Culture-Bound Psychosomatic Syndromes

Suzanne O’Sullivan is an Irish neurologist who traveled the world to investigate mystery illnesses and epidemics of mass hysteria. In her book The Sleeping Beauties And Other Stories of Mystery Illness she recounts fascinating stories and redefines what it means to have a psychosomatic illness. She explains how making social problems visible on the body allows voiceless people to make themselves heard.

The Sleeping Beauties

The Sleeping Beauties of the title refers to a strange epidemic of “resignation syndrome” in Sweden. Refugee girls from the Yazidi ethnic minority indigenous to Iraq, Syria, and Turkey have been repeatedly denied refugee status in Sweden and have been left in limbo. They react by becoming immobile, limp, and nonresponsive. They are not catatonic, comatose, malingering, or asleep. Extensive medical evaluations in hospitals have not revealed any physical or physiologic abnormalities. They do not eat and must be kept alive by tube-feeding. Eventually they may recover after being granted asylum. This does not fit the traditional picture of a psychosomatic illness; it requires consideration of the entire biopsychosocial picture. These children are unconsciously playing out a sick role that has entered the folklore of their small community.

Grisi siknes

This bizarre Swedish illness is not unique. It is reminiscent of epidemics of mass hysteria elsewhere. In the Miskito community of Nicaragua, the symptoms of “grisi siknes” are a way of expressing conflict and asking for help. The symptoms are plastic; it is highly contagious, shaped by suggestion and expectation, and it can spread like wildfire. It typically starts with one child and can quickly affect a whole school. They may attribute it to “demons” and prefer treatment by shamans to treatment by doctors, and the shamans are more likely to effect a cure. Illness is a metaphor.

O’Sullivan explains functional neurological disorders, predictive coding, dissociation, physical processes in the brain that we have no control over, and the way the brain is primed by past learning and experience. Her explanations make a lot of sense.

An epidemic of tics in schoolgirls in Le Roy, New York

It started when a high school senior who was a straight-A student and cheerleader awoke from a nap to discover she had developed involuntary movements and verbal outbursts similar to those seen in Tourette’s syndrome. The symptoms seemed to be contagious, spreading to others in her social group and becoming more serious and disabling, with inability to walk, falls that required victims to use wheelchairs, and non-epileptic convulsions diagnosed as dissociative seizures. The diagnosis of Tourette’s became untenable, and victims were diagnosed with conversion disorder. A thorough investigation ruled out environmental toxins and infectious agents, but parents refused to accept the evidence and demanded that the authorities find a more acceptable, non-psychogenic cause. A media frenzy ensued. Celebrity investigator Erin Brockovich got involved. She scoffed at psychological explanations. The tics were blamed on the plume from a toxic spill from a train crash four miles from the school, but the train crash had occurred 40 years earlier, the toxins were not known to cause tics, and the plume had been directed away from the school, not towards it. The public trusted unqualified observers more than the experts who had done the testing. When the girls were withdrawn from the media spotlight, the outbreak quickly subsided.

Havana syndrome

In August 2017 several people at the American embassy in Cuba developed alarming symptoms including headaches, earache, hearing impairment, dizziness, tinnitus, unsteadiness, visual disturbance, memory problems, difficulty concentrating, and fatigue. Doctors who evaluated them thought they had discovered a new syndrome, a “complex brain network disorder” consistent with a traumatic brain injury. Patients reported hearing a strange noise at the onset; the noise was eventually attributed to cicadas. There was speculation that the Cubans had attacked embassy personnel with some kind of sonic weapon. Never mind that no such weapon was known to exist and sound is not known to damage the brain. The speculation was easy to believe because of a pervasive atmosphere of paranoia and distrust; Cubans were known to have spied on American embassies. There were diplomatic and political consequences.

Dr. O’Sullivan tells a chilling story about what happened. Hers is the best account I have read so far. Knowledgeable medical experts were quick to realize Havana syndrome was a mass psychogenic illness, but many doctors were just as much victims as the patients; they were caught up in the controversy and willingly denied the evidence. Articles were published in The Journal of the American Medical Association (JAMA) and other journals. It was all about the sociopolitical environment in which the story unfolded; it had benefits for the doctors who had created it and for others who had a vested interest in Cuba-US relations. It exteriorized tensions within the embassy. Staff were told to scrutinize themselves even if they felt well. Anomalies in normal scans were misinterpreted. Experts in blast injury and concussion were consulted; Havana syndrome was widely believed to be due to a sonic attack and explanations were hypothesized. O’Sullivan says:

The academic papers and public statements from the medical teams involved all toed an awkward line between admitting that they had found no proof of brain disease, while still managing to imply that an attack was a safe bet and that proof of it would come with time.

Politician Marco Rubio called the attack “a documented fact” even after the FBI said they had found no evidence for it. Havana syndrome was soon reported in China (with a different constellation of symptoms, not just in a patient but in her mother when she flew to China to support her daughter). Both were evacuated from China. Both believed their “brain injuries” were permanent. Several other members of the embassy staff reported anomalous symptoms that were attributed to Havana syndrome.

The book reports a number of other “mysterious illnesses”. The author says:

a true mass-hysteria outbreak says much more about the society in which it occurs than it does about the individuals affected.

Conclusion: I highly recommend this book

This book is well written, well documented, and the author is a darned good storyteller. It is entertaining as well as educational. It will give readers new insights into psychosomatic illnesses and mass psychogenic illnesses.

This article was originally published in the Science-Based Medicine Blog.

Dr. Hall is a contributing editor to both Skeptic magazine and the Skeptical Inquirer. She is a weekly contributor to the Science-Based Medicine Blog and is one of its editors. She has also contributed to Quackwatch and to a number of other respected journals and publications. She is the author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon and co-author of the textbook, Consumer Health: A Guide to Intelligent Decisions.

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