IN DECEMBER 2005 pupils and teachers at a school in the Shelkovsk region of Chechnya reported that they were suffering respiratory difficulties, seizures and fainting. The symptoms, which quickly spread to schools in surrounding villages, did not respond to medical treatment. Eventually close to 100 people were affected, mainly adolescent girls.
The Chechens, traumatised by more than a decade of Russian counter-terrorist operations, suspected poisoning by the Russians. When the Russian authorities diagnosed mass hysteria, people dismissed this as just more official duplicity. However, one Chechen psychologist, Khapta Akhmedova, was aware of the sizeable literature on mass hysteria and thought the authorities could be right. She knew that a community like hers, ravaged by war, with poor general health and high anxiety, can be fertile ground for mass hysteria. All it takes is a bad smell from a school drain and you have an outbreak of something that looks like mass poisoning.
In the face of strong opposition from fellow health professionals, including other psychologists who were convinced that the cause was nerve poison, Akhmedova set up a programme of psychological rehabilitation for the sick children. After months of reassurance and patient explanation that the true cause of their illness was stress, they are now getting better. They are all out of hospital and most have gone back to school. Toxicological investigations have failed to turn up a poisonous agent in any of the affected schools.
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Mass hysteria has been documented since the Middle Ages. Psychiatrist Simon Wessely of the King’s Centre for Military Health Research at King’s College London says its causes tend to reflect a society’s beliefs. In the past, witchcraft was often blamed – and in some societies it still is – but in the industrialised world, environmental contamination is more often seen as the culprit. After the 9/11 terrorist attacks, Wessely predicted outbreaks of mass hysteria related particularly to bioterrorism. And despite the difficulties in spotting outbreaks, that now seems to be happening.
In 1987 Wessely suggested that there were two types of mass hysteria: acute episodes that happen all the time and vanish quickly once their true cause has been acknowledged, and a more serious, chronic variety that tend to take place against the backdrop of social trauma in which trust between people and the ruling authorities has broken down. “For an episode to become chronic it has to be believable by those affected, and it has to be reinforced, at least at the start, by local experts, including physicians and the media,” he says.
The thousands of anthrax scares or “white powder incidents” that followed 9/11 fall into the category of acute episodes. The vast majority turned out to be false alarms or hoaxes, even though many people claimed to have the symptoms of anthrax infection.
Pat Troop, now chief executive of the UK’s Health Protection Agency, was the British government’s Deputy Chief Medical Officer in September 2001, a time when there was a feeling in the UK that the country’s close links with the US made it a prime target for terrorists. When the white powder incidents began, the emergency services and the labs investigating the samples came close to being overwhelmed. Gradually, as more and more samples proved innocuous – and the media lost interest – the investigators became more circumspect. Within three months of the first one, the white powder incidents had stopped.
“Chronic mass hysteria tends to occur when trust in the authorities has broken down”
Clearly public health officials have to err on the side of caution – it’s unthinkable that they should ignore a case of suspected bioterrorism – but scares of this kind represent a serious burden on emergency services. For health authorities it’s a tough call, Wessely says. If the cause is anxiety, they need to know so that it can be treated appropriately. Yet if the authorities tell people bluntly that they are suffering from mass hysteria, as the Russians did in Shelkovsk, they risk losing credibility. “When you get it wrong, you become part of the problem,” he says.
Troop is convinced that the best way to handle outbreaks of uncertain origin is to be open with people, while conducting thorough environmental investigations. If no contaminant is found, then let the public know that, she says. It doesn’t always work, though. The notion that psychological illness is somehow less serious than illness with an organic cause is deep-seated among the public. Even the medical profession isn’t immune, though fortunately doctors are increasingly aware of how anxiety can manifest itself in the form of fits, rashes and even coma.
In Shelkovsk, teachers, parents and doctors continue to reject the Russian verdict of mass hysteria, even though psychological treatment is the only thing that has helped their children. What will it take to cure those who remain sick? Perhaps an acknowledgement from those around them that the only thing poisoning them is their own anxiety.
