characterised by dissociation, Background Episodes of mass Mass sociogenic illness refers to the rapid histrionics and alterations in psychomotor sociogenic illness are becoming spread of illness signs and symptoms activity e.g. shaking, twitching, con- affecting members of a cohesive group, tractures), usually persisting for weeks or increasinglyrecognised as a significant originating from a nervous system distur- months.months. health and socialproblemthatissocialproblemthat is more bance involving excitation, loss or alteration commoncommonthanis than is presentlypresentlyreported. reported. of function, whereby physical complaints that are exhibited unconsciously have no THE MIDDLE AGES Aims To provide historical continuity corresponding organic aetiology. In the with contemporary episodes of mass standard psychiatric nomenclature, mass Prior to the 20th century, most reports of sociogenicsociogenicillnessin illnessin order to gain a broader sociogenic illness is subsumed under the mass sociogenic illness involved motor transcultural and transhistorical general heading of `somatoform disorder', hysteria incubated by exposure to long- subcategorised as `conversion disorder' or standing religious, academic or capitalist understanding of this complex, protean `hysterical neurosis, conversion type' discipline. Between the 15th and 19th phenomenon. American Psychiatric Association, 1994). centuries, exceedingly strict Christian religious orders appeared in some European MethodMethod Literature survey to identify convents. Coupled with a popular belief in historical trends. BACKGROUND witches and demons, this situation triggered dozens of epidemic motor hysteria ResultsResults Mass sociogenic illness mirrors Mass sociogenic illness is an under- outbreaks among nuns, who were widely prominent social concerns, changing in appreciated social problem that is both believed to have been demonically relation to context and circumstance. underreported and often a significant possessed. Episodes typically lasted months Prior to1900, reports are dominated by financial burden to responding emergency and in several instances were endured in a services, public health and environmental waxing and waning fashion for years. episodes of motor symptoms typified by agencies and the affected school or occu- Histrionics and role-playing were a sig- dissociation, histrionics and psychomotor pation site, which is often closed for days nificant part of the syndrome. Young girls agitationincubatedin an environmentofenvironment of or weeks Jones et aletal, 2000). The typical typically were coerced by elders into joining preexisting tension.Twentieth-century study of mass sociogenic illness is written these socially isolating religious orders, by health care professionals who briefly practising rigid discipline in confined, all- reports feature anxiety symptoms that review the contemporary literature and female living quarters. Their plight are triggered by sudden exposure to an add a singular episode in which they were included forced vows of chastity and anxiety-generating agent, most inadvertently involved. Although hundreds poverty. Many endured bland near- commonly an innocuous odour or food of books and articles have appeared on starvationstarvationdiets,diets, repetitious prayer rituals poisoning rumours.Fromthe early1980s the historical aspects of individual hysteria and lengthy fasting intervals. Punishment see Micale, 1995), excluding the for even minor transgression included tothepresenttherehasbeen anincreasing voluminous literature on medieval dance flogging and incarceration. The hysterical presence of chemical and biological manias and tarantism, there is a paucity fits appeared under the strictest admini- terrorism themes, climaxing in a sudden of books and articles assessable in English strators. Priests were summoned to exorcise shift since the11September 2001terrorist on detailed historical aspects of mass the demons, and disliked individuals often attacks in the USA. sociogenic illness Madden, 1857; Hirsch, were accused of casting spells and were 1883; Small, 1896; Burnham, 1924; banished, imprisoned or burned at the Conclusions A broad understanding Rosen, 1968; Markush, 1973; Sirois, stake. Witchcraft accusations also were a 1974; Bartholomew & Sirois, 1996, way to settle social and political scores oftheofthehistoryof historyof mass sociogenicillness and 2000; Boss, 1997). Given this situation, under the guise of religion and justice. a knowledge of episode characteristics are it is easy to lose sight of the dynamic, These rebellious nuns used foul and useful in the more rapid recognition and protean nature of mass sociogenic illness blasphemous language and engaged in lewd treatmentof outbreaks. and its historical and transcultural mani- behaviour: exposing genitalia, rubbing festations, which mirror popular social private parts or thrusting hips to denote Declaration of interest None. and cultural preoccupationsthat define mock intercourse Calmeil, 1845; Garnier,

300 PROTEAN NATURE OF MASS SOCIOGENIC ILLNESS

1895; Loredan, 1912). Community Symptoms included crying fits, screaming, by contagious shaking and convulsions members often attended the spectacles in a abnormal movements, possession states involving female students who were unable daily theatre-like atmosphere while priests and histrionics. The battle with autocratic to complete in-school written assignments. would try to exorcise the demons. An out- administrators climaxed in 1987 when, Symptoms subsided after school hours, break was recorded in the USA at an Ohio during an outbreak, the desperate girls took relapsing only upon re-entering school convent as recently as 1880 Davy, 1880). hostages at knife-point and demanded grounds Aemmer, 1893). In 1904, the The number and descriptions of these changes. No one was hurt and the girls, same school reported a similar outbreak complex episodes of demon possession in claiming impunity through possession, Zollinger, 1906). At Gross-tinz, Germany, nunneries are remarkable. There are more were not held legally accountable. The between 28 June and mid-October 1892, than 100 books alone on the outbreaks at episode ended after an ex-Prime Minister hand tremors affected the entire body and Loudun, France, between 1632 and 1634, met with the girls and oversaw their 8/20 victims exhibited altered conscious- where Father Urbain Grandier purportedly transfer to a liberal school Bartholomew, ness and amnesia Hirt, 1893). At a school bewitched a convent into hysterical fits and 2000: pp. 192±193). in Chemnitz, Germany, in February 1906, was burned alive Huxley, 1952; de arm and hand tremors in female elementary Certeau, 1970). On rare occasions, nuns students appeared during their writing were executed for bewitching other THE 18th18THE thTOTHETO THE EARLY 220 0th exercise hour. The symptoms began in members of their religious orders. In CENTURY two pupils but gradually spread to 21 1749, in one of the last recorded cases of females over 4 weeks Schoedel, 1906). its kind, abnormal movements and trance During the 18th, 19th and early 20th The pupils performed all other manual states affected the Unterzell convent near centuries and the realisation of the in- tasks normally, including gymnastics class. WuWurzburg,È rzburg, Germany. Suspicion of witch- dustrial revolution, harsh working con- Electric shocks were administered to those craft fell on a Sister Maria von Mossau ditions and weak or non-existent labour affected, and during their writing period who was beheaded Robbins, 1966). Major unions led to mass motor hysteria out- demanding drills in mental arithmetic were convent outbreaks were recorded in Lyons breaks in oppressive Western job settings, given; the symptoms ceased soon after. in 1526, Wertet in 1550, Kintorp in typically factories. Episodes were recorded Some school episodes during this period 1552,1552,CologneCologne and Flanders in 1560, in England, France, Germany, Italy and appear to have been relatively minor, short- Oderheim in 1577, Mons in 1585, Milan Russia and included convulsions Franchini, lived and unrelated to academic discipline in 1590, Aix in 1609, Lille in 1613, Madrid 1947), abnormal movements Bouzol, Small, 1896), such as left arm paralysis in in 1628, Chinon in 1640, Louviers in 1642, 1884) and neurological complaints Schata- four girls at a London school in February Auxonne in 1662 and Toulouse in 1681 low, 1891; Bekhtereff, 1914). The indus- 1907. A girl with infantile palsy of the left Calmeil, 1845; Madden 1857; Robbins, trial revolution was notorious for child arm fractured her right arm. She returned 1966). At Cambrai, France, in 1491 a labour, low wages and appalling con- to class several weeks later and `within a group of nuns exhibited fits, yelped like ditions. The first recorded outbreak in a few days three children had lost the use of dogs and foretold the future, and in Xante, job setting occurred in England at a Lanca- their left arms, and a fourth . . . had such Spain, in 1560 nuns `bleated like sheep, shire cotton mill in February 1787, invol- severe pains in her left arm that she held tore off their veils [and] had convulsions ving violent convulsions and sensations of it to the side and could not be persuaded in church' Robbins, 1966: p. 393). At suffocation among one male and 23 female to use it' Kerr, 1907: p. 32). one French convent, `the nuns meowed workers St Clare, 1787). The episode During the 20th century, epidemic together every day at a certain time for occurred 2 years after Edmund Cartwright hysteria episodes were dominated by several hours together' Hecker, 1844: invented the power-loom, revolutionising environmental concerns over food, air and p. 127). During this period it was widely the textile industry Sirois,1982). The ab- water quality, especially exaggerated or believed that humans could be possessed sence of similar motor hysteria reports inreportsin imaginary fears involving mysterious by certain animals considered to be potential Western countries during the second half odours. Outbreaks had a rapid onset and demonic familiars, and in France cats were of the 20th century may result from union recovery and involved anxiety hysteria. despised for this reason Darnton, 1984), gains and more rigorous occupational Unsubstantiated claims of strange odours possibly explaining the `meowing nuns'. health and safety regulations. The disap- and gassings were a common contemporary The recipe for these outbreaks seems to pearance of reportsin the former Soviet trigger of MSI outbreaks in schools Philen have been long-standing anxiety, which Union may reflect the rise of anti-capitalist et aletal, 1989; Selden, 1989; Cole, 1990; engendered dissociation and hyper- and, more recently, Western-type political Krug, 1992; Taylor & Werbicki, 1993; suggestibility± with the content of their systems Bartholomew & Sirois, 2000). SmallSmall et aletal, 1994). A typical incident delusions reflecting the ZeitgeistZeitgeist.. During this same period strict academic occurred in August 1985, when 65 students In modern-day Malaysia, under similar discipline in many European schools, and a teacher at a Singaporean secondary conditions, outbreaks of motor hysteria especially Germany, Switzerland and school were suddenly stricken with chills, affect adolescent Muslims sent by their France, triggered outbreaks of motor headaches, nausea and breathlessness. A parents or guardians to socially isolated hysteria involving convulsions Armainguad, battery of environmental and medical tests all-female religious boarding schools. One 1879; Hagenbach, 1893), contractures were negative. The episode began when episode in the remote state of Kedah Regnard & Simon, 1887), trembling several pupils detected an unusual smell, affected 36 girls over a period of 5 years. Laquer,Laquer,1888;1888; Wichmann, 1890) and and occurred amid a preexisting rumour Native healers bomohsbomohs) were summoned laughinglaughingRembold,Rembold, 1893). In 1893, a girls' that a gas had infiltrated the school from intermittently to exorcise demons. school in Basel, Switzerland, was affected a nearby construction site. Investigators

301 BARTHOLOMEW & WESSELY

found `that those who accepted the idea chance event combined to worsen the situa- meteor had fallen from Mars and I was sure succumbed, and those who were indifferent tion. Some recruits were `resuscitated' in that he thought that, but in the back of my to it were immune' Goh, 1987: p. 269). the early confusion because medics had head I had the idea that the meteor was just This report is similar to a mystery gas at a wrongly assessed their conditions to have a camouflage . . . and the Germans were Hong Kong school a few years earlier, been more serious. These factors created attacking us with gas bombs' Cantril, affecting over 355 students aged 6±14 more anxietyand further breathing prob- 1947: p. 160). years. Before the outbreak there were lems. A study of the incident showed that There has been a recurrence of this rumours of a recent toxic gas scare at a those seeing the`resuscitations' or wit- trend since the early 1980s. In March and nearby school. Several teachers had even nessing others exhibit symptoms were three April 1983, 947 residents of the Jordan discussed the incident with their pupils ± times more likely to report symptoms West Bank reported various psychogenic some to the point of advising them on what Struewing & Gray, 1990). complaints: fainting, headache, abdominal action to take if it should hit their school pain, dizziness Modan et aletal, 1983). The TamTam et aletal, 1982).,1982). episode happened amid poison gas rumours On 8 July 1972 in Hazelrigg, England, CHEMICAL AND BIOLOGICAL and a long-standing Palestinian mistrust of stench from a pigsty may have triggered WARFARE Jews. Symptoms appeared over 15 days an outbreak of stomach pain, nausea, faint- amid rumours and publicity that poison ness and headache at a schoolchildren's During the 20th century, strange odours gas was being sporadically targeted at gala Smith & Eastham, 1973). That same and the presumed presence of toxic gases Palestinians. The outbreak began in, and year, headache and overbreathing affecting also were commonly blamed in episodes was mainly confined to, schools in several 16 pupils at a school in Tokyo, Japan, was of mass hysteria that spread to adjacent villages. In one incident, 64 traced to a pungent smog Araki & Honma, comcommunitiesmunities Johnson, 1945; McLeod, residents in Jenin were rushed to doctors 1986). A 1994 episode of breathing prob- 1975; Christophers, 1982; Gamino et aletal,, after erroneously believing that they had lems among 23 students in a female 1989; David & Wessely, 1995; Radovanovic, been poisoned when thick smoke belched dormitory at an Arab school in the United 1995), occasionally involving the fear of from an apparently faulty exhaust system Arab Emirates was triggered by a `toxic chemical and biological weapons. On 22 on a passing car. Following negative medical fire' that turned out to be the harmless April 1915, German soldiers released tests, it was evident that no gassings had smell of incense Amin et aletal, 1997). The chlorine gas near Ypres, Belgium, killing occurred, the hypothesis was discredited perceived threatening agent must be seen 5000 allied troops and injuring 10 000. and the transient symptoms rapidly ceased. as credible to the affected group. On any Before the First World War ended 90 000 A similar episode occurred in Soviet Georgia given school day, a fainting student would people on both sides were killed by poison during political unrest in 1989. Symptoms not be expected to trigger mass sociogenic gases and over one million were injured spread among 400 adolescent females at illness. Yet, if this occurred during the Harris & Paxman, 1991). The psycho- several nearby schools. The incident 1991 Persian Gulf war, and it coincided logical effects of what historian Elvira transpired after rumours that students were with the detection of a strange odour in Fradkin 1934) termed `the poison gas exposed to poison gas by Russian auth- the building, many of the native school- scare' would haunt the American psyche orities who had recently used the chemical children might exhibit sudden, extreme for the next three decades and trigger agent chloropicrin to disperse an opposi- anxiety after assuming that it was an Iraqi several prominent episodes of mass socio- tion rally Goldsmith, 1989). Intense media poison gas attack. A similar episode was genic illness and related social delusions. publicity surrounding the confirmed use of reported at a Rhode Island elementary In rural Virginia between 1933 and 1934 poison gases, and rumours that the students school during the Gulf War, coinciding there were dozens of reported attacks invol- had been gassed, triggered the rapid spread with intense publicity about chemical ving someone spraying a noxious gas inside of anxiety reactions. The transient com- weapons attacks on Israel and the possibility homes at night. After committing signifi- plaints mimicked the poison gas symptoms: of terrorist attacks on the USA RockneyRockney cant time and resources, authorities stomach ache, burning eyes, skin irritation & Lemke, 1992). concluded that all cases had mundane and dry throat. Media coverage of this Strange odours also were a common origins ± from backed up chimney flues to and the previous case were instrumental in 20th century trigger of epidemic anxiety passing flatulence Bartholomew & Wessely, spreading both episodes to the wider com- hysteria in job settings Colligan & 1999). Another `mad gasser' scare occurred munity. Mass sociogenic illness flourishes Murphy, 1979; Boxer et aletal, 1984; Boxer, in Mattoon, Illinois, in 1944 and this also where the threat has a basis in reality. The 1985), with environmental pollutant fears was attributed to anxiety and imagination 1995 terrorist attacks using sarin nerve leading to lost productivity time from data Johnson, 1945). Typical symptoms in both gas on the Tokyo subway system by the processing centres Stahl & Lebedun, episodes included breathlessness, nausea, Aum Shinrikyo sect triggered a series of 1974; Stahl, 1982) to telephone offices headache, dizziness and weakness. Even MSI episodes involving benign odours Alexander & Fedoruk, 1986), electronic the famous Martian invasion scare on Wessely, 1995). assembly plants Colligan et aletal, 1979) and Halloween eve 1938 reflected the pre- Although neither the Serbs nor the a compressor factory Sinks et aletal, 1989).,1989). occupation with chemical and biological Israelis have used chemical and biological An outbreak of breathing problems in male weapons. Of a survey of listeners who were weapons, the bitter and radical nature of military recruits at their California army frightened or panicked, 20% assumed that the conflicts means that the belief was con- barracks in 1988 happened when the air the Martian `gas raids' were in fact a gruent with the reality of the threat. Now was laden with a heavy odour from brush German gas attack on the USA. One typical that the American people have vivid proof fires and mistaken for toxic fumes. A respondent stated: `The announcer said a that attacks with chemical and biological

302 PROTEAN NATURE OF MASS SOCIOGENIC ILLNESS

weapons are not science fiction, we are danger of responding to every incident in conflicting and inconclusive findings are recreating the exact situations that existed space suits and inadvertently amplifying not surprising because episodes involve in Kosovo or on the West Bank. psychological responses. Indeed, the US social realities and the consequences of government may line the Washington, DC beliefs. Investigators of modern-day out- subway system with chemical warfare breaks of mass sociogenic illness in school THE 21st21THE stCENTURY agent detectors, yet such devices tend to and job settings have used standardised indicate false alarms. There were 4500 false personality tests to identify social, psycho- The psychological impact of terrorism positives in the Persian Gulf war ± without logical and even physical characteristics, involves the overexaggerated response to a single confirmed attack. Installation of such as gender, in trying to tell why some a real or perceived terrorist threat. The such alarms may cause disruptions to trans- members of the same group are affected 11 September attacks on the USA and port systems, creating more of an impact whereas others are not. There is no con- the subsequent use of anthrax as a than an actual event Wessely et aletal, 2001).,2001). sistent pattern. Thirty-five affected weapon have created a heightened state There is concern that after a chemical, workers at a fish packaging plant scored of anxiety and alertness. At a time when biological or nuclear attack, public health higher than controls on the Eysenck we are understandably preoccupied with facilities may be rapidly overwhelmed by Personality Inventory scale for extro- the threat from biological and chemical the anxious and not just the medical and version Smith et aletal, 1978), whereas 90 terrorism, an awareness of the acute psychological casualties. Following the affected electronics assembly workers physiological disturbances that are Brazilian `Goiania' incident, where in- scored lower than those who were un- associated with, and sometimes hard to advertent exposure of radiation caused affected. Goldberg associated absenteeism distinguish from, that threat is more four deaths and several hundred and mass sociogenic illness Goldberg, needed than ever. For instance, during casualties, about 10 000 people or 10% 1973), but Cole 1990) did not. Some the Persian Gulf war the first missile of the local population sought medical results suggest that those affected score attack on Israel by Iraq was widely feared examinations Petterson, 1998). Somatic higher on scales for paranoia Goldberg, to contain chemical weapons. Although symptoms are common in all populations 1973), neuroticism McEvedy et aletal,, such fears were unfounded, about 40% and are more frequent under stressful 1966; Moss & McEvedy, 1966) and hys- of civilians in the immediate vicinity of conditions Barsky & Borus, 1999). terical traits Knight et aletal, 1965), whereas the attack reported breathing problems Although 39% of those exposed during others foundno correlations Olson, CarmeliCarmeli et aletal, 1991).,1991). the 1996the1996 Sea Empress oil spill off Wales 1928; Olczak et aletal, 1971; Teoh et aletal,, The social, psychological and economic reported one or more symptoms, so also 1975; Tam1975;Tam et aletal, 1982). Gary Small and impact of mass sociogenic illness and associ- did 20% of the unexposed controls Lyons his colleagues linkacademic performance ated anxiety may be as severe as that from et aletal, 1999). Uncertainty and fear after and becoming ill Small et aletal, 1991),,1991), confirmed attacks Hyams et aletal, 2002). For disasters commonly generate psychogenic whereas Goh 1987) found no association. instance, anthrax is not a very effective symptoms such as hyperventilation, head- Small also correlated the death of a signif- method for causing mass physical casualties, ache and nausea, which may be difficult icant other during early childhood and yet its mere presence can terrorise a nation to distinguish from the early stages of a being stricken with epidemic hysteria and expend a high toll in human and finan- chemical, biological or nuclear attack. Small & Nicholi, 1982), and yet this cial resources. There have been reports of About 4000 of a total 10 000 New York observation was not confirmed in another mass sociogenic illness related to such fears firefighters who have visited the site of study by the same researcher Small & Durbin & Vogt, 2001; Villanueva et aletal,, the World Trade Center attacks have Borus, 1983). Some investigators report 2001). In one incident a man sprayed a mys- reported respiratory difficulties, dubbed that those affected have below-average terious substance into a Maryland subway `World Trade Center syndrome'. Many IQs Knight et aletal, 1965), whereas opposite station, resulting in 35 persons being treated others who live and work near ground zero impressions were given by others Olson, for nausea, headache and sore throats. The in lower Manhattan are reporting similar 1928; Schuler & Parenton, 1943). It seems fluid later was identified as a relatively symptoms shortness of breath, chest clear that there is no particular predis- harmless window cleaner Lellman, 2001). pressure and pain, coughing and general position to mass sociogenic illness and it In the Los Angeles subway, a strange odour anxiety), despite the New York Health is a behavioural reaction that anyone can forced its temporary closure after many Department's continuous monitoring of show in the right circumstances. commuters reported feeling ill Becerra & airborne contaminants by city, state and Malnic, 2001). federal agencies, which continue to indicate Over 2300 anthrax false alarms contaminant levels below that which poses CONCLUSIONS occurred during the first 2 weeks of a public health threat Price, 2001). October 2001 Cable News Network A prompt diagnosis of mass sociogenic ill- special report, A. Brown, 16 October ness is problematic because controversy 2001), many involving sociogenic symp- IS THERE A PREDISPOSITION often surrounds outbreaks and time is toms. In one case, a teacher and student TO MASS SOCIOGENIC needed to analyse environmental and reported minor forearm `chemical burns' ILLNESS medical test results. It has been argued that after opening a letter and discerning a rapidly dissipating, volatile airborne powder in the air. Subsequent analysis Scientists typically search for the causes organic compounds Black & Murray, revealed no foreign substance in the of mass sociogenic illness by seeking 2000;2000;Goode,Goode, 2000; Miller & Ashford, envelope Lehman, 2001). There is a abnormalities in those affected. Their 2000), or a mixture of low levels of

303303 BARTHOLOMEW & WESSELY

industrial air pollutants, coupled with diagnosis and hence the potential treatment Becerra, H. & Malnic, E. %2001) Complaints of incomplete environmental investigations of outbreaks. Treatment of mass sociogenic dizziness shut down subway. Los AngelesTimes,27,27 September.September. Faust & Brilliant, 1981), could have illness involves identifying and eliminating triggered short-lived symptoms erroneously or reducing the stress-related stimulus Bekhtereff,V. %1914) DonneDonnees¨ es sur l'el'epidemie¨ pide¨ mie neuro- psychique observeobservee¨ e chez les travailleurs d'usine de Riga attributed to mass sociogenic illness. Some perceived.perceived. de Petrograd en mars 1914. [Given on the neurological researchers conclude that sick building No one is immune from mass socio- epidemic observed at the homes of the factory workers syndrome is attributable, in whole or part, genic illness because humans continually at Riga and Petrograd in March 1914]. ObozrienieObozrienie Psikhiatrii Nevrologii +Petrograd),, 19,,585^613. 585^613. to polluted air Bauer et aletal, 1992; Ryan construct reality and the perceived danger & Morrow, 1992). Indeed, a cursory needs only to be plausible in order to gain Black,D.&Murray,V.%2000)Mass psychogenic illness attributed to toxic exposure at a high school 3letter). environmental probe leading to the diag- acceptance within a particular group and New England Journal of Medicine,, 342,1674.,1674. nosis of mass sociogenic illness among a generate anxiety. As we enter the 21st EpidemicEpidemichysteria:areviewofthe hysteria: a review of the group of mostly female garment-makers in century, epidemic hysteria again will mirror Boss, L. P. %1997) published literature. Epidemiological Reviews,, 19,, Puerto Rico was later traced to toxic fumes the times, likely thriving on the fear and 233^243. that had caused respiratory and de- uncertainty from terrorist threats and Bouzol, M. %1884) Relation d'une eepidemie¨ pide¨ mie a© generative diseases, and some deaths Cruz, environmental concerns. What new forms phephenomene¨ nome© ne hystehysterico-choreique¨ rico-chore¨ ique observeobservee¨ ea a© Algon 1990). Hamilton concluded that `epidemic it will take and when these changes will 3Ardeche) en 1882. [On the relation of epidemic hysteria' at a rayon plant in the 1930s appear are beyond our capacity to predict. hysterical chorea observed at Algon 3Ardeche) in 1882]. Lyon Medical,, 4747,142^148; 174^184; 211^217. was actually caused by carbon disulphide exposure Hamilton, 1943). An outbreak Boxer, P. A. %1985) Occupational mass psychogenic REFERENCES illness: history, prevention, management. 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