Gary Small & Gigi Vorgan Read online

  “I wonder if it would be possible for me to speak with one or two of the families and maybe pass out a brief questionnaire so we can be absolutely sure this type of thing doesn’t happen again. Because I know you wouldn’t want that.”

  “Well, I don’t know. I’ll have to look into that,” he said. “You know…we have to be very sensitive to the privacy of our families. Listen, I’ve got another meeting right now. Call me and we can discuss it.” He stood and escorted me out of his office. He was clearly not interested in my little study and wanted things to go back to status quo.

  I drove over to State Street Community Hospital and parked by the front entrance. I hoped to find some staff who had treated the fainting children. The lobby was crowded with families waiting and kids running around, and there was no one at the information booth. I walked down the hall looking for a nurses’ station when an orderly practically knocked me over coming around a corner. He was pushing a patient on a gurney while steadying the IV pole. “Could you give me a hand, Doc? I’ve got to get this guy up to the O.R., and we’re short-staffed.”

  I realized that I was still wearing my white coat, and I panicked. How short-staffed were they? Was I going to have to scrub up and do this man’s surgery? I’d performed appendectomies in med school, but if this guy needed a heart transplant, he was in big trouble. To my relief, the surgical team was ready and waiting in the operating room, and I quickly retreated through a side door.

  I walked down another hallway and spotted a nurse with a friendly face. I asked her about the fainting schoolgirls.

  “Oh, that thing came and went. They never figured out what caused it.” She looked down the hallway and pointed. “Right there are the parents of the last little girl who’s getting discharged today.” I thanked her and hurried over to the parents.

  Dorothy and George Holland were talking quietly outside the door of their daughter’s room. I introduced myself as a Harvard doctor and didn’t mention that I was a psychiatrist because I didn’t want them getting defensive right off the bat.

  They were eager to talk to me about what had happened at the school. They were frustrated because no one had figured out why their daughter had passed out. “Those kids were so sick,” Dorothy said, “they could hardly breathe. I heard that our daughter Lindsey was twitching on the ground and practically paralyzed.”

  George jumped in. “The school botched the whole thing. No one brought in the CDC, and those health inspectors hardly looked anywhere. Something made all those kids sick. I think the school is pulling a cover-up.”

  I said, “It’s true, we don’t know what caused the outbreak, but I’d certainly like to find out too.”

  George smiled. “Thank you. It’s nice to have a doctor agree with me.”

  I went on. “I heard there was a lot of anxiety and chaos going on. Do you think that might have made the symptoms worse?”

  Dorothy glared at me. “What do you mean?”

  “I mean, do you think the panic and hysteria may have made the kids get sicker?”

  George looked puzzled, and Dorothy was angry. “Are you saying my daughter was faking her illness? Are you calling her a liar? She’s been in the hospital for two days. What are you? Some kind of psychiatrist?”

  “Well, yes, I am.”

  “I don’t want to hear any more of this,” George snapped. “We’re done talking with you. Come on, Dorothy.” She followed her husband into their daughter’s room and shut the door. I guessed they wouldn’t be filling out my questionnaire that day.

  Their defensiveness was typical. When mass-hysteria victims and their families are approached about possible psychological causes for their very physical symptoms, they run the other way. Most people don’t want to be told that their illness is “all in their heads.”

  In the years that followed, I studied several episodes of these strange outbreaks and learned to tread very gently when discussing any psychological underpinnings. It makes sense when you think about it from the victim’s point of view. The physical symptoms are experienced as real, and when they strike, the victim is swept up by the excitement and anxiety of the crowd. How could real physical experiences—hyperventilation, fainting, nausea, stomach pains—be the result of anything but an actual physical illness?

  Victims are more likely to endorse a far-fetched or outlandish cause for their illness than to cop to the mind-over-matter theory. Examples of bizarre explanations for mass hysteria have included a “mad gasser” that Mattoon, Illinois, residents believed was spraying poisonous mist into the bedroom windows of teenage girls, causing nausea, vomiting, and burning sensations in their mouths and throats. In the early 1950s, when people in the state of Washington were nervous about nuclear testing, many believed that cosmic rays or shifts in the earth’s magnetic field were causing previously unnoticed windshield pits or dings. Some even blamed it on “supernatural gremlins.” Although this was an example of collective delusion rather than mass hysteria, it shows how a worried group can overinterpret physical phenomena that were already there but went unnoticed before the spread of anxiety.

  My Boston-suburb elementary school outbreak had its own set of rumors. Two priests arrived to attend to the families of the “deceased” because of a rumor that a dozen children had died of food poisoning. Another rumor circulated that the boy who cut his chin on the riser underwent open-heart surgery shortly after fainting. These and several other rumors about toxic fumes and poisonous water were all false.

  When we face uncertainty, our minds crave explanations. If we have no way to account for symptoms, we feel out of control and our fear escalates. And if we learn that our own minds caused the very real symptoms, then we feel more anxiety about what our minds might do next. People might worry that their brains are possessed by some outside spirit, or perhaps a poltergeist has taken charge of their willpower. They’d rather latch on to something like the mysterious poisonous-water theory.

  Psychosomatic specialists have come up with additional physiological explanations for some of the symptoms of mass-hysteria outbreaks. When people get excited and scared, they might hyperventilate or start breathing too quickly, thus exhaling too much carbon dioxide. Low carbon dioxide levels in the body cause muscles in the extremities to spasm, which can explain the numbness, tingling, and muscle twitching some victims experience. If the carbon dioxide depletion is treated by simply breathing into a paper bag, the symptoms rapidly disappear.

  In a heightened state of anxiety, victims often notice and misinterpret normal physical sensations. A stomach gurgle can be mistaken for a sign of food poisoning. And if others around you grab their stomachs and fall to the floor, your fear level might heighten, your knees might buckle, and you might fall to the floor as well. The sheer force of group dynamics tends to take over, and people get swept up in the symptoms of the crowd. The social hierarchy of the group can also play out in the spread of symptoms. If the “popular” girls faint first, the less popular will likely follow their lead. In this Boston-suburb outbreak, the original boy who fell ill and cut his chin was one of the most well-liked kids in the school.

  A decade later I studied a similar outbreak of illness that suddenly afflicted a group of student performers in Southern California. Our research team found that the best predictor of a child getting the symptoms of hysteria was when that child observed a friend become sick. An outbreak of mass hysteria is like a perfect storm, where all the necessary elements are lined up together: the crowd, heightened anxiety, physical stress such as heat, fatigue, or hunger, and influential social networking. One trigger, whether it’s a chin cut on a riser or a friend’s indigestion, can cascade into a full-blown outbreak of group hysteria. Today, when mass hysteria strikes, health officials are savvier in identifying both physical and psychological explanations. What people often don’t realize is that even if the symptoms have a psychological cause, the victim is not making a “decision” to get sick. It’s an unconscious process, and the physical symptoms are real.
r />   I WAS BECOMING FAMILIAR WITH THE ROUTE to the suburbs as I drove back down to the elementary school for the Friday-evening performance. I parked a couple of blocks away from the school, and as I walked toward the auditorium, I started to worry about what I would do if there actually was another outbreak. Maybe I should have stopped at the market and brought a couple of hundred brown paper bags for people to breathe into. Then I wondered whether there might truly be a physical cause and I would get sick as well. Or worse, what if I fell victim to mass hysteria? Okay, I had to calm down. I was getting hysterical before I even got to the auditorium. Some big-shot Harvard psychiatrist I was.

  I entered wearing an anonymous blue blazer rather than my white coat. The place was filling up with parents and siblings of kids in the show. I took a seat in the back, with my notepad in pocket, prepared to jot down any potentially important observations. I subtly sniffed in several directions to make sure I didn’t detect any toxic fumes. I noticed Dorothy and George from the hospital, sitting toward the front of the auditorium. George was talking with some friends, but Dorothy was staring straight at me. Oh boy, she was probably still pissed. I nodded toward her, and to my surprise she nodded back in a friendly way.

  Saxon welcomed the audience and introduced the chorus. I watched them perform while scanning the room for any signs of unusual behavior. After about twenty minutes, I was bored. Everything went along smoothly, without incident—no stomachaches, no fainting schoolgirls, no mass hysteria at all. I admit I was a little disappointed but also greatly relieved.

  As I got up to leave after the show, I heard someone calling, “Dr. Small! Dr. Small! Please, wait.” Seeing Dorothy rushing toward me, I braced myself.

  “I’m glad to see you again. I’m sorry I was so short with you at the hospital. We were just worried about Lindsey.”

  “How is she doing?” I asked.

  “Much better, thank you,” Dorothy said. “But she’s had some difficulties, and I wanted to talk to you about that. Do you have a moment?”

  “Of course,” I replied. “Let’s step outside.”

  We sat down on a nearby bench, and Dorothy told me that she blamed the school for mishandling the whole affair, but she wasn’t surprised that Lindsey got sicker than the other kids. “She’s been getting sick a lot and having a hard time of it ever since I divorced her father two years ago. It’s gotten even worse since I married George. She’s missed a lot of school—she plays up every little sniffle or stomachache and then refuses to go. I can’t seem to lay down the law with her.”

  “Why do you think that is?” I asked.

  “I guess I feel guilty about the divorce and then marrying George so soon.”

  “Have you talked to your doctor or a therapist about this?” I asked.

  “No, I haven’t…When you said you were a psychiatrist, at first I got mad, but you seemed like you really wanted to help, and Lindsey’s only gotten worse since this school thing. Now she claims that if she goes to school, the other kids might get her sick again.”

  It sounded like Lindsey had been playing up her physical symptoms to cope with feelings about the divorce. This defense mechanism, known as somatization, allows people to express emotional pain as physical pain. If Lindsey coped with stress this way, it wasn’t surprising that her mass-hysteria symptoms were more severe than those of the other children. Her mother’s guilt about the divorce likely reinforced Lindsey’s somatization. Dorothy would have been better off setting limits and insisting that her daughter go to school. It would also have been helpful if Dorothy had given her daughter an opportunity to talk about her feelings around the divorce. I guessed that there hadn’t been much real communication going on in this family.

  “Dorothy,” I said, “I appreciate your telling me about Lindsey. It might be a good idea for the two of you, or at least Lindsey, to meet with a therapist to talk about what’s been going on.”

  “Could we talk with you about it? You seem to understand,” she said.

  “I’d be happy to, but it would be a lot easier for you if I found you someone who’s nearby. Lindsey’s issues aren’t going to disappear overnight, and you might want to schedule regular meetings with somebody more convenient.” I told Dorothy that I would call her the next week with some names of local therapists. She thanked me and gave me her phone number. She said George would be relieved as well.

  As I walked back to my car, I thought about Lindsey’s situation. Perhaps some of the other kids had similar issues. Divorce was pretty common; maybe children whose parents had divorced would be more likely to get symptoms from mass hysteria. Also, the hysteria outbreak may have been partly triggered by the psychological stress of impending losses. The sixth-graders were graduating, the principal had recently announced that he was moving to another school, and many of the students were about to go on their first overnight trip. It was possible that anxiety about these impending separations and losses contributed to the episode of mass hysteria.

  I could easily test the hypothesis that previous loss influenced a child’s vulnerability to current loss, and predisposed that child to mass hysteria by using a questionnaire that simply asked whether these kids had experienced divorce or other losses, like the death of a close relative. Finally, I had a clear idea for my study. My old loss-obsessed supervisor, Professor Lochton, would have loved this spin. But I had to convince the principal first.

  I called him after the weekend, and his secretary put me right through.

  “Dr. Small, nice to hear from you,” Saxon said.

  “Thank you. I really enjoyed the Spring Sing on Friday night. The kids were great. And you were right—there was nothing to worry about, no more mystery illnesses.”

  “I’m not going to say I told you so, but I’m glad you enjoyed the show. How can I help you today?” he asked.

  “I wanted to follow up on that questionnaire I mentioned. It would be a great opportunity for you to help other principals who might have to deal with this type of incident. It’s just one page with a few questions for the parents. The kids don’t have to be involved at all. You and your school would be helping a lot of other school systems.” I tried to play down the idea that we’d be doing a research study and appeal to his sense of altruism, as well as his ego. It worked.

  “I guess that sounds reasonable. It would be nice to help other schools, and since it won’t involve the students directly, I think I can get it past the board. Can you get me a copy of the questionnaire?”

  “No problem. I’ll send one over today.” Maybe there was a future for me in research after all. If not, perhaps I had a shot at elementary school politics.

  With numerous phone calls and persistence, I eventually got an 80 percent response to my questionnaire. I had a statistician help me analyze the results, and my hypotheses proved to be true. The outbreak definitely had the characteristic features of mass hysteria. And early loss—a death within the family or parental divorce—was significantly more frequent in students who got sick than in those who did not.

  I was thrilled. My first attempt to publish a study succeeded, and I got it into a fairly good journal.

  It was interesting to note the reaction of the medical community itself to my findings. I remember presenting my paper to the medical staff at Harvard’s Massachusetts General Hospital Research Symposium. When I reported that mass hysteria consistently affected girls more than boys, many of the scholars and clinicians actually hissed and chuckled. Whenever I described the gender differences in hysteria symptoms, it often seemed to stir up a charged response from both scholars and families of victims. Years later Harvard’s Larry Summers lost his presidency there for suggesting, at an academic conference, that “innate sex differences” might explain why fewer women have successful careers in science. I made sure that when I talked about women being more prone to mass-hysteria symptoms I was merely reporting the news, not editorializing. The studies proved it so, but no one really knew why—perhaps it had to do with girls having closer fri
endships and tighter social networks, or maybe they were just more likely to talk to one another about their feelings than boys. Adolescent boys tend to hold their feelings inside and tough it out, the way they envision their fathers would behave.

  Almost exactly two years after the mystery illness in the suburbs, a strikingly similar outbreak struck a different Boston suburb: another chorus rehearsal, kids fainting and being rushed to the hospital, and lots of worry about environmental toxins. Again the kids got better quickly, and before I could even get out there, the school decided to go ahead with the actual performance that very evening. However, soon after the kids began to sing, a new wave of nausea and fainting spread through the chorus. Ambulances and fire trucks stirred up the hysterical crowd of parents as the sickest kids were rushed to the hospital for the second time that day. Once again, all the children recovered in a few hours, and, like most mass-hysteria outbreaks, mostly girls were afflicted.

  Before rushing down to another principal’s office, I decided to get some advice from one of the top psychiatric researchers in the country. Gerald Klerman had returned to Harvard after a stint at the National Institute of Mental Health, and I was able to meet with him that afternoon. I summarized the current mystery school illness, as well as the events and study I’d conducted two years earlier. He told me to forget about dealing with the school this time and go straight to the local health department. Health officials have a mandate to get to the truth; the school system, on the other hand, is usually more interested in not making mistakes and covering its tracks. What Klerman said seemed so obvious to me now—I wished I’d had that conversation with him two years earlier.

  The health department was delighted to have me join their team—a Harvard psychiatrist with real experience in this type of epidemic would be an asset to its investigation. They were happy to help me with any research study I wanted to do, as well. They made me an ad hoc health investigator, giving me full access to all school and hospital records.