‘There was an explosion, and I had to close my eyes’: how TV left 12,000 children needing a doctor

[SNT Gatchaman]

https://www.theguardian.com/tv-and-radio/2022/dec/16/pokemon-explosion-tv-japan-children-hospital

Twenty-five years ago, at precisely 6.51pm on 16 December 1997, hundreds of children across Japan experienced seizures. In total, 685 – 310 boys and 375 girls – were taken by ambulance to hospital. Within two days, 12,000 children had reported symptoms of illness. The common factor in this sudden mass outbreak was an unlikely culprit: an episode of the Pokémon cartoon series.

Twenty minutes into the cartoon, an explosion took place, illustrated by an animation technique known as paka paka, which broadcast alternating red and blue flashing lights at a rate of 12Hz for six seconds. Instantly, hundreds of children experienced photosensitive epileptic seizures – accounting for some, but far from all, of the hospitalisations.

The mystery persisted for four years, until it piqued the attention of Benjamin Radford, a research fellow at the Committee for Skeptical Inquiry in the US, and co-host of the podcast Squaring the Strange. “The investigation had just stalled, the mystery sort of faded away without an explanation,” he says. “I wanted to see if I could solve the case.”

The next day, in playgrounds and classrooms, in news bulletins and at breakfast tables, all the talk was of Pokémon Shock. At which point, more children began to feel unwell. This was exacerbated when, astonishingly, some news shows actually screened the offending clip. But this time, the symptoms (headaches, dizziness, vomiting) were, says Radford, “much more characteristic of mass sociogenic illness [MSI] than photosensitive epilepsy”.

According to Radford: “MSI is complex and often misunderstood, but basically it’s when anxiety manifests itself in physical symptoms that can be spread through social contact. It is often found in closed social units such as factories and schools, where there is a strong social hierarchy. The symptoms are real – the victims are not faking or making them up – but the cause is misattributed.” The condition is perhaps best understood as the placebo effect in reverse. People can make themselves ill from nothing more than an idea.

 

[Hutan]

The symptoms are real – the victims are not faking or making them up – but the cause is misattributed

Obviously, this can be true without the cause being psychogenic. Lots of children have a headaches or feel a bit unwell any given day. Some children might have eaten a bad prawn or something. If there's a possible and well-publicised cause for the illness, then it may well get incorrectly attributed.

 

[Hutan]

To medical experts, the figure of 12,000 children requiring medical treatment made no sense. The programme had been watched by 4.6 million households. About one in 5,000 people has photosensitive epilepsy: 0.02%. But 0.02% of 4.6 million would mean 920 people were affected – this figure was more than 10 times that amount.

The mystery persisted for four years, until it piqued the attention of Benjamin Radford, a research fellow at the Committee for Skeptical Inquiry in the US, and co-host of the podcast Squaring the Strange. “The investigation had just stalled, the mystery sort of faded away without an explanation,” he says. “I wanted to see if I could solve the case.”

Along with Robert Bartholomew, a medical sociologist, he set about examining the timeline of events, and unearthed a key detail. “What people missed was that it wasn’t just a one-night event but instead unfolded over several days, and the contagion occurred in schools and over the news media.”

What Radford and Bartholomew discovered was that the vast majority of affected children had become ill after hearing about the programme’s effects. Although the cartoon’s transmission on 16 December did indeed cause hundreds of children to experience symptoms resulting from photosensitive epilepsy, something else was at play in the subsequent cases. The next day, in playgrounds and classrooms, in news bulletins and at breakfast tables, all the talk was of Pokémon Shock. At which point, more children began to feel unwell. This was exacerbated when, astonishingly, some news shows actually screened the offending clip. But this time, the symptoms (headaches, dizziness, vomiting) were, says Radford, “much more characteristic of mass sociogenic illness [MSI] than photosensitive epilepsy”.

Seriously? It seems that photosensitive epilepsy is indeed a thing, and so some of the cases arising from the first screening are not in question. They suggest the figure should have been 920 based on accepted rates of prevalence, and question why 12,000 children (or people?) reported feeling unwell. The article then goes on to note that 'some news shows actually screened the offending clip'. Obviously that is going to increase the numbers exposed. I have no doubt that there was a lot more private viewing of the clip from recordings too - lots of people, especially older children, would have wanted to see what it was all about and what effect it had. For sure, the clip had a much wider viewing than that relating to the first screening.

Throw in a whole lot of people who happened to feel sick at this time due to other causes, and wondered if the symptoms were attributable to having watched the clip, and the 12,000 is hardly surprising.

And then, I wonder about this figure of 12,000.

Within two days, 12,000 children had reported symptoms of illness.

How exactly did the children report these symptoms of illness? I can't imagine it was the children calling up a dedicated hotline to report their illness. Presumably they told their parents, as in 'Mum, I feel a bit sick'. It may have been the parents misattributing the symptoms that the child did not connect to the Pokemon clip at all to the publicised cause. That isn't psychogenic illness. It's simple misattribution.

And who exactly was keeping track of all these reports? It does not seem that 12,000 children were turning up at hospital. Presumably most just were a bit dizzy or had a headache for a bit. I wonder if whoever came up with the 12,000 children estimate had a bit of a reason for making it seem to be a big thing.

The share price of Nintendo, the company behind the Pokémon games, dropped by 3.2%.

Maybe it was the journalists wanting to sell the story, maybe it was someone keen on buying Nintendo shares cheaply....

I think "Benjamin Radford, a research fellow at the Committee for Skeptical Inquiry in the US" needs to be a bit more skeptical.

As for Dr Mario Almeida:

One medic, Dr Mario Almeida, said at the time: “I know of no disease which is so selective that it only attacks schoolchildren.”

I think he needed to get his textbooks out and do a bit of revision. For goodness sake, young animals are often much more likely to become sick with a disease, because they haven't yet developed the immunity that the adults have. And illnesses can appear differently at different ages. I suspect the Portuguese story is a lot more complicated than the simple psychogenic story that is presented here.

 

[Peter T]

We, members of S4ME, seem to be very sceptical of all supposedly psychosomatic conditions. Is this a healthy scepticism or an irrational prejudice? I assume the reason we have a broader interest in this topic is that many in medicine wrongly attribute ME/CFS as psychogenic and we therefor seek to more widely debunk excessive psychologising of physical health issues.

Are we being fair in contesting all psychosomatic diagnoses? Are there any conditions that are uncontrovertibly psychosomatic?

This is a scientifically problematic area as often such diagnoses are not easily subject to unambiguous empirical confirmation or rejection. As @Hutan points out could this example in Japan rather than being a socially transmitted hysteria be misattribution of unrelated physical health issues, would the health symptoms been there anyway only being linked to the TV event(s) after the fact?

As a Speech & Language Therapist one condition, that in theory is very clear cut, is elective mutism. It was taught as a situation where the individual chooses not to speak either consciously or unconsciously for psychological reasons. However, my experience when I was still working, though limited in this field, was that things were never that clear cut. Though I have come across people who were reluctant to communicate verbally, often in specific situations, invariably there were also complicating factors such as a motor speech disorder or language processing issues or learning disabilities.

Thought I can’t remember the source, I have read that hysterical blindness is diagnosed surprisingly often in Norway(?) but generally closer examination suggests there are also biomedical visual issues as well, raising the question are the psychogenic issues part of individuals visual difficulties or does it rather reflect the beliefs of the diagnosing physician.

 

[Sean]

or does it rather reflect the beliefs of the diagnosing physician.

At this stage of history a psychosomatic diagnosis tells us what is going on in the head of the diagnostician, not in the head of the patient.

The concept of psychosomatic influences on human health is not the problem. The lack of methodological (and ethical) rigour in assessing its validity, and any practical applications of it, is the problem.

 

[rvallee]

How exactly did the children report these symptoms of illness? I can't imagine it was the children calling up a dedicated hotline to report their illness. Presumably they told their parents, as in 'Mum, I feel a bit sick'. It may have been the parents misattributing the symptoms that the child did not connect to the Pokemon clip at all to the publicised cause. That isn't psychogenic illness. It's simple misattribution.

And who exactly was keeping track of all these reports? It does not seem that 12,000 children were turning up at hospital. Presumably most just were a bit dizzy or had a headache for a bit. I wonder if whoever came up with the 12,000 children estimate had a bit of a reason for making it seem to be a big thing.

Given the way mild symptoms are tracked, this is indeed laughable. Long Covid has shown how lousy medicine is at this stuff and that's when there is pressure to do it. Sounds a lot like "people are saying", there is simply no way that such reports would ever make it anywhere to count like this. The vast majority of mild illnesses are not recorded anywhere, probably 95%+.

Sounds a lot like confirmation bias. When ideologues want to see something, they'll claim to have seen it even though there is no way for them to have seen it this way. It's basically the #1 mistake in medicine.

Frankly, borderline this:

 

[Hutan]

We, members of S4ME, seem to be very sceptical of all supposedly psychosomatic conditions. Is this a healthy scepticism or an irrational prejudice?

I did actually wonder whether I was being irrationally prejudiced as I began my post upthread. But, the more I thought about the report, the easier it got to poke holes in it and the less I worried about my irrationality. There just doesn't seem to be much care in excluding the more mundane possibilities before trumpeting about the psychosomatic ideas that make such great stories.

As a Speech & Language Therapist one condition, that in theory is very clear cut, is elective mutism. It was taught as a situation where the individual chooses not to speak either consciously or unconsciously for psychological reasons. However, my experience when I was still working, though limited in this field, was that things were never that clear cut. Though I have come across people who were reluctant to communicate verbally, often in specific situations, invariably there were also complicating factors such as a motor speech disorder or language processing issues or learning disabilities.

Yeah, surely choosing not to speak, and particularly choosing not to speak in some situations, is decision-making rather than an illness? I would have thought 'elective' in the name rather signalled that. It might be bad decision-making, and it might be decision-making driven by real rational fear or by irrational fear or some other psychological issue that can be helped, but I can't see it as a psychogenic illness.

 

[Peter T]

Yeah, surely choosing not to speak, and particularly choosing not to speak in some situations, is decision-making rather than an illness? I would have thought 'elective' in the name rather signalled that. It might be bad decision-making, and it might be decision-making driven by real fear or by irrational fear or some other psychological issue that can be helped, but I can't see it as a psychogenic illness.

I have seen elective mutism, under this name or under other names, included as FND or as a psychosomatic condition. I agree that it is qualitatively different in formulation to such as non epileptic seizures or fainting however the conversion disorder advocates do not see it as such and it was part of the WW1 understanding of shell shock as a conversion disorder where officers were supposedly prone to elective mutism and stammering, but other ranks developed hysterical paralysises.

Also with the idea of secondary gains even such as ME is seen by some BPS believers as ‘bad decision making’ and ‘driven by by fear or irrational fear or some other psychological issue that can be helped’. My point was even with ‘elective mutism’ that is by definition a purely psychological phenomenon, at least in my experience, is not in real life so clear cut, that it is often if not always much more complex including structural, physiological or neurological speech or language issues.

I raised elective mutism here because I suspect advocates of it as a purely psychological phenomenon are only able to include it as such by ignoring the significant non psychological aspects. I suspect it arises as a coping strategy albeit a potentially unhelpful one in relation to pre existing speech or language issues and that looking at the underlying speech or language issues should precede and even determine any subsequent psychological or behavioural intervention if they continue as issues for some people, in the same way as such as CBT is not a treatment for ME but may be a possible adjunct to help relevant individuals cope with having ME.

 

[SNT Gatchaman]

@Peter Trewhitt thank you for the above. I have no professional knowledge of this, but I do have a friend who was diagnosed with, initially, elective mutism (framed as attention-seeking) but subsequently selective mutism, as a young teenager. This was disabling and certainly interfered with their schooling. However, they recovered to completely normal as a young adult and went on to obtain the highest of academic qualifications in a scientific domain. To meet them, you would never guess this was in their background.

They take a very dim view of the unevidenced concept of psychogenic illness, both in general and in the specific. I haven't discussed at length, but I think from their lived experience, they favoured that it was a postviral syndrome that had an effect on sympathetic/parasympathetic functioning, possibly mediated via the vagus nerve. If it were something like that, I wonder if the physiological speech dysfunction could be overcome in a favourable (eg calm, home) environment but harder to compensate for when fight/flight are more dominant. You can imagine how framing around anxiety would confuse the medical understanding and promote psychological factors as causative.

 

[SNT Gatchaman]

Another follow-on. I saw a post responding to the Guardian article and drawing the analogy with Wind Turbine Syndrome as another form of mass psychogenic illness. A book was written which described how the initial deployment of wind turbines later led to complaints of multiple symptoms, but that over time this is no longer the case (implying that the symptoms don't occur anymore).

The explanation might better be that symptoms were and are genuinely present (and not psychogenic) but were misattributed to this new environmental factor at that time. I'm not excluding the possibility that repetitive low frequency noise could have adverse physiological effects, and I imagine there are potentially other environmental factors that could be questioned, eg pesticide use in a rural area. Or those viruses...

Anyway, I was interested in this passage, when skimming the relevant section of his linked book —

Pierpont’s reputation among her followers as an authority on ‘wind turbine syndrome’ derives from her book, in which she describes wind turbine syndrome as including:

sleep disturbance, headache, tinnitus, ear pressure, dizziness, vertigo, nausea, visual blurring, tachycardia, irritability, problems with concentration and memory, and panic episodes associated with sensations of internal pulsation or quivering when awake or asleep.​

That list of symptoms sounds awfully familiar, not least to anyone currently frequenting a long COVID support group.

ETA: has been mentioned here before — S4ME search for wind turbine syndrome

 

[rvallee]

Another follow-on. I saw a post responding to the Guardian article and drawing the analogy with Wind Turbine Syndrome as another form of mass psychogenic illness. A book was written which described how the initial deployment of wind turbines later led to complaints of multiple symptoms, but that over time this is no longer the case (implying that the symptoms don't occur anymore).

This is a great example of how there's always a natural explanation and why hyper-specialized specialists shouldn't opine on things outside their expertise.

It's actually well-known that early wind turbines were noisy, newer ones are usually larger in part because of this. It was an engineering problem that had engineering solutions. The solutions relied on materials science, simulations and scientific experimentation, a kind of evidence that medicine doesn't have access to and so doesn't really think about.

Those early small noisy wind turbines produce high-pitched noises, which is right where hearing loss tends to occur, especially in older men, exactly the people who will make up stories about there being no noise because they can't hear it. So because they themselves can't hear it, or aren't bothered by it, which is likely to be random and have underlying explanations, they can't factor it in. Well, they could, if they had a scientific mind.

And of course wind turbine manufacturers improved on their design in part because of all the complaints, which makes psychogenic attribution especially foolish, but that's one thing that happens when you have hyper-specialized people who work in a very narrow field of expertise and can't account for factors they're not aware of. This is why multiple perspectives are often better than even hyper-specialized expertise, microscope vision is very detailed but extremely narrow.

More likely than not many of those were false attribution of neglected chronic illness, a void of explanation always get filled, which is also a problem that only exists because of medicine's failure. So that's like failing not just once, or twice, but three times over on the same problem. Which is comparable to making 3 mistakes on a single-letter word. Impressive. Bad. But impressive.

 

[SNT Gatchaman]

The author of the book is Simon Chapman, AO (Emeritus professor of public health at Sydney University and previous Australian Skeptic of the Year.). He has done an immense amount of good: particularly in the areas of tobacco and gun control.

However, I don't think this particular post will come to be seen in the same light —

This Japanese case study in nocebo effect mass psychogenic illness likely has many parallels in those claiming covid vax injury today: the "disease" is spread by reading & hearing about it - a "communicated disease" https://www.theguardian.com/tv-and-radio/2022/dec/16/pokemon-explosion-tv-japan-children-hospital I wrote a book about another manifestation of this phenomenon: Wind Turbine Syndrome: a communicated disease -- it appeared briefly for a few years and then disappeared when it stopped being reported.

"Those claiming vax injury" are becoming increasingly scientifically validated, subsequent to their already compelling independent and strikingly similar testimonies. Eg "Consequently, POTS and POTS-associated conditions may be among the most common adverse events after COVID-19 vaccination." (Nature Cardiovascular Research, 2022).

Vaccine injury/adverse effect is already a well established concept, which is not to say it hasn't been grossly over-stated at times. It would be surprising indeed if COVID-19 vaccines were uniquely free of such adverse effects.

There's also a key difference in these two groups, per the MPI explanation. As proposed, those previously claiming illness relating to wind turbines are said to have been themselves against wind turbines or influenced against.

Those that do attract complaints often have a history of being targeted by organised anti-windfarm lobby groups who set about trying to spread concern and anxiety among local residents. The central argument of this book has been that for some, concern and anxiety can be contagious, ‘infecting’ others who are exposed to it. Some of those develop symptoms of anxiety and can express these somatically in ways that can be objectively measured and which can be experienced as highly unpleasant.

Those who have been vaccine-injured are, by definition, people who were pro-vaccine and thought it was a good idea.

Last quote from the wind turbine book, with parallels to our situation and BPS hypotheses —

Many people who worry themselves sick are highly resistant to accepting that this is what is happening to them. They feel it is some sort of character defect to be susceptible in this way and are embarrassed by the idea. They rationalise that the agents concerned (here, wind turbines) must be directly noxious. They become preoccupied with confirming this belief. They link up with others and share evidence, often regardless of its abject quality, that confirms their conviction that the agent really is harmful.

Replace "wind turbines" with "viruses" and that's the characterisation of us. Ironically the evidence being shared about our condition, regardless of its abject quality, is almost wholly that of the biopsychosocial school.

 

[Mithriel]

Just seen this thread and it touches on things I feel very strongly about.

I have some tangential experience with abused children. In some cases they have learnt the consequences of talking are so bad they chose to say nothing. This becomes worse when they are questioned about their home situation when they are all to aware of the dire punishment for sharing any details. Like abused women, they make decisions that seem to go against their interest but are actually their best choice for safety. Elective mutism without any sign of disease is still not likely to be
psychogenic.

McEvedy and Beard did a couple of papers before they turned their attention to ME. They looked at 2 cases of vomiting among schoolgirls in the North of England (I think). To give them their due, at the time it was believed that vomiting bugs could only spread by faecal oral routes so they assumed that younger schoolgirls saw older pupils get sick and copied them in a case of mass hysteria. Nowadays, the situation screams norovirus.

Therein lies the problems with psychogenic illness. Finding a physical problem that covers the symptoms not only shows that we now know better, but also that the diagnosis of mass hysteria was ALWAYS wrong. Therefore the reasoning used to deduce a psychogenic cause was faulty so can't EVER be relied upon in its present state. It is not fit for purpose.

The other lesson to be learned is that science can be dogmatic to the point of blindness. The argument over whether vomiting could be spread any way except faecal oral paths was fierce and only accepted after a study which followed who became infected and in what order after a customer vomited in a restaurant. The map was irrefutable.

It seems amazing that it was not considered that the body expels the contents of the because of virus infection so those contents will contain viral particles which can form an aerosol in the air and be spread that way. As seen in these posts, proponents of psychogenic disease never consider the possibility and plausibility of alternative explanations.

As for Pokemon, I wonder if the figures were inflated to show that computer games are bad for kids, always a perennial, or if some parents hoped that the mild infection their kid had could be added to any compensation claim!

 

[Woolie]

We, members of S4ME, seem to be very sceptical of all supposedly psychosomatic conditions. Is this a healthy scepticism or an irrational prejudice?

Once you've seen the massive problems with psychogenic reasoning you cannot unsee them: its reliance on the absence of evidence - rather than the presence of it - combined with very woolly ill-specified and untestable ideas about how the "psyche" works.

We are the equivalent of Victorians who worked out how those spirit photographs were faked. Of course, knowing that some spirit photos were faked does not mean that there are no spirits, or no genuine spirit photographs. It just makes a person more sceptical - they would want to see pretty strong positive evidence before believing any such instance again.

The examples of psychogenic illness and spirit photographs are similar in other ways too. Both involve an explanation which is much more imaginatively appealing than the alternative: people love a "power of the psyche" narrative just as they do a good ghost story. People want the "power of the psyche" narrative to be true. Health care practitioners want it to be true even more than the rest of us, because it empowers them in situations where they would otherwise feel disempowered. This is another very good reason to be cautious of it.

 

[rvallee]

Once you've seen the massive problems with psychogenic reasoning you cannot unsee them: its reliance on the absence of evidence - rather than the presence of it - combined with very woolly ill-specified and untestable ideas about how the "psyche" works.

We are the equivalent of Victorians who worked out how those spirit photographs were faked. Of course, knowing that some spirit photos were faked does not mean that there are no spirits, or no genuine spirit photographs. It just makes a person more sceptical - they would want to see pretty strong positive evidence before believing any such instance again.

The examples of psychogenic illness and spirit photographs are similar in other ways too. Both involve an explanation which is much more imaginatively appealing than the alternative: people love a "power of the psyche" narrative just as they do a good ghost story. People want the "power of the psyche" narrative to be true. Health care practitioners want it to be true even more than the rest of us, because it empowers them in situations where they would otherwise feel disempowered. This is another very good reason to be cautious of it.

See also: miracle crying statues.

More often than not, it's toilet water seeping somewhere. But when no one bothers to figure it out, well, anything goes. And then you're ruining a perfectly good business model of selling the toilet water and it gets people mad.

 

[Sean]

TPeople want the "power of the psyche" narrative to be true. Health care practitioners want it to be true even more than the rest of us, because it empowers them in situations where they would otherwise feel disempowered. This is another very good reason to be cautious of it.

Usually worth asking who benefits from a particular belief. And who doesn't.