Massachusetts Puritans once blamed witches for the trances and
strange utterances of young girls in Salem Village.
More than 300 years later in the same town, now called Danvers,
state health officials investigated a mysterious
2012 outbreak of chronic hiccups in 24 teenagers, mostly
girls, at two local high schools. After two years of studying
possible environmental factors — in the schools’ water
fountains, air vents, and sports fields — the state came up
no real explanation.
Among former students, opinions vary widely.
“Some massive inside job perpetrated by our U.S. government,”
Theenith Chroek, a 21-year-old former student who now lives in
Lynn, Massachusetts, told BuzzFeed News over Facebook
messenger. “The government or at least the ‘real’ government is
working on a new biological weapon.”
“Why or how it happened isn’t too big of a concern for me,”
said another, 21-year-old Jeremy Cronan, who now lives in the
UK. “I heard rumored that it was one case of the vocal tic and
the rest of the group of ladies that caught it were more
A researcher in New Zealand broadly concurs with the latter
idea, using a more precise term: “psychogenic conversion
disorder” — a condition typically seen in teenage girls in
which psychological stress turns into real physical symptoms.
After making public records requests for state documents,
sociologist Robert Bartholomew discovered that the
Massachusetts investigators had also suspected that this
stigmatized disorder (once known as “mass hysteria”) was the
culprit. But they never disclosed it to the public.
“What I can say for certain is that the Massachusetts health
department knowingly issued an inaccurate, incomplete report,”
Bartholomew told BuzzFeed News by email. “They have an
obligation to issue accurate diagnoses, and patients have a
right to know what made them sick.” He has filed medical
malpractice complaints to both state and federal officials.
Documents released to Bartholomew last year show that state
officials considered a group psychological phenomenon early on
in the outbreak. By stalling and avoiding that conclusion,
Bartholomew contends, they were hoping to avoid the notoriety
that attended a similar
twitching outbreak in Le Roy, New York, a year earlier,
where doctors made the diagnosis plain.
Although widely assumed to be a mental illness, conversion
disorder is actually a group reaction to stress.
But burying this diagnosis just keeps its stigma alive,
Bartholomew said. Although widely assumed to be a mental
illness, conversion disorder is actually a group reaction to
“There is a popular perception that victims of ‘mass hysteria’
are somehow weak-minded or suffering from a mental disorder,”
he said. “This perception needs to change, and I believe it
begins with public health officials investigating these
He and other experts emphasize that patients aren’t faking
their symptoms, and that this should be formally recognized.
“These patients are really suffering, it’s important to say
that,” University of Rochester Medical Center neurologist
Jonathan Mink, who investigated the 2011 episode in Le Roy,
told BuzzFeed News.
When asked why it did not publicly acknowledge that a group
stress reaction explained the outbreak, the Massachusetts
Department of Public Health said that would have gone beyond
the scope of its investigation.
“The purpose of the study was to look for potential
environmental factors contributing to vocal disorders in some
students at the two schools; not to provide a diagnosis for the
conditions that some of the students were experiencing,” Scott
Zoback, a representative of the department, told BuzzFeed News
BuzzFeed News reached out to more than 70 students who attended
the two affected high schools during the 2012 outbreak. Just
four responded, perhaps attesting to the stigma surrounding the
Chroek’s conviction of a massive government conspiracy is not
at all surprising, Bartholomew said, when public health
officials leave the cause of an outbreak up in the air. “I
think the manner in which the case was handled has only served
to feed this kind of social paranoia.”
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The outbreak began, in August 2012, with one boy at
North Shore Technical High School in Middleton, Massachusetts,
who had “vocal tics and chronic hiccups” that wouldn’t go away.
That school’s principal later
reported “a handful of incidences” that came and went
before the holidays.
Within weeks of starting, the tics had also spread to a sister
school, Essex Agricultural Technical High School in Danvers
(the two schools later merged).
“The tics were described as hiccups, grunts and yelps,”
Bartholomew wrote in a Journal of the Royal Society of
Medicine report earlier
this year. The episodes seemed to peak in September and were
still affecting 19 students at both schools in November, when
the investigation began. Most of the students were on sports
The two technical schools, which drew students from dozens of
communities in the northeastern part of the state, held
carpentry shops, a horse barn, and a cosmetology salon. As word
of the vocal tics first spread, airborne toxins were
“Before this whole thing got started, I remembered smelling
something distinct in the air. It was almost some sort of
Febreze scent,” Chroek said. “I didn’t think much of it at
first but the smell stayed in the air even hours later. That’s
maybe around the time all of the hiccups started.”
Some parents, meanwhile, believed the culprit was
PANDAS (or pediatric autoimmune neuropsychiatric disorders
associated with streptococcal infections). This controversial
diagnosis, which is contested by some
medical researchers, is thought to begin with a strep
infection that triggers an immune reaction in the brain that
can cause neurological tics.
By Christmas Eve, the state’s environmental health chief
medical officer, Jonathan Burstein, was circulating articles
about mass psychogenic illness to other investigators,
the records show. But when a Boston Globe reporter
contacted a Danvers official the next month,
he was told that no “confirmed” cases had been reported and
was discouraged from writing a news story.
“To some extent this is very normal human behavior. Look at
how yawning can become contagious.”
State health officials investigated vents in the schools,
queried 2,600 local doctors about symptoms, and peeked into two
abandoned tunnels under one school’s grounds. They also
conducted three environmental assessments over three months,
looking for mold, asbestos, mercury, carbon monoxide, and other
pollutants at the school that might have triggered neurological
symptoms. They found nothing.
The investigators worked on their report for two years.
Bartholomew is sympathetic to officials not publicizing any
psychogenic suspicions initially, particularly with parents of
some students complaining they were being harassed. But
the records show that Burstein compiled a list of possible
culprits in the outbreak and found them all highly unlikely —
except one. “It is not possible,” he wrote, “to rule in or rule
out the possibility of any conversion or mass psychogenic
report, however, doesn’t mention this diagnosis. ”[T]he
crude prevalence estimate for the students with confirmed vocal
tics/chronic hiccups at the schools is estimated at 1%, which
appears consistent with prevalence estimates for tic
disorders,” the report concluded.
In other words, according to the state’s report, tics just
happen sometimes. The outbreak was an explainable statistical
fluke, a happenstance of hiccups, grunts, and yelps, in numbers
you might reasonably expect.
Medical records did show that one student had three years
earlier been diagnosed with
Tourette syndrome, marked by random vocal outbursts, and
two others had been previously diagnosed with vocal tics.
But Bartholomew said the 1% prevalence estimate for tics is
bogus. The number came from an investigation of vocal tics in
4,479 Swedish schoolchildren, he pointed out, which actually
concluded that among teen girls, only 0.15% have vocal tics. He
believes the 1% argument is a fig leaf for state officials
walking away from the whole mess.
Diagnosing group psychogenic outbreaks is trickier than
diagnosing a virus or infection, Mink said, because you can’t
run a simple test for it. But he agrees that the Massachusetts
case was a likely one.
“To some extent this is very normal human behavior,” he told
BuzzFeed News. “Look at how yawning can become contagious. We
pick up on other people, it’s part of the human condition.”
At least one parent came to this conclusion, too. In an
email sent to a public health official just after the final
report came out, the parent wrote that their child’s symptoms
had been gone for more than a year, adding: “Our initial
suspicion of conversion was probably correct.”
With the rise of Facebook and other social media that connect
teenagers in new ways, group stress disorders might spread more
widely now, some medical sociologists say.
For example, the
similar outbreak in Le Roy, which Mink helped investigate,
partly spread through people connected only by Facebook. “We’re
actually doing a disservice by avoiding making a definite
diagnosis and perpetuating that this is mysterious,” he said.
Three centuries ago, a similar outbreak appeared in this
same Massachusetts town, with tragic consequences. In the
winter of 1692, seven girls in Puritan
Salem Village began contorting, twitching, and uttering
unintelligible noises. Some complained of being bitten and
pinched by witches and devils.
Salem Witch Trials, variously ascribed to mass hysteria,
hallucinogenic bread, or greed for the property of the accused,
led to 20 executions for consorting with the devil. They ended
a year later, with apologies from some, but not all, of the
ringleaders. The trials have resonated in the public
imagination for centuries and turned Danvers into a tourist
In hindsight, according to Bartholomew, it’s clear the Salem
Village girls were suffering from some sort of group conversion
Psychogenic illness seems to be most common in distressed
communities: Salem Village in 1692 had recently lost in a
conflict with Native Americans, filling the town with refugees.
Le Roy, New York, was reeling from the 2008 economic downturn.
Danvers didn’t seem to have economic stress (the unemployment
rate there was 5.4% at the time of the outbreak), other
than the coming merger of the two schools, but there doesn’t
always need to be a stark conflict to trigger an episode.
Psychiatrist Simon Wessely of King’s College London agrees that
the Massachusetts students likely suffered from a group
psychogenic disorder. But unlike Bartholomew, he endorses the
state’s silence on that diagnosis, saying it’s better to let
these episodes quietly fade from the news instead of creating a
national sensation similar to the 2011 Le Roy outbreak. In that
case, he points out, some students’ tics persisted far longer
than usual, perhaps because of the diagnosis and media
“It’s a very difficult situation for public health officials to
handle,” Wessely told BuzzFeed News. “When it is over, [the
students] get better, and the symptoms generally don’t come
It’s also worth noting that not every scholar who has looked at
Le Roy is convinced that mass psychogenic illness was the right
diagnosis there. Last year, for example, two University of
Colorado Boulder anthropologists argued
in American Ethnologist that Le Roy investigators gave
short shrift to toxicological explanations for that
Regardless of their cause, you only have to look back to the
Salem Witch Trials to see that these outbreaks are
long-standing afflictions of humanity, Wessely said. “They
happen all the time, probably more than we know. The best thing
is to handle them as calmly as possible.”