Hysterical Over Hysteria

'Mass hysteria hits school'

Syed Azhar and C. A. Zulkefli of The Star Online reported on April 14th that an incidence of mass hysteria had broken out in a Kota Baru secondary school with more than 50 female students and some teachers affected by it. According to the report, some students were unable to attend classes because of this incident. Some students even claimed seeing “all sorts of strange beings” in the school, from a pontianak to a pochong. The reporters believe that the state education department sent several ustaz (male religious teacher) to the school to recite Al-Quran verses and conduct prayers with the pupils and staff members. Teachers and other school staff declined to comment on the matter.

This is not the first time we have heard of incidents like this in Malaysian schools where students (mostly girls) have been affected by a bout of hysteria. In Malaysia, hysteria is still associated with paranormal activity and the person is believed to be dirasuk (possessed).

What do we really know about hysteria? How did it all start? 

Brief Hyster-y 

This condition has been exclusively associated with women for over 4 millennia. Hysteria comes from the Greek word 'hysteron' which means uterus (a.k.a. womb).

The first description referring to the ancient Egyptians dates to 1900 BC and identifies the cause of hysterical disorders in spontaneous uterus movement within the female body.

Plato, a Greek philosopher argued that the uterus is 'sad and unfortunate when it does not join with the male and does not give rise to a new birth'. I feel like slapping Plato now but you know we all make mistakes.

Hippocrates during 5th century BC is the first person to use the term 'hysteria'. He also believes that the cause of this disease lies in the movement of the uterus which he then called the "wandering womb". He asserts that a woman’s body is physiologically cold and wet and hence prone to decomposition of the humors (as opposed to the dry and warm male body). For this reason, the uterus is prone to get sick, especially if it is deprived of the benefits arising from sex and reproduction. To cure this 'sickness' a woman's canals (uh, the uterus?) has to be widened to 'cleanse the body'. Especially in virgins, widows, single, or sterile women, this “bad” uterus that is not satisfied, not only produces toxic fumes but also wanders around the body which causes various kinds of disorders such as anxiety, sense of suffocation, tremors, sometimes even convulsions and paralysis. For this reason, he suggests that even widows and unmarried women should get married and live a satisfactory sexual life within the bounds of marriage. I honestly feel like slapping Hippocrates in the face now too, but you know.

Source: Pinterest

Hysterical cures were revolutionized by Soranus, a Greek physician from the 1st half of 2nd century AD, practicing in Alexandria and Rome who wrote a paper on women’s diseases and considered to be the founder of scientific gynecology and obstetrics. Soranus theorized that women’ disorders arise from reproductive issues. Their recovery is encouraged by sexual abstinence and perpetual virginity is women’s ideal condition. According to Soranus, fumigations, cataplasms and compressions (which were previous methods of "curing" hysteria) are ineffective. Instead, the hysterical body should be treated with care by immersing in hot baths, massages and exercise are the best prevention of such women' diseases. I can only imagine he was a true romantic. 

Greek physicians was obviously obsessed with the women's womb a.k.a. uterus. I guess it was a way to explain why women were from Venus and men from Mars, physically and mentally.

Hysteria received intense attention during the late 1800s. The French neurologist Jean-Martin Charcot proposed hysteria was an inherited nerve disease, similar to multiple sclerosis, and that it was not a ‘sexual problem’ unique to women. Charcot investigated hysteria using hypnosis. In lectures he invoked characteristic symptoms in male and female hysterics by applying pressure to specific spots on the hypnotized patient’s body. Critics argued these performances testified to Charcot’s powerful influence over his patients, not the nature of hysteria. I do agree.

By the mid- to late 19th century, hysteria had come to refer to what is today generally considered to be sexual dysfunction. Typical treatment was massage of the patient's genitalia by the physician and, later, by vibrators or water sprays to cause orgasm. Hot dayumm!

The father of psychoanalysis Sigmund Freud provided a contribution that leads to the psychological theory of hysteria and the assertion of a “male hysteria” (Simon, 2014). Men get so-called hysteria too! Freud proved that he experienced it himself. His study of male hysteria eventually gave rise to his famous Oedipus complex theory (Simon, 2014). Most importantly, Freud made it very clear that psychological disorders come from the brain, not from a malfunctioning womb (Simon, 2014). 

There were many more people involved in the study of hysteria but I chose to name only some of them because this is supposed to be a brief history not a complete history. There is always Google!

 "Hysterical behavior among men were not diagnosed for social and political reasons." -  Abigail Tucker

Current Studies  

Today, the term 'hysteria' is no longer used by psychiatrists as its symptoms have been broken down into different disorders. Current psychiatric terminology distinguishes two types of disorder that were previously labelled 'hysteria' which are somatoform disorder (now known as somatic disorder) and dissociative disorder.

The somatic and dissociative disorders have a few things in common: 

1. Both may occur in response to severe stress 

2. Both have traditionally been viewed as forms of escape from stress 

3. A number of individuals suffer from both a somatic and a dissociative disorder

Dissociative disorders in DSM 5 (a diagnostic manual for therapy/mental health professionals) are patterns of memory loss and identity change that are caused almost entirely by psycho-social factors such as stress rather than physical ones.

Somatic disorders are problems that appear to be medical but are due to psycho-social factors such as stress.

Male hysteria was associated with symptoms now mostly considered to be signs of post-traumatic stress disorder or PTSD.

Hysteria was mainly associated with women but not men, seriously people? According to Tucker (2009), it’s not that the hysterical behavior among men didn’t exist. Men were as prone to nervous breakdown as women were. Hysterical behavior among men were not diagnosed for social and political reasons. Men were believed to be more sane, more motivated by reason, more in control of themselves emotionally. Ultimately it comes down to patriarchy and power (Tucker, 2009).

Mass Hysteria 

In 1374, hundreds of people were seized by an agonizing compulsion to dance in dozens of medieval towns scattered along the valley of the River Rhine (Waller, 2008). They danced for hours or days in succession only pausing scarcely to rest or eat. They were victims of one of the strangest afflictions in Western history. Within weeks the mania had engulfed large areas of north-eastern France and the Netherlands, and only after several months did the epidemic subside. In the following century there were only a few isolated outbreaks of compulsive dancing. Then it reappeared, explosively, in the city of Strasbourg in 1518. Chronicles indicate that it then consumed about 400 men, women and children, causing dozens of deaths (Waller, 2008).

Source: The British Psychological Society

Mass hysteria is also known as collective hysteria or mass psychogenic illness. It typically begins when an individual becomes ill or hysterical during a period of stress. After this initial individual shows symptoms others begin to manifest similar symptoms typically nausea, muscle weakness, fits or headache. 

Mass psychogenic illness (MPI) remains a part of the human condition even if mass dancing plagues are long gone, mob-dances are not included. According to Colligan and Murphy (1982 as cited by Waller, 2009), MPI has been defined as the ‘collective occurrence of physical symptoms and related beliefs among two or more persons in the absence of an identifiable pathogen’. Simon Wessely (1987 as cited by Waller, 2009) has usefully separated outbreaks of MPI into two different kinds: ‘mass anxiety hysteria’ and ‘mass motor hysteria’.

Mass anxiety hysteria usually involves the sudden expression of intense anxiety in response to a false threat. In Western settings, plausible fears of poisoning or exposure to toxic chemicals have been known to trigger classic stress-reactions such as fainting, nausea, weakness and hyperventilation. In an Asian setting like Malaysia, possible food poisoning may cause the same effects. In 1965 as many as 141 pupils in a school in Blackburn were affected by psychogenic dizziness, nausea, spasms and shortness of breath after several girls had publicly fainted (Bartholomew & Wessely, 2002 as cited by Waller, 2009). Unless the initial fear is given credibility by the media or authorities, cases of mass anxiety hysteria seldom last more than a few days.

Mass motor hysteria typically requires a prolonged build-up of psychological tension which then manifests itself in dissociative states, conversion symptoms and other psycho-motor abnormalities. These can persist longer for weeks or months. These kind of outbreaks are often shaped by super-naturalist beliefs that were responsible for the dancing mania and the possession crises of European nunneries. For example, in modern-day Malaysia and Singapore, factory workers are often drawn from rural communities steeped in beliefs about the spirit world (Phoon, 1982 as cited by Waller, 2009). Those who find it hard to adjust to the regimentation of factory life sometimes enter a dissociative state in which they behave in a manner shaped by their culture’s understanding of spirit possession. MPI may arise where fellow-workers share the same beliefs and are also experiencing severe psychological strain. These outbreaks are often brought to an end with a religious ritual involving the slaughter of a goat (Phoon, 1982 as cited by Waller, 2009). Or with the calling of a bomoh (Malay shaman).

In both Western and non-Western settings, mass motor hysteria usually occurs in schools. Mass anxiety hysteria and mass motor hysteria can be hard to distinguish from the effects of actual exposure to environmental hazards (Waller, 2009). Experts have therefore identified several features that are indicative of a psychogenic origin for a sudden outbreak of illness symptoms in a group of people. These include:

• the lack of a plausible organic basis;
• their occurrence in a relatively closed group;
• the prior existence of high levels of stress

In these cases, it is always necessary to test thoroughly for potential toxic or pathogenic (a medical term that describes viruses, bacteria, and other types of germs that can cause some kind of disease such as the flu) exposures. In 1990 several children at a London primary school fell sick with typical symptoms of MPI which are nausea, vomiting and abdominal pain and over-breathing. It looked like a classic case of hysteria. However, it turned out that they were actually suffering from poisoning from pesticides used on cucumbers (Bartholomew, 2001 as cited by Waller, 2009). Phew!

There have been numerous mass hysteria attacks documented throughout history such as the dance hysteria mentioned above, the case of the 4 adolescent girls that started the Salem witch trials, Würzburg nunnery and many more.

Explanations

According to Small (2010), 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 may hyperventilate or start breathing too quickly. Thus, these people exhale 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 that some victims experience. If the carbon dioxide depletion is treated by simply breathing into a paper bag, the symptoms quickly disappear. 

In a heightened state of anxiety, victims often notice and misinterpret normal physical sensations (Small, 2010). A gurgling stomach 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 may heighten, your knees might buckle, and you may fall to the floor as well (Small, 2010). The sheer force and power 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 (Small, 2010). Something like these "fainting" goats.

So is 'hysteria' caused by possession? Or is there more to the story? Thanks for reading until the end. See you on the next post!

MY. 

References 

Tasca, C., Rapetti, M., Carta, M. G., & Fadda, B. (2012). Women And Hysteria In The History Of Mental Health. Clinical Practice and Epidemiology in Mental Health : CP & EMH, 8, 110–119. http://doi.org/10.2174/1745017901208010110

Science Musuem: Brought to Life. Hysteria. Retrieved from http://www.sciencemuseum.org.uk/broughttolife/techniques/hysteria

Simon, M. (2014). Wired. Fantastically wrong: the theory of the wandering wombs that drove women to madness. Retrieved from http://www.wired.com/2014/05/fantastically-wrong-wandering-womb/

Waller, J. (2009). The British Psychological Society. Dancing plagues and mass hysteria. Retrieved from https://thepsychologist.bps.org.uk/volume-22/edition-7/dancing-plagues-and-mass-hysteria

Tucker, A. (2009). Smithsonian.com. History of the hysterical man. Retrieved from http://www.smithsonianmag.com/science-nature/history-of-the-hysterical-man-43321905/?no-ist=&page=1

Small, G. (2010). Psychology Today. Mass hysteria can strike anywhere, anytime. Retrieved from https://www.psychologytoday.com/blog/brain-bootcamp/201009/mass-hysteria-can-strike-anywhere-anytime