Mass hysteria blamed for Afghan schoolgirl 'poisoning,' not the Taliban

The Taliban have been poisoning scores of Afghan schoolgirls for attending school, right? Wrong – at least that’s the position of the World Health Organization.

Schoolgirls and teachers complaining of nausea and other symptoms have reported poisoned water supplies at at least 12 girls’ schools across Afghanistan since 2009. But there have been no fatalities, and despite extensive efforts by the UN's World Health Organization to get to the bottom of the matter no one has found proof of poison or any other organic cause.

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Now, investigators at the World Health Organization (WHO) report that the most likely answer to the mystery is that the reports of poisoning are a form of mass hysteria.

The girls and teachers suffering from symptoms really believe they're sick, and in a way, they really are. Nausea is nausea, fainting is fainting. And though it seems odd, there have been similar cases around the world down the centuries. Some historians believe the precipitating events that led to the Salem, Mass. Witch Trials of 1692-93, which led to the murder of about two dozen accused "witches," was mass hysteria among a group of girls.

In a little noticed article in the WHO's Weekly Epidemiological Monitor from May titled "Mass Psychogenic Illness in Afghanistan" the organization reports on the latest allegation of poisoning in Taluqan district, Takhar Province”:

"A total of 103 … school girls from Bibi Hajerah High School were admitted with symptoms of weakness, nausea, dizziness, and syncope. Some reported smelling a stench.... Clinical assessment by the attending physicians and similar past history rule out an organic cause. The cases were considered as a mass psychogenic illness, given treatment and discharged home." 

The WHO goes on: "This is the fourth year where episodes of suspected mass poisoning of school girls is reported from Afghanistan. Like in the previous years the events are triggered off with one girl developing symptoms of headache, weakness, dizziness, nausea, and fainting. Often these outbreaks were believed to be the work of political elements in the country who oppose girls education. Reports of stench smells preceding the appearance of symptoms have given credit to the theory of mass poisoning.... However, investigations into the causes of these outbreaks have yielded no such evidence so far. In the last four years over 1,634 cases from 22 schools have been treated for Mass Psychogenic Illness in Afghanistan. There are no related deaths reported."

As far as I can tell, The Daily Telegraph was the first to pick up on the WHO assessment that there hasn't been any poisoning.

The cases the Afghanistan incidents most resemble are the Tanganyika laughter epidemic of 1962, in which hundreds of people, mostly schoolgirls, were overcome by fits of mirthless, extended laughter, in what is now known as Tanzania, and the West Bank fainting epidemic of 1983.

A history of mass hysteria

The similarities between the heavily studied epidemic in the occupied West Bank and Afghanistan are particularly striking. Both places are in a state of conflict, where political violence is a fact of life, and both have powerful local rumor mills. The incidents follow a similar pattern: First a single report of a bad smell, then a small number of girls come down with symptoms, then it spreads. Local media fueled the rumors and the incidents spread in Afghanistan, just as they did in Israel and Palestine.

Albert Hefez, Israel's lead psychiatric investigator of the incident, wrote in his 1985 study "The Role of the Press and the Medical Community in the epidemic of ‘Mysterious Gas Poisoning’ in the Jordan West Bank" that Israeli newspaper reports of “poisoning” at the start of the epidemic added fuel to the flames. A front page article in Haaretz on March 28, 1983 even claimed that Israeli military investigators had found traces of nerve gas and quoted "army sources" as saying they suspected Palestinian militants were poisoning their own people in order to blame Israel and provoke an uprising. 

Palestinian leaders followed up with accusations that Israel had poisoned them in an attempt to drive them from the West Bank.

The Monitor reported on the mass hysteria in the West Bank in April of 1983, within weeks of the epidemic. Special correspondent Trudy Rubin explained the political background, the fears, and rumors that made a case of hysteria likely:

A series of events over recent weeks and months have produced a pervasive atmosphere of distrust throughout the West Bank.... West Bankers' fears are fanned by statements like that of Deputy Speaker of the Knesset [parliament] Meir Cohen, a member of Prime Minister Menachem Begin's Herut Party, who said in mid-March that Israel had made a fatal mistake when it did not drive 200,000 to 300,000 Arabs of Judea and Samaria [biblical names for the West Bank] across the river Jordan in the 1967 war... bolstering West Bank suspicions that this is government policy. ...According to Professor Baruch Modan, Director General of the Israeli health ministry there is ''no clinical evidence'' of toxic poisoning in the girls' cases, nor have laboratory or environmental examinations produced any positive result. Dr. Modan quoted at length from reports in the British medical journal and the journal of the American Medical Association to support his argument that similar ''epidemics'' of mass hysteria have been recorded in the US, England, and Kenya.

And while most of the victims are girls in both cases, adults have not been immune. In Afghanistan, a number of teachers have been overcome by the same symptoms. In the West Bank in 1983, a number of female Israeli soldiers sent to villages where reports of "poisoning" had been made also came down with symptoms. Finally, the West Bank epidemic occurred just before exams, which doctors at the time theorized was an additional stress on the girls. The same seems to hold true in Afghanistan, the WHO writes. "These outbreaks tend to follow a seasonal pattern. According to the Afghan authorities, the events start around April/May and close to the examination period." 

Dragging on

But there is one important difference between the cases. The 1983 epidemic in the West Bank ended within weeks, particularly after an April 1 announcement by Israeli health authorities that said no poison was found and mass hysteria was the likely cause. By the end of April, the US Department of Health and Human Services had concurred in a report of its own that dismissed allegations of poison, and claims made by Israeli officials that the girls were either deliberately malingering to avoid exams or part of a Palestinian conspiracy to make Israel look bad. US, Israeli, and Palestinian medical investigators came to the joint conclusion that the outbreak was a legitimate “psychogenic event.”

While propagandists, generally from the Israeli right, continue to insist that the mass hysteria outbreak is evidence of Palestinian perfidy, it's a largely forgotten episode, of interest only to psychologists and other medical researchers today.

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Yet in Afghanistan, this has been going on for years with no such clarity. In mid-April, there was a report that at least 140 schoolgirls and teachers in Takhar Province had been poisoned by "extremists opposed to women's education," according to Afghan officials. News wires and television stations broadcast claims from local Afghan health officials that poison was the only explanation for what had happened. This paper has joined dozens of others in uncritically broadcasting the "Taliban poisons schoolgirls" claim as fact.

Afghanistan today is of course a much more dangerous place than the West Bank was in 1983 (or today). The Taliban are a potent force, and they are resolutely hostile to educating girls and women. Attacks on schools, or on individual schoolgirls are, in fact, occasionally made. The local population is far less educated, and much more isolated from the broader world. It's an atmosphere ripe for terror – real or imagined.

Yet something that took a few weeks to put to bed 30 years ago, has dragged on in Afghanistan for years, a reminder of how hard it is to accurately research and disseminate results. 

Make no mistake: The Taliban hate women. Their abuses are legendary and frequent (a majority of non-Taliban Afghan men of course also have pretty regressive views of women and murdering women for adultery is far from confined to the insurgents).

But this one almost certainly isn't on them.