On Wednesday the 15th of February 2017, a Facebook friend of mine Mr. Richard “Zanovuyo” Stephenson tagged me on a Facebook post from Mr. Sizwe Kupelo who is a Spokesperson for the Eastern Cape Department Of Health. In his Facebook post, Mr Sizwe Ka Kupelo reported as follows: “News Just In-Scores of children from Bhekisizwe School, Nothintwa Village in Mqanduli have been rushed to hospitals in the area with a mysterious illness. One was certified Dead On Arrival at Ngcwababa CHC. The ‘hysteria’ is only attacking girls, they have visuals – this is a developing story”.
My comment on this FB post from Mr. Richard ‘Zanovuyo’ Stephenson was “These kinds of mysterious group illnesses or mass hysteria are becoming a common occurrence in various parts of South Africa. The fact that only girls are affected is a mystery on itself, and from a medical point of view we obviously must rule out things like poisoning with hallucinogens that can make them see non-existent things, hear voices, or even have abnormal tactile sensations.
Once poisons have been ruled out and other relevant medical illnesses, a serious thought must be given to African Cultural Syndromes…which would require interventions of Traditional Health Practitioners who are now recognised as parts of the health system in South Africa. It is said that a kid has already died from the mysterious affliction”.
The following day the 16th of February 2017, the mysterious Massive Hysteria Outbreak was reported widely by several prints and electronic media in South Africa. Additional information that came through was that 18 teenage girls were affected in this Mass Hysteria Outbreak. Apparently, the outbreak was triggered by an incident wherein a 16-year-old Grade 8 student collapsed when students were lining up for classes, she was reported to have had shortness of breath and was rushed to a nearby clinic, where she was declared Dead on Arrival (DoA).
Further, it was reported that the other students who witnessed the incident, subsequently presented with sudden strange behaviour, during which they had visions, hearing voices and were screaming and crying, and the 17 students were taken to the Community Health Clinic for emergency care, and about 10 of them were taken by ambulances to nearby hospitals, and some of them were put on some intravenous ‘drips’.
Since that initial Facebook post this past Wednesday, as a reasonably qualified, knowledgeable and experienced Family Physician, I have been mentally consumed by this latest Mass Hysteria Outbreak story, especially the fact that for the 1st time in South Africa, this Mass Hysteria Outbreak was accompanied by an unexplained death of a teenage 16-year-old girl, who is reported by family members to have been a healthy person, with no history of any form of chronic illness.
Like all medical scientists, I decided to review published scientific and non-scientific literature on the concept of Mass Hysteria Outbreaks, with a view to making sense and better understanding what might have taken place to those school children in Bhekisizwe School, Nothintwa Secondary School in Mqanduli a small village town in the former Transkei homeland.
I have a special interest in this Mass Hysteria Outbreak case because I am quite familiar with the Mqanduli area, which is less than 100km from my home rural village of Tabase Mission outside Mthatha, where I grew up from childhood to adulthood, in the former capital town of the Transkei homeland.
Another reason for the interest is that since 1997 when I was doing my Master’s Degree In Family Medicine with the University Of Natal, I chose to do my Master’s Research Thesis on the Topic “Use Of Traditional Healers by Urban Black Africans, A Family Practitioner’s Perspective”. Since that initial academic research project, I have immersed myself in learning more about the world of African Cultural Syndromes, the role of Traditional Healers, the African Traditional Belief Systems or World View.
My review of available scientific and non-scientific literature has revealed that the concept of Mass Hysteria dates to more than 600 years ago, and has happened virtually in all the continents of the world. Mass Hysteria Outbreak cases have over centuries been reported in the Americas, Europe, Asia, Middle East and Africa.
The most famous Mass Hysteria case from the continent of Africa is the Tanganyika Laughter Epidemic that occurred in 1962 in the village of Kashasha on the West Coast of Lake Victoria in the modern nation of Tanzania near the border with Kenya. That mass hysteria epidemic spread from a boarding school in Kashasha, which had to be closed, and it spread to nearby schools and villages, and it stopped 18 months later. The affected people presented with uncontrollable laughter, complains of non-specific body pains, episodes of fainting, respiratory problems, unexplained rashes and crying.
In South Africa, there has been several Mass Hysteria Outbreaks that have been reported mainly in the Eastern Cape and Kwa-Zulu Natal provinces, although there have been cases reported in other provinces like Gauteng as well, more specifically in Soweto. There have also been reports of multiple Mass Hysteria outbreaks in Lesotho, our neighbouring country that is landlocked by South Africa.
In my formal literature research, I came across a PhD thesis that was conducted and submitted by a Lesotho citizen, Ms. Lineo Tsekoa to UNISA in 2013, as part of her fulfillment of her academic qualification programme be certified a Doctor of Literature and Philosophy.
This PhD thesis by Ms. Tsekoa is the most comprehensive, and most culturally relevant piece of scientific research about Mass Hysteria which I have come across. Ms. Tsekoa thesis provided to me a lot of critical insights on this complex subject, the possible causative dynamics, presentation types, personal experience testimonies, observation testimonies, and recommended interventions approaches.
The credible information that comes out of the Ms Tsekoa’s thesis entitled “Mass Hysteria: The Experiences Of Young Women In Lesotho”, reveals that Basotho people are divided on the causation of this mysterious illness, with some believing that Mass Hysteria is caused by Natural causes, whilst others believe that it is due to Supernatural causes.
The literature theories in support of Natural causes are as follows:
Sociological Theory: In this theory, they postulate that Mass Hysteria is a social problem that emanates from society, and being cultural in origin (Kotler 2012; Smelser 1996:1)
- Biological Theory: In this theory, the belief is that Mass Hysteria is linked to womanhood, with females believed to have weak mental constitutions that make them prone to emotional instability which predisposes them to Mass Hysteria. (Barthalomew and Scrious 1966:290; Gilman et al 1993: viii)
- Psychological Theory: In this theory, the postulation is that Mass Hysteria victims react to the extreme unconscious stress-related emotional conflict which is converted into Psychosomatic symptoms. They believe that Mass Hysteria is linked to Histrionic personality. (Allin et al 2005: 207; Roach and Langley 2004:1271)
- Food Related: students eating the same food, like cabbage that is infected by a poisonous worm, which results in the poison effects on those who ate the cabbage.
- Drug Abuse: teenagers experimenting with illicit substances like Dagga, which when consumed causes hallucinations.
Those who believe that Mass Hysteria is due to Unnatural causes believe Mass Hysteria is due to forces beyond the forces of nature often associated with superstition/irrational behaviour, jealousy triggering witchcraft, resulting in collateral damage to other teenagers who are with the targeted teenager.
In this study, there was general agreement between traditional healers and priests that the root cause is evil spirits, that have attacked Mass Hysteria sufferers. The sub causes in this group are;
- Evil Spirits (Amafufunyana Syndrome/Thikoloshe evil spirit)
The thinking in this Unnatural causes theory is that to understand the socio-cultural and religious beliefs to the causation of Mass Hysteria, one must have a deeper understanding of perceptions of causes of illnesses and diseases, in order that relevant and appropriate interventions can be adopted and administered.
Researchers, Legare, Evan, Rosengren, and Harris (2012) concluded as follows: “Supernatural beliefs are sanctioned across all cultures in both industrialised and developing nations. They contend that supernatural phenomena are important and are a permanent aspect of human thinking”. In the Lesotho study, the Basotho people overwhelmingly perceive that the phenomenon of Mass Hysteria is due to supernatural agents, and they believe in resolving it, prayer, exorcism and other traditional healer’s interventions are required.
Other researchers who are quoted on this Mass Hysteria thesis had the following to say on the subject:
- Yasamy and Zaddinni (1999:710) affirm that the cause of Mass Hysteria is associated with the victim’s cultural background.
- Bartholomew (1993:178) believes that Mass Hysteria has effectively been masked by cultural customs.
- Govender (2010: 318) says many outbreaks of Mass Hysteria are not reported due to the stigma associated with it.
- Jones (2000: 159) believes that diagnosis and or recognition of Mass Hysteria phenomenon is difficult because at times the presentation of Mass Hysteria is like employees from the same building that suffer from the effects of the Sick Building Syndrome.
- Rataemane et al (2002: 12), cautions that resources can be wasted fruitlessly in search for the diagnosis during outbreaks of Mass Hysteria and that it was important for Mass Hysteria to be recognised early and dealt with appropriately to avoid waste of financial or resources.
- Matti, Gupta, Balraj et al (2002:643) concluded that Mass Hysteria remains a mystery or medical anomaly to western health trained health workers.
The presentation amongst the Lesotho Mass Hysteria subjects was broadly classified into two groups of symptoms as follows:
- Physical Symptoms:
Extreme Strength; Choking; Fainting/Convulsions; Foaming from the mouth; Screaming and crying; Muscle weakness and rigidity; Fatigue.
- Psychological Symptoms:
Anxiety; Hallucinations (Visual, Auditory, Olfactory, Tactile, and Gustatory); and Confusion
From the literature review, especially from Ms. Tsekoa’s Mass Hysteria thesis, it is argued strongly by several researchers, and she also agrees that Mass Hysteria should be viewed as a Cultural Syndrome or Ukufa KwaBantu, as such interventions to deal with Mass Hysteria must be contextualised within the ambit of the cultural belief systems of the affected community.
Many researchers quoted in the study argue to effectively deal with Mass Hysteria, there is a role for both Western-trained health professionals, and Traditional Healing practices, individually and collectively. The western trained health workers can rule out genuine medical illnesses, and possible cases of poison, whilst providing symptomatic treatment. The Traditional Healers, on the other hand, can administer their interventions, for example, prayer, exorcism of evil spirits, use of herbal medicines and other relevant intervention like healing with holy water.
As a qualified orthodox medical professional, I fully support the involvement of orthodox health professionals in assisting the victims of Mass Hysteria, however, my personal experience, insights, and knowledge to date inform me that as orthodox health practitioners, we have limitations when it comes to intervening and treating cases of Cultural Syndromes. Like any other professional, it is important to acknowledge one’s professional strengths, as well as to recognise one’s weaknesses or limitations.
In South Africa today, we have two parallel health systems, one orthodox/western oriented, and the other based on traditional philosophies of healing. The Traditional Healing Practitioners Act 22 of 2007, has now recognised the Traditional Healers as an essential component of the broader healthcare system, reversing the Health Act of 1974 which outlawed the use of Traditional Healers, an Act that failed dismally because literature tells that 60-70% of Black African South African do believe in Ancestors and their role in disease or illness causation.
My personal view is that as long as the Traditional Healers interventions are not going to cause harm to the patient, especially to conduct cultural rituals, then I have no reason to stop them from consulting them or subjecting themselves to their harmless interventions. I however also need to acknowledge that from time to time one does hear of charlatans who masquerade as qualified traditional healers, and some of these fake traditional healers occasionally administer herbal concoctions that result in ill health and sometimes death of their clients.
Being aware of the above risks with the use of Traditional Healers, the majority of whom are not as yet registered to practice as traditional healers in compliance with their relevant Government Act, I must also admit that Orthodox health practitioners, from time to time do unintentionally administer health interventions that sometimes cause morbidity and mortality to their patients, from drugs side effects or post-operative complications.
We call those iatrogenic morbidities and or mortalities, which in many instances could be due to negligence. In some instances, we also do hear about reports of fake orthodox health care professionals, or qualified healthcare professionals that are not registered with the relevant statutory bodies, to protect the general public and provide an assurance that should something go wrong with their practice, then the patients have an avenue to report their malpractice cases.
Back to the Mass Hysteria outbreak in Mqanduli, I do think that the provincial association or council of genuine and registered traditional healers and clergy should work hand in hand with their provincial health department’s orthodox health practitioners to find a common practical approach to dealing with the cases of Mass Hysteria outbreaks. If they can manage to do so, in a climate of mutual respect, then I believe that such an approach could be the benchmark for dealing with all outbreaks of Cultural Syndromes in the future.
With regards to the initial death of the 16-year-old learner, which was observed by the other learners and triggered the whole outbreak, for professional and ethical reasons I would like to reserve my thoughts on what could have caused such a sudden death. Such a death is classified as an unnatural death, and by law, there must be a formal inquest into such a death, which must include a post mortem being conducted on the deceased.
There are several genuine medical conditions that could have caused such a sudden and inexplicable death of this teenager. At this moment, we must be patient and await the findings of a post-mortem before we discuss further, also as part of Ubuntu values we should desist from speculating on the possible causes of the unnatural death, during this bereavement period.