Thursday, January 12, 2023

Mass Psychogenic Illness

When you have a physical problem that can't be explained by medical science, it's called a "somatic symptom disorder." In other words, it's described as a mental problem that has manifested as a physical problem. Some people will tell you that it's all in your head, and some people think that makes this kind of problem even worse.

Long-covid sufferers know what this is like, but plenty of other people have known it too. Sometimes, lots of people suffer from this together, and that's called "mass psychogenic illness." It's also called "mass sociogenic illness." You might know it as simply "mass hysteria," and recall plagues of hysterical laughter that have been recounted throughout history. 

It's a topic that sits at the intersection of memetic transmission, olfactory perception, and occupational health. It's "memetic" because it's spread through the mind, "olfactory" because that's the sense most susceptible to illusion and cognitive override, and "occupational" because it tends to happen in groups existing in some kind of hierarchy, and although society is one big hierarchy, workplaces are microcosms of social organization.

A couple smelly people on an airplane are real good for sending the entire cabin into a paranoid frenzy over suspicions of a bioterror attack. Too much chlorine in the pool? With the right mixture of hypersensitive olfactory receptors, general distrust in the way the pool is managed, and strong communication networks between the occupants, and you're passing out whether it's the chlorine or not.

Potential carbon monoxide poisoning after six people were sent to the emergency room? Three people in the staff lounge smelled a dead mouse in the wall cavity, couldn't recognize it as a dead-mouse-smell, concocted a scenario about alchemical reactions from the science lab 3 doors down, and spread their paranoia to another group of people eating lunch in another part of the building, who then spread their paranoia to another group somewhere else, until 15 people are asphyxiating at their own thoughts, 6 of whom were not even in the initial group but were sent to the emergency room.

Mass hysteria is a difficult subject to talk about, because it's cruel to dismiss the ill health effects of another person, or especially an entire group of people, as being pure fiction. Yet, there are plenty of stories of this throughout history, where lots of people absolutely confirm they have a physical problem, and yet lots of doctors and special investigators are absolutely certain they've tried everything, looked for everything, and can't find anything wrong.

In fact, and unfortunately, there are many instances of potentially dangerous environmental exposures causing shortness of breath, fainting, blinding migraines, seizures, etc. where the dangerous exposure remains elusive, has no plausible explanation, the investigation is stopped, the cause is recorded as "mass psychogenic illness" and the case is closed. 

Somewhere in the middle is an organization -- be it a church, a workplace, or an entire community -- that has lost its social capital. The hierarchical strata no longer trust each other, they feel powerless to improve their conditions, and are unable to escape. In a world where private industry is valued more than public good, social capital is a liability, not an asset. The next time you hear about an odor sending a whole building full of people to the hospital, consider the social and psychological effects of power and control on a population suffering from a breakdown of social capital. 

Here's a list of qualities of an outbreak of mass psychogenic illness:
  • symptoms with no plausible organic basis;
  • symptoms are transient and benign;
  • symptoms with rapid onset and recovery;
  • occurrence in a segregated group;
  • the presence of extraordinary anxiety;
  • symptoms that are spread via sight, sound or oral communication;
  • a spread that moves down the age scale, beginning with older or higher-status people;
  • a preponderance of female participants.
-"Mass sociogenic illness". Erica Weir (2005). Canadian Medical Association Journal. 172 (1): 36. doi:10.1503/cmaj.045027. PMC 543940. PMID 15632400.

Here's some examples of strong, offensive odors making people sick, or not:

3 custodians treated at N.J. college after chemical smell sweeps through building
Jul 2022, NJ Star Ledger

Three custodians working early Tuesday at Bergen Community College were overcome by chemical fumes and treated on site by paramedics, a college spokesman said.

The incident occurred about 2 a.m. in a building at the campus on Paramus Road in Paramus. The custodians called emergency medical workers because they were concerned about breathing the fumes, the spokesman said.

The spokesman said the smell was caused by a masking agent used to cover a chlorine smell from power-washing a day earlier and the air conditioner carried the masking agent smell throughout the building.

Chlorine fumes at N.J. pool send 14 campers to hospital for observation, officials say
Jul 2022, NJ Star Ledger

Fourteen participants in a soccer camp were taken to the hospital for observation Monday after they became sick while at a pool on Drew University’s campus in Madison, officials said.

The campers experienced chlorine inhalation symptoms when “a small amount of chlorine was accidentally released” at the Simon Forum’s Pool shortly after noon, according to a statement from Madison officials.

The soccer camp participants — ranging in age from 10 to 17 — received medical care at the scene and were taken to a local hospital within an hour, officials said.

Tests at the pool showed normal levels of chlorine and all systems were working properly, according to a school spokesperson.

Some campers reportedly smelled chlorine vapors and were vomiting in a nearby area. It was not immediately clear how the chemical was released, but there was no active leak.

“Initial reports indicated that some of the children were suffering from shortness of breath, difficulty speaking between breaths, nausea and general airway issues,” said Morris County Emergency Management Director Jeffrey Paul.

Dead Zebra Mussels
American Industrial Hygiene Association Catalyst Forum, 2022
I recall an event when workers were cutting through an old cooling water intake from the Hudson River and a strong odor resulted in having to evacuate the building until it was determined that the odor was from torching zebra mussels that had lined the inner surface of the intake!

Here's a study about this phenomenon from 1978 in a journal for nurses:
An investigation was undertaken of an apparent outbreak of contagious psychogenic illness at an electronics plant in which approximately 50 females reported a variety of subjective nonspecific symptoms. The workers believed that the physical symptomatology was triggered by an unidentified odor in the plant which was not verified by environmental sampling for chemicals or by medical evaluations of affected workers. A random sample of non-affected and affected workers was surveyed by means of psychological health status inventories and epidemiological indices to determine the role that life-history, personality characteristics and job dissatisfaction had on susceptibility to illness. Results indicated that those workers reporting the highest level of perceived stress due to job dissatisfaction, family problems, and personal conflict were most likely to experience somatic symptoms. In the present study sources of dissatisfaction identified as potential precipitating factors of the illness outbreak were: 1) working conditions, 2) supervisory style, and 3) personal lifestyle.

The incident, preceded by some form of stress and structural strain, usually is contingent upon several factors including level of environmental stressors, host susceptibility, and mode of rumor transmission, culminating in a collective action.

Work Environment Scale (WES) - ascertain the role of job stress in the etiology of the illness, intended to be predictive of worker satisfaction or adjustment:
  • 1) involvement - the extent to which workers are enthusiastic or committed to their jobs;
  • 2) peer cohesion - the extent to which workers are mutually supportive;
  • 3) staff support - the extent to which management is perceived as supportive by the workers;
  • 4) autonomy - the extent to which the workers feel self-sufficient and independent;
  • 5) task orientation - the extent to which the climate emphasizes productivity and efficiency;
  • 6) work pressure - the extent to which workers perceived pressure to produce;
  • 7) clarity - the extent to which workers know what is expected of them in the perform- ance of their jobs;
  • 8) control - the extent to which management imposes rules and regulations on the workers;
  • 9) innovation - the extent to which variety and new approaches are emphasized in the workplace; and
  • 10) physical comfort - the extent to which the physical surroundings contribute to a pleasant work environment. [19] Moss AH, Insel PM, Humphrey B: Family Work and Group Environment Scales Manual. Palo Alto, Consulting Psychologists Press, Inc, 1974.
  • *Needs: more cohesiveness, more support, less work pressure, more control, less ambiguity of work role; physical comfort is actually negligible.

It appeared that neither the mutual interest of workers for one another nor the relationships between the workers and plant management were conducive to strong interpersonal support and trust.

This lack of trust was reflected in the unwillingness of employees to express their feelings or to reveal their work problems to supervisors. 

Consequently, affected workers perceived no way to resolve the problems facing them; they were locked into a situation with mounting difficulties without any hope of resolution.

When individuals perceive all outlets for help as closed and yet feel compelled to maintain the job, vulnerability to succumb to a mass illness in order to find some relief increases.

Similarly, worker autonomy and innovative approaches were not encouraged. This evident blocking of any outlet for expression by the workers by prohibiting them from contributing their own ideas, sharing their knowledge, or initiating any improvements at their worksite, built up tension and employee anxiety. [hopelessness]

Perceived increased pressure to produce relative to normal population (but may be related to other workers not doing their end of the deal, which multiples the work required on the 'affected' and negates the possibility for pride in work)

A profile of the affected worker emerges from this study as a female, less educated than her peers, who works under great pressure to maintain a job to support her family. Poor relations with supervisors, role ambiguity, work overload, and use of inferior materials are daily stressors. More importantly, opportunities for expressing ideas, grievances, or alleviation of difficulties are stymied so that the worker is without control over her work-life, without pride or self-esteem. Having been left no resource to cope with the situation, an objective physical stressor such as the smell of gas leak, can serve to provide justification to display somatic symptoms severe enough to necessitate a physician's care.

It would therefore appear that the underlying causes of this mass psychogenic illness episode were a function of the employees' working conditions and plant supervision style which produced psychological stress for which no outlets were available, causing anxiety and depression. Over long periods of time such anxiety and depression produced a socially acceptable means of expression - a mass psychogenic reaction with physical symptomatology which was triggered by some undefined toxic agent in the plant environment.
-Cohen, B.G.F., Colligan, M.J., Wester II, W., and Smith, M.J. (1978). An investigation of job satisfaction factors in an incident of mass psychogenic illness at the workplace. Occupational Health Nursing, January 1978:10-16. [pdf].

Here is another old article, this time from a journal of occupational psychology:
The "trigger" is almost always a strange odor, but sometimes bug bites, and one time the threat of staff-wide pregnancy tests, and sometimes related to limited outbreaks of disease in the community such as polio or gonnorhea.

Symptoms are almost always headache, dizziness, nausea, etc., or irritable throat, eyes, coughing, shortness of breath or even skin rashes

The more dramatic symptoms such as catatonic posture, spasms and muscular twitching, and simulated gonorrhoeal vaginitis, were most frequent among adolescent populations.

Most victims appeared to feel a strong need to associate their illness with a physical rather than a psychogenic cause.

Tendency of affecteds to have a history of absenteeism from work prior to the contagious outbreak. It appears, then, that the higher absenteeism rate of affecteds may be more a function of coping style than general health status. It is also possible that the affecteds are hypersensitive to their health state in general.
  • Environment: organized, structured, clear roles, not voluntary, ie, stress daily, escape limited
  • Boredom: repetitive tasks
  • Production pressure: forced overtime, deadlines
  • Physical stressors: noise, lighting, thermal comfort, odors (hypersensitivity?)
  • Labor-management relations: lack of trust
  • Communication: scheduled break times means no meeting friends, noisy means can't hear
The initiator and convergence vs contagion: convergence happens independently of each other instead of passing one to the other (authors saying most mass psychogenic illness is convergence not contagion).

After the first person is visible or vocal with their symptoms, it goes from convergence to contagion real quick, as the initiator disinhibits newly acceptable expression of symptoms.

Sequential decline in symptom severity as the epidemic progressed.
-Colligan, M.J., and Murphy, L.R. (1982). A review of mass psychogenic illness in work settings. In M.J. Colligan, J.W. Pennebaker, and L.R. Murphy (eds.) Mass Psychogenic Illness, NJ: Erlbaum, 171-182.

Here's some written work on the subject:
  • Wheeler, L. (1966). Towards a theory of behavioural contagion. Psychological Review, 73:179-192.
  • Kerckhoff, A.C. and Back, K.W. (1968). The June Bug: A Study in Hysterical Contagion. New York: Appleton-Century-Crofts. 
  • Stahl SM, Lebedun M: Mystery gas: An analysis of mass hysteria. J Health Soc Behav 15:44-50, 1974.
  • Mechanic D: Discussion of research on relations between stressful life events and episodes of physical illness, in Dohrenwend BS, Dohrenwend BP (eds): Stressful Life Events: Their Nature and Effects. New York, John Wiley& Sons, Inc, 1974.
  • Freedman, J.L., and Perlick, D. (1979). Crowding, contagion and laughter. Journal of Experimental Psychology, 15:295-303.
  • Freedman, J.L. (1982). Theories of Contagion as they relate to mass psychogenic illness. In M.J. Colligan, J.W. Pennebaker, and L.R. Murphy (eds.) Mass Psychogenic Illness, N.J: Erlbaum, 171-182.
  • Turner, R.H. and Killian, L.M.(1987). Collective Behavior (3rd ed.) NJ: Prentice-Hall.
  • Goodenough, O. R. and Dawkins, R. (1994). The "St. Jude" mind virus. Nature, 371:23-24 (ask Nature; they'd like you to rent a roughly 30 year old article for $8.99).
  • Jones, M.B., and Jones, D.R. (1995). Preferred pathways of behavioural contagion. Journal of Psychiatric Research, 29:193-209. [Danish twins study, more about criminality, also more about genetics vs contagion.]

Image credits: AI Art - Policeman in Leathery Squid Skin Leaking PVA Glue (set of 5) - 2022

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