Psychosocial approaches to mass hysteria phenomena: a case study in Mozambique

Author: Carla Penna1
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  • 1 Ph.D, psychoanalyst in Circulo Psicanalítico of Rio de Janeiro, , Brazil, group analyst, Group Analytic Society International
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This article has two aims. First, it will provide an overview of hysteria and mass hysteria phenomena throughout history, by exploring the psychosocial elements underneath selected historical episodes such as medieval ‘dance plagues’ and ‘Loudun possessions’ (1632–34), but also by presenting recent social-psychiatric and epidemiological case analysis on the topic. Second, it will present and discuss an episode of what could be described as mass hysteria, which occurred in 2010 in a secondary school in Maputo, Mozambique. Using psychoanalytic and group analytic inputs, both aims will enable a suggestion as to the psychosocial aspects that lie underneath the referred episode. The article will also consider, although in the background, the role played by apparatuses of power and colonial discourses in shaping some of the analysis and visions that mass hysteria portrayed in the case study may have acquired. A transdisciplinary perspective will allow a broader understanding of mass hysteria, highlighting the relevance of psychosocial approaches to investigations of collective phenomena.

Abstract

This article has two aims. First, it will provide an overview of hysteria and mass hysteria phenomena throughout history, by exploring the psychosocial elements underneath selected historical episodes such as medieval ‘dance plagues’ and ‘Loudun possessions’ (1632–34), but also by presenting recent social-psychiatric and epidemiological case analysis on the topic. Second, it will present and discuss an episode of what could be described as mass hysteria, which occurred in 2010 in a secondary school in Maputo, Mozambique. Using psychoanalytic and group analytic inputs, both aims will enable a suggestion as to the psychosocial aspects that lie underneath the referred episode. The article will also consider, although in the background, the role played by apparatuses of power and colonial discourses in shaping some of the analysis and visions that mass hysteria portrayed in the case study may have acquired. A transdisciplinary perspective will allow a broader understanding of mass hysteria, highlighting the relevance of psychosocial approaches to investigations of collective phenomena.

Introduction

In the past few decades, psychoanalysts have been called on to discuss psychological problems in connection to the social world (Rustin, 1991). Psychoanalytic interventions, outside of the consulting room, are growing, facilitated by the use of object relations theories that have conferred not only diversity and plurality but also a dialogue between different intersubjective matrices (Figueiredo and Coelho Jr, 2003). The nexus between intersubjective and trans-subjective approaches and the social sciences has been a source of exploration in group analysis for decades (Hopper, 2003). Nevertheless, relevant topics that interweave people, groups and societies remain unexplored.

In its turn, psychosocial studies is defined as a critical approach, based on a dialogue between different disciplines, interested in articulating a place of ‘suture’ between elements whose contribution to the production of the human subject is theorised separately. Psychosocial studies of these kinds focus on conceptualising and researching a type of subject that is both social and psychological, and which is constituted in and through its social formations (Frosh and Baraitser, 2008). In this sense, the challenge for psychosocial studies is immense because several lines of work are still unnoticed, one of them being research on the interconnection between psychopathological and psychosocial expressions of collective phenomena.

Hysteria

During the past few decades, medical history shifted from the scientific history of diseases to the cultural history of diseases (Gilman et al, 1993). This change revealed the role played by power relations and discourses (Foucault, 1980) in the social construction of mind and body (Mbembe, 2001), transforming the investigation and diagnosis of medical conditions. In terms of the study of hysteria, this acknowledgement revealed how medical and psychological theories are embedded not only in power relations and gender-linguistic dimensions (Gilman et al, 1993) but also in colonial discourses (Mbembe, 2001). These influences, even inadvertently, have been shaping the analysis and visions of hysteria and mass hysteria phenomena over the years.

Historically, hysteria has been associated with medicine and the natural sciences but also with the inner world and the supernatural. Related to womanhood since the classical antiquity, hysteria dates back to the beginnings of medical research, although in the medieval age it became connected with witchcraft and demonic possession. According to Trillat (2006), medieval obscurantism provoked a philosophical-cultural change that represented for hysteria a regression in its conceptualisation. By that time, the art of healing had abandoned the medical milieu, giving rise to an upsurge of mysticism. Thus, the hysterical manifestations that in the ancient world were attributed to physical causes and uterine humours were then seen as the fruit of demonic possessions. Within this framework, the first descriptions of mass hysteria were recorded. Among the best known is an account of ‘dance plagues’ in Strasbourg, France in 1518. Unleashed by a woman called Frau Troffea, 400 people were affected by a kind of trance and danced to exhaustion for a month, which led to about 100 deaths. Waller (2008) speculates that the dancing was ‘stress-induced psychosis’ on a mass level, because the region where the people danced was dominated by starvation, diseases and mysticism. Within the context of the 16th century, it has been suggested that (Waller, 2008) dance plagues were an example of psychosocial distress, revealing how traumatising sociocultural contexts may co-create expressions of psychopathological and collective suffering in people and groups. Moreover, seven other similar cases were reported, presenting a phenomenon that would later become known as ‘dance mania’ or ‘tarantism’. These manifestations could be understood today as episodes of mass psychogenic illness (Waller, 2008).

It is possible to find in the literature numerous reports of collective outbreaks that could be described by the ‘all-embracing title of mass hysteria’ (Wessely, 1987: 109). Different, but quite often synonymous, terms such as mass sociogenic illness (Bartholomew and Wessely, 2002), mass psychogenic illness, mass psychogenic disorder and epidemic hysteria (Sirois, 1974) have been coined to define what might be viewed as collective outbursts of hysteria. Among these possibilities, this article will use the name of mass hysteria, commonly used in psychology and social psychology (Bartholomew, 2001), applying when necessary Wessely’s (1987) distinction between two types of mass sociogenic illness: mass anxiety hysteria and mass motor hysteria, which will be described later in this article.

For Trillat (2006), between the 15th and 18th centuries, most records on mass hysteria involved the hierarchy and inflexibility of the Roman Catholic Church. The author points out that the ‘witch-hunt’ began in Europe at a critical juncture where the millenarian order, founded under an alliance between feudalism and the Church, was broken off, giving rise to the influences of a nascent humanism. The ‘witch-hunt’ brought together the anxieties of a conservative social body that in transition deposited its innermost fears about the social transformations on the behaviour of witches and ‘possessed’ women. In this direction, a contextualised analysis of episodes of mass hysteria, which investigates the interplay between personal and collective psychopathology, may reveal unexplored psychosocial dimensions of the phenomenon.

Through an example of an historical episode of demonic possession, it is possible to observe some of the features of such mass hysteria. In the famous case known as the ‘Loudun possessions’, which occurred in France between 1632 and 1634, crises, convulsions and vulgar language among a group of Ursuline nuns were credited to demonic possession. Following the events, a local Catholic priest, Urbain Grandier, was accused of sorcery and burned at the stake (Rapley, 1998). The Loudun possessions have been analysed by reputed researchers throughout history, namely Alexandre Dumas (1634), Jules Michelet ([1862] 1939, 2008), Jean-Martin Charcot (1866), Aldous Huxley (1952) and Michael de Certeau ([1970] 2000). It might be argued that the case revealed not only the influences of the tense atmosphere shaped by the Catholic Church and the repressed sexuality of the nuns, but also psychosocial strains and sociopolitical dimensions that were overshadowed by the manifestations. Further explorations interconnect conspiracy and simulation of the nuns to the virile personality of Grandier and his rivalry with Cardinal Richelieu. The influence of disputes between Huguenots and Catholics was also evident (Rapley, 1998).

The story of the Loudun possessions suggests an intimate connection between the outburst of mass hysteria and turbulent sociopolitical and religious contexts. More than that, it enables exemplification of the cross-fertilisation of historical, religious, political, psychological, sociological, linguistic and discursive dimensions that are necessary for an in-depth understanding of phenomena that might be understood in terms of mass hysteria. In psychosocial studies, such an analysis might be described in terms of interdisciplinary research but also transdisciplinary (Frosh, 2013) efforts to foster encounters of ‘lines of flight’ (Deleuze and Guattari, 1987). The concept of ‘lines of flight’ describes lines of intensity that do not present a closed form, because they move in various directions, open and close, spread and disappear, build and deconstruct, without definite connection. ‘Lines of flight’ allow us to tangle and untangle encounters of multiple dimensions in ‘trans spaces’ (Frosh, 2013: 1) as unveiled by psychosocial investigations.

Gilman et al (1993) described the subversive and misterious nature of hysteria in both mind and body, for 18th- and 19th century medicine. However, after Mesmer’s experience with animal magnetism, the phenomena could be seen through a new angle, favouring the emergence of dynamic psychiatry, which distanced the observation from its collective outlook in the previous centruries (Gay, 2006). Thus, within this perspective, hysteria established itself as a mental pathology, with detailed clinical descriptions and morbid states. However, despite the advances of the alienists and the medical pathology, hysteria still could not fit within the nosography of the time, and only when it acquired neurological interest did it manage to move away from other psychopathological frameworks and find a place of its own (Gay, 2006).

At the end of the 19th century, through experiments with hysteria and hypnosis in the Salpêtrière Hospital in Paris, the French neurologist Jean-Martin Charcot finally conferred a differentiated status for hysteria, providing elements for the flourishing of psychoanalysis (Gay, 2006). It was here that Freud (1893–95) started researching the psychic mechanism of hysteria and its aetiology, by discussing the relevance of trauma as the trigger for hysteria, as well as its relation to the body and the role of sexuality in the onset of neurosis (Gay, 2006). However, after the apex of its valorisation as a symptom of repressed sexuality and as an unconscious communication, hysteria ended up, in the contemporary world, acquiring a pejorative connotation, which led again to the creation of new discursive formations and association with simulation and mysticism (Gilman et al, 1993).

The contemporary classification of disorders formerly known as hysteria and phenomenologically related syndromes has long been contentious and unsettled in psychiatry, being constantly explored and reconceptualised. Diagnostic manuals such as the fifth edition of the Diagnostic and statistical manual of mental disorders (DSM-V; American Psychiatric Association, 2013) and the 11th revision of the International classification of diseases and related health problems (ICD-11; World Health Organization, 2018) present new diagnostic classifications for dissociative, conversion and somatoform syndromes for phenomena that extensively and phenomenologically overlap one another. So the classification schemes for these disorders can help to address the continuing controversy over the topic (North, 2015). These considerations seem to confirm that hysteria plunges again into a diffuse field, remaining as Wessely (1987) affirms a controversial term.

Mass hysteria

In the past few decades, episodes that could be nominated as mass hysteria have raised interest among psychiatrists, psychologists and sociologists. Epidemiological studies have identified cases worldwide (Sirois, 1974; Wessely, 1987; Boss, 1997; Bartholomew, 2000; Balaratnasingam and Janca, 2006). However, diagnosis of an episode is difficult and involves expensive medical, psychological and toxicological examinations before it can be confirmed, delaying appropriate interventions. François Sirois (1974) compiled an historical collection of 78 mass hysteria episodes that occurred in schools, factories, convents and hospitals from 1872 to 1972, using the term epidemic hysteria – defined as ‘a constellation of symptoms suggesting an organic disease, without identifiable origin, and occurring in two or more people who share beliefs associated to those symptoms’ (Boss, 1997: 233) – to describe the phenomenon.

But no satisfactory definition of mass hysteria exists. A wide variety of crazes, dances, panics and ‘abnormal group beliefs’ have all been labelled as mass hysteria. However, the boundaries of collective behaviour and mass hysteria have yet to be drawn and it is paramount to understand that ‘these epidemics, while definitely of a pathological order, are certainly psychosocial phenomena rather than manifestations of individual mental illness’ (Wessely, 1987: 109). They are historical, transcultural, discursive and linguistic manifestations, which mirror the psychosocial constrains of a specific social system ‘in each era and reflect unique beliefs about the nature of the world’ (Bartholomew and Wessely, 2002: 300).

Bartholomew (2000: 2001) identified no less than 82 different ways to call the phenomenon, named by him as mass sociogenic illness. This fact is evidenced not only in the forms in which it appears but also in the controversy, prejudice and different points of view that are at stake while dealing with individual or mass hysteria. In this regard there is an increasing recognition of the ‘protean nature of phenomena, that still remains underappreciated, under-reported and posing a significant health and social problem’ (Bartholomew et al, 2012: 509). Mass sociogenic illness refers to the ‘rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss or alteration of function, whereby physical complaints that are exhibited unconsciously have no corresponding organic etiology’ (Bartholomew and Wessely, 2002: 300).

Wessely (1987) identified two types of mass sociogenic illness: mass anxiety hysteria and mass motor hysteria. Mass anxiety hysteria, the most common in Western countries, describes short episodes involving sudden and extreme anxiety, following the perception of a false threat. The second type, mass motor hysteria, is characteristic of situations in which there is a slow accumulation of stress in oppressive and confined social settings, being characterised by conversion symptoms, dissociation, trance, hystrionism and alterations in psychomotor activity that persist for weeks or months.

Historically, it is possible to suggest that until the 18th century, most reports of mass hysteria involved episodes of mass motor hysteria (Bartholomew, 2000). From the 18th century until the beginning of the 20th century, reports focused on cases in which poor working conditions in factories, and distress and conflicts in boarding schools and institutions, provided the setting and psychosocial background for the emergence of symptoms (Boss, 1997; Bartholomew and Wessely, 2002; Balaratnasingam and Janca, 2006). In general, episodes of mass hysteria are triggered in environments where socioeconomic problems and psychosocial distress are intermingled with cultural and traditional religious beliefs, as in the increasing number of reported cases of spiritual-demonic possessions (Bartholomew, 2001).

From the 20th century onwards, it is possible to observe episodes related to environmental worries and false beliefs, such as the fear of food poisoning, air pollution or exposure to toxic fumes (Goh, 1987). Today – particularly after the terrorist attack involving sarin nerve gas in Tokyo, Japan in 1995 and the 9/11 terrorist attack on the World Trade Center in New York in 2001 – we observe an increase in the number of cases characterised by a short outburst, a quick remission and a lack of pre-existing tensions, in which the fear of chemical or biological attacks in airports or underground stations triggers the episodes: ‘Mass sociogenic illness flourishes where the threat has a basis in reality. The 1995 terrorist attacks using sarin nerve gas on the Tokyo subway by Shinrikyo sect triggered a series of MSI [mass sociogenic illness] episodes involving benign odours’ (Bartholomew and Wessely, 2002: 302).

Recently, the first episodes of mass hysteria as a result of the impact of social networking have been reported (Bartholomew et al, 2012: 510). Widespread criticism, suspicion and media speculation are transforming these cases into a public health issue. In addition, the media boast created around the publicity of the outbreaks might, as a whole, be marking an historic shift in the spread of conversion disorders. As hypothesised by Bartholomew et al (2012: 510): ‘[W]e may be witnessing a milestone in the history of mass psychogenic illness where the primary agent of spread will be the Internet and social media networks’. This shift might find a parallel in the 19th-century’s transformations during public debate around the ‘Dreyfus affair’, which marked, according to Gabriel Tarde, the birth of the public era (Penna, in press).

Mass hysteria is present in both genders, but 83% of the cases occur among young women from underprivileged populations and from cultures that are strongly influenced by ethnic and religious traditions (Boss, 1997). Therefore, we might propose that mass hysteria episodes emerge in populations in which psychosocial anxieties, distress and uncertainty prevail and the possibility for personal and collective working through of these conflicts cannot find ways of expression in either their groupings society. Therefore, mass hysteria episodes seem to reflect latent conflicts and the fears present in the current Zeitgeist (Bartholomew and Wessely, 2002). Viewed this way, they are a collective phenomenon under the influence of group psychodynamics.

Mass hysteria in a school in Mozambique

In 2011, I visited Maputo, the capital of Mozambique, for a conference organised by the Brazilian Psychoanalytic Society of Rio de Janeiro (filiated to the International Psychoanalytical Association) and by an intergovernmental organisation, known in English as the Lusophone Commonwealth. At that time, I was requested to comment on the official report presented by the Health Ministry’s technicians following an investigation of a mass hysteria episode. The episode occurred in 2010, in a secondary school, when 71 female teenagers, aged between 15 and 19 years, suffered systematic faints for months. The incident mobilised the entire Mozambican society, the press and religious and social entities. The Health Ministry team investigated the case within the classic Western model of medical-psychiatric intervention and did not find any organic aetiology that had triggered the symptoms. However, they requested to discuss the case with their psychoanalytic colleagues from the Lusophone Commonwealth.

It was verified that among the teenagers involved, there was a strong belief, based on the local culture and traditional religion, that they were being possessed by the spirits of dead ancestors, specifically by the spirits of the families ‘Mv’ and ‘Mg’. This belief had turned into a strong conviction for those involved. However, through the observation of media, newspapers and unofficial blogs, it was possible to hypothesise about the influence of local pre-existing psychosocial conflicts, which remained overlooked by the medical authorities. The school had been built on the soil where the remains of the families ‘Mv’ and ‘Mg’ were previously buried, although the remains had been removed due to the construction of the new school. The rumour was that the place was ‘impure’ because the appropriate traditional religious ceremonial had not been performed. Because of this, the teenagers believed they were being possessed by the spirit of ‘Granny My’ and of ‘Granny Mg’. Following local practices, the traditional religious entities suggested that a ceremonial should be performed to summon the dead spirits. However, there was conflict around the procedures. On the one hand, families and members of the community pressured the authorities towards a solution based on traditional medicine, with the collaboration of local witchdoctors/curandeiros. On the other hand, authorities from the Health Ministry ruled that out, favouring clinical and psychological examinations based on Western practices. The dissociation and the changes in psychomotor activity continued until they ended spontaneously after a few months. However, in the meantime, a traditional religious service for summoning the spirits, including animal sacrifice, was conducted.

A brief overview of Mozambican history

The Republic of Mozambique is a country in south-east Africa. It was a Portuguese colony for centuries. Mozambique has been occupied by a vast mosaic of peoples from different backgrounds and cultures, such as African, Arab, European and Indian groups. Ethnic groups are enormously diverse not only in terms of language and religion but also in terms of habits and culture. Regional differences have had an important impact on the social structure of the country, interconnecting ethnicities, geography and history as well as socioeconomic, political and historical trends. From the 19th century onwards, the influence of South Africa became remarkable and the patrilineal population of the south, especially Maputo, grew rapidly. Thus, the economic development in the south led to a higher degree of ‘modernisation’ and change in social relationships than in the rest of the country. Therefore, the north remained more traditional than the southern and central parts of the country. It brought disparities and conflicts in the economic, sociocultural and gender relationships between the inhabitants (Newitt, 1995).

Different religions are dispersed throughout Mozambique; nevertheless, the adherence to traditional African religion is great. In general, traditional beliefs and practices of African peoples include various traditional religions that are usually oral rather than scriptural, including a belief in spirits, the veneration of ancestors and the use of magic and traditional medicine. Traditional African medicine, with its belief that illness is derived from spiritual or social imbalance, differs greatly from Western medicine. Diagnosis is reached through spiritual means and a treatment is prescribed, usually consisting of a herbal remedy, counselling or unusual practice that is considered to have not only healing abilities but also spiritual significance. So, traditional healers known as spirit mediums or witchdoctors play a crucial role in the health of Mozambicans, accumulating a significant power among civilians (Newitt, 1995).

After four centuries of colonial presence in Africa, Portugal became embroiled in various wars of independence with its colonies, beginning in 1961. The Mozambican War of Independence (1964–75) was led by Samora Machel and the FRELIMO (Mozambique Liberation Front) party. They successfully defeated the colonial forces, and the Portuguese settlers left the country. However, only two years later, with an underdeveloped infrastructure, too few skilled professionals, recession and poverty, the initial revolutionary fervour eroded. The atmosphere of dissatisfaction with FRELIMO’s internal Marxist–Leninist policies added to ideological and economic polarisation in African decolonisation processes, which led to the creation of the RENAMO (Mozambican National Resistance) party and to the eruption of the Post-Colonial Civil War (1976–92) (Igreja and Skaar, 2013).

The civil war further depleted the country’s infrastructure, which helped to exacerbate deep splitting and hatred among families and ethnicities (Igreja and Skaar, 2013). Life in the war zones spoiled the psychosocial tissue of the communities, introducing the inhabitants to experiences of betrayal, murder, starvation, depletion of relationships and a real threat of annihilation. Children became child-soldiers and young virgin females were sexually abused (Efraime Júnior, 1996). These cumulative traumas fractured the life within communities, bringing deep divisions among citizens and the society that prevailed in the post-civil war context (Igreja, 2015).

Today, Mozambicans remain affected by the traumatic experiences of colonialism, civil war and the outcome of the general amnesty that took place in its aftermath (Igreja, 2015). This state of affairs keeps alive a strain and violent tension that affects the fragile identity of the new state (Cahen, 1994). Moreover, globalisation and the influence of Western cultures in the reconstruction of the country have brought additional challenges by fostering, on a daily basis, cultural, religious and discursive conflicts in the psychosocial milieu. Consequently, the coexistence of African traditions and Western cultures has led the population to experience a real clash of cultures, a daily confrontation between different Zeitgeists.

The mass hysteria episode in context

According to analyses of epidemiological records, manifestations of mass motor hysteria are more common in Africa and Asia than in other continents (Boss, 1997). The psychodynamics of mass hysteria cases indicate unique figurations (Elias, 1984) while the analysis of the features of mass hysteria is complex, requiring interdisciplinary and transdisciplinary ‘spaces’ (Frosh, 2013) in the investigations.

Bartholomew (2000) argues that mass motor hysteria episodes are recurrent in social settings such as schools, particularly among female adolescents such as occurred in the Mozambican school. In Western psychoanalytic thinking, adolescence is a stage of development characterised by a psychosexual restructuring, leading to subjective changes and the search for a personal and a social identity. Identification, previously focused on parental figures, becomes centred on peer identification and gender choices (Blos, 1998). Safety previously found in family traditions and habits is replaced by rebellion against them and a search for new values. In this sense, the adolescent oscillates between two worlds: one of childhood safety and one that entails a frightening discovery of adulthood. In addition, teenagers are susceptible to suggestion and affect contagion and have a great need for acceptance and self-affirmation, being eager to conform to a group by sharing its identity, beliefs and ideals (Blos, 1998). It may be argued that the adolescents in the Mozambican mass hysteria case, personified (Hopper, 2003) through their own bodies, personal, familial, social and cultural conflicts.

Efraime Júnior (1996) discussed how childhood and adolescence were affected by the war in Mozambique, revealing how the younger population was deprived in its aftermath. In addition, as he observed, the country’s psychosocial milieu has been exposed to a clash not only between ethnicities but also between the traditional African beliefs and Western sociocultural patterns. There are both visible and invisible effects of colonial discourses in the development of the independent country (Mbembe, 2001). This reality brings great uncertainty and distress, especially for children and adolescents, who seem not to be able to find a trustful harbour to contain their development.

So, living in a transition period − post-independence, post-civil war − Mozambique is struggling with conflicts around its own identity as a nation (Cahen, 1994). This situation might be characterised by a psychosocial strain, an ‘excess’ that is traumatic par excellence. It leads not only the adolescents, but also all Mozambicans to experience traumatic experiences in the conscious and unconscious life of their groups and social systems (Hopper, 2003). That is, the Mozambican specific figurations (Elias, 1984) create a propitious context for the emergence of mass hysteria phenomena, where personal and collective symptoms become shared by a strongly identified group.

From this perspective, it is important to remember that Freud (1921) postulated that a group is maintained by the aggregative force of Eros, and each individual is connected by libidinous ties to other members of the group and to the leader. During this process, individuality is compromised, since individual initiatives are hampered by the group dynamics, leading to the emergence of a group individual. So, ‘a primary group of this kind is a number of individuals who have put one and the same object in the place of their ego ideal and have consequently identified themselves with one another in their ego (Freud, 1921: 116). Thus, mass motor hysteria involves not only identifications and ego-ideal instances but also the psychodynamic of traumatised groups and/or traumatised social systems (Hopper, 2003). In this sense, it is important to note that the literature about mass motor hysteria highlights exactly the existence of a pre-existent psychosocial strain, that is, traumatic experiences that contribute to the triggering of episodes in which the structural regression, a need for protection and the tendency to merge shape the group behaviour (Wessely, 1987).

But how is it possible to understand such powerful defences that involve intricate interdependences between the personal and the social? In a classic outlook, it is suggested that a mass hysteria outburst discloses, in the psychosocial milieu, repressed symptoms (Freud, 1916 [1917]) that have not yet acquired mental representation. Its manifestation is spread by contagion and suggestion, which are features of crowd psychology put forward by the French social psychologist Gustave le Bon ([1895] 1995). However, under a more contemporary lens and taking into account intersubjective psychoanalytic approaches, mass hysteria might be presented through enactments (Jacobs, 1986) or by collective enactments in the ‘psychosocial stage’. The term ‘enactment’ is used colloquially in terms of a sense of theatrical representation, similar to ‘act’ or ‘play’. The same use is found in psychoanalytic texts. In psychoanalysis an enactment is defined as an intersubjective phenomenon in which, from the mutual emotional induction, the analytical field is taken by discharges and behaviours that involve both members of the analytic double (Cassorla, 2018). So, ‘enactments represent primitive traumatic situations that could not be verbally symbolised by a patient because they were recorded before the development of the symbolic mind’ (Cassorla, 2018: 48). In mass hysteria episodes it is possible to affirm that, within a stressful, traumatised and regressed sociocultural context, personal unsymbolised traumatic experiences may be unconsciously, intersubjectively and transpersonally shared and collectively enacted. Therefore, experiences that remain in a raw state in a person’s mind may finally find unconscious forms of expression/legitimation in the public sphere through the collective enactments within a regressed and highly identified group.

Expanding the scope of the investigation by highlighting the interdependences between the personal, the group and the society, Hopper (2003) through his fourth basic assumption theory − incohesion: aggregation/massification − describes ubiquitous features of traumatic experiences in the unconscious life of groups and group-like social systems. To understand mass hysteria, especially mass motor hysteria, under Hopper’s lens it is important to realise that it emerges in psychosocial environments and distressed social settings where traumatic experiences are present. These threatening contexts lead the individuals to regress, not only by experiencing failed dependency within the personal, the family and the psychosocial sphere, but also by feeling real or imagined threats of annihilation. In these situations, the psychological defences lead to a massification state (Hopper, 2003) and consequently to an absolute need to merge with a group. This manoeuvre offers protection, guaranteeing the imaginary/real survival of the individuals concerned. So, in a social system that regresses structurally, as Mozambique did with its warfare, a hysterical symptom, shown by one of the members of the affected group, ends up being taken over by other identified and merged members (Hopper, 2011). Thus, defences as primitive identifications, projective identifications and primitive forms of communication are regressively shared by the members of the group who find, through fusion/merging, protection against the fear of annihilation. In addition, applying a group-analytic perspective, mass motor hysteria might be understood as collective enactments of constraints and restraints that lie in the social unconscious of individuals and groups in a traumatised and regressed social system (Hopper and Weinberg, 2011). It confers a broader understanding of the phenomenon by including not only the unconscious role of personal and collective unmourned traumas and losses but also the influence of intergenerational and transgenerational psychic transmissions in the outbursts.

Taking into account a specific framework that combined historical and social psychiatry literature research with psychoanalytic and group analytic perspectives, the investigation of the mass hysteria episode in Maputo, described in a nutshell how the school hosted, through the emergence of hysterical symptoms, the core contradictions that lie in the social unconscious (Hopper and Weinberg, 2011) of Mozambican people. Although the school was oriented by Western practices, local religious and traditional beliefs still prevailed in its daily activities. The mass hysteria case perhaps unveiled not only the clash between traditional and Western cultures (Efraime Júnior, 1996) but also some of the subtle forms that power relations acquire in the daily life of African countries (Mbembe, 2001). In addition, through field observations it was possible to notice how the local authorities, which identified with Western procedures and discourses, somehow overlooked the relevance of strong traditional beliefs and practices paramount to the resolution of the case. The described episode was therefore arguably a collective enactment of intricate figurations between personal non-symbolised anxieties, socially unconscious repressed contents of individuals and their groupings in a traumatised new country/social system.

Concluding comments

Since ancient times, hysteria has revealed ungrasped meanings that have been related, throughout history, to different discourses and formations related to the sociopolitical and cultural context of a certain period of time. Mass hysteria research has been mobilising disciplinary and multidisciplinary endeavours to understand the intriguing psychosocial phenomenon. However, as it is possible to observe in this article, there are so many ‘lines of flight’ (Deleuze and Guattari, 1987) related to the investigation of the topic, that even making a good use of interdisciplinary resources it becomes impossible to find a ‘unity of knowledge’ (Frosh, 2013) regarding mass hysteria cases, because it pushes the researcher far beyond the traditional boundaries of academic disciplines. Following Frosh’s (2013) postulations, mass hysteria might be considered as a topic that brings more questions than answers, and a certain disillusionment to traditional researches. Indeed, it demands a deconstruction of psychiatric, epidemiologic, psychoanalytic, group analytic and psychosocial disciplines’ assumptions, which need to be revised so as to include a more transdisciplinary approach. In addition, the topic is permeated by colonial discourses and language–gender dimensions, which, as power apparatuses, as a capillary power (Foucault, 1980), have been shaping hysteria in their personal and collective outlooks.

It is a hard task and sometimes it seems impossible or misleading because this shift involves a blow to the researcher’s narcissism and their taken-for-granted theories and assumptions. However, the loss of this realm allows the critical discovery of new ‘lines of flight’ that can transform, change directions and multiply, allowing the creation of conscious and unconscious new meanings, as well as macro and micro connections that grow and create new ‘trans spaces’ (Frosh, 2013), but also may spread and dilute.

Transdisciplinary perspectives point to new and less comfortable paths that deconstruct a myriad of illusions, already pointed out by Freud in his works on psychoanalysis and culture. Notwithstanding, it permits renovated discoveries and explorations in the uncertain, incohesive (Hopper, 2003) and fragmented social world.

Conflict of interest

The author declares that there is no conflict of interest.

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  • Cassorla, R. (2018) The psychoanalyst, the theatre of dreams and the clinic of enactment, London: Routledge.

  • Charcot, J. M. (1866) Préface de M. le Professeur Charcot. In:Legué, G; De La Tourrette, G. (1866), Soeur Jeanne des Anges, supérieure des Ursulines de Loudon (XVII siècle): autobiographie d’une hysterique possédée, Paris: A. Delahaye & Lecrosnier.

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  • De Certau, M. ([1970] 2000) The possession at Loudun, Chicago, IL: University of Chicago Press.

  • Deleuze, G. and Guattari, F. (1987) Thousand plateaus I: Capitalism and schizophrenia, Minnesota, MN: University of Minnesota Press.

  • Dumas, A. (1634) Urbain Grandier, celebrated crimes, retrieved from www.gutenberg.org/license.

  • Efraime Júnior, R. (ed) (1996) Children, war and persecution: Rebuilding hope, Maputo, Mozambique: Rebuilding Hope.

  • Elias, N. (1984) What is sociology?, New York, NY: Columbia University Press.

  • Figueiredo, L.C. and Coelho Jr, N. (2003) Patterns of intersubjectivity in the constitution of subjectivity: dimensions of otherness, Culture & Psychology, 9(3): 193208.

    • Search Google Scholar
    • Export Citation
  • Foucault, M. (1980) Power/knowledge: Selected interviews and other writings 1972–1977, New York, NY: Pantheon.

  • Freud, S. (1893–95) The standard edition of the complete psychological works of Sigmund Freud: Volume II: Studies on hysteria, London: Hogarth Press, pp 1323.

    • Search Google Scholar
    • Export Citation
  • Freud, S. ([1916] 1917) The sense of symptoms, in The standard edition of the complete psychological works of Sigmund Freud: Volume 16: Introductory lectures on psycho-analysis (part III), London: Hogarth Press, pp 25772.

    • Search Google Scholar
    • Export Citation
  • Freud, S. (1921) Group psychology and the analysis of the ego, in The standard edition of the complete psychological works of Sigmund Freud: Volume 18: Beyond the pleasure principle, London: Hogarth Press, pp 67143.

    • Search Google Scholar
    • Export Citation
  • Frosh, S. (2013) Transdisciplinary tensions and psychosocial studies, Enquire, 6(1): 115.

  • Frosh, S. and Baraitser, L. (2008) Psychoanalysis and psychosocial studies, Psychoanalysis, Culture & Society, 13: 34665. doi:

  • Gay, P. (2006) Freud: A life for our time, New York, NY: Norton & Company.

  • Gilman, S.L., King, H., Porter, R., Rousseau, G.S. and Showalter, E. (1993) Hysteria beyond Freud, Berkeley, CA: University of California Press.

    • Search Google Scholar
    • Export Citation
  • Goh, K.T. (1987) Epidemiological enquiries into a school outbreak of an unusual illness, International Journal of Epidemiology, 16(2): 26570. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hopper, E. (2003) Traumatic experience in the unconscious life of groups, London: Jessica Kingsley Publishers.

  • Hopper, E. (2011) Personal communication on mass hysteria.

  • Hopper, E. and Weinberg, H. (2011) Social unconscious in persons, groups and societies: Volume 1: Mainly theory, London: Karnac Books.

  • Huxley, A. (1952) The devils of Loudun, New York, NY: Harper Perennial.

  • Igreja, V. (2015) Amnesty law, political struggle for legitimacy and violence in Mozambique, International Journal of Transitional Justice, 9: 23958. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Igreja, V. and Skaar, E. (2013) A conflict does not rot: state and civil society, Nordic Journal of Human Rights, 31(2): 14975.

  • Jacobs, T. (1986) On countertransference enactments, Journal of the American Psychoanalytic Association, 34: 289307. doi:

  • Le Bon, G. ([1895] 1995) The crowd, Piscataway, NJ: Transaction Publishers.

  • Legué, G. and De La Tourrette, G. (1866) Soeur Jeanne des Anges, supérieure des Ursulines de Loudon (XVII siècle): Autobiographie d’une hysterique possédée, Paris, France: A. Delahaye & Lecrosnier.

    • Search Google Scholar
    • Export Citation
  • Mbembe, A. (2001) On the postcolony, Berkeley, CA: University of California Press.

  • Michelet, J. ([1862] 1939, 2008) The sorceress: A study in medieval superstition, New York, NY: Biblio Bazar.

  • Newitt, M. (1995) A history of Mozambique, New York, NY: Witts University Press.

  • North, C. (2015) The classification of hysteria and related disorders: historical and phenomenological considerations, Behavioral Sciences, 5(4): 496517. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Penna, C. (in press) The psychodynamics of crowds: Historical and contemporary reflections, London: Routledge.

  • Rapley, R. (1998) Case of witchcraft: The trial of Urbain Grandier, Québec, Canada: McGill-Queen’s University Press.

  • Rustin, M. (1991) The good society and the inner world: Psychoanalysis, politics and culture, London: Verso.

  • Sirois, F. (1974) Epidemic hysteria, Acta Psychiatrica Scandinava, 252: 144.

  • Trillat, E. (2006) Histoire de l’hystérie, Paris, France: Frison-Roche.

  • Waller, J. (2008) A time to dance, a time to die: The extraordinary story of the dancing plague of 1518, New York, NY: Icon Books.

  • Wessely, S. (1987) Mass hysteria: two syndromes?, Psychological Medicine, 17(1): 10920. doi:

  • World Health Organization (2018) International classification of diseases and related health problems (11th revision, ICD-11), Geneva: World Health Organization.

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  • American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th edition, DSM-V), Philadelphia, PA: American Psychiatric Association.

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  • Bartholomew, R. (2001) Little green men, meowing nuns and head-hunting panics: A study of mass psychogenic illness and social delusion, Jefferson, NC: McFarland & Company.

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  • Bartholomew, R. and Wessely, S. (2002) Protean nature of mass sociogenic illness: from possessed nuns to chemical and biological terrorism fears, British Journal of Psychiatry, 180: 3006. doi:

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  • Bartholomew, R., Wessely, S. and Rubin, G. (2012) Mass psychogenic illness and the social network: is it changing the pattern of outbreaks?, Journal of the Royal Society of Medicine, 105: 50912. doi:

    • Crossref
    • Search Google Scholar
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  • Blos, P. (1998) On adolescence, London: Free Press.

  • Boss, L. (1997) Epidemic hysteria: a review of the published literature, Epidemiological Reviews, 19(2): 23343. doi:

  • Cahen, M. (1994) Mozambique: histoire géopolitique d’un pays sans nation, Lusotopie, 1: 24383.

  • Cassorla, R. (2018) The psychoanalyst, the theatre of dreams and the clinic of enactment, London: Routledge.

  • Charcot, J. M. (1866) Préface de M. le Professeur Charcot. In:Legué, G; De La Tourrette, G. (1866), Soeur Jeanne des Anges, supérieure des Ursulines de Loudon (XVII siècle): autobiographie d’une hysterique possédée, Paris: A. Delahaye & Lecrosnier.

    • Search Google Scholar
    • Export Citation
  • De Certau, M. ([1970] 2000) The possession at Loudun, Chicago, IL: University of Chicago Press.

  • Deleuze, G. and Guattari, F. (1987) Thousand plateaus I: Capitalism and schizophrenia, Minnesota, MN: University of Minnesota Press.

  • Dumas, A. (1634) Urbain Grandier, celebrated crimes, retrieved from www.gutenberg.org/license.

  • Efraime Júnior, R. (ed) (1996) Children, war and persecution: Rebuilding hope, Maputo, Mozambique: Rebuilding Hope.

  • Elias, N. (1984) What is sociology?, New York, NY: Columbia University Press.

  • Figueiredo, L.C. and Coelho Jr, N. (2003) Patterns of intersubjectivity in the constitution of subjectivity: dimensions of otherness, Culture & Psychology, 9(3): 193208.

    • Search Google Scholar
    • Export Citation
  • Foucault, M. (1980) Power/knowledge: Selected interviews and other writings 1972–1977, New York, NY: Pantheon.

  • Freud, S. (1893–95) The standard edition of the complete psychological works of Sigmund Freud: Volume II: Studies on hysteria, London: Hogarth Press, pp 1323.

    • Search Google Scholar
    • Export Citation
  • Freud, S. ([1916] 1917) The sense of symptoms, in The standard edition of the complete psychological works of Sigmund Freud: Volume 16: Introductory lectures on psycho-analysis (part III), London: Hogarth Press, pp 25772.

    • Search Google Scholar
    • Export Citation
  • Freud, S. (1921) Group psychology and the analysis of the ego, in The standard edition of the complete psychological works of Sigmund Freud: Volume 18: Beyond the pleasure principle, London: Hogarth Press, pp 67143.

    • Search Google Scholar
    • Export Citation
  • Frosh, S. (2013) Transdisciplinary tensions and psychosocial studies, Enquire, 6(1): 115.

  • Frosh, S. and Baraitser, L. (2008) Psychoanalysis and psychosocial studies, Psychoanalysis, Culture & Society, 13: 34665. doi:

  • Gay, P. (2006) Freud: A life for our time, New York, NY: Norton & Company.

  • Gilman, S.L., King, H., Porter, R., Rousseau, G.S. and Showalter, E. (1993) Hysteria beyond Freud, Berkeley, CA: University of California Press.

    • Search Google Scholar
    • Export Citation
  • Goh, K.T. (1987) Epidemiological enquiries into a school outbreak of an unusual illness, International Journal of Epidemiology, 16(2): 26570. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hopper, E. (2003) Traumatic experience in the unconscious life of groups, London: Jessica Kingsley Publishers.

  • Hopper, E. (2011) Personal communication on mass hysteria.

  • Hopper, E. and Weinberg, H. (2011) Social unconscious in persons, groups and societies: Volume 1: Mainly theory, London: Karnac Books.

  • Huxley, A. (1952) The devils of Loudun, New York, NY: Harper Perennial.

  • Igreja, V. (2015) Amnesty law, political struggle for legitimacy and violence in Mozambique, International Journal of Transitional Justice, 9: 23958. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Igreja, V. and Skaar, E. (2013) A conflict does not rot: state and civil society, Nordic Journal of Human Rights, 31(2): 14975.

  • Jacobs, T. (1986) On countertransference enactments, Journal of the American Psychoanalytic Association, 34: 289307. doi:

  • Le Bon, G. ([1895] 1995) The crowd, Piscataway, NJ: Transaction Publishers.

  • Legué, G. and De La Tourrette, G. (1866) Soeur Jeanne des Anges, supérieure des Ursulines de Loudon (XVII siècle): Autobiographie d’une hysterique possédée, Paris, France: A. Delahaye & Lecrosnier.

    • Search Google Scholar
    • Export Citation
  • Mbembe, A. (2001) On the postcolony, Berkeley, CA: University of California Press.

  • Michelet, J. ([1862] 1939, 2008) The sorceress: A study in medieval superstition, New York, NY: Biblio Bazar.

  • Newitt, M. (1995) A history of Mozambique, New York, NY: Witts University Press.

  • North, C. (2015) The classification of hysteria and related disorders: historical and phenomenological considerations, Behavioral Sciences, 5(4): 496517. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Penna, C. (in press) The psychodynamics of crowds: Historical and contemporary reflections, London: Routledge.

  • Rapley, R. (1998) Case of witchcraft: The trial of Urbain Grandier, Québec, Canada: McGill-Queen’s University Press.

  • Rustin, M. (1991) The good society and the inner world: Psychoanalysis, politics and culture, London: Verso.

  • Sirois, F. (1974) Epidemic hysteria, Acta Psychiatrica Scandinava, 252: 144.

  • Trillat, E. (2006) Histoire de l’hystérie, Paris, France: Frison-Roche.

  • Waller, J. (2008) A time to dance, a time to die: The extraordinary story of the dancing plague of 1518, New York, NY: Icon Books.

  • Wessely, S. (1987) Mass hysteria: two syndromes?, Psychological Medicine, 17(1): 10920. doi:

  • World Health Organization (2018) International classification of diseases and related health problems (11th revision, ICD-11), Geneva: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 1 Ph.D, psychoanalyst in Circulo Psicanalítico of Rio de Janeiro, , Brazil, group analyst, Group Analytic Society International

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