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January 2012: Tourette Epidemic or Mass Hysteria?

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  • January 2012: Tourette Epidemic or Mass Hysteria?

    An Explanation for Mass Hysteria?
    Andrew N. Wilner, MD
    Posted: 07/11/2012
    Mirror Neurons: Introduction

    In January of this year, a group of teenagers, nearly all girls, in the small town of Le Roy in western New York suddenly came down with severe Tourette-like symptoms.

    The case attracted extensive media attention and has been the subject of articles in the Huffington Post and New York Times, stories on local news stations, as well as YouTube and Facebook posts. Two of the girls also appeared on the Today Show, accompanied by their distraught mothers. Environmental toxins from the town's old Jell-O® factories, a 1970 toxic train accident, PANDAS (pediatric autoimmune neuropsychiatric disorders associated with Streptococcus infection), and other unlikely etiologies have been put forward as possible explanations for this unusual phenomenon, but neurologists have confidently diagnosed conversion disorder. It is a classic case of mass hysteria.

    Conversion Disorder and Mass Hysteria
    Conversion disorder, or hysteria, dates back at least to the days when Egyptians were writing on papyrus rather than tweeting on Twitter. The term indicates "a disturbance of body function that is characterized by neurological, sensory, or motor symptoms for which the available medical explanations either do not explain, or fail to account for the severity of, the patient's impairment."1 Conversion disorder affecting groups of people (mass hysteria) often occurs in schools or other closed communities.2 Odors or gas leaks (perceived or real) are common contemporary triggers.3

    Neurobiology of Conversion Disorder
    To understand conversion disorder from a neurobiological standpoint, one must accept that the mind is the product of the brain. Multiple models have been proposed to explain conversion reactions. Freud proposed the concept of "conversion" of intolerable memories into somatic symptoms.2 The concept of "neodissociation" has been suggested, in which a patient with loss of function, such as hysterical visual loss, still processes visual stimuli that influences his or her behavior, yet he or she is not consciously aware of the visual input. Conversion symptoms have also been attributed to "rogue representations" of sensory data that are mistakenly integrated into consciousness.

    Another theory suggests that conversion states are a protective strategy that invoke a prelearned behavioral state. One complex hypothesis implicates "false body mapping," requiring dysfunction in a circuit that contains the cingulate cortex, insula, thalamus, brainstem nuclei, amygdala, ventromedial prefrontal centers, supplemental motor area, and other key areas. Another postulate is dysfunction of the striatothalamocortical pathways, which control sensorimotor function and voluntary motor behavior. Advances in neuroimaging, such as functional MRI (fMRI), magnetoencephalography (MEG), SPECT, and transcranial magnetic stimulation (TMS), are supplying the tools to scientifically investigate the neurologic circuitry involved.

    Are Mirror Neurons the Answer?
    Recently, Lee and Tsai4 suggested that mirror neurons may play a role in the pathogenesis of mass hysteria. The mirror neuron circuit refers to "neurons in the frontal, parietal and temporal cortex of the monkey, that discharge both when a movement is executed and when the same movement is observed."5 Although less well characterized, it is believed the mirror neuron system exists in humans as well. This mirror neuron system may help us understand the actions of others.5 An inhibitive feature of the mirror neuron system keeps us from imitating everything we see. The existence of mirror neurons has been used to design more effective rehabilitation for stroke7 and may explain some of the cognitive deficits of Parkinson disease.5

    According to Lee and Tsai,4 4 characteristics of the mirror neuron system could contribute to their role in the pathogenesis of mass hysteria. First, failure of the inhibitory component in certain individuals might predispose them to imitate others. Second, transmission of mass hysteria symptoms typically occur by visual and auditory means, both of which are processed by mirror neurons. Third, mirror neurons may play a role in emotional contagion, which allows us to "catch" and feel the emotions of others. Finally, mirror neuron activity is more active in females, a group consistently overrepresented in episodes of mass hysteria.

    Incidents of mass hysteria have been a feature of human society for thousands of years, and its cause remains unexplained. Continued research with improved neuroimaging (fMRI, MEG, SPECT) and neurostimulation (TMS) may soon bridge the ever-narrowing chasm between the mind and the brain and provide a neurobiological explanation for mass hysteria. In the meantime, we are left to struggle with unproven hypotheses and propose empiric treatment for patients with symptoms that place them in the uncomfortable borderland between neurology and psychiatry.

    1. Kozlowska K, Williams LM. Self-protective organization in children with conversion symptoms: a cross-sectional study looking at psychological and biological correlates. Mind & Brain, The Journal of Psychiatry. 2005;1:43-57.
    2. Illis LS. Hysteria. Spinal Cord. 2002;40:311-312. Abstract
    3. Boss LP. Epidemic hysteria: a review of the published literature. Epidemiol Rev. 1997;19:233-243. Abstract
    4. Lee YT, Tsai SJ. The mirror neuron system may play a role in the pathogenesis of mass hysteria. Med Hypotheses. 2010;74:244-245. Abstract
    5. Alegre M, Guridi J, Artieda J. The mirror system, theory of mind and Parkinson's disease. J Neurol Sci. 2011;310:194-196. Abstract
    6. Small SL, Buccino G, Solodkin A. The mirror neuron system and treatment of stroke. Dev Psychobiol. 2012;54:293-310. Abstract
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  • #2
    Re: January 2012: Tourette Epidemic or Mass Hysteria?

    This is why it is so important to stay calm as a parent. Try to keep emotions and feelings to yourself. I admit I'm the worst but because of this article today is a new day for me. I'm going to try my best to keep it together in this stressful world.