BMJ Editorial 1970 - Epidemic Malaise- probably by Martin Ware

[chrisb]

We are all familiar with the two McEvedy and Beard papers which appeared in the January !970 BMJ. Less familiar is the third paper published elsewhere in 1973. There has been little attention paid to the Editorial which accompanied the papers. It does little credit to the journal or its editor. Here it is:https://www.bmj.com/content/bmj/1/5687/1.1.full.pdf

Among the most severely affected cases a previous history of neurotic symptoms, instability, recurrent illness of uncertain origin, or actual breakdown may be elicited. Whether or not prominent conversion symptoms such as hysterical convulsions, paralysis, aphonia, disorientation, and dissociative episodes are observed may depend on whether some leading or popular member of the group, who happens to have been an early case, responded in this manner and thus provided a pattern for simulation. The term "hysteria" is not properly applicable to these epidemics, partly because the many uses of this term have blunted its meaning and partly because anxiety or panic appears to have been the central feature of most of the epidemic cases. Motivated, self-dramatizing, and importunate behaviour, conversion symptoms, and dissociation of consciousness are inconsistent, often fleeting, and may be secondary to anxiety. The pejorative meaning that has come to be attached to "hysteria" adds to the reasons for the use of terms such as "epidemic anxiety state" or "epidemic neurotic reaction" and for referring to "epidemic hysteria" only when strictly justified

It is far worse than the M and B papers.

This is the obituary of the editor: https://doi.org/10.1136/bmj.317.7168.1323

It is not clear what experience or authority the editor had to expound on the subject.

 

[rvallee]

Yes, we've failed at the germ theory of disease once, but how about seconds?

This is embarrassingly incompetent, matched only by the fact that this blatant nonsense was ever taken seriously, more so that it is still taken seriously to this day, if anything it's actually gotten worse because the substance is identical and the only adaptation has been to lie and be deceitful about lying. By comparison the humors were a rational construct. These people are completely full of it but the fact that medicine can't see through pure charlatanism is a much worse failure all things considered. Those ramblings belong in a psychiatric institutions and not on the wearing-of-the-stethoscope side. Medicine needs massive system-wide reform to end this cyclical nightmare.

 

[chrisb]

On reflection that editorial or leading article, whatever it is, looks like a positioning paper and, judging by the difficulties Dave has encountered, the position hasn.t changed much in fifty years.

It must be assumed that the views expressed represent an unsuspected body of opinion. Journals like to please their readership. Presumably Beard, perhaps Walshe and Thomas, but there must be other psychiatrists. It is dreadful that it goes far beyond McEvedy. He appeared to try to be as conciliatory as possible. This is just throwing petrol on the flames. The editing of McE.s thesis and failure to publish the third paper can be seen in a new light.

This was clearly intended to be picked up by journalists. It is interesting to see, on the Twitter RFH thread the articles by Brian Inglis and Alfred Freindly which borrow extensively .

It is hard to regard the BMJ as a serious journal.

 

[Hutan]

Affected communities tend to be relatively isolated and are often marked by a cohesion that springs from common purposes or shared emotions. Ignorance, insecurity, and anxiety are important among the generating factors. It is of interest that states of panic are prone to engender imitation as in the echolalia and repetitive movements of "latah,"a neurosis of underdeveloped peoples.'

Wikipedia Latah

Latah was included in Diagnostic and Statistical Manual of Mental Disorders (DSM) IV under the "Dissociative Disorder: Not Otherwise Specified" section as a culture–bound syndrome. DSM IV describes latah as a hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, and dissociative or trancelike behavior. It mentions other cultures where latah is found, but the only further information the DSM IV gives us is that in Malaysia, it is more often found in middle–aged women. It has been removed from DSM 5

The onset of latah is often associated with stress. In a study done by Tanner and Chamberland in 2001,[9] a significant number of research participants had experienced a life stressor (such as a child or husband dying) just before becoming latah. Additionally, a large number of participants from many research studies have reported strange dreams occurring just before the onset of latah. These dreams usually had a sexual element to them, often involving penises or enlarged penises. According to Tanner and Chamberland, perhaps the dreams, although with variation, indicate some sort of dysfunction in a specific anatomical area. Exploring this further might lead to more insights as to the cause and/or cure of latah.

good grief

 

[chrisb]

Among the most severely affected cases a previous history of neurotic symptoms, instability, recurrent illness of uncertain origin, or actual breakdown may be elicited

I don't recall seeing evidence for that in M and B. And I have checked the first paper, which is the only relevant one. That is similar to the claims in Imboden et al, where it seemed dubious. The BMJ would not be making spurious unsupported claims, would they?

For anyone wondering why I thought McE sought to be conciiatory, in contrast to the editorial

Many people will feel that the diagnosis of hysteria is distasteful. This ought not to prevent its discussion, but perhaps makes it worthwhile to point out that the diagnosis of hysteria in its epidemic form is not a slur on either the individuals or the institution involved. Whereas it is true that sporadic cases of hysterical disability often have disordered personalities, the hysterical reaction is part of everyone's potential and can be elicited in any individual by the right set of circumstances. The occurrence of a mass hysterical reaction shows not that the population is psychologically abnormal but merely that it is socially segregated and consists predominantly of young females.

Conciliatory unless you are a young female. He was a product of his time.

 

[rvallee]

Wikipedia Latah





good grief

Most of the fiction I read is more believable and credible than this.

I mostly read science-fiction with time travel and FTL and all that stuff. It's way more believable than this crap, not even close.

 

[chrisb]

I thought I would highlight this apparent anomaly.

From the editorial:

Patients, male members of staff, and other members of the community appeared to be notably immune to the presumed infection

The authors have performed a valuable service in drawing attention to the possible psychological origins of some outbreaks of illness that are disseminated in an explosive manner and for which a physical explanation is apt to be readily assumed. Communities of young women living in relative seclusion appear to be particularly susceptible, but meeting with other people may lead to a fresh crop of cases and cause the spread and recrudescence of the disorder.

From the paper https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1700894/pdf/brmedj02268-0019.pdf

Epidemiology
The epidemiological study by Crowley et al. (1957), of the bacteriology department of the Royal Free Hospital School of Medicine, gives the attack rates as follows:

Males 27 out of 950 (2.8%)
Females 265 out of 2,550 (10.4%)

These attack rates are for the whole institutional population (staff, students, and patients) and include cases treated on an outpatient basis. By using a rather more rigorous definition of the illness (in terms of timing and days off sick), by excluding the hospital patients, and by excluding all those treated on an outpatient basis, we have obtained the following figures:

Males 5 out of 600 (0-8%)
Females 193 out of 1,760 (11%)

As they say, if you torture the evidence, it will say whatever you like.

 

[AR68]

On reflection that editorial or leading article, whatever it is, looks like a positioning paper and, judging by the difficulties Dave has encountered, the position hasn.t changed much in fifty years.

It must be assumed that the views expressed represent an unsuspected body of opinion. Journals like to please their readership. Presumably Beard, perhaps Walshe and Thomas, but there must be other psychiatrists. It is dreadful that it goes far beyond McEvedy. He appeared to try to be as conciliatory as possible. This is just throwing petrol on the flames. The editing of McE.s thesis and failure to publish the third paper can be seen in a new light.

This was clearly intended to be picked up by journalists. It is interesting to see, on the Twitter RFH thread the articles by Brian Inglis and Alfred Freindly which borrow extensively .

It is hard to regard the BMJ as a serious journal.

Just dug out an old article with a reply from (I suspect the same) Walshe. If you want I can post it on the RFH account.

 

[chrisb]

Just dug out an old article with a reply from (I suspect the same) Walshe. If you want I can post it on the RFH account.

Please do. I think he may be complicit in this. Some of the language is comparable to his The diagnosis of Hysteria.

In case people have not seen this, here is what he said in 1965, after the reports of the Blackburn School hysteria, and the newspaper articles linking that to the RFH outbreak

Finally, we cannot ignore the epidemics of mass hysteria
that are on record. We can hardly dismiss these as organically
determined or as a conspiratorial mass-malingering.
Centuries ago these were attributed to witchcraft or to
demoniacal possession, but, armed-perhaps " hampered
would be the better word-with all the modern science of our
time, it is likely to-day that we should declare them to be due
to some unknown and undiscoverable virus and call the
condition encephalitis. This could very well happen and,
indeed, may have happened already.

@AR68 I find myself in something of a diemma. I don't wish to detract from your invaluable thread with my wittering, but there are some fascinating issues which arise. There's more I want to find out about Alfred Freindly's contribution to proceedings

 

[AR68]

Please do. I think he may be complicit in this. Some of the language is comparable to his The diagnosis of Hysteria.

In case people have not seen this, here is what he said in 1965, after the reports of the Blackburn School hysteria, and the newspaper articles linking that to the RFH outbreak

Finally, we cannot ignore the epidemics of mass hysteria
that are on record. We can hardly dismiss these as organically
determined or as a conspiratorial mass-malingering.
Centuries ago these were attributed to witchcraft or to
demoniacal possession, but, armed-perhaps " hampered
would be the better word-with all the modern science of our
time, it is likely to-day that we should declare them to be due
to some unknown and undiscoverable virus and call the
condition encephalitis. This could very well happen and,
indeed, may have happened already.

@AR68 I find myself in something of a diemma. I don't wish to detract from your invaluable thread with my wittering, but there are some fascinating issues which arise. There's more I want to find out about Alfred Freindly's contribution to proceedings

Posted.

 

[AR68]

Please do. I think he may be complicit in this. Some of the language is comparable to his The diagnosis of Hysteria.

In case people have not seen this, here is what he said in 1965, after the reports of the Blackburn School hysteria, and the newspaper articles linking that to the RFH outbreak

Finally, we cannot ignore the epidemics of mass hysteria
that are on record. We can hardly dismiss these as organically
determined or as a conspiratorial mass-malingering.
Centuries ago these were attributed to witchcraft or to
demoniacal possession, but, armed-perhaps " hampered
would be the better word-with all the modern science of our
time, it is likely to-day that we should declare them to be due
to some unknown and undiscoverable virus and call the
condition encephalitis. This could very well happen and,
indeed, may have happened already.

@AR68 I find myself in something of a diemma. I don't wish to detract from your invaluable thread with my wittering, but there are some fascinating issues which arise. There's more I want to find out about Alfred Freindly's contribution to proceedings

Thanks for the comments. I'm not sure I have anything too much on Friendly as he wasn't intrinsically involved in the RFH or associated, FWIW.

You're not wittering at all. I'm enjoying the posts.

 

[chrisb]

@AR68 Thanks for posting that. It is the same Francis Walshe. That letter was published before his paper in the BMJ in December 1965 which was his answer to Eliot Slater and began:

Brit. med. J., 1965, 2, 1451-1454

" The diagnosis of 'hysteria ' is a disguise for ignorance
and a fertile source of clinical error. It is in fact not only
a delusion but also a snare" (Eliot Slater, 1965).

"Il vaut mieux ne plus discuter sur les mots, mais vous
enquerir de la viriti des choses." (Collected Works of
Galen, Ch. 1, Daremberg's translation.)

Dr. Eliot Slater ends his Shorvon Lecture on this subject*
with the Cromwellian gesture cited above, telling neurologists
to " take away that bauble" hysteria. When the Lord Protector
of the Realm thus dismissed the Long Parliament's mace, it
did indeed go into a brief recess, soon to return with its
significance and prestige undimmed to our own day.
I think it likely that the concept of hysteria will repeat
history in this respect, but even if, to hide the term's etymology,
we replaced it by another the idea symbolized by the new name
would still keep what of reality the old embodied

He was apparently much enamoured with the sound of his own voice. It is interesting to see the emphasis in the letter on the condition only affecting girls. It is not entirely clear that that is an adequate justification for the tampering with the RFH evidence which seems to have taken placeto exclude most of the men and patients affected.

 

[Hutan]

These attack rates are for the whole institutional population (staff, students, and patients) and include cases treated on an outpatient basis. By using a rather more rigorous definition of the illness (in terms of timing and days off sick), by excluding the hospital patients, and by excluding all those treated on an outpatient basis, we have obtained the following figures:

That is extraordinary. It's easy to think of ways those exclusions might affect the male: female ratio. For example, the (female) nurses in the nurses home would probably all be treated as inpatients whereas male doctors would be much more likely to be able to convalesce at home, cared for by their wives and being treated as outpatients.

As they say, if you torture the evidence, it will say whatever you like.

indeed