American Journal of Epidemiology
Copyright C 2000 by The Johns Hopkins University School of Hygiene and Public Health
All rights reserved
Vol. 151, No. 2
Printed In USA.
LETTERS TO THE EDITOR
RE: "EPIDEMIC HYSTERIA: A REVIEW OF THE PUBLISHED LITERATURE"
The otherwise excellent review of epidemic hysteria by
Boss (1), which was published in Epidemiologic Reviews, is
flawed by the author's decision to organize his data by using
Francois Sirois' influential paradigm for diagnosing epidemic hysteria (2). It is also misleading because it omits
recent criticisms of this schema that fails to distinguish
between epidemic hysteria and collective delusions—a
limitation that Sirois himself acknowledges (3). These are
two separate problems; the former represents the pathologic
spread of conversion symptoms, and the latter is typified as
the nonpathologic manifestation of conformity dynamics
and reality testing exacerbated by human perceptual fallibility. For clarity, it should be emphasized that psychiatrists
and medical practitioners typically use die word "delusion"
to describe a persistent pathologic belief associated with
serious mental disturbance, usually psychosis. I use the term
"collective" or "mass delusion" as typified widiin the standard sociologic and social psychological nomenclature to
describe the spontaneous, temporary spread of false beliefs
in a given population (4).
Sirois (2, 5) has developed a five-part classification taxonomy of epidemic hysteria ranging from the "explosive
type," almost exclusively confined to small, cohesive, institutionalized social networks, to "diffuse outbreaks" in community or regional settings, whereby a particular cohort is
overwhelmed by the rapid spread of false rumors and
beliefs. However, one category in his schema, diffuse outbreaks, has been challenged (6-8). In a dialogue I had with
the author (9), Sirois acknowledged the limitations of this
category, conceding that "I agree here with Bartholomew
that these community outbreaks are best studied by sociology and bear only a loose linkage with epidemic hysteria, as
tJiey are more often examples of group anxiety" (3, p. 47).
In following the original Sirois paradigm (2), Boss (1) erroneously includes under the epidemic hysteria rubric two diffuse episodes affecting the public at large: the Martian panic
(10) and the Seattle, Washington, windshield pitting episode
(11). While these incidents were characterized by widespread anxiety and are often described as "mass hysteria,"
no one reported illness symptoms or conversion reactions.
On the evening of October 30, 1938, many people in the
United States became anxious or panicked after listening to
a realistic radio broadcast depicting a fictitious Martian
landing in New Jersey (10). While there was an absence of
illness symptoms, the reactions by some residents were
widely attributed at the time to hysteria-induced irrationality or "mass hallucination." This assessment was further
reinforced by reports that in addition to panic, during the
broadcast some New Jersey residents reported to police that
they observed "Martians on meir giant machines poised on
die Jersey Palisades" (12, p. 379), while others claimed to
have heard the machine guns or fires raging in the distance
(13) or to feel the heat rays as described on the radio (14).
But such behaviors are explainable without recourse to hysteria, irrationality, or pathology. Human perception is unreliable (15-18), and an effect can be exacerbated by stress,
ambiguity, and uncertainty (19-22). A person's frame of ref-
erence also has a strong influence on how external stimuli
are interpreted and internalized (23).
The Seattle windshield pitting episode involved hundreds
of reports of tiny pit marks on automobile windshields in the
vicinity of Seattle, Washington, between March and April
1954, but no illness. The sudden presence of the "pits" created widespread anxiety, as they were widely attributed to
atomic fallout from hydrogen bomb tests diat had been conducted recently in the Pacific Ocean and received widespread media publicity. The Seattle mayor even sought help
from US President Dwight Eisenhower. However, an investigation (11) determined that the pits had always existed and
were the result of mundane events such as ordinary road
wear but had gone unnoticed. In the wake of rumors such as
the presence of harmful fallout, and spurred by a few initial
cases amplified by the news media, residents began looking
at instead of through their windshields.
Certainly the Martian panic (10) and the Seattle pitting
episode (11) were uncommon events triggered by anxiety
fostered by adherence to a false belief and exacerbated by
die mass media. However, while mass anxiety is a prerequisite for epidemic hysteria, group anxiety, in conjunction
with die rapid spread of a seemingly irrational belief, should
not be die basis for diagnosing epidemic hysteria, since no
illness symptoms were reported. Rationality is determined
by social and cultural circumstances and is not a constant
from which unproblematic assessments can be made of a
particular behavior from outside of any given period, culture, subculture, or social group.
Professional medical ideology is typified as an unproblematic value-neutral enterprise diat cuts across social and
cultural strata in its dispassionate application of universal
scientific principles to explain, diagnose, and treat disease
and disorder. However, researchers must be cautious in their
construction of classificatory schemes, as taxonomies do not
exist as objective elements in nature awaiting description.
The fundamental impediment to better understanding epidemic hysteria is the inability to formulate a unitary interdisciplinary definition. For instance, some investigators exclude
from their definition die rapid spread of benign, transient illness signs and symptoms that are precipitated within an institutionalized, organized, or ritualized religious setting, since
they were not spontaneous but induced by artificial means
(24). Distinguishing between epidemic hysteria and collective delusion is a beginning. The present lack of agreement is
a challenge to the medical and psychiatric communities.
REFERENCES
1. Boss LP. Epidemic hysteria: a review of the published literature. Epidemiol Rev 1997; 19:233-^3.
2. Sirois F. Epidemic hysteria. Acta Psychiatr Scand Suppl 1974;
252:7^6.
3. Sirois F. Epidemic hysteria: a dialogue with Robert E.
Bartholomew. Med Principles Pract 1997;6:45-50.
4. Bartholomew RE. Collective delusions: a skeptic's guide.
SkepInql997;21:29-33.
5. Sirois F. Perspectives on epidemic hysteria. In: Colligan M,
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Letters to the Editor
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Erlbaum, 1982:217-36.
Bartholomew RE. Ethnocentricity and the social construction
of "mass hysteria." Cult Med Psychiatry 1990; 14:455-94.
Bartholomew RE. Redefining epidemic hysteria: an example
from Sweden. Acta Psychiatr Scand 1993;88:178-82.
Bartholomew RE. Tarantism, dancing mania and demonopathy: the anthro-political aspects of "mass psychogenic illness."
Psychol Med 1994;24:281-306.
Bartholomew RE. Epidemic hysteria: a dialogue with Francois
Sirois. Med Principles Pract 1997;6:38-44.
Cantril H. The invasion from Mars: a study in the psychology
of panic. Princeton, NJ: Princeton University Press, 1940.
Medalia NZ, Larsen O. Diffusion and belief in a collective
delusion. Am Sociol Rev 1958;23:180-6.
Markush RE. Mental epidemics: a review of the old to prepare
for the new. Public Health Rev 1973;2:353-442.
Bulgatz J. Ponzi schemes, invaders from Mars and more extraordinary popular delusions and the madness of crowds. New
York, NY: Harmony Books, 1992:129.
Ward P. A dictionary of common fallacies. Cambridge, UK:
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Loftus E. Eyewitness testimony. Cambridge, MA: Harvard
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Buckhout R. Nearly 2000 witnesses can be wrong. Bull
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Wells G, Turtle J. Eyewitness identification: the importance of
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18. Ross DF, Read JD, Toglia MR Adult eyewitness testimony:
current trends and developments. Cambridge, UK: Cambridge
University Press, 1994.
19. Sherif M, Harvey OJ. A study in ego functioning: elimination
of stable anchorages in individual and group situations.
Sociometry 1952; 15:272-305.
20. Asch SE. Opinions and social pressure. Sci Am 1955;193:31-5.
21. Krech D, Crutchfield RS, Ballschey EL. Individual and society. New York, NY: McGraw-Hill, 1962.
22. Turner R, Killian L. Collective behavior. Englewood Cuffs,
NJ: Prentice-Hall, 1972:35.
23. Buckhout R. Eyewitness testimony. Scientific Am 1974;231:
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24. Wessely S. Mass hysteria: two syndromes? Psychol Med 1987;
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Robert E. Bartholomew
Department of Psychology and Sociology
James Cook University of North
Queensland
Townsville 4811
Queensland, Australia
Editor's note: In accordance with Journal policy, Dr.
Boss was asked whether he wanted to respond to this letter
but chose not to do so.
RE: "SYRINGE EXCHANGE AND RISK OF INFECTION WITH HEPATITIS B AND C VIRUSES"
After close review, I must respond to the interchange
regarding the article by Hagan et al. (1) on needle exchange
and hepatitis in Seattle, Washington. They found significant
increases in the risk of both hepatitis B and hepatitis C in the
participants in the Seattle needle exchange. In their invited
commentary, Moss and Hahn (2) went through great rigors
to rationalize the findings of Hagan et al. and then attacked
the Director of National Drug Control Policy, General Barry
McCaffrey, for what they characterized as "language reminiscent of the McCarthy era" (1, p. 216). Is it not significant
that Bruneau et al. (3) and Strathdee et al. (4) found failure
of needle exchange programs and increases in human
immunodeficiency virus conversion despite the needle
exchanges in Montreal and Vancouver, Canada?
Perhaps the answer really does lie in the unthinkable possibility that needle exchanges just do not work! Why does the
public health community seem to have such a difficult time
rejecting needle handouts while continuing to claim that they
should be the "cornerstone" of public health programming?
After all, needle exchange programs do nothing to change the
underlying destructive activity of intravenous drug use. No
exchanges have demonstrated clear advantages over aggressive
outreach and treatment Would we adhere to programming that
increased the incidence of tuberculosis or venereal disease?
The needle exchange community should take heed from
Hagan et al.'s closing thoughts: "Drug treatment programs
that lead to cessation or reduction in drug injection may
lower the risk of both [hepatitis C virus] and [hepatitis B
virus] in current drug injectors" (1, p. 217).
REFERENCES
1. Hagan H, McGough JP, Thiede H, et al. Syringe exchange and
risk of infection with hepatitis B and C viruses. Am J
Am J Epidemiol
Vol. 151, No. 2, 2000
Epidemiol 1999;149:203-13.
2. Moss AR, Hahn JA. Invited commentary: needle exchange—
no help for hepatitis? Am J Epidemiol 1999;149:214-16.
3. Bruneau J, Lamothe F, Franco E, et al. Highratesof HTV infection among injection drug users participating in needle
exchange programs in Montreal: results of a cohort study. Am
J Epidemiol 1997;146:994-1002.
4. Strathdee SA, Patrick DM, Currie SL, et al. Needle exchange
is not enough: lessons from the Vancouver Injecting Drug Use
Study. AIDS 1997;ll:F59-65.
Eric A. Voth
The International Drug Strategy
Institute
Topeka, KS 66606
FIVE OF THE AUTHORS REPLY
In Dr. Voth's letter (1) responding to our article (2), he
seems to have missed the point of our remarks regarding
drug treatment as a hepatitis C virus (HCV) and hepatitis
B virus (HBV) prevention strategy. Drug treatment for
addictions remains an extremely limited resource in this
country, with demand for treatment by drug users consistently exceeding supply (3). Furthermore, drug treatment
tends to attract primarily older injection drug users, most
of whom have already been infected with HBV and HCV
by the time they enter a treatment program. In our study,
which focused on those who continued to inject during the
period when they could have acquired infection, there was
no effect of drug treatment on HBV or HCV incidence.
This is consistent with another study that could not find a
protective effect of methadone treatment against HCV
infection (4).