The management of episodes of mass psychogenic illness poses a challenge for mental health professionals who have a history of inadvertently exacerbating episodes. This article identifies the two major presentation types (anxiety vs. motor), discusses their significance as a public health issue, and offers guidelines for responding to outbreaks and addressing the media.
Keywords: mass psychogenic illness; mental health community; mass sociogenic illness; conversion disorder
Mass psychogenic illness (MPI) refers to the rapid spread of illness signs and symptoms within a cohesive social unit for which there is no plausible organic cause. Episodes are triggered by an anxiety-generating stimulus within the victims' immediate environment (either real or imagined), and symptoms appear within a close temporal proximity of exposure to the perceived harmful agent. Symptoms are transient and benign, have rapid onset and recovery, and victims are overwhelmingly female. The gender breakdown is a contentious issue. Some researchers argue that it is a function of innate female susceptibility (nature; Klein, 1993); others contend that it reflects a social and cultural patterning (nurture; Kerckhoff, 1982). Common synonyms include mass sociogenic illness, multiple unexplained symptoms, mass or epidemic hysteria, and hysterical contagion. While prior to the 20th century, MPI was typically referred to with pathological labels such as "psychic disturbance" and "epidemic insanity," there is a contemporary consensus that most victims are normal, healthy subjects who are devoid of major psychological or personality disturbances (Wessely, 2000).
Although the diagnostic use of the term "hysteria" was discontinued by the American Psychiatric Association (APA) in 1994 and replaced by "conversion disorder" (APA, 1994), use of the word "hysteria" persists in the scientific literature. This is unfortunate due to its pejorative, stigmatizing connotations. The term mass hysteria continues to be used as a "catch-all" category under which various heterogeneous behaviors, which have little or nothing to do with conversion reactions, are erroneously categorized-everything from mass suicide and cargo "cults" to moral and financial panics. MPI episodes mirror social and cultural fears and uncertainties that define each era and reflect unique worldviews that are grounded in the zeitgeist.
Public Health Significance
MPI is becoming increasingly recognized as a significant health and social problem. Jones et al. (2000) surmise, based on "war stories" from colleagues attending medical conferences, that the incidence of MPI is greatly underreported. Episodes are typically a significant financial burden to responding emergency services, public health and environmental specialists, hospital personnel, and the affected school or work site, which may be closed for days or weeks. MPI victims may refuse to enter the premises again and change schools or work sites. In some instances, the financial costs are staggering. In 1999, several clusters of MPI among Belgian schoolchildren attributed to tainted soda resulted in nationwide anxiety and the recall of Coca-Cola products. This cost the company upward of US$250 million (Nemery, Fischler, Boogaerts, & Lison, 1999). In 2007, an Australian MPI episode associated with an inoculation campaign for human papillomavirus was linked to the loss of AU$1 billion in the share market value of the corporation producing the vaccine Gardasil (Chapman & MacKenzie, 2007).
MPI diagnoses often meet fierce resistance from victims, their families, and community members, fostering an atmosphere of suspicion and mistrust among health care professionals about employing the stigmatizing label that often accompanies such diagnoses-which is frequently reported in the media as having been "all in their heads" or "mass hysteria." The resultant hostility is typically reflected in the news media, newly formed social movements, and emotionally charged public forums. …