An Unbearable Sweetness
Outbreaks of epidemic hysteria are not restricted to children and schools. They have been documented in adults too. One systematic review of cases of epidemic hysteria identified seventy outbreaks that occurred between 1973 and 1993 and found that 50 percent of them took place in schools, 40 percent in small towns and factories, and only 10 percent in other settings.15 The outbreaks usually involved at least thirty people, and often hundreds. Most outbreaks lasted less than two weeks, but 20 percent lasted more than a month.
One of the more improbable examples was the case of the “phantom anesthetist of Mattoon.” In 1944, over a period of a few weeks during the climax of World War II, many adult residents of Mattoon, Illinois, became convinced that an “evil genius” was on the loose in their town of fifteen thousand people. This unseen person would open bedroom windows and spray victims with a “sweet-smelling” anesthetic gas that would temporarily paralyze them but, strangely, leave others in the same room unaffected. Citizens banded together to form armed patrols, but the anesthetist was never caught. The local sheriff, fearing that an innocent person might be shot, eventually ordered the posses to disband. As one investigator of this outbreak dryly noted, “The ‘gasser’ hypothesis asserts that the symptoms were produced by a gas which was sprayed on the victims by some ingenious fiend who has been able to elude the police. This explanation…is widely believed in Mattoon at present. The alternative hypothesis is that the symptoms were due to hysteria.”16
Another, more recent case occurred in 1990 among the Triborough Bridge toll employees in New York City. On February 16, workers began to complain of headaches, abdominal discomfort, dizziness, and throat and chest pain. More and more workers came down with the same symptoms over the next several days, with some of the ill workers noting what they described as a “sweetness” in the air. Symptoms were reported when workers were inside or near a toll booth, but they would subside soon after workers left the booths. The outbreak ended on February 22, when some of the workers’ superiors sat with them at the tolls. By that time, thirty-four workers had become ill enough to go to the hospital, and many others shared their symptoms. After spending hundreds of thousands of dollars searching in vain among dozens of potential culprits for a physical cause of the symptoms, it became clear to many that the illness was psychogenic. It forced 44 percent of the female workers to go to the hospital, almost twice the proportion of male workers with debilitating symptoms.
These cases share many characteristics of MPI. The symptoms tend to pop up in and spread through highly connected communities (with high network transitivity). These communities tend to be isolated and stressed. A physical culprit is seldom found. In most cases, the majority of those affected are women. It is not clear why the incidence in women and girls is higher, but it is possible that because women are inclined to discuss their symptoms, more sympathy cases result in other women. The fact that women have a more sensitive sense of smell might also play a role.
For some reason that is not well understood, smells, both real and imagined, are frequent triggers of modern outbreaks of MPI. This may have to do with the well-established connection between olfaction and emotions. Experiments have demonstrated that smell and emotion are both regulated by a part of the brain called the orbitofrontal cortex.17 Experiments have also shown that memories evoked by smell induce stronger emotions than those evoked by verbal descriptions of the same odor.18 Words are powerful, but one familiar whiff can jolt the mind into the past with more emotional intensity than can a signal from any other sense. This is called the Proust phenomenon, after the author who described a poignant memory inspired by the scent of a cookie. Smelling a perfume associated with a happy memory leads to more activity in the amygdala (a part of the brain involved in emotion and emotional memory) than seeing the bottle that the perfume comes in.19
Paradoxically, the presence of official personnel—whether police officers, rescue workers, scientific investigators, or government officials—often worsens the epidemic, for it reinforces the belief that something serious is going on and that the situation is potentially dangerous. When these same officials attempt to provide reassurance that the situation is safe and that no cause was found, it typically generates deep suspicions among the emotionally charged populace that a cover-up is under way, especially because the official response was previously so substantial. Paranoia can spread too, undermining the very authority that is needed to bring an end to such an episode.
The recommended treatment for MPI outbreaks focuses on social networks and recognizes that social ties are the medium for spread. The psychological guidelines for emergency workers include “providing reassurance…using a calm and authoritative approach” and “separating those who are ill from those who are not.”20 As one expert put it, “You can only stop these things by being honest…. I could get caught up in this kind of thing too, as a parent or just a person. We all could. It’s a very powerful thing, and it needs to be respected and understood. And health officials shouldn’t be so scared to call a spade a spade.”21
It’s often difficult to establish why exactly these epidemics start. Just as an unfamiliar noise can trigger a cattle herd to start running, many triggers can cause emotional stampedes. However, it is usually fairly simple to identify the initial cases. For example, in the African laughing epidemic, even though the investigators could not explain why it started, they easily located the first girls to have symptoms.
It only took a few people to start La Ola in the stadium in Mexico City or to get passersby to stop and look up at a window in New York City, and the same is true of MPI outbreaks. When a small group of people begin acting in concert or experiencing similar, visible symptoms, the epidemic can spread along social-network ties via emotional contagion, and large groups can very quickly become emotionally synchronized.
The present obsession with nut allergies in the United States may be a case in point. The number of schools declaring themselves to be entirely “nut free” is by all accounts rising. Nuts and staples like peanut butter are prohibited from campus, and so are homemade baked goods and any foods without detailed ingredient labels. School entrances have signs admonishing visitors to wash their hands before entering to safeguard students from possible contamination.
Approximately 3.3 million Americans are allergic to nuts, and even more, 6.9 million, are allergic to seafood. However, all told, serious allergic reactions to foods cause just two thousand hospitalizations per year (out of more than thirty million hospitalizations nationwide). And, at most, only 150 people (both children and adults) die each year from food allergies. Compare that to the fifty people who die each year from bee stings, the hundred who die from lightning strikes, and the forty-five thousand who die from motor vehicle accidents. Or compare that to the ten thousand children who are hospitalized each year for traumatic brain injuries acquired during sports, or the two thousand who drown, or the roughly thirteen hundred who die from gun accidents. Yet there are no calls to end athletics. There are likely thousands of parents who rid their cupboards of peanut butter but not guns. And more children assuredly die walking or being driven to school each year than die of nut allergies.
The question is not whether nut allergies exist, or whether they can occasionally be serious, or whether reasonable accommodations should be made for the few children who have documented serious allergies. The question is, what accounts for society’s extreme response to nut allergies? Not surprisingly, the response bears many of the hallmarks of MPI. A few people have clinically documented concerns, but others who do not then copy the behaviors of those who do. Anxiety spreads from person to person to person, and a sense of proportion and the ability to be reassured are lost.
Well-intentioned efforts to reduce nut exposure actually fan the flames since they indicate to parents that nuts are a clear and present danger. This encourages more parents to worry, which fuels the epidemic. It also encourages more parents to have their kids tested, thus detecting mild and meaningless allergies to nuts. And, finally, this encourages still more avoidance of nuts, which may actually lead to a rise in true nut allergies because lack of exposure to allergens early in life is thought to contribute to the onset of allergies later.22
MPI is a pathological phenomenon, but it takes advantage of a nonpathological process that is fundamental in humans, namely, the tendency to mimic the emotional state of others. Real laughter also can be contagious and so can real happiness. But comparing epidemic hysteria to these more normal processes is like comparing the stampede of a herd to its more usual and orderly migration.
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