The Globe and Mail
The Mad Anesthetist, as a Chicago newspaper dubbed him, struck one evening in September, 1944, in the small town of Mattoon, Ill. In her account to police, his first victim, a stay-at-mom named Aline Kearney, said someone opened her bedroom window and sprayed a sweet-smelling gas that paralyzed her. Word spread over the next week, and more nocturnal attacks were reported.
The victims – more than 25 in all – described being suddenly stricken with nausea, vomiting or paralysis, usually, though not always, after a strange smell. Citizens took to sitting on their porches at night, shotguns on their laps, watching for the elusive prowler. FBI agents were called to Mattoon. “State Hunts Gas Madman,” read one headline.
From the beginning, there were holes in the criminal-mastermind narrative. The lack of a motive, for one, since nothing was ever stolen. The victim’s dogs didn’t bark, and no trace of a prowler was found. The gas itself was also problematic. It needed to be powerful enough to cause temporarily paralysis, weak enough that not everyone in the house was harmed and leave no trace.
Indeed, an analysis of the case, written up the following year in the Journal of Abnormal and Social Psychology, concluded that the logical explanation for these extraordinary events was not “some ingenious fiend,” but what scientists now call, a mass psychogenic illness. A mix of shared symptoms, brought on by stress, worry and emotions rather than a physical cause, had spread unconsciously through a socially connected group of people. As the author of the paper, Donald M. Johnson observed, those involved didn’t "realize the intensity and variety of effects produced by psychological forces.” This was not, however, a possibility the victims cared to discuss, Mr. Johnson noted. Judged to be lying or hysterical, and mocked in the news, he writes, they felt victimized twice over.
The misconception that people who experience physical symptoms for psychological reasons are fakers, work shirkers and malingerers – or just plain weaklings – is not only scientifically flawed but harmful to patients and costly to the medical system. And this stigma sticks, despite years of public-awareness campaigning, stress research and a modern understanding of mental illness.
Jump ahead more than half a century to the lawsuit filed by the Canadian diplomats who served in Cuba and are now suing Ottawa for $25-million, for harm wrought by what’s come to be called the Havana Syndrome. As their claim states, suggestions that their physical symptoms may have been stress-induced left the families in the lawsuit struggling with rumours “that they were faking it, or that their injuries were not real, compounding their injuries with reputational harm.” In allegations yet to be proven in court, they claim the government minimized their symptoms, was slow to respond and “created a narrative" that they were “suffering from mass hysteria,” itself an outdated term with belittling connotations.
“I know this is real and I’m going through this,” one former embassy staffer said, in a previous interview with The Globe and Mail. “And that language is very destructive and devastating.”
Another diplomat called the suggestion “ridiculous,” adding, "You’re talking about people who’ve been through military coups, states of emergency, cyclones, who have evacuated huge numbers of people in crisis … It’s the most resilient group you could have.”
But neuroscientists, psychiatrists and sociologists following the case suggest that it’s legitimate – and not dismissive – to consider a psychosomatic diagnosis. Stress, as a mountain of research now shows, is a powerful force on our bodies, wreaking havoc with our nervous systems and, often, as invisible to us as gravity. A book to be published this fall, based on an analysis of the case by a pair of experts, will argue that a “collective stress disorder” is, indeed, the most likely scientific explanation for what happened in Cuba.
In Cuba, the Canadians diplomats began to feel sick – struck by headaches, dizziness, loss of concentration, unexplained nosebleeds – shortly after their American colleagues also reported similar symptoms. They described hearing strange sounds prior to becoming ill, for which no clear source has been found. Rumours spread that the diplomats were facing some kind of attack from a foreign government. (The statement of claim says they are “clearly a victim of new weaponry,” which is “extremely frightening.”) But, far as the public record states, no such weapon has been discovered. An RCMP investigation on the ground found nothing. One American theory – that the symptoms were caused by the noise made by cicada beetle – was discounted after a pair of FBI agents visited the home of a leading cicada expert and were told that physical damage could only result from physically placing the bug in a victim’s ear.
The idea that a tight-knit community, duly alarmed about a rumoured source of harm, might spread the physical symptoms of stress like a cold virus is arguably less fantastical than a noisy beetle.
“The human brain is flawed, it is easily fooled” says Robert Baloh, a neurologist at the UCLA Medical Center in California, and the co-author of the upcoming book on the Havana Syndrome. “Everyone is susceptible.”
In May, 2004, a man stepped off the 98 bus in downtown Vancouver. “How’s your day going?” he was overheard asking the bus driver, and when the bus driver answered positively, the man made this vague comment: “It won’t be for long.” Several stops later, the bus driver felt sick and vomited and, fearing a chemical attack, called emergency services. Two paramedics arrived, and also began to feel ill. Rumours spread that a terrorist attack was involved. A witness description of the mystery man on the bus suggested Middle Eastern descent. A crowd of passengers and journalists were quarantined. A team of RCMP investigators were brought in to conduct tests of the bus, but found nothing.
“All they found was an acorn under the seat,” says John Blatherwick, who was then Vancouver’s chief medical officer, one of the longest serving in the country. “They tested the hell out of it and found nothing.”
Dr. Blatherwick went public with his assessment that the incident was a mass psychogenic incident, putting him at odds with the police. In a familiar refrain, one investigator argued that senior ambulance attendants, who have "seen everything,” couldn’t succumb to something "all in their heads.”
However, as Dr. Blatherwick noted, one of the paramedics who had become sick had never even gotten on the bus; the theory became, he says, that their partner had somehow spread the toxin by coughing on them. Meanwhile, others who did get on the bus didn’t get sick. In the end, more testing of the bus found methyl chloride in one of the filters of the bus. “Look up methyl chloride,” Dr. Blatherwick says in an interview. “It’s used to make bus seats.” Two years later, Vancouver police closed the file; no suspect was found.
Cases of mass psychogenic illness have been recorded across cultures for centuries. Over time, however, the nature of the complaints have changed. The uncontrollable seizure-like dancing reported across European towns around the time of the Black Plague was credited to demonic possession, among other theories. More recently, environmental “toxins" are the trending culprit, and symptoms such as headaches and dizziness have become more common than seizures and paralysis. In 2000, for instance, a teacher at a school in Tennessee reported smelling a gas-like odour in her classroom, resulting in nearly 150 student and staff falling ill, many of them rushed to hospital in an ambulance; after a thorough investigation of the school and nearby property by multiple government agencies no evidence of a contamination was found. Similar cases have prompted the term “sick building syndrome,” where one individual may be exposed to a chemical or toxin, but the symptoms spread to their co-workers.
Psychogenic events are often framed by the anxiety of the day, says Robert Bartholomew, a New Zealand-based sociologist who has been studying mass psychogenic events for decades, and is the other author of the Havana Syndrome book.
He has investigated the cases in Illinois, in Vancouver and Cuba, among many others. At the time of Vancouver’s toxic bus, fear of terrorists attacks were heightened. (Dr. Blatherwick says his officer was getting weekly calls about suspicious white-powder packages.) The Mad Anesthetists arrived amid worries that Nazi spies were infiltrating the United States to launch gas attacks.
And that framing, he suggests, happened in Havana, as well. With Dr. Baloh, his conclusions are based on an analysis of scientific findings as well as media reports, and interviews with U.S. embassy staff. For instance, he points out, the diplomats in Cuba had historically been the target of unsettling spy games – waking up to television turned on in their homes, items out of place. A sonic attack or a harmful surveillance device sounded possible in context, only becoming questionable later when engineers and sound experts weighed in.
Dr. Bartholomew argues, “It is the equivalent of someone waking up in the middle of the night to a noise in the attic, and immediately assuming it is ghost, rather than calling the plumber.”
But the thought of being under attack, with no means to prevent it, and with their families potentially in danger, Dr. Bartholomew says, was a reasonable source of stress. Any critical questioning, he says, should not be seen as undermining their personal stories.
“I am very sympathetic,” he says. “They are victims.”
What they are not doing, he argues, is faking.
In the Havana Syndrome case, a team of researchers who studied the American diplomats reported that they found evidence of concussion-like symptoms without a concussion. The paper, published in JAMA, was controversial. Dr. Baloh, for instance, says he was given the paper to review, found the science questionable, and told the journal it should be rejected. A team of experts argued, in a responding letter to the editor, that cognitive tests had been interpreted too broadly and had captured brain differences within the group, and not damage. One complication, not unique to this case, is that researchers did not have a “before” picture to compare with test results, which were taken several months after the first reports of symptoms. In a published reply, the authors of the paper stood by their findings, while acknowledging the results were “preliminary” and more testing was needed.
But the paper also appeared to equate malingering to psychosomatic symptoms, and suggest the patients could be excluded from the latter diagnosis because they were keen to return to work – thus, as several other letter writers noted, furthering perpetuating a myth about somatic disorders. A subsequent paper in Miami also met with controversy. Dr. Baloh says the study overstated the conclusions that could be drawn from certain tests, including one related to the inner ear that he had helped design himself.
At the same time, Dr. Baloh makes clear, “This is as real as a brain tumour.” In fact, he suggests, “psychogenic pain can be worse than damage from an injury. The medical community doesn’t seem to understand this.”
The doctors who treat these complex patients – often with a combination of psychological and physical therapies, and medication – say these misconceptions feed skepticism from family and doctors, and lead to delays in treatment. (Post-traumatic stress disorder, for instance, is a common cause of physical symptoms – are the soldiers who return from war suffering from PTSD also weaker of character?) Patients with somatic disorders account for as many as 20 per cent of family-doctor appointments. They often make repeat emergency-room visits, and bounce between specialists who can find no clear medical cause for their symptoms.
Even patients themselves often resist the idea that what feels solely like a hardware problem could be a software glitch. But what they experience is a version of a lump in the throat or butterflies in the stomach, both unconscious physiological responses to sadness or nerves. When the stress is chronic enough, or the repressed trauma severe enough, the body never releases the lump, or the butterflies. In severe cases, that stress “converts” into serious symptoms such as seizures, paralysis, choking and even blindness, all distressingly real.
While modern brain science and stress research is expanding our understanding of how this happens, conversion disorders aren’t a new diagnosis. The condition was first identified at the turn of the century in Europe, when Sigmund Freud and psychologist Pierre Janet famously connected these seemingly physical symptoms with psychological distress. The doctors suggested treating patients correspondingly – with an emphasis on listening for underlying causes.
More recently, a book published last fall by two neuropsychiatrists in British Columbia coached family doctors on how to better identify and treat these often confounding patients. In Halifax, a publicly funded short-term intensive therapy program focuses on somatic disorders. These cases have also been making their way into medical journals from specialties outside psychiatry. Last May, in the Journal of Otolaryngology, Matthew Bromwich, a pediatric otolaryngologist in Ottawa, published a paper with several colleagues on three unusual cases of “conversion disorder.”
In Dr. Bromwich’s paper, two 11-year-old girls were describing dizziness that made it impossible to walk; in a third case, a 13-year-old boy had become mysteriously paralyzed following a successful surgery. In each situation, the doctors identified anxiety as serious factors, and treated the children, in large part, by validating their symptoms. Being told they were believed and that their symptoms had a legitimate cause was part of the cure.
Another case, described last summer in the Annals of Family Medicine, finds a physician treating a long-term patient, Lisa, for the occasional loss of her peripheral vision in both eyes. But an MRI, an EEG and angiography, searching for tumours or evidence of an aneurysm, found nothing. “You think I’m lying,” Lisa told the doctor, and stomped out of the appointment. But her blindness became worse, and lasted for longer periods. Finally, in a home visit, Lisa described the death of her husband, her childhood sweetheart, before their son’s first birthday – trauma she had refused to look at her entire life, a symbolic connection to her current symptoms not lost on her doctor, who prescribed relaxation techniques and antidepressants. Lisa’s blindness "still occasionally visits,” the doctor writes in the paper. But, understanding the cause, she deals with it until it passes. The paper was called: “On Blindness and Blind Spots.”
These physical symptoms are a way for the brain to process stress that has nowhere else to go, or, in some cases, past trauma that is buried out of shame. This is why Jon Davine, a Hamilton, Ont., psychiatrist who specializes in educating family doctors about somatic disorders, suggests that as society gets better at treating mental illness, cases will decline.
A team of Dalhousie psychiatrists are expected to report back on their physical exams of the Canadian diplomats later this summer. Even then, whether the Havana Syndrome is a classic case of mass psychogenic illness may remain the subject of debate. But as experts observing the case point out, there should be no shame in considering this diagnosis – that stress and trauma experienced by the body’s most powerful organ can make us physically sick isn’t a character flaw, it is what makes us human. And as a trio of European experts noted in a letter to the Journal of the American Medical Association, not even “hardworking diplomatic staff” would be immune.
With reports from Doug Saunders
Editor’s note: An earlier version of this article stated Dr. Robert Balow worked at the Cedars-Sinai Medical Centre. In fact, he works at the UCLA Medical Center.