Gary Small & Gigi Vorgan Read online

  I was able to meticulously review the health records of all the students afflicted, and this time I distributed study questionnaires to both the kids and parents. Thanks to the health department, the response was 100 percent. The study confirmed that all the typical characteristics of mass hysteria were present—fainting and hyperventilation, rapid onset and remission of illness, girls affected more than boys, and spread of symptoms by observing them in others—strongly arguing against a physical epidemic.

  There was, however, an interesting twist to this outbreak. Two days after it occurred, the hospital’s laboratory disclosed that urine samples from thirteen of the sick children contained a chemical compound found in insecticides, plastics, and disinfectants.

  Despite the community anxiety about environmental contaminants, many parents were surprisingly relieved to learn about the laboratory reports of toxins in the urine of the children. They wanted to latch on to that explanation rather than consider the possibility that the kids’ minds had made them sick. But weeks later, sheepish officials announced that no toxin had been found in or around the school. As I reported in the New England Journal of Medicine article describing the study, it was the plastic containers in which the urine samples had been stored that had leached the toxin into the samples. All the urine samples that were stored in glass containers were clean. This intermingling of physical and psychological evidence became typical of the dozens of mystery illnesses I studied over the years.

  In all the mass-hysteria episodes I’ve studied and written about since then, the lingering question for me is why they don’t happen more often. The essential ingredients—groups under psychological and physical stress, perhaps hungry, tired, or both—come together almost daily all around the world. So what is that ultimate trigger that pushes people over the edge and lets their minds take over their bodies en masse? I’m still searching for the answer.

  CHAPTER FIVE

  Baby Love

  Winter 1981

  DURING MY LAST YEAR AT HARVARD’S Mass General, I landed the position of chief resident of the consultation service. I supervised a group of less experienced residents in the day-to-day care of medical patients with psychiatric problems. I quickly learned that just because I had this fancy title and a larger office with a view of the Charles River, my Ivy League trainees—only one year behind me—weren’t convinced that I had all that much to teach them. They saw me more as a big brother than a supervisor.

  The residents I got to know best were in my year of training. We learned about one another, and about ourselves, in our notorious little therapy/training group, or T-group. Led by a senior psychoanalyst, the group, which met weekly, was meant to teach us group-psychotherapy techniques by putting us through it. It wasn’t really a therapy group per se, but for most of us, it ended up being therapeutic.

  One guy in my T-group who I hung out with a lot was Jim Schaeffer. He was a few years older, since he had worked in a research lab before coming back and doing his psychiatry residency. I admired his ability to be candid with his feelings about people in the group. If he didn’t like somebody, he’d let that person know it. Jim came from big money but wasn’t obnoxious about it. He was quick-witted and had a competitive streak that sometimes got out of control. He also had quite a reputation as a womanizer.

  Our T-group had just ended and Jim and I were walking back to the clinic building. Jim said, “I can’t believe what a moron Mike Calhoun is. His backstory is such bullshit that even he wasn’t buying it.”

  “Are you saying you don’t think he was a NASCAR driver after his rock band toured Europe and he gave it all up to be a psychiatrist? I can see all that happening,” I said, laughing.

  “And what about Arlene?” he asked, referring to our group leader. “Is it me, or does everybody want to go home with her and get tucked in at night?” He suddenly looked at me and said, “Gary, don’t turn around, but Pam Sefton is walking toward us. God, she is one hot O.B. How’s my hair?”

  I turned to check her out, and before I could tell him she wasn’t my type, Jim spoke up. “Hey, Pam, what’s happening? Looking good.”

  She smiled, “Hi, Jim. Always good to see you. Gary, I’m glad I ran into you. I saw on the board that you’re covering the O.B. clinic for psychiatry this afternoon.”

  “You dog,” Jim muttered under his breath.

  “In fact, Gary, could you walk with me for a few minutes? I want to discuss a patient with you.”

  “Sure, Pam,” I said. “See you later, Jim.”

  “You two have fun now. Don’t do anything I wouldn’t do,” he said as he walked away sulking.

  Once out of Jim’s earshot, Pam said, “Jeez, what’s with that guy? He’s all over me like a cheap suit, and he doesn’t even know me.”

  “What can I say—he has a warped sense of self. So, tell me about this patient.”

  “Her name is Anne Drexler. She’s in her mid-twenties and almost ten weeks pregnant, but I just got back a negative test result.”

  “So she miscarried?” I asked, stating the obvious.

  “Yes, for the third time,” Pam said.

  “You must see a lot of these cases. Why do you need me?”

  “She’s so into having a baby that I’m concerned she’s going to freak out when I break the news. I’d feel a lot better if you were there for backup. She’s coming to my clinic in an hour.”

  Mass General’s obstetrics clinic was in one of the new structures nestled among the potpourri of architectural styles that made up the medical center. During my hurried trek through the maze of corridors and shortcuts over to the clinic, I had to answer a page that tied me up for a few minutes. By the time I got to the exam room, it was obvious that Pam had already delivered the unpleasant news.

  Anne Drexler was agitated. “That can’t be! I’ve been through this too many times before. I just can’t lose another baby.” She started to cry, and Pam handed her a tissue box. Anne slapped it away.

  I entered the room and said, “Hello, Anne. I’m Dr. Small, one of the hospital psychiatrists.”

  When Anne heard the word psychiatrist, she really started to wail. “I don’t need a psychiatrist, I need an obstetrician who knows what the hell she’s talking about!”

  “Look,” Pam said, fed up, “lab tests are lab tests. You can believe what you want. I have to see other patients. I suggest you talk with Dr. Small.” Then she left abruptly.

  So much for Pam’s bedside manner.

  Anne stood up and began collecting her things to leave.

  “Please, Anne, don’t go just yet. Let’s talk for a minute.”

  She glared at me. “Talk about what? I look pregnant. I feel pregnant. Obviously there’s something wrong with the doctors and labs in this hospital.”

  Anne was in denial. She was so wrapped up in the idea that she was pregnant that even the hard evidence of laboratory results indicating a miscarriage couldn’t shake her conviction. I needed to make a quick maneuver to get through to her, so I tried to convey empathy and hoped she’d respond.

  “I can understand how you feel, Anne, and I think you should definitely get another opinion.”

  “Thank you, Dr. Small. That’s the first sensible thing I’ve heard around here.” She sat back down on the exam table. “You know, my feet are so swollen, I could use a minute to rest.” She rubbed her eyes, and I noticed how striking they were—large, piercing, and hazel.

  “Sounds like you’ve had quite a day,” I said.

  “It actually was pretty good until this appointment. I can’t believe how completely wrong Dr. Sefton is. I mean, in my family the women are so fertile, you just look at us and we get pregnant.”

  “Really,” I said as I instinctively looked away.

  “My mom was only nineteen when she had my oldest sister, Karen, and a year later Valerie was born. Karen had three kids right after she got married, and Valerie’s twins are due any day now.”

  “So there are a lot of babies in your family,” I said.
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  “Yeah. And now I’m having one too.” She stood and stretched her lower back, emphasizing her protruding abdomen. “Look, Dr. Small, you’re a nice guy, but I don’t need a psychiatrist. I’m actually a therapist myself. I got my marriage and family counseling degree two years ago. What I need right now is an obstetrician who knows what she’s doing.”

  I handed her my card and said, “If you ever just want to talk—about anything—give me a call.”

  As I headed back to my own clinic, I figured I would never hear from Anne. Though she was in denial now, she’d probably come to her senses after a second opinion confirmed Sefton’s diagnosis. From what little Anne had told me about her life, I could understand why it was so difficult to face the pain of another miscarriage. Her older sister with her three kids was probably getting lots of attention, and now that her other sister was having twins, Anne’s ovaries must have been feeling the competition to step up and deliver.

  THAT NIGHT I MET JIM FOR DRINKS at the Harvest, a popular restaurant in Harvard Square. We managed to find two stools at the bar and ordered some beers. On the TV, the Celtics were playing the Lakers, and as an L.A. boy, I was completely outnumbered by Boston fans. Jim was taunting me because the Celtics were up by nine, but we could hardly hear the game anyway, since the music was blaring and so many people were jammed into the little space, milling around and scoping one another out.

  Jim sipped his beer and asked, “So how did you make out with my true love, Pamela Sefton?”

  “I think she really likes you, Jim. I could tell by how she ran the other way,” I said with a smile.

  “She just hasn’t tried the Schaef-man.” He laughed. “But what was this big case she needed you for?”

  “Oh, some twenty-five-year-old who had her third miscarriage. Pam couldn’t handle delivering the news herself,” I said.

  “So how did the patient take it?” Jim asked.

  “Not well. In fact she didn’t believe it and wants a second opinion,” I said, taking a sip of my beer.

  “So she was in denial?” he asked. I was beginning to get his attention.

  “Completely, and I can understand her disappointment. To me she looked more than ten weeks pregnant—her stomach was bulging, she had that glow thing going on, and she looked so sad.”

  Jim leaned back and said, “Boy, are you clueless.”

  “What do you mean?” I asked.

  “Ever heard of pseudocyesis, you moron?” he asked.

  A lightbulb lit up in my tiny brain. “If you mean hysterical pregnancy, just say so.”

  “What were you thinking?” he asked, incredulous.

  “Okay, so maybe I wasn’t thinking and you’re the psychiatric genius at this bar,” I said, embarrassed. “I’ve got to get her old charts and check this out.”

  “I hope you got her to come back and start therapy,” Jim said.

  “Well, I gave her my card, but she told me she was an MFCC and didn’t need a shrink.”

  Jim slammed his hand on the bar. “That’s so rare. She was a real find—a mental health professional with pseudocyesis. I would have jumped all over that.”

  “You jump all over anything with a pulse.”

  “No, really, Gary. You have to be more aggressive, man. She’ll never call you now.” He laughed. “I may have to report you to the psychiatric police.”

  I laughed too but felt humiliated and realized that I had blown it with Anne Drexler. Anyway, maybe she really had been pregnant and Jim was wrong.

  Pseudocyesis, also known as false or hysterical pregnancy, is an extremely rare condition but one that has been documented since antiquity. In 300 B.C., Hippocrates reported twelve cases, and in the sixteenth century, Queen Mary of England had several episodes. In hysterical pregnancy, all the typical signs and symptoms of a real pregnancy can occur: morning sickness, breast tenderness, sensations of fetal movements, and weight gain. The woman’s abdomen might expand the same way it does during a normal pregnancy, so she really does look pregnant. The patient stops menstruating and becomes convinced that she is pregnant. Hormonal imbalances often contribute to the physical symptoms and result in false-positive pregnancy tests. Stress can sometimes alter pituitary gland function, resulting in an increase in the hormone prolactin, and as a result, the patient will produce breast milk even though she is not pregnant. In fact, the symptoms can be so convincing that an estimated one out of five women with pseudocyesis get diagnosed as pregnant at some point by a medical professional.

  What I find most interesting about the condition is its underlying psychological causes. What could drive a woman who is not otherwise psychotic to make her body change to the point that she is convinced she’s pregnant? Often she is desperate to become pregnant—her self-esteem and identity might be tied up in having a baby, or at least carrying one in her uterus, or it might help her to overcome loneliness or gain attention. For some infertile women, the sense of biological failure pushes their minds to trick them into a hysterical pregnancy. And for others, pregnancy gives them power—the power to procreate or to keep a man.

  The next couple of weeks went by quickly. I was busy attending seminars, seeing patients, and finishing a research paper. I was in my office preparing notes for my Thursday-afternoon teaching rounds when the phone rang; it was Anne. I was happy to hear from her, but she was sobbing so hard I could barely understand her. “Take a deep breath and slow down, Anne,” I said.

  “I got my period! I’m not pregnant! That bitch Sefton was right.” She paused to blow her nose. “I have nothing to live for…” That definitely caught my attention.

  “How soon can you come in? We need to talk.” It crossed my mind that it would bring my oh-so-superior buddy Jim down a notch to know I’d gotten the patient back after all.

  Two hours later, after my teaching rounds, Anne dragged herself into my office looking haggard and sad. She was thin and showed no signs of pregnancy.

  “Please, Anne, sit down. Tell me what happened.”

  She sat on the sofa and looked at me. “Dr. Sefton was partly right, but I never was pregnant. I just wanted it so badly that my mind made me feel like it was really happening. I’m a therapist, for God’s sakes. I should know better. I know how crazy people are when they want something they can’t get.”

  “Go on,” I urged her.

  “But for me it was so bizarre. I could’ve sworn I felt the baby kicking. Now my new doctor says it must have been gas. How can that happen?”

  “Sometimes we want something so much that our minds trick our bodies into believing it. Tell me why you want to be pregnant so much.”

  “I’ve always wanted to be a mother, and it’s just not fair that there are so many babies in my family and I don’t have one.”

  “I remember you mentioned your sister was going to have twins. Did that happen yet?” I asked.

  Anne burst into tears. “Yes—a boy and a girl. And they’re adorable. Valerie’s so lucky, I hate her.” I handed Anne a tissue. She blew her nose and continued, “And I can’t stand Karen and her three perfect little angels, either.”

  “Sounds like there’s friction between you and your sisters,” I said.

  “No kidding. But they’re so blissed out that they don’t even notice it. Nobody notices me anymore.”

  We were really getting into something here. Anne had finally accepted the reality of her situation and was willing to explore what might be driving it.

  “When did you start feeling like this?” I asked.

  “I don’t know. I guess when we were little, I was the baby and I got treated special—everybody thought I was so cute and precocious. I always felt like I was Mom’s favorite. And my sisters would fight over who got to babysit me.”

  “When did that change?”

  “It was gradual. I guess by the time I got into middle school, I wasn’t the cute little baby anymore. Karen was ‘the pretty one,’ Valerie was ‘the funny one,’ and I didn’t know what I was.”

  “So you no
longer felt special. How did you cope with that?” I asked.

  “I worked really hard in school and became ‘the smart one.’ But it turns out nobody cared—especially when my sisters got married straight out of high school and started popping out babies. My parents couldn’t have been happier with that. Then they started worrying about me, their poor spinster daughter, going to college to be a therapist.”

  “Did you ever get married?”

  “Gordon and I have been living together for five years. We don’t believe that a piece of paper will make us any more committed to each other, and frankly, I resent that my family is more concerned about that piece of paper than they are about me.”

  “If Gordon wanted to get married, would you?” I asked.

  She started crying again. “I don’t know, maybe. But it would just be to get my mom off my back. Or maybe I do want it. I don’t know! But I want a baby more, and we can’t seem to have one.”

  Anne went on to tell me about her miscarriages and how she hadn’t told her parents after the first one because they were so disappointed—not for her, of course, but because they were denied another grandchild. Despite her problems with infertility and concerns about Gordon possibly leaving her if she couldn’t have a baby, she still managed to keep a busy psychotherapy practice specializing in adolescents. It struck me that it was during Anne’s adolescence that her insecurities about her identity emerged. It was probably no coincidence that she chose to specialize in treating adolescents.

  Many mental health professionals are drawn to the field in part to resolve their own personal struggles. I’ve known anorexic-looking psychiatrists who focus on patients with eating disorders, hypomanic psychologists who run mood-disorder clinics, and obsessive therapists who focus on treating obsessive-compulsive disorders. Some of these individuals, especially those who have overcome their personal struggles, are better therapists for it, because they have more empathy for their patients who are going through what they themselves have experienced. Other therapists, still grappling with their issues, might find that their patients’ problems are too close to their own, and it can interfere with their ability to help.