Mass illness tied to contagious fear.

Illness spread rapidly through a McMinnville, Tenn., high school on Nov. 12, 1998. A teacher noted a gasoline-like smell in her classroom and then complained of a headache, nausea, shortness of breath, and dizziness. Several students in her class soon reported similar problems. School officials ended up evacuating the facility amid the din of ambulances, police, and firefighters.

A local emergency room admitted 80 students and 19 staff members; 38 were hospitalized overnight. When the school reopened 5 days later, the emergency room treated another 71 individuals who developed symptoms that they attributed to toxic gas exposure.

While people at the school suffered from genuine physical ailments, an extensive investigation conducted by several government agencies uncovered no medical or environmental explanation, a research team reports in the Jan. 13 NEW ENGLAND JOURNAL OF MEDICINE.

Instead, the McMinnville outbreak stemmed from anxiety and fear about possible poison exposure, contend epidemiologist Timothy F. Jones of the Tennessee Department of Health in Nashville and his colleagues. These feelings and related physical symptoms spread like a contagion in a closely congregated group, they say.

Comparable outbreaks of "mass psychogenic illness" have been noted for centuries and probably occur more commonly than assumed by many researchers, Jones' team asserts. Physicians often shy away from this diagnosis for fear of causing shame and anger in those affected, the investigators add.

At the McMinnville school, ill students and staff came from 36 scattered classrooms that weren't along any specific air-distribution route. Many of the ill had noted a smell, but the reports gave it no consistent quality or location.

Blood and urine specimens, obtained from most people treated at the hospital, contained no traces of toxic chemicals. Only one affected person had an elevated body temperature, according to medical records. No one admitted to the hospital for overnight observation suffered complications.

Exhaustive testing failed to identify any toxic compounds at the school, the researchers say.

Even if the McMinnville students responded to contagious anxiety, they experienced authentic pain and suffering, comments physician Simon Wessely of Guy's, King's, and St. Thomas' School of Medicine in London. He says, in the same journal, that it's difficult to convey this message without "blaming or demeaning the victims."