The most unpopular diagnosis


Psychogenic: Mysterious bouts of illness in crowded, stressful places are often a sort of mass hysteria, researchers say.

May 05, 2000|By Marego Athans | Marego Athans,SUN NATIONAL STAFF

McMINNVILLE, Tenn. -- First there were fumes that made a teacher sick. Then some students got sick, and the ambulances came, and 170 people went to the emergency room. The school closed for nearly two weeks while experts tested the air and water. And more than a year later, the people of Warren County found out what had been wrong with their school building.


On Jan. 13, the New England Journal of Medicine reported that the mysterious ailment at Warren County High in November 1998 was a form of mass hysteria, called mass psychogenic illness. The symptoms -- headache, dizziness, nausea and breathing difficulty -- were real. But they weren't caused by a toxin. They were caused by anxiety.

The episode is not as bizarre as it sounds. Analysts say the phenomenon frequently affects schools, factories, offices and army barracks, where people are under stress and share common space.

"It's much more common than most of us realize," says Timothy Jones, an epidemiologist at the Tennessee Department of Health and the lead author of the journal article. At the time of the outbreak, Jones was an officer at the Centers for Disease Control and Prevention.

"The huge majority [of cases] are not published or widely announced, so they tend to be dealt with locally and they go away and that's the end of it. Any time I've discussed the topic with groups, someone always comes up afterward to tell me about their experience. Schools are a pretty common place for them to happen."

But no one knows how often these cases happen, because they are rarely examined scientifically and reported. Even when health care officials suspect mass psychogenic illness early in an outbreak, they are often reluctant to label it as such because of community pressure to pursue an investigation.

The prolonged quest for answers -- coupled with intense media attention -- only fuels the anxiety and suspicion of a coverup, at great cost to the community, the journal article says. In the Mc- Minnville case, along with the missed school days, an estimated $93,000 was spent on emergency medical care.

Mass psychogenic illness has occurred throughout the world since at least the Middle Ages.

Centuries ago, outbreaks were usually triggered by fear of demons and spirits, religious ceremonies or feverish dancing. Today, the catalysts more typically are worries about exposure to toxins and bacteria. The journal article's authors say cases might increase with rising fears of bioterrorism.

In Belgium last summer, 250 people complained of illness after drinking Coca-Cola, prompting the largest recall in Coke's 113-year history -- 2.5 million bottles. It was attributed in large part to mass hysteria.

"You scare yourself into it," says Ron House, a University of Toronto researcher who investigated an outbreak at a fish-packing plant in New Brunswick, Canada, in the early 1990s. "Seeing somebody becoming ill is a trigger for other people to develop symptoms, and you have a wave of symptoms through the room pretty quickly. You feel like your life is in danger."

Researchers say that's what happened on Nov. 12, 1998, near McMinnville (population 11,000), a town 66 miles southeast of Nashville that calls itself the nursery capital of the world because of its wealth of tree farms.

The day began like most others at Warren County High, an impressive new $15 million brick building set on former farmland, where 1,825 students attended school.

In room 307 of the vocational wing, teacher Susan Davis was preparing for her first class in food management when she noticed a gasoline-like smell. She felt dizzy, nauseated and short of breath, and she got a headache. Soon, several students in her room began to feel the same symptoms.

When Principal George Bolding arrived he also noticed an odor, which smelled to him like insecticide. He, too, got a headache. School officials sounded a fire alarm, evacuating the school. Still more students reported symptoms.

Several people were taken to the hospital by ambulance; classes were canceled, and before the day was over 100 people went to the emergency room.

Fire, gas company and state health and safety experts spent two days inspecting, but found nothing wrong. When school reopened four days later, there was a new wave of complaints about odors. Bolding, 59, a tall man with a gray mustache and a dry wit, retells the story with a mixture of mild annoyance and amusement.

By 9 a.m. the next day, a half-dozen students were lying down in the lobby because the clinic was already packed. Ambulances returned, the school was again evacuated and closed, and 71 people went to the emergency room. This time, government agencies launched an extensive investigation. "They even had a cave expert to check the underground water," Bolding says. "I didn't realize we had that many people in this country called air experts."

While the school closed for nearly two weeks, the community rallied to support the investigators.

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