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					A study is presented of an outbreak of hysterical attacks in a school
of a Louisiana town. The presentation includes a definition of the
epidemiological, psychological, and psychiatric characteristics
of the affected students and of those in a control group.
Precipitating factors are identified and other significant
factors studied.

James A. Knight, M.D., M.P.H.; Theodore I. Friedman, M.A.; and Julie Sulianti, M.D., M.P.H.

THIS study deals with an unusual "ill-         generally lasted only a few minutes but
   ness" which took place in a school          occasionally a student would not re-
setting. It is a excellent field example       cover for over an hour. Most of them
of the phenomenon of behavioral con-           manifested drowsiness and dizziness
tagion, originally formulated by Fritz         after a so-called "blackout spell."
Redl4 and later verified in laboratory            Almost all of the students were taken to
studies by other investigators.1               the physician who initially diagnosed
   From approximately February 14th            the disorder. In each case he examined
through early August, 1962, 22 sub-            the student, gave an injection of seda-
jects, all females except one, experienced     tive or a tranquilizer, and prescribed a
hysterical episodes, or what they called       mild tranquilizer or sedative. At first
"blackout spells." This outbreak took          there was confusion as to the nature of
place in the Negro school of a south-          the illness, and some of the students
western Louisiana town of about 3,300          were subjected to a thorough medical
population.                                    examination, including a lumbar punc-
   All of the spells were not alike. Some      ture.
were suggestive of the hyperventilation           The tranquilizers and sedatives used
syndrome. In these the student appeared        did not prevent the further occurrence
anxious, began to breathe deeply, ex-          of the attacks in most of the cases. Many
perienced fluttering of the eyelids, ting-     of the students continued to have at-
ling in the fingers, dryness of the mouth,     tacks in spite of taking the prescribed
then became dizzy and passed out. Most         medication on a regular basis.
of the students described some kind of            Two years before the outbreak de-
modified aura prior to passing out, such       scribed in the present study, one of the
as headache or dizziness. Some kept the        girls in this school became pregnant.
deep, rapid breathing even after they          She and a fellow-student (the admitted
had passed out. Several of the attacks         father of her child) were sent to the
resembled epileptic-type seizures-espe-        State Correctional School. Prior to the
cially petit mal. Some students showed         onset of the present outbreak in the
catatonic posturing. Others manifested         school, a rumor circulated that one or
a very gross type of tremor throughout         two of the girls were pregnant, and
the attack. Period of unconsciousness          that these girls would be sent to the

858                                                              VOL. 55. NO. 6. A.J.P.H.
                                                                     EPIDEMIC HYSTERIA

   Correctional School. There had been          cause of the daily nature of the attacks.
   considerable sexual promiscuity among        On March 6, another girl had an at-
   the students. Some of this, for example,     tack at school, and two days later a
  took place at school during lunch time        different girl had an attack. By the 22nd
  in the photography darkroom. A 14-            of March eight girls were having the
  year-old crippled girl with a very low        "blackout spells" and by April 3 over
  mental age had had intercourse with           20 girls and one boy were affected. The
  more than 30 boys. Another girl, age          weekly distribution of attacks for the
  15, was found to be pregnant and was          major period of this study is shown in
  requested to leave school. The word cir-      Figure 1.
  culated that all the girls would be given       All of the investigators in this project
  pregnancy tests, and anxiety swept           observed some of the attacks. On a few
  through the school. The attacks began        occasions there were as many as seven
  shortly thereafter.                          students having attacks simultaneously
     During the course of the outbreak,        while the investigators were present.
  the parish probation department investi-        Twenty-two students who suffered at-
  gated the promiscuity in the school. Sev-    tacks were included in the study. Addi-
  eral students suspected of promiscuity       tional cases were reported but were ex-
  were asked to appear with their par-         cluded when they personally denied hav-
 ents for a Juvenile Court hearing. Five       ing attacks.
 were placed on probation, and four were          By the end of May the outbreak had
 sent to the State Correctional School for     subsided, except for an occasional at-
 undetermined periods of time. Only one        tack during the summer months plus
 of the girls in the group of those having     several during the latter part of July
 hysterical attacks was found to be de-        and early August when the EEG studies
 linquent because of sexual misbehavior.      were done.
 This 15-year-old girl was offered pro-           The school has acquired a new princi-
 bation provided she would adhere to          pal who assumed his duties at the be-
 certain rules of conduct. Because of her     ginning of the 1962-1963 session. He re-
 refusal, she was sent to the Correc-         ports that an occasional member of the
 tional School. Following the sentencing      patient group has had an attack, though
 she had a hysterical attack which lasted     often mild in character. The principal
for hours.                                    seems to be able to maintain order and
    As far as we were able to determine,      discipline in the school while remaining
the first attack took place in the Meth-      supportive and understanding in the
odist Church on the night of February         over-all management of the students'
14, 1962, following a choir concert. A        problems.
13-year-old girl became dizzy, passed
out, and was taken home in an un-             Method of Study
conscious condition. Her family re-
ported that she was difficult to arouse          After seeing a few of the students and
for several hours. This student said that     studying the progression of attacks from
prior to her passing out, she felt her        one student to another, the local physi-
breath "coming short" and then be-            cian was certain he was dealing with
came dizzy.                                   hysteria. Since many people in the com-
    The following day at school, a close      munity, however, kept emphasizing eti-
friend (age 13) who had witnessed the         ological factors, such as "dope," toxic
attack in church had a "blackout spell."      substances, and infectious agents, he
She continued to have attacks and was         notified the State Board of Health. The
kept home from school for a month be-         staff of the State Board of Health

JUNE, 1965                                                                           OS?


            t   24.


            < 16.

            t 12.



                      14 28 14 28 11 25 9 23 6 20 4 18                  1
                      -   Feb.-I Mar._IApr-    ..May
                Figure 1-Weekly Number of Reported Hysterical Attacks

studied the situation and confirmed the       ish has 21.2 per cent Negroes, whereas
local physician's impression of an out-       the average for the state of Louisiana
break of hysteria.                            is 32 per cent.
   At this point the present team of in-         The Negro school for this community
vestigators, upon invitation of the Louisi-   is modem and well-equipped. The all-
ana State Board of Health, initiated          Negro teaching staff is relatively young
a thorough study of the outbreak, which       and inexperienced in handling the prob-
included a definition of the epidemi-         lems associated with public school teach-
ological, psychological, and psychiatric      ing. The school has an enrollment of
characteristics of the affected students      about 400, with an average of 33 stu-
when compared with a control group.           dents in each class.
A battery of psychological tests and a           The Negro community is a typical
clinical psychiatric evaluation were          subcommunity for southern Louisiana.
used in the study. Also electroencephalo-     The socioeconomic status is predomi-
grams were run on both groups.                nantly lower class, with a few families
                                              in the lower middle class. The homes
The Community                                 are simple, but generally neat and clean.
                                              Most of the men work in service jobs
  The community where the outbreak            or on the farm. The women work in
took place is principally rural. The par-     white homes as domestic servants.

860                                                           VOL. 55. NO. 6. A.J.P.H.
                                                                   EPIDEMIC HYSTERIA

   The four Negro churches in the com-       bringing in "dope." The chewing gum
munity are two Baptist, one Methodist,       in a neighboring store was suspected of
and one Catholic. The majority of the        containing "dope." Possibly the boy and
Negroes are affiliated with the Baptist      the store were involved in some way.
churches.                                    The Laboratory Division of the State
   There is little social mobility among     Board of Health tested the chewing gum
the Negroes in this community. Those         and other similar items. However, the
born there seldom leave the parish.          negative report did not stop the rumor.
Many have not travelled more than 50         Even the principal of the school con-
miles from their homes.                      tinued to relate the attacks to narcotics
   The whites of this community had          or a toxic substance after studies had
varying attitudes toward the outbreak.       been done to disprove such rumors.
Some were concerned about a possible            Several of the parents related the at-
"disease." Most of the whites, after a       tacks to some kind of black magic. Most
few weeks had passed, felt the Negroes       of the students rejected this view and
were "acting foolish," "showing child-       attributed such thinking to that of the
ishness," or possibly evidencing the         "older generation." In this community,
effects of something "bad," such as tak-     there is a comfortable blending of scien-
ing narcotics. After a short period of       tific and folk medicine.
time the whites lost interest in following      The students discovered early in the
the progress of the attacks.                 outbreak that those students who were
   The newspapers in the neighboring         especially influenced and likely to have
cities published stories of the outbreak.    attacks were those who touched, sup-
A front page story in one newspaper          ported, or carried to the lounge some
was entitled, "Mysterious Ailment Strikes    girl who had had a "blackout spell."
Negro Students." The story went on to        Thus, they concluded that having an
say how an unidentified malady which         attack was a highly individual thing
renders its victims unconscious had          and would involve only certain ones. On
struck at the Negro school. The names        some level they recognized the sexual
of several students were given with a        implications. This became clear when
description of their attacks. Other news-    the one male student had a "blackout
paper accounts later reported the prog-      spell," and the comment swept through
ress of the outbreak or the fact that the    the school, "Will he have a boy or girl?"
outbreak was subsiding.
                                             Definition of Cases
Rumors Regarding Outbreak
                                                The students included in the patient
   Many of the parents and teachers          group were those who definitely had at-
thought at first that the attacks were       tacks with the symptom complex de-
caused by some infectious process, but       scribed in the opening part of this paper.
this view was abandoned after medical        The cases were ascertained from re-
studies were done. The most persistent       ports of teachers, students, and the lo-
belief held by students, teachers, and       cal physician. A case was defined as a
parents was that some kind of "dope"         student who had one or more attacks
was used. Shortly before the outbreak,       and who had lost consciousness or un-
an adblescent boy from the high school       dergone an altered state of awareness
of a city 30 miles away was transferred      during the attack.
into the school. He was considered by           Each control was matched for grade,
many as a "bad" boy who might be             sex, and age to a particular member of

JUNE. 1965                                                                         861
Table 1-Distribution of Affected and Normal Girls by Grade and Age (Normals in

                                                        Grade                                       Per cent
 Age                     6              7           8           9          10       11     Total    Affected

  10                  1 (3)                                                                1 (3)       4.6
  11                  2 (6)                                                                2 (6)       9.1
  12                               1 (13)                                                  1 (13)      4.6
  13                               1 (3)          2 (6)                                    3 (9)      13.6
  14                                              3 (2)     2 (8)                          5 (10)     22.7
  15                                                        1 (8)        3 (9)             4 (17)     18.2
  16                                                                     2 (2)    1 (4)    3 (6)-     13.6
  17                                                                     1 (2)    2*(4)    3 (6)      13.6
Total                 3 (9)        2 (16)         5 (8)     3 (16)       6 (13)   3 (8)   22 (70)
Per cent
  Affected               13.6               9.1    22.7         13.6       27.4    13.6
      *   Includes the one male case.

the patient group and selected in a ran-                               Highest incidence of attacks was on
dom manner. The controls came from                                  the days when there were visitors in
the same school as the affected group.                              the school making inquiries regarding
Thus, the control group was similar in                              the hysteria outbreak. Some of the stu-
all relevant respects to the patient group.                         dents also had attacks at home, in
                                                                    church, and in the movie theater.
Findings                                                               The number of incidents per day
                                                                     reached a peak during the 14-day pe-
  Epidemiological-A comparison of                                   riod: March 21 through April 3. The
general information collected from the                              number of attacks subsequently de-
affected and control groups revealed                                creased except for several incidents
very few important differences. In the                              during May, late July, and early August
hysteric group there was a slightly                                 when the investigation team returned to
higher proportion of families with some                             the school to continue the study. The
irregularity such as divorce, father dead                           presence of outsiders appeared to be re-
or in jail, or parents on relief. Socio-                            lated to the occurrence of hysterical
economic factors, religious affiliation,                            attacks.
and rural-urban distribution showed                                    The attacks occurred most often in
little difference in the two groups and                             the afternoon at school. There seemed
reflected the distribution of such factors                          to be no relation between attacks and
in this Negro community. Onset of                                   any one teacher or subject taught in
menstrual period was not markedly dif-                              the school.
ferent in the two groups.                                              Psychological-The psychological tests
   The ages of the students affected                                administered to both the affected and
ranged from 10 through 17, with a                                   control groups were: Full Range Picture
mode of 14. Half of them came from                                  Vocabulary Test, Bender-Gestalt, Minne-
the 8th and 10th grades, the remainder                              sota Multiphasic Personality Inventory
coming from the 6th, 7th, 9th, and 11th                             (MMPI), and Rorschach.
grades (Table 1).                                                      The mean I.Q. for the hysteric group

862                                                                                 VOL. 55. NO. 6. A.J.P.H.
                                                                    EPIDEMIC HYSTERIA

 was 72.4, with a range of 55-92. The           large reservoir of children in this com-
 control group had a mean I.Q. of 73.4         munity with cerebral dysrhythmia. Many
 and a range of 40-105.                         of the records have some characteristics
   The MMPI results revealed that the           similar to those encountered in convul-
 hysteric group scored higher on items          sive states. The type of abnormality
 related to conversion of psychic to body       evidenced in these EEG tracings would
complaints, unrealistic ideational trends,      tend to be more strongly associated with
and excessive productivity of actions           a convulsive state than with "brain
 and/or ideas.                                  damage" alone.
   The meager results of the Rorschach             Psychiatric-The psychiatrist inter-
in both groups suggested a poor type           viewed individually each student who
of ideational productivity, lowered emo-        was having "blackout spells" as well as
tional maturity, and a reduced level of         each member of the control group. The
internal affective control.                     clinical differences between the two
   The MMPI and Rorschach studies              groups were as follows:
pointed to some minor differences be-              The controls were far less interested
tween the control and hysteric groups.         in sexual matters, talked less about sex,
The controls seemed somewhat more              and were much less seductive than the
normal and less prone to emotional in-         affected students.
stability.                                         The controls seemed much less in-
   Electroencephalographic* -The ma-           volved in the total situation and at times
chine employed in this study was the           showed some hostility. The affected stu-
Model III-D Grass 8 channel EEG. The           dents seemed more appreciative of the
technic used included both monopolar           concern and attention given them. They
and bipolar recordings. Waking, sleep,         enjoyed talking about their attacks,
and hyperventilation recordings were           whereas the controls were not interested
obtained.                                      in speaking even about their health in
   The per cent of abnormal EEG rec-           general.
ords was extremely high in both groups            There was greater poverty of imag-
-53 per cent for the patient group             ination in the control group than the
and 57 per cent for the controls.              affected group. The affected group had
   The most striking feature of the rec-       more exciting plans for the future and
ords was the similarity throughout both        a richer fantasy life.
the control and patient groups. The               More of the so-called classical hys-
records could be divided for both              terical features were seen in the affected
groups fairly equally into bioccipital         students. They were more dramatic, ex-
slow abnormalities, a paroxysmal gen-          pressive, and related more easily. How-
eralized type, and paroxysmal activity         ever, there were three students in the
which tended to localize to the temporal,      control group who surpassed most of the
occipital, and bifrontal areas.                members of the affected group with their
   These records indicate that a brain         dramatic self-presentations.
dysrhythmia did not play a definite role          The psychiatrist found rapport more
in determining whether or not the stu-         easily established with the affected
dent developed hysterical symptoms. The        group.
EEG studies suggest the presence of a             The members of the affected group
  *We are indebted to Arthur W. Epstein,
                                               seemed to have little fear of what had
M.D., and Charles Fontana, EEG Technologist,   befallen them. They showed to an aston-
Department of Psychiatry and Neurology,        ishing degree the much-quoted "la belle
Tulane University School of Medicine, for      indifference." The controls did not want
major assistance with the EEG part of this
study.                                         to be implicated in any way with the

JUNE. 1965                                                                           863
affected group. Each was afraid of          the school authorities and the probation
catching the disorder and took meas-        officers in an effort to control the
ures to prevent having an attack.           promiscuity in the school. The threat of
   The control and affected groups were     being sent to the State Correctional
observed on many occasions as they          School for sexual misbehavior was al-
mingled with the other students in the      ways present.
school. They did not appear obviously          The fact that these "sexed-up" girls
different from their peers.                 were the ones who passed out rather
                                            than acted out is a good example of
Discussion                                  "shock-effect," which in turn becomes
                                            a "contaged" solution.
   The outbreak began when some sexual         There have been only a few papers
promiscuity was discovered in the school    in the literature in recent years related
by the authorities and the rumor spread     to mass hysteria. Many reports appeared
that all the girls would be given preg-     in the 19th and the early part of the
nancy tests and those found to be preg-     20th century, but these were mostly ob-
nant would be sent to the State Correc-     servations with little examination of the
tional School. Possibly this punitive re-   patients themselves.
action of the adult authorities to the         Schuler and Parenton5 reported an
students' promiscuous behavior caused       interesting mental epidemic which took
the students to fragment and develop        place in the spring of 1939 in an aca-
an illness as a way of handling their       demically superior white high school in
conflict between authority and their        southern Louisiana. It involved a group
impulses.                                   of girls, ages 16 through 18. The symp-
   Although the precipitating factors as-   toms consisted primarily of spasmodic
sociated with the onset of the outbreak     involuntary movements of the extremi-
may explain part of the picture, other      ties. This paper contains also an excel-
significant factors should be mentioned.    lent review of the literature on out-
The hysterical symptoms were communi.       breaks of hysteria.
cated by seeing or touching victims in         Johnson2 studied in 1944 an outbreak
attacks or hearing about the attacks.       in Mattoon, Ill., in which the rumor
The lowered intellectual controls, a dis-   of a "madman" who gassed his victims
organized school setting, tendencies to-    with some kind of paralyzing agent sent
ward superstitious beliefs, unstable home   many individuals, mostly women, into
environments, and the attainment of         states of panic.
secondary gain also seemed important,          Other studies are available, but these
though no cause and effect relationship     are most often concerned with less well
is claimed.                                 documented situations than those in-
   This outbreak seems to be an excellent   vestigated by Schuler and Parenton and
field example of a phenomenon orig-         by Johnson.
inally formulated by Fritz Redl as "con-       Causal relationships have been empha-
tagion and shock effect" which he ob-       sized in the literature as related to: (a)
served in groups of disturbed children      communication of symptoms via view-
in summer camps.4 Grosser, Polansky,        ing; (b) predisposition to hysteria; (c)
and Lippittl later verified Redl's find-    circumstances stimulating stress, fear, or
ings3.4 in a series of laboratory studies   guilt; (d) the high suggestibility of
on the problem of behavorial contagion      the victims; and (e) a convergence of
in group situations.                        all or most of the factors given above.
   The atmosphere in the school we          In most of the studies females have
studied was punitive and made so by         usually been the victims.

864                                                         VOL. 55, NO. 6. A.J.P.H.
                                                                              EPIDEMIC HYSTERIA

Summary                                             The EEG studies were not remarkable
                                                 as to differences between affected and
    From approximately February 14               control groups but indicated a very high
 through early August, 1962, 22 sub-             degree of abnormality in both groups-
 jects, all females except one, experi-          53 per cent in the hysteria group and
 enced hysterical attacks, or what the           57 per cent in the-control group.
victims described as "blackout spells."             The precipitating factors associated
The outbreak took place in a Negro               with the onset of the outbreak were
 school of a southwestern Louisiana town.        identified and other important factors
    The study includes a definition of the       studied.
epidemiological, psychological, and psy-            The study of the affected subjects,
chiatric characteristics of the affected         their attacks and the progression of the
students when compared with a control            illness from one student to another, sug-
group.                                           gests a true outbreak of hysteria of
    There were some differences between          epidemic proportions.
the patient and control groups, but these        REFERENCES
were not significant in many respects.           1. Grosser, D.; Polansky, N.; and Lippitt, R. A Labo-
The mean I.Q. for each group was in                 ratory Study of Behavioral Contagion. Human Rela-
                                                    tions 4:115-142, 1951.
the Borderline Defective Range, though           2. Johnson, D. M. The "Phantom Anesthetist" of
the control group showed more persons               Mattoon: A Field Study of Mass Hysteria. J. Abnorm.
                                                    & Social Psychol. 40:175-186, 1945.
with average intelligence than the af-           3. Redl, F. Group Emotion and Leadership. Psychiatry
fected group. The social factors related         4.
                                                    5:573-596, 1942.
                                                                 . "The Phenomenon of Contagion and
to the outbreak were not especially sugges-         'Shock Effect' in Group Therapy." In Searchlights on
tive except that the hysteria group                 Delinquency. Eissler, K. R. (Ed.). New York, N. Y.:
                                                    International Universities Press, 1949, pp. 315-328.
showed a slight tendency to have more            5. Schuler, E. A., and Parenton, V. J. A Recent Epidemic
                                                    of Hysteria in a Louisiana High School. J. Social
broken homes.                                       Psychol. 17:221-235, 1943.

          Dr. Knight is assistant dean and professor of psychiatry and Dr. Sulianti is
        research fellow, Department of Epidemiology, Tulane University School of
        Medicine, New Orleans, La. Mr. Friedman is qualified psychological examiner
        and coordinator of special services, East Main Schools, Niles, fli.
          This paper was submitted for publication in December, 1963.

JUNE. 1965                                                                                          865

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