A total of 26 young people had these ailments at once, which required the sending of six ambulances and two motorcycles for first aid. Despite the confusion, none of the sufferers had to be sent to the hospital.
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Although it attracts attention, such episodes are not entirely new: collective psychotic epidemics, whose official name in medical textbooks is “psychogenic mass reaction”has been recorded for at least 600 years – from the 14th century, when there was a “fever” of uncontrolled dance that affected entire villages in Europe, a severe stress crisis that affected Acre’s young people after the HPV vaccine in mid-2015. .
In short, this phenomenon is associated with a number of symptoms – from anxiety attacks and nausea to fainting and paralysis – and affects dozens or hundreds of people who belong to the same social group.
Understand below how these collective psychotic epidemics occur and what can be done to prevent or combat such events.
Emotions are transmitted
Psychiatrist José Gallucci Neto explains that a mass psychogenic reaction is “a collective and common problem involving physical or emotional symptoms and having no biological cause or external factor.”
In other words, the reaction of these individuals cannot be explained, for example, by an infectious disease or gas poisoning that pollutes their common environment.
“What triggers this process is psychological, intimacy and the sharing of beliefs between people,” says the expert, director of the Institute of Psychiatry’s (IPq) electroconvulsive therapy and electroencephalography service at Hospital das Clínicas de São Paulo.
“When we see someone feeling sick, our own psyche can suggest that we are suffering from the same symptoms. After that, we start to ‘follow’ the body and interpret any sign as something of concern.”
“This in turn triggers a chain reaction and leads to collective epidemics,” the doctor adds.
Among the typical symptoms of a psychogenic mass reaction, Gallucci mentions shortness of breath, dizziness, fainting, belching, nausea, anxiety attacks, muscle contractions, convulsions, and paralysis.
And all of this happens precisely because we live in a society and care about the feelings of others, especially the closest group we’re dealing with.
“Sociality is a necessity for the survival of our species,” analyzes psychiatrist Lucas Spanemberg, a researcher at the Instituto do Cérebro do Rio Grande do Sul.
“Our psyche is built on this human ability to care, empathize, communicate, and influence the behavior of others,” adds an expert who is also a professor at the Pontifical University of Rio Grande do Sul.
Although young people are most likely to have such collective reactions (because they are naturally more affected by the external environment), such phenomena have already been recorded in several profiles.
For example, in World War I, some soldiers who spent months or years in trenches had a so-called shell shock, a state of deep pain in which they were unable to move, talk, or do any other activity.
In World War I, soldiers like the picture caused a “shell shock,” a paralysis that prevented any activity – Photo: GETTY IMAGES
It is worth mentioning here that many of these concepts are still the subject of intense debate in the medical community. For example, the World Health Organization (WHO) does not like the use of the word “psychogenic” to describe these massive emotional reactions.
Previously, this situation was even classified as “collective hysteria.” But the term has become obsolete and is even considered inappropriate today. Hysteria, which comes from the Greek word hysterus or uterus, was a disease that doctors previously mistakenly exaggerated only for women, as if mental disorders had occurred only in women and were in some way related to lack of sex or dysfunction of the reproductive system.
In general, psychogenic mass reactions can be divided into two major groups: acute and chronic.
“The acute reaction usually occurs suddenly, is transient, and most cases go away in less than 24 hours,” concludes Dr. Renato Luiz Marchetti, who coordinates the IPq epilepsy and psychiatry project in São Paulo.
“It is likely that if the right behaviors are made, these types of episodes will not be repeated and will not be crippling to those affected,” he adds.
Due to the limited information available, experts believe that the latest section of Recife fits this first definition.
In the Middle Ages, cases of choreomania, a mass psychogenic reaction in which a group of people could not stop dancing, were reported – Photo: GETTY IMAGES
In the case of chronic mass psychogenic reactions, the situation becomes slightly more challenging.
“In this case, there is usually a time lag between the stimulus and the onset of symptoms. The course of the crisis is also prolonged and much more crippling,” Marchetti describes.
People with this type can develop tremors, tics, loss of muscle strength, and even paralysis of the limbs — manifestations associated with the effects of emotions on the nervous system.
The latest example A massive and chronic reaction occurred in Acressa from mid-2012 to 2017.
A group of 74 young people (mostly girls) began to experience severe discomfort, such as convulsions and paralysis, after the first dose of HPV vaccine, a virus that is behind cervical cancer and several other tumors.
In the face of such atypical manifestations, the first reaction of all parties involved was to suspect that the immunizer was at fault.
The matter became so serious that the Ministry of Health decided to launch a formal investigation and invited Gallucci and Marchet, two of the doctors interviewed in this article, to conduct the investigations.
“We selected the 12 most serious patients and took them to São Paulo, where they were taken to hospital and subjected to a series of tests such as MRI and CSF analysis. [líquido que circunda o cérebro e a medula espinhal]”Gallucci says.
From this test batch, the experts aimed to determine whether there was evidence of the effect of vaccine doses on the neural system of these adolescents. The results showed that there was no lesion or substance that could explain the seizures and paralysis.
“The Acre case was, in fact, a mass psychogenic reaction that became chronic without anyone making the correct diagnosis and proposing appropriate treatment,” Gallucci analyzed.
The results of the Brazilian study were published in October 2020 in the specialty journal Vaccine.
“At Acre, we saw how the occurrence of such a condition is something complex, depending on a number of factors. The girls affected were part of social groups with significant problems related to patriarchal culture in crisis, family conflicts, inappropriate use of social networks, religious influence and a very important belief against the vaccine, “Marchetti lists.
In short, the fear that the HPV vaccine could cause side effects was enough for these young people to get really serious reactions (without the immunizer having anything to do with it). And because emotions are contagious, this scenario provoked a chain reaction in the group that presented a series of similarities.
Marchetti says that when it comes to this mass psychogenic epidemic, there is even a specific term for vaccines: the reaction associated with the stress caused by immunization.
“The WHO has had a team monitoring and investigating these vaccine-related psychogenic reactions since 1972. Cases have already been reported in Bolivia, Japan, Denmark, Brazil and, more recently, Thailand with the covid-19 vaccine.” , remember.
And let me be clear again: the vaccine has nothing to do with this effect. The problem is due to a mixture of environment, social group, emotions and stress.
But are there ways to treat these diseases?
The key is in communication
Experts interviewed by BBC News Brazil point out that there is a lot of care and extra dialogue involved in treating mass psychogenic reactions.
“The big difficulty lies in the fact that doctors themselves are not aware of this phenomenon, which makes diagnosis difficult. Psychogenic mass illnesses have always occurred but have been forgotten for the past 40 or 50 years,” Marchetti says.
In acute cases (as perhaps in Recife), the first step is to dismiss the people in crisis so that they gradually calm down. The idea is to limit the emotional infection in that group – and prevent other individuals from making an impact as well.
“However, in chronic situations, there is a need to take advantage of cognitive-behavioral psychotherapy, which has been developed specifically for psychogenic mass reaction,” Gallucci says.
This psychological treatment applies not only to patients but also to the family and the entire social group. The goal is to analyze the behaviors and thoughts in order to change the ingrained beliefs that led to the situation.
Marchetti confirms how communication is an integral part of the process of diagnosing and treating such a disease.
“As our doctors, we need to explain what the person had and make it clear that he or she did not have a serious organic disease,” the psychiatrist recommends.
“But then there’s a big risk: when it’s said it’s not a serious illness, the patient and family members might think it was pretense or frivolity,” he continues.
As we know, just because a problem is “in someone’s head” doesn’t make it wrong or less relevant – anxiety, depression, and other mind-altering disorders are debilitating and can have serious health effects.
“Therefore, it is important to make it clear that this is a mass psychogenic reaction, a disease that is transient most of the time and can be resolved properly,” Marchetti adds.
In the two main examples that helped illustrate this report – vaccinations at Acre and students at Recife – the situation is still open and without many definitions.
“In the case of Acre, we suggested that health teams dealing with young people be trained to apply cognitive-behavioral therapy, but the covid-19 pandemic paralyzed the project,” Gallucci says.
“Unfortunately, many families ended up following treatments for which there is no scientific evidence,” he complains.
BBC News Brasil contacted the Pernambuco Ministry of Education and Sport to understand what happened in Recife after the outbreak.
The community communications department sent responses via email stating that the school where the session took place “got a psychologist on the first working day after the incident to listen to students who claimed to have experienced an anxiety crisis last week.”
“The professional will do a survey for those who do not have psychological support to refer them to service.”
“The teaching unit also planned a meeting with another psychologist and those in charge of students to discuss the topic and the responsibilities of each (school and family) in this process,” the note continues.
Finally, the school promises to create projects to strengthen “active listening and dialogue with students.”