Skip to main content Accessibility help

Protean nature of mass sociogenic illness: From possessed nuns to chemical and biological terrorism fears

  • Robert E. Bartholomew (a1) and Simon Wessely (a2)



Episodes of mass sociogenic illness are becoming increasingly recognised as a significant health and social problem that is more common than is presently reported.


To provide historical continuity with contemporary episodes of mass sociogenic illness in order to gain a broader transcultural and transhistorical understanding of this complex, protean phenomenon.


Literature survey to identify historical trends.


Mass sociogenic illness mirrors prominent social concerns, changing in relation to context and circumstance. Prior to 1900, reports are dominated by episodes of motor symptoms typified by dissociation, histrionics and psychomotor agitation incubated in an environment of preexisting tension. Twentieth-century reports feature anxiety symptoms that are triggered by sudden exposure to an anxiety-generating agent, most commonly an innocuous odour or food poisoning rumours. From the early 1980s to the present there has been an increasing presence of chemical and biological terrorism themes, climaxing in a sudden shift since the 11 September 2001 terrorist attacks in the USA.


A broad understanding of the history of mass sociogenic illness and a knowledge of episode characteristics are useful in the more rapid recognition and treatment of outbreaks.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Protean nature of mass sociogenic illness
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Protean nature of mass sociogenic illness
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Protean nature of mass sociogenic illness
      Available formats


Corresponding author

S. Wessely, Academic Department of Psychological Medicine, King's College School of Medicine and Institute of Psychiatry, 103 Denmark Hill, London SE5 8AF, UK


Hide All

Declaration of interest




Hide All
Aemmer, F. (1893) Eine Schulepidemie von Tremor Hystericus [A school epidemic of hysterical tremor (so-called epidemic chorea)]. Basel: Kreis.
Aldous, J. C., Ellam, G. A., Murray, V., et al (1994) An outbreak of illness among schoolchildren in London: toxic poisoning not mass hysteria. Journal of Epidemiology and Community Health, 48, 4145.
Alexander, R. W. & Fedoruk, M. J. (1986) Epidemic psychogenic illness in a telephone operator's building. Journal of Occupational Medicine, 28, 4245.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM – IV). Washington, DC: APA.
Amin, Y., Hamdi, E. & Eapen, V. (1997) Mass hysteria in an Arab culture. International Journal of Social Psychiatry, 43, 303306.
Araki, S. & Honma, T. (1986) Mass psychogenic systemic illness in school children in relation to the Tokyo photochemical smog. Archives of Environmental Health, 41, 159162.
Armalnguad, M. (1879) Recherches cliniques sur l'hystérie; relation d'une petite épidémie d'hystérie observée à Bordeaux [Clinical research on hysteria and its relation to a small epidemic of hysteria observed in Bordeaux]. Mémoire et Bulletin de la Société de Médecine et Chirurgie de bordeaux, 551579.
Barsky, A. & Borus, J. (1999) Functional somatic syndromes. Annals of Internal Medicine, 130, 910921.
Bartholomew, R. (2000) Exotic Deviance: Medicalizing Cultural Idioms — From Strangeness to Illness. Boulder, CO: University Press of Colorado.
Bartholomew, R. & Sirois, F. (1996) Epidemic hysteria in schools: an international and historical overview. Educational Studies, 22, 285311.
Bartholomew, R. & Wessely, S. (1999) Epidemic hysteria in Virginia: the case of the phantom gasser of 1933–34. Southern Medical Journal, 92, 762769.
Bartholomew, R. & Sirois, F. (2000) Occupational mass psychogenic illness: a transcultural perspective. Transcultural Psychiatry, 37, 495524.
Bauer, R. M., Greve, K. W., Besch, E. L., et al (1992) The role of psychological factors in the report of building-related symptoms in sick building syndrome. Journal of Consulting and Clinical Psychology, 60, 213219.
Becerra, H. & Malnic, E. (2001) Complalnts of dizziness shut down subway. Los Angeles Times, 27 September.
Bekhtereff, V. (1914) Données sur l'épidémie neuropsychique observée chez les travailleurs d'usine de Riga de Petrograd en mars 1914. [Given on the neurological epidemic observed at the homes of the factory workers at Riga and Petrograd in March 1914]. Obozrienie Psikhiatrii Nevrologii (Petrograd), 19, 585613.
Black, D. & Murray, V. (2000) Mass psychogenic illness attributed to toxic exposure at a high school (letter). New England Journal of Medicine, 342, 1674.
Boss, L. P. (1997) Epidemic hysteria: a review of the published literature. Epidemiological Reviews, 19, 233243.
Bouzol, M. (1884) Relation d'une épidémie à phénomène hystérico-choréique observée à Algon (Ardeche) en 1882. [On the relation of epidemic hysterical chorea observed at Algon (Ardeche) in 1882]. Lyon Medical, 47, 142–148; 174–184; 211217.
Boxer, P. A. (1985) Occupational mass psychogenic illness: history, prevention, management. Journal of Occupational Medicine, 27, 867872.
Boxer, P. A., Singal, M. & Hartle, R. W. (1984) An epidemic of psychogenic illness in an electronics plant. Journal of Occupational Medicine, 26, 381385.
Burnham, W. H. (1924) The Normal Mind. New York: D. Appleton-Century.
Calmeil, L. F. (1845) De la Folie, Considerée Sous le Point de vue Pathologique, Philosophique, Historique et Judiciaire [On madness, consideration on the point of pathology, philosophy, history and justice]. Paris: Balllière.
Cantril, H. (1947) The Invasion from Mars: A Study in the Psychology of Panic. Princeton, NJ: Princeton University Press.
Carmeli, A., Liberman, N. & Mevorach, L. (1991) Anxiety-related somatic reactions during missile attacks. Israel Journal of Medical Sciences, 27, 677680.
Christophers, A. J. (1982) Civil emergency butyl mercaptan poisoning in the Parnell civil defence emergency: fact or fiction. New Zealand Journal of Medicine, 95, 277278.
Cole, T. B. (1990) Pattern of transmission of epidemic hysteria in a school. Epidemiology, 1, 212218.
Colligan, M. J. & Murphy, L. R. (1979) Mass psychogenic illness in organizations: an overview. Journal of Occupational Psychology, 52, 7790.
Colligan, M. J., Urtes, M. A., Wisseman, C., et al (1979) An investigation of apparent mass psychogenic illness in an electronics plant. Journal of Behavioral Medicine, 2, 297309.
Cruz, C. M. (1990) Health and work: the case of the gas emissions at the industrial complex of Mayaguez. Puerto Rician Health Sciences Journal, 9, 123125.
Darnton, R. (1984) The Great Cat Massacre and Other Episodes in French Cultural History New York: Basic Books.
David, A. S. & Wessely, S. C. (1995) The legend of Camelford: medical consequences of a water pollution accident. Journal of Psychosomatic Research, 39, 19.
Davy, R. B. (1880) ‘St Vitus’ dance and kindred affection; the recent epidemic at the Ursulin convent in Brown County, Ohio; a sketch of the historic disease. Cincinnati Lancet and Clinic, 4, 440445; 467473.
de Certeau, M. (1970) La Possession de Loudun [The possession of Loudun]. Julliard: Collection Archives.
Durbin, K. & Vogt, T. (2001) Fumes, lack of ventilation made students, teacher ill. Columbian (Washington State), 29 September.
Faust, H. S. & Brilliant, L. B. (1981) Is the diagnosis of ‘mass hysteria’ an excuse for incomplete investigation of low-level environmental contamination? Journal of Occupational Medicine, 23, 2226.
Fradkin, E. T. K. (1934) The Air Menace and the Answer. New York: Macmillan.
Franchini, A. (1947) Manifestazioni isteriche collettive interpretate come sintomi di intossicazione da gas ignoto [A manifestation interpreted as collective hysteria presenting as symptoms of intoxication by flammable gas]. Medicina di Lavoro, 38, 5760.
Gamino, L. A., Elkins, G. R. & Hackney, K. U. (1989) Emergency management of mass psychogenic illness. Psychosomatics, 3, 446449.
Garnier, S. (1895) Barbe Buvee, en Religion, Soeur Sainte-Colombe et la Prétendue Possession des Ursulines d'Auxonne [Barbara Buvee, and Religion, Sister Columbe and the Feigned Possession of the Ursulines at Auxonne]. Paris: Felix Alcan.
Goh, K. T. (1987) Epidemiological enquiries into a school outbreak of an unusual illness. International Journal of Epidemiology, 16, 265270.
Goldberg, E. L. (1973) Crowd hysteria in a junior high school. Journal of School Health, 43, 362366.
Goldsmith, M. F. (1989) Physicians with Georgia on their minds. Journal of the American Medical Association, 262, 603604.
Goode, M. D. (2000) Mass psychogenic illness attributed to toxic exposure at a high school (letter). New England Journal of Medicine, 342, 1674.
Hagenbach, E. (1893) Chorea-epidemie [Epidemic chorea]. Kor-Blatt f Schweit Arzte (Basel), 631632.
Hamilton, A. (1943) Exploring the Dangerous Trades: The Autobiography of Alice Hamilton. Boston, MA: Little Brown.
Harris, R. & Paxman, J. (1991) A Higher Form of Killings: The Secret Story of Chemical and Biological Warfare. New York: Noonday Press.
Hecker, J. F. C. (1844) Epidemics of the Middle Ages (translated from German by Babington, B.), p. 127. London: Sydenham Society.
Hirsch, A. (1883) Handbook of Geographical and Historical Pathology. London: New Sydenham Society.
Hirt, L. (1893) Eine Epidemie von Hysterischen Krampfen in einer Schleisischen Dorfschule [An epidemic of hysterical cramp in a village school in Schleisischen]. Zeitschrift für Schulgesundheitsplfege, 6, 225229 (summary of an article by L. Hirt in the Berliner Klinische Wochenschrift).
Huxley, A. (1952) The Devils of Loudun. New York: Harper and Brothers.
Hyams, K. C., Murphy, F. & Wessely, S. (2002) Responding to a terrorist attack with chemical, biological, or nuclear materials: the indirect and long-term health effects may present the greatest challenge. Journal of Health Politics, Policy and Law, in press.
Johnson, D. M. (1945) The ‘phantom anesthetist’ of Mattoon: a field study of mass hysteria. Journal of Abnormal and Social Psychology, 40, 175186.
Jones, T. F., Cralg, A. S., Hoy, D., et al (2000) Mass psychogenic illness attributed to toxic exposure at a high school. New England Journal of Medicine, 342, 96100.
Kerr, J. (1907) Report of the London Medical Officer (Education), p. 32. London: London County Council.
Knight, J. A., Friedman, T. I. & Sulianti, J. (1965) Epidemic hysteria: a field study. American Journal of Public Health, 55, 858865.
Krug, S. (1992) Mass illness at an intermediate school: toxic fumes or epidemic hysteria? Pediatric Emergency Care, 8, 280282.
Laquer, L. (1888) Uber eine chorea-epidemie [an epidemic of chorea]. Deutsche Medizinische Wochenschrift (Leipzig), 14, 10451046.
Lehman, D. (2001) Substance in Argyle still a mystery. Glens Falls (New York) Post-Star, 10 November, p. 1.
Lellman, L. (2001) Suspicious incident forces subway's closing. Rutland Dally Herald, 10 October, p. A3.
Loredan, J. (1912) Un Grand Procès de Sorcellerie au XVIIe siècle, L'Abbé Gaufridy et Madéleine de Demandolx (1600–1670) [The grand process of witchcraft in the seventeenth century, L'Abbe Gaufridy and Madeleine de Demandoux (1600–1670)]. Paris: Perrin et Cie.
Lyons, R., Temple, D., Evans, D., et al (1999) Acute health effects of the Sea Empress oil spill. Journal of Epidemiology and Community Health, 53, 306310.
Madden, R. R. (1857) Phantasmata or Illusions and Fanaticisms of Protean Forms Productive of Great Evils. London: T. C. Newby.
Markush, R. E. (1973) Mental epidemics: a review of the old to prepare for the new. Public Health Reviews, 4, 353442.
McEvedy, C. P., Griffith, A. & Hall, T. (1966) Two school epidemics. BMJ, ii, 13001302.
McLeod, W. (1975) Merphos poisoning or mass panic? Australian and New Zealand Journal of Psychiatry, 9, 225229.
Micale, M. S. (1995) Approaching Hysteria: Disease and its Interpretations. Princeton, NJ: Princeton University Press.
Miller, C. & Ashford, N. (2000) Mass psychogenic illness attributed to toxic exposure at a high school (letter). New England Journal of Medicine, 342, 1673.
Modan, B., Tirosh, M., Weissenberg, E., et al (1983) The Arjenyattah epidemic. Lancet, ii, 14721476.
Moss, P. D. & McEvedy, C. P. (1966) An epidemic of overbreathing among schoolgirls. BMJ, ii, 12951300.
Olson, W. C. (1928) Account of a fainting epidemic in a high school. Psychology Clinic (Philadelphia), 18, 3438.
Olczak, P., Donnerstein, E., Hershberger, T., et al (1971) Group hysteria and the MMPI. Psychological Reports, 28, 413414.
Petterson, J. (1998) Perception vs. reality of radiological impact: the Goiania model. Nuclear News, November, 8490.
Philen, R. M., Kilbourn, E. M. & McKinley, T. W. (1989) Mass sociogenic illness by proxy: parentally reported in an elementary school. Lancet, ii, 13721376.
Price, J. (2001) New York firefighters suffer after effects. Washington Times, 3 November.
Radovanovic, Z. (1995) On the origin of mass casualty incidents in Kosovo, Yugoslavia, in 1990. European Journal of Epidemiology, II, 113.
Regnard, M. & Simon, J. (1887) Sur une épidémie de contracture des extremités observée a Gentilly [On an epidemic of limb contracture observed in Gentilly]. Comptes Rendus des Séances de la Société de Biologie (Paris), 3, 344–347, 350353.
Rembold, S. (1893) Acute psychiche contagion in einer madchenschule [Acute psychic contagion in a girls' school]. Berliner Klinische Wochenschrift, 30, 662663.
Robbins, R. H. (1966) The Encyclopedia of Witchcraft and Demonology, pp. 408414. New York: Crown.
Rockney, R. M. & Lemke, T. (1992) Casualties from a junior high school during the Persian Gulf war: toxic poisoning or mass hysteria? Journal of Developmental and Behavioral Pediatrics, 13, 339342.
Rosen, G. (1968) Madness in Society. London: Routledge and Kegan Paul.
Ryan, C. M. & Morrow, L. A. (1992) Dysfunctional buildings or dysfunctional people: an examination of the sick building syndrome and allied disorders. Journal of Consulting and Clinical Psychology, 60, 220224.
Schatalow, N. (1891) Zur Frage von der epidemischen histerie [On the question of epidemic hysteria], Neurologische Centralblatt, 10, 405.
Schoedel, J. (1906) Uber induzierte krankheiten [On induced illness]. Jahrbuch für Kinderheilkunde, 14, 521528.
Schuler, E. A. & Parenton, V. J. (1943) A recent epidemic of hysteria in a Louisiana high school. Journal of Social Psychology, 17, 221235.
Selden, B. S. (1989) Adolescent epidemic hysteria presenting as a mass casualty, toxic exposure incident. Annals of Emergency Medicine, 18, 892895.
Sinks, T., Kerndt, P. R. & Wallingford, K. M. (1989) Two episodes of acute illness in a machine shop. American Journal of Public Health, 79, 10241028.
Sirois, F. (1974) Epidemic hysteria. Acta Psychiatrica Scandinavica Supplementum, 252, 746.
Sirois, F. (1982) Perspectives on epidemic hysteria. In Mass Psychogenic Illness: A Social Psychological Analysis (eds Colligan, M., Pennebaker, J. & Murphy, P.), pp. 217236. Hillsdale, NJ: Lawrence Erlbaum.
Small, G. W. & Nicholi, A. M. (1982) Mass hysteria among student performers: early loss as a predisposing factor. Archives of General Psychiatry, 39, 721724.
Small, G. W. & Borus, J. (1983) Outbreak of illness in a school chorus. Toxic poisoning or mass hysteria? New England Journal of Medicine, 308, 632635.
Small, G. W., Propper, M. W., Randolph, E. T., et al (1991) Mass hysteria among student performers: social relationship as a symptom predictor. American Journal of Psychiatry, 148, 12001205.
Small, G. W., Feinberg, D. T., Steinberg, D., et al (1994) A sudden outbreak of illness suggestive of mass hysteria in schoolchildren. Archives of Family Medicine, 3, 711716.
Small, M. H. (1896) The suggestibility of children. Pedagogical Seminary, 4, 176220.
Smith, H. C. T. & Eastham, E. J. (1973) Outbreak of abdominal paln. Lancet, ii, 956958.
Smith, M., Colligan, M. & Hurrell, J. (1978) Three incidents of industrial mass psychogenic illness. Journal of Occupational Medicine, 20, 339400.
St Clare, W. (1787) Gentleman's Magazine, 57, 268.
Stahl, S. M. (1982) Illness as an emergent norm or doing what comes naturally. Mass Psychogenic illness: A Social Psychological Analysis (eds Colligan, M., Pennebaker, J. & Murphy, L.), pp. 183198. Hillsdale, NJ: Lawrence Erlbaum.
Stahl, S. M. & Lebedun, M. (1974) Mystery gas: an analysis of mass hysteria. Journal of Health and Social behavior, 15, 4450.
Struewing, J. P. & Gray, G. C. (1990) Epidemic of respiratory complalnts exacerbated by mass psychogenic illness in a military recruit population. American Journal of Epidemiology, 132, 11201129.
Tam, Y. K., Tsoi, M., Kwong, G. B., et al (1982) Psychological epidemic in Hong Kong. Part 2, Psychological and physiological characteristics of children who were affected. Acta Psychiatrica Scandinavica, 65, 437449.
Taylor, B. W. & Werbicki, J. E. (1993) A case of mass hysteria involving 19 schoolchildren. Pediatric Emergency Care, 9, 216217.
Teoh, J., Soewondo, S. & Sidharta, M. (1975) Epidemic hysteria in Malaysia: an illustrative episode. Psychiatry, 8, 258268.
Villanueva, R. L., Payumo, M. C. & Lema, K. (2001) Flu scare sweeps schools. Business World (Philippines), 3 October, p. 2.
Wessely, S. (1987) Mass hysteria: two syndromes? Psychological Medicine, 17, 109120.
Wessely, S. (1995) Hysteria after gas attacks. The Times (London), 4 July, p.14a.
Wessely, S., Hyams, K. & Bartholomew, R. (2001) Psychological implications of chemical and biological weapons. BMJ, 323, 878879.
Wichmann, R. (1890) Eine sogenannte veitstanzepidemie in Wildblad [A so-called epidemic of St Vitus dance in Wildbad]. Deutsche Medizinische Wochenschrift (Leipzig), 16, 632636; 659–663.
Zollinger, E. (1906) Uber die padagogische bahandlung des nervosen zitterns der schulkinder [On the educational treatment of nervous trembling in school children]. Jahrbuch der Schweiz Gesellschaft für Schulgesundheitspflege, 7, 2047.

Protean nature of mass sociogenic illness: From possessed nuns to chemical and biological terrorism fears

  • Robert E. Bartholomew (a1) and Simon Wessely (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Protean nature of mass sociogenic illness: From possessed nuns to chemical and biological terrorism fears

  • Robert E. Bartholomew (a1) and Simon Wessely (a2)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *