What’s Causing Cheerleader Hysteria? Signs of a Struggle Within the Brain

By Vaughan Bell | February 29, 2012 9:50 am

Vaughan Bell is a clinical and research psychologist based at the Institute of Psychiatry, King’s College London. He’s also working on a book about hallucinations due to be out in 2013.

Cheerleaders from a small town in New York state have been making headlines because several of them began to display tics and involuntary movements that have been diagnosed as conversion disorder—a situation which has often described in the media as being due to “mass hysteria” or a “mystery illness.” I can’t say for sure whether the diagnosis of conversion disorder is accurate or not because I’ve not been clinically involved with the affected people, and if I had, I couldn’t talk about it due to patient confidentiality, but what I can say is that some of the media reporting of conversion disorder, “hysteria” and its related concepts has been highly confused.

Hysteria is used in everyday language to mean “panic” but it has a long history as a medical condition, originating from Hippocrates who thought that a whole range of symptoms could be caused by the womb “wandering” around the body. As you might expect, it was traditionally thought of as a female disease until the French neurologist Jean-Martin Charcot shocked the medical world by reporting the first male cases. Although the connection with a wandering womb was comprehensively disproved, doctors were still puzzled by patients who seemed to have neurological disorders without damage to the brain and nervous system. The core definition of hysteria as neurological symptoms without neurological damage remains with us today.

A student of Charcot’s, Sigmund Freud, became curious about the condition and added another element to the definition, which both made his career and became the basis of psychoanalysis itself. As a neurologist, Freud came to believe that mental energy was equivalent to neural energy and, therefore, our mind obeys something akin to the laws of thermodynamics. The first such law says that energy cannot be created or destroyed, only converted into another form. This is why Freudian psychology is full of mechanical concepts such as “repression” and “conversion” and the idea that all emotional disturbance must be “processed” or “dealt with” (think: a release valve) or else it will express itself in another form (think: a burst or bulging pipe). Many of the theory’s predictions have been disproved but the theory lives on and, to a great extent, it has become what we unfortunately think of as common sense. Nevertheless, Freud applied the same thinking to hysteria, saying that these seemingly neurological symptoms can appear without neurological damage because the unconscious mind is shutting down the body to prevent us from encountering a deep emotional disturbance. A bit like locking the basement in a rushed attempt to deal with a burst pipe—the problem is easier to ignore but not any less serious.

As Freud fell out of fashion, many people assumed that the concept of hysteria had gone with him, but this is not the case. Although his theory about hysteria being caused by the “unconscious repression of trauma” isn’t very popular among scientists, it’s a simple fact that patients can develop what seem like neurological disorders—such as paralysis, blindness, seizures, and tics—despite having a perfectly functioning nervous system. And despite popular claims that the condition is rare or “doesn’t happen any more,” it still commonly presents in neurological clinics. Numerous studies have found that up to onethird of patients who consult with neurologists typically have symptoms that are not fully explained by neurological damage.

So how can these “pseudo-neurological symptoms” be distinguished from genuine neurological disorders? Neurologists can rule out such damage to the nervous system because they are specialists in the lower-level machinery of the brain—the neurology rather than psychology. As an analogy, while you may not understand how your iPhone works, an electronic engineer could check every component and electrical connection to try to pin down the source of a problem. If each part were working fine, we would know that an issue that would normally be caused by physical damage, such as a loss of sound, was actually due to a software problem.

In this situation, neurologists do something similar for the brain. If the patient can’t hear, a neurologist tests the electrical parts of the hearing system; if those work, then it must be an issue with how the functional hearing circuits are being coordinated by the control systems. In brain terms, this doesn’t mean there isn’t an issue, just that it’s not due to low-level nervous system damage. This is also why it is unlikely that the New York teenagers’ problems are linked to an “unknown virus”, “mystery illness,” or “toxin,” which many media outlets mentioned as potential causes: Viruses, bacteria, or poisons are most likely to cause these symptoms by damaging the neural pathways—something we can normally detect fairly easily.

Cynics might suggest that conversion disorder patients are just faking, but we have good evidence that this is not the case. The majority gain nothing from their disability, making a poor case for deception. What’s more, neuroimaging studies show that someone with conversion disorder paralysis has markedly different brain activity during an attempt to move an immobilised limb, compared to people who have been taught to fake the same symptoms.

So when the LeRoy cheerleaders were diagnosed with “conversion disorder,” the doctor was saying that although the symptoms appear to be due to neural damage, there were no problems with the neural pathways, and there was no evidence of faking, so the symptoms were likely due to psychological factors. “Mass hysteria,” on the other hand, is not a recognised diagnosis and just describes where seemingly physical symptoms with no medical explanation affect a whole group of people at once—usually with the suggestion that a temporary conversion disorder-like syndrome is the cause. As the history of mass hysteria shows, the effects can be astounding at times.

But even with a diagnosis like conversion disorder, there remains the question of how the brain is causing these strange effects. Talk of “psychological factors” just shifts the burden of explanation from the brain circuits that directly deal with movement or sensory functions to those involving “higher” brain functions that coordinate and control them.

What studies are increasingly showing is that these symptoms might be generated by the involuntary control, or tamping down, of brain areas that control sensory and movement functions. In this case, the systems doing the involuntary control are thought to be the higher-level brain functions like attention and executive function that rely heavily on the frontal lobes. Our own research group recently reviewed brain-imaging studies of people with conversion disorder and found that when patients try and do something contrary to their impairment—for example, trying to move a limb paralysed with conversion disorder—activity in the frontal lobes massively increases, as if the control mechanisms were suddenly putting the brakes on.

Nevertheless, we’re still not entirely sure why this situation occurs in the first place—why does the brain’s control system decide to hit the brakes, destabilize a coordination system, or cause unnecessary movement? We have some clues. It turns out very similar brain activation patterns occur in hypnotized people if they are given suggestions to simulate conversion disorder-like symptoms, but these effects are temporary, unlike conversion disorder, which can be long-lasting. We know that patients with conversion disorder are more likely to have other forms of emotional instability. While the Freudian idea of conversion disorder as a direct unconscious attempt to repress or avoid painful thoughts is unlikely to be accurate, it may be that unstable emotion might be adversely affecting the control of more basic sensory and coordination systems in the brain, and this may help us explain why some patients have conversion disorder in its chronic form. The effects of “mass hysteria,” however, typically pass quickly, perhaps suggesting that social suggestion might be a more important cause for these sorts of temporary outbreaks.

It’s worth noting that despite its long history we still know relatively little about hysteria, partly because it falls thought the cracks of medicine, as it is usually detected by neurologists but is best treated by psychologists or psychiatrists. However, anyone who has seen its effects knows that the old cliche about the power of mind over body has a ring of truth to it.

CATEGORIZED UNDER: Mind & Brain, Top Posts
  • Steve

    It seems a strange coincidence that there was a toxic site located nearby, where the EPA recently started moving corroded drums of toxic materials long forgotten from years ago, and from where soil and rocks were collected and used in a recent lot improvement at the girl’s school.

    The fact that the school would not let Erin Brockovich on premises to take soil and water samples to either prove or disprove that theory only adds to the suspicion of a cover-up.

    The scientific analysis you present is only valid if all of the facts are considered, but there are obviously forces at play in this case that do not want that to happen.

  • Jacques

    Interesting read. Indeed, the surgical removal of a womb today is known as a “hyster-ectomy”. An unfortunate association which has persisted since the time of Hyppocrates.

  • Mike

    Conversion disorder is a real condition, but the facts in this case are overwhelmingly against it. This is happening to a group of kids living in the same geographic area around the same time. Logic demands that the cause is external and common between victims.

    I’m no expert on neurological agents, but it could be something as simple as contamination in the school lunch. I’m not sure if the symptoms are consistent with botulism, but all environmental avenues should be followed because it is definitely one of them.

    For instance, it probably isn’t terrorism (e.g. someone deliberately releasing some sort of nerve agent or neurotoxin) but it’s a lot more likely than conversion disorder that somehow affects all of these people who live near each other almost simultaneously.

  • Quinn O’Neill

    According to other sources, a young male and a 36-year-old nurse practitioner also had the condition. Were they cheerleaders too or is “cheerleader hysteria” maybe not such a great name for the condition? I expect that the references to cheerleading will help those who are inclined to stereotypes toward an assumption that the affected LeRoy residents are emotionally unstable.

  • Norman Rosenblood

    It is a pity that my fellow psychoanalysts in New York state did not take the opportunity to visit the town in New York and conduct a series of interviews with the afflicted students.

    It wouldn’t take very long to identify the shared group phanatsies and uncover the reasons why they were repressed in the first place.

    The actual tics would also be an integral source of explaining what Dr. Felix Deutsch long ago referred to as the mysterious leap from the mind to the body. Yes, conversion is alive and well in upper New York state just as it was in Vienna in the 1900’s. nd I shall hazard a guess the students were not all Jewish ladies.

  • rork

    It must be something, right?
    Well there already is a possible something: conversion disorder. Neurologists are saying it not uncommon, though ordinary folks like me had not heard much about it before.

    “Logic demands” we consider it as a possibility. It explains why the outbreak is localized. It explains how it is happening in time: not perfectly synchronized (as school lunch would be expected to be) nor spread out over years. It mostly explains why only one of the affected people was male (an important clue I don’t think was mentioned here). It explains why nobody has been able to find a different cause.

    Scientists are still looking the situation over, and it might be something else, but it might not be.
    PS: “only valid if all of the facts are considered” – does that mean we must have perfect knowledge before we act on anything. Cause you won’t be acting much.

  • brook

    but the author mentioned social suggestion, and surely that can work on a group of people in one location at the same time?
    I think causes such as these (influence from authority figures or other people) is often discounted because we would all like to think we are in complete control of our minds. The funny thing is that once we start looking at how these social forces work then perhaps we can be more aware of them and hence be more in control

  • Jimmy

    Read about PANDAS.

  • Chas

    My nonprofessional guess is some form of dyskinesias brought on by drug experimentation.

  • Pingback: A non hysterical view of ‘cheerleader hysteria’ « Mind Hacks()

  • http://blog.ketyov.com Bradley Voytek

    Jacques, you seem to have the relationship wrong. “Hysterectomy” literally translates to “cutting out of the womb”, as “hyster” comes from the Greek word for womb. “Hysterectomy”, therefore, is a perfectly fine word.

    Hysteria and hysterical, on the other hand, are strongly and gender biased and inappropriate.

  • Bob

    If these girls believe strongly enough that a toxin is responsible for a friend’s tic or spasm, and that they have also been exposed to it, then it is like the ‘placebo effect’ that must be dealt with in virtually all pharmaceutical clinical trials. The mind exerts complete control over the body, and there is a great deal more sub-conscience activity going on than most people understand. There doesn’t have to be any positive payoff either — if someone tells you NOT to think of pink elephants, you will anyway, even though you might not want to (who would?). Witness the history of ‘witchcraft’ and ‘black magic’ …. if the victim believes in these strongly enough, then they will be affected by it. Witness also the ‘laughing disease’ that once affected the residents of a village for more than a year. I heard it said that if the effect fade away, then the cause is more likely a conversion disorder than a true toxin-induced movement disorder. IMO, we need to know a lot more about how the brain really works, and I even think it’s a mistake to use ‘conversion disorder’ and ‘psychological’ in the same sentence — a doctor might understand it, but for most, it’s taken as dismissive ….

  • cheryl

    seriously? a nearby toxic site, and nobody linked them, questioned it? it’s about as bad as the current proposal to put a freeway through the Rocky Flats plutonium site, where nearby soil shows no sign of decay of radiation since it was shut down many years ago. oh, BTW, there’s “no danger” to any human population that lives within a mile or more of the site…

  • HeatherT

    I feel for the women. It may be conversion disorder … but I have to say, I had a duck with the same symptoms, probably based on water quality. Those “tics” are often toxic, and not necessarily what you would expect, like pesticides. Manganese will do it too. GOOD SCIENCE is what helps in cases like this.

  • DrugMonkey

    They DID rule out common exposure to recreational drugs, right?

  • Susan Durham

    I agree with Steve. Suggestion NOTHING! It is obvious these people have a real disorder, probably caused by some environmental hazard to which they are either more sensitive than others, or by happenstance, to which they were exposed to a greater extent than others similarly situated. It is an unfortunate truth today that when something cannot presently be explained it is chalked up to “stress.” As if humans had somehow evolved free of stress and are now too fragile to tolerate it! However, that is not the case here. If Steve could locate a toxic waste site close to the school, why continue to call it “stress,” or postulate some sort of hysteria? I want to see someone who is having her young and otherwise privileged life messed up with this kind of obvious problem who is NOT having “other forms of emotional instability.” I’m having other forms of emotional instability just listening to it!

  • Kerberus of Styx

    Very interesting case.

    Freud was the founder of the psycho-dynamic model of psychology that expresses very nicely the relationship between memories in the body (mind) and the ego, and even though many of his ideas have been discredited because they were too mechanical, he still remains a super-giant in the history of our ability to understand the psychology of the unconscious. Sounds like this author has an unconscious bias against Freud because psycho-dynamic psychology can’t be understood as nothing-but chemicals; the mind operates according to ideas and perceptions and the structure of the mind is akin to the structure of language (Lacan). The further away psychologists and psychiatrists get from the relationship of language and symbols to the mind is the farther away we get from our own humanity.

  • http://www.MentalHealthandIllness.com Robert Bransfield, MD, DLFAPA, President New Jersey Psychiatric Association

    Labeling this as mass hysteria, hysteria or conversion disorder without a proper presonal exam with an adequate consideration of medical causes is irresponsible.

  • Tony Mach

    My money is on pathogen.

    As it stands, one needs evidence to prove an involvement of a pathogen, as one guy called Koch once postulated long a ago.

    No such rules apply to psych* disciplines – they simply claim a illness/disease/disorder as their own, without evidence.

    To go to your (in my view crude) analogy: You need to prove that the hardware is malfunctioning, but you can not simply reason if there is nothing known wrong with the hardware (known to you!), then it *must* therefore be software.

    As someone with an education in electrical engineering and working over a decade in software development, I can tell you that you can *not* rule out every failure mode of hardware that one can think of and simply reason it *must* therefore be software.

    To paraphrase Koch’s postulate for iPhone diagnostics: To say it is a hardware failure, you must *prove* that it is a hardware failure. To say it is a software failure, you must *prove* that it is a software failure. Even if you think one is much more likely than the other, until you *know* what is causing it, you can’t rule out one or the other. (And having seen hardware failures cause problems in only certain software revisions, I can tell you that gut feelings can be wrong.)

    And while you may rule out *some* (surely not all) of the conditions known to you (which most certainly is a subset of the *known* conditions, which in turn is a subset of all conditions afflicting humans), and that may give you a gut feeling that it might not be organic and psych* instead, this is in no way scientific proof.

    And that is the reason that psych* disciplines are not part of the sciences. (Just looking at “medically unexplained symptoms” and how these “medically” unexplained symptoms out of thin air get explained by psych* disciplines anyway, shows one that psych* disciplines are not part of the medical sciences.)

    Come back when you have proof.

  • Gunner

    Wow! you said a lot (of nothing) Tony.. Perhaps you should get the CSI team involved to
    find your ‘pathogen…
    By the way, I guess you think Astronomy is not a science either, since it involves a lot of gut feelings, hypotheses and downright guessing…huh… Most people don’t realize that Einstein could only prove his theories with ‘thought experiments, psych!

    If a computer (hardware) sends a message (software) to a printer (hardware) and the printer doesn’t print then you have several ways to figure out what the problem is.. But no one asks the computer or the printer how they ‘feel about the problem……

  • Jan

    If this is neurological those girls could be running out of time. If it is not, then there is more time to help them. The search for a physical cause must continue even while the girls are being treated for “conversion”. Their lives are in danger. My sister had “conversion disorder” in the 1970’s. They treated her with Valium for a week and it went away. The symptoms in the current case do not respond to medicine.

  • SimonW

    Tony Mach: Science isn’t a group of disciplines, it is a way of dealing with knowledge. Psychologists use the same principles as chemists, biologists and the other ‘hard’ scientists.

    The placebo effect on its own is a demonstration that psychology is part of medical science.

  • Lyme father

    LYME DISEASE. Test these girls with a Western Bolt only (ELISA is not a good screen). My son had these symptoms. Nine months of antibiotics and he is better, likely cured. LYME DISEASE PEOPLE!!! Watch “Under Our Skin” it’s on Netflix.

  • Ryan

    I agree that Lyme disease should be considered. It sounds very much like symptoms of the disease, and its pattern (affecting women in a school) is very suspicious, too, which could imply a common trait among them getting infected (which could just geography). So its pattern of occurrence implies it could be Lyme, too.

  • Sam

    This has happened many times and the4 CDC has form on not investigating it properly.

    There are many outbreaks of ‘mystery illness’ documented that have been called M.E, CFS or CFIDS.

    In the USA there are the Lyndonville and Lake Tahoe outbreaks – decades later people are still ill.

    In the UK there was an outbreak at the Royal Free Hospital in 1955 some of those people are still alive and still ill.

    There have been outbreaks of something like M.E all over the world for centuries.

    Also nobdy has ever discovered the mechanism for somatisation and if people are labelled as conversion patients they are unlikely to get any deep bio-medical testing and therefore no treatment either.

    I genuinelly hope that this is not another M.E type outbreak – it destroy’s peoples lives for decades.

    There is a film about the Lake Tahoe outbreak: http://www.youtube.com/watch?v=OsGS3hcpMX4

    And Dr Bell who has been caring for the people in Lyndonville who got ill has written an excellent book about his experience of the jhourney of his patients over years free online:


    There is a long history in this kind of illness of disbelieving patinets and then blaming them for not recovering – it is a very very long story and it is ongoing.

  • Peter

    The discussion of Freud and common sense highlights a side of this I also haven’t seen covered – being a normal, well-adjusted person by the standards of our society might not necessarily be mentally healthy, and might even be leading people towards weird tics and breakdowns. We’re conditioned by advertising or our parents to worry about things we don’t need to worry about, to think that our brain works in ways such that we can’t possibly feel ok about (Y) unless we do (X), and all of that is amplified when you’re a teenager in high school constantly meeting deadlines that are designed to prepare you for a desk job. So I always wonder where the line is with psychology, between what is accepted as something you can change and something that isn’t, and how optimistic the placement of that line is about the ability of society to change how its thinking too.

    All that said – I would not be at all surprised if an environmental factor is being ignored. Look at leaded gasoline, that was covered up for half a century. But particularly in a small group like this, it could also be contaminated food outside of school, or some other product that they all happened to buy around the same time. Or it could be some combination of personality with an outside factor, like with cat owners and Toxoplasma gondii.

  • constant reader

    Whatever you call it, the phenomenon described by “conversion disorder” exists. I think the two girls who first exhibited the symptoms may be being done a grave disservice by all the focus on toxins — the toxins become a place to “offload” the very real problems in their family lives that these girls have been forced to contend with and carry on, uncomplainingly. A so-called conversion disorder allows a person to be “cared-for,” to receive the cconcern they have not been receiving in daily life.

    I know because I experienced it. A few years ago, during a time of great family stress, I experienced symptoms very similar to those of these girls. My legs jerked and buckled. I had tics and large, embarrassing twitches. The first neurologist who examined me and did all kinds of tests (MRI, blood tests, spinal tap, reflex testing) did not have an answer and concluded I had some kind of neurodegenerative disease that would slowly progress, though he couldn’t say exactly what it was. Then one night, while googling frantically for information, I came across a description of conversion disorder. It so perfectly matched my symptoms that I had to consider the possibility that this is what I had. Here is what I did: I simply allowed myself to stop going to the doctor. I took a meditation course and told myself that it couldn’t hurt to relax and become more mindful, even if I did have a neurodegenerative disease. I focused on trying to acknowledge the stresses in my life and get the support I needed. Little by little, over a period of months, the symptoms waned and only came back when I was sleep-deprived. They are completely gone now (even when tired). I’m now convinced that the tics and twitches were psychogenic and were an expression of my need to escape the stressors in my life and be cared for. If I hadn’t diagnosed my own problem, I don’t think any doctor in the world could have convinced me — I felt no conscious control over what was happening, and in in fact, the harder I tried to control the tics and involuntary movements, the worse they got. My heart goes out to these girls, and I hope they find relief.

  • susan

    SimonW said:
    “Science isn’t a group of disciplines, it is a way of dealing with knowledge. Psychologists use the same principles as chemists, biologists and the other ‘hard’ scientists.”

    The first statement is correct, the second, completely and resoundingly wrong.
    Cognitive Psychology claims to study the “mind”. It takes a top down approach, something akin to learning how to bake bread by studying a loaf and some crumbs rather than the basic ingredients and their chemical interactions with temperature and water.

    The mind is merely an illusion of consciousness.
    Double dissociation of mind and brain has never been demonstrated.

    Psychologists do not study the basics of science – they do not speak the language of science.
    Like trying to do calculus without knowing how to do arithmetic.

    Psychology is not, and never will be, a science. You don’t get to be a scientist just because you can shove some numbers into SPSS!

    Sue. (BSc. Hons. (2i) Psychology)

  • susan

    Is the SimonW commenting here the same SimonW as decided the Camelford water poisonings were some form of hysterical conversion disorder?

    Whatever happened to that good old honest medical word, “ideopathic”?

  • Karin

    At the age of internet, YouTube, television in each room, why aren’t teenage girls all over the country starting to have tics, if it were mass hysteria? Why is it confined to Le Roy? There has to be an environmental factor involved.

  • Geack

    @ 30. Karin (and others):
    These students have all been examined thoroughly by people who make a living tracking down the causes of symptom outbreaks like this. They were tested for drugs and toxins and infections and none were found. Everyone in the area knows about the decades-old chemical spill; it’s not that close to the school, and not all the kids with symptoms went to the school nearest the location, and other people with greater daily exposure to the area than the students have never shown these symptoms, and the decay rates of the chemicals spilled are well known and understood, and there are about a dozen other good reasons why the spill is irrelevant. Erin Brockovich and her lawsuit squad weren’t allowed on school grounds because they have proven themselves to have little regard for facts and would contribute nothing useful.

    Why is it that every time something like this makes the news, so many people assume that every single person directly involved in the situation is either hopelessly incompetent or actively participating in a conspiracy?

  • Rafael Morales

    I get a kick out of all you people with your complicated theories about this disorder. But all of you, but one (DrugMonkey, March 2nd, 2012 at 9:11 am ), ignore the most likely scenario. Talk about the typical “Gordian Knot”.

    Those girls won’t admit it, but they all most likely have been taking recreational drugs. There are drugs that will not show up in testing, unless you know exactly for what you are testing.

  • elahrairah

    as a professional drugs worker, i can tell you that the symptoms displayed are unlikely to be linked to ingestion of any known recreational drugs. the social patterns and numbers of sufferers don’t match either. i have no idea what it is, but i doubt that drug use is anything to do with it.

  • Nancy Hope

    The first thing I thought of the Creuztfeld Jacob. Mad cow. I saw video of a young woman and she had odd symptoms at first followed by degeneration. Such a rare disease that its full range of possible onset symptoms may yet be unknown.

  • http://hypnosis.fridaten.net Jennine Hoheisel

    Performing conversational hypnosis, unlike most styles of hypnotherapy performed by professionals, is done without the other person’s knowledge. This is a subtle form of hypnotherapy, and borders the line of ethics. If you want only purely ethical hypnotherapy, conversational hypnotherapy is not for you.


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