Tuesday, May 14, 2013

Dancing with the Devil

Hysteria usually calls to mind thoughts of the Salem Witch Trials and delirious frenzies from history. However, mass hysteria, or mass psychogenic illness, is not simply an improbable, incomprehensible madness of the past. It has occurred throughout history and into our current generation, taking form as dancing plagues, dissociative possession of nuns, and involuntary twitches of high school girls in New York. Is it something they all ate? Or maybe there is something in the water… How is it that anxiety manifests itself into a dance that spreads among populations?

Fear and distress terrorized populations in Medieval
Europe and made them more prone to psychogenic illness. Certainly it seems there must be more to the story than merely these common denominators, for fear, anguish, stress, and trauma are commonly faced and dealt with sans mass hysteria. But the other factors needed for the exact formula of mass hysteria are difficult to pinpoint. 

Is it the perfect combination of despair, devastation, and distress that manifests itself into a psychosomatic reaction? Does it require a specific threshold of suggestion and susceptibility in our belief and cultural context? The panic and frenzy that overtook groups throughout history is a fascinating and frightening occurrence. Epidemics surged along the Rhine River, taking hundreds as victims to the dancing plague [8].  This affliction of compulsive dancing ran rampant in regions where the population believed dancing to be some sort of sickness or a curse that could be cast upon them. Once they formed the belief that they had caught the dancing disease, or they had been cursed to dance, dance, dance, there was no stopping them. People would dance until muscles were strained; they would even dance to their deaths. In 1374 a plague swept through Germany and France that drove thousands to dance in “agony for days or weeks, screaming of terrible visions and imploring priests and monks to save their souls.” Also, in years to come, people danced for as long as six months, some even dying after breaking “ribs or loins” [7].
In our scientifically-informed hindsight, the mass anxiety and physical hysteria that plagued hundreds in medieval Europe may seem improbable and unbelievable. It is difficult to understand by what means anxiety translates to such mysterious physical manifestations, especially in the form of a dance. Psychogenic illness continues to plague the modern world today. Usually occurring within tightly knit communities, a fearful belief manifests and spreads from one susceptible victim to another. Teenage girls in New York recently suffered from involuntary body movements [2]. Eleven people follow suit after one teenage girl fainted during Sunday mass at an Australian church [6] and then chemistry students in a lab suffered from nosebleeds and asthma-like symptoms one by one [5].



These physical manifestations create the impression of being contagious. Most of us know what it is to say that someone’s laugh is contagious, or that we suddenly yawn because someone next to us yawns. The imitation of these phenomena as well as other behavior within our society is an interesting aspect of human psychology. Much like a laugh or a yawn, these psychogenic symptoms are of an infectious nature. However, it seems much easier to imagine why laughter spreads rather than a compulsive dancing affliction. We all imitate behavior and mannerisms to a certain extent; this opens channels of interpersonal connection and is illustrated by our mirror system response. Mirror neurons are thought to play a role in action performance. In a study investigating the dissociation between object directed and non-object directed actions, Agnew, Wise, and Leech discuss the importance of mirror neurons in theories of motor simulation, “which proposes that observed actions are mapped onto existing motor schema, supporting both imitation and understanding” [1].

These means of imitation support give rise to a possible causal explanation of mass psychogenic illness. Our mirror response system observes and executes actions – lending to problematic consequences if left unchecked by the brain’s executive control. Perhaps mirror neurons were the perpetuators of the dancing plague.

But our brains’ abilities of executive control keep us in check and usually allow us to “opt out” of unwanted behaviors. The prefrontal cortex is the house of executive control in the brain and this self-control is an important social and evolutionary tool. Kühn, Haggard, and Brass investigated self-control in the “veto area” of the brain. “Activation of the dorsal fronto-median cortex (dFMC) was associated with vetoing the neural processes translating intentions into actions” [5]. Studies “suggest that dFMC provides an intentional mechanism for stopping an ongoing action in a top-down fashion. Inputs from dFMC to pre-SMA therefore potentially control whether actions occur or not” [5].

Executive control’s ability to interrupt lower levels of processes (veto power) seems to be missing in the instances of psychogenic illness. If that initial “opt out” checkpoint is bypassed, then the other checkpoints are easily bypassed as well, and we get lost in the hysteria. This raises the question if the individuals who endure psychogenic illness have free will. Don’t the involuntary dance movements impede upon the plagued dancers’ agency? A study of the neurology of volition looked at several types of movement disorders in relation to free will. Kranick and Hallett categorize psychogenic movement disorders (PMDs) from other tic disorders by way of saying that the movements often share features of volitional or intentional movement, but are experienced as involuntary: “what sets [patients with PMD] clinically apart from most patients with tics, however, is the denial of any sense of volition for the movements; they are not performed on a compulsory basis, but rather the patient states that the movements ‘just happen’ without any warning or opportunity for suppression. The patient with PMD often has a strong sense that their disorder is an organic disease, such as a brain tumor, and not psychological” [3]. 

Utilizing a model that illustrates the influence of top-down processing and belief systems on volition, they explain how an action might be generated while the agent denies their volition of the movement. 


Fig. 1 from Kranick and Hallett
Kranick and Hallett argue, “the structural and functional neuroimaging studies suggest a network of abnormal inputs from the limbic areas that may trigger movement (or block it in the case of paralysis), not producing a normal feedforward signal. With the resultant mismatch between the actual movement genesis, feed-forward signal and the prior expectation about how movements should be willed, there would be a loss of the sense of both willing and agency. Hypoactivation of the right temporoparietal junction with psychogenic movements is consistent with this idea” [3].

All possibilities considered (fainting, seizures, involuntary tics), why would the mass anxiety manifest itself as a dance? Of course, all I may offer forward is speculation on this point. As a dancer myself, I find it particularly intriguing that human beings suffered from dancing afflictions. Perhaps the mere force of groups gathering and dancing together has something to do with it. Dancing within a group is a powerful phenomenon, allowing for individuals to basically lose themselves to the group and to the movement. At a certain point, the dance “just happens."

This could easily account for the altered states of consciousness the dancers would have to achieve in order to dance for such extended amounts of time. It also accounts for the loss of volition and being consciously aware of intentions of movement. While dance itself is not some form of hysteria, it is easy to see how hysteria may take form as a dance. Dancing is an explicit from of expressive behavior, exaggerated when aggregated within a group. Easily, the power and feeling of dance could be fearfully misunderstood to be the hand of a malevolent supernatural being. Now, however, we know better than to believe dancing to be a plague from Saint Vitus and we no longer see psychogenic illness taking form as his dance, but in other forms as well. While I cannot address all types of psychogenic illness in one blog post, evaluating the manifestation of anxiety as a dance leads me to conclude that belief context (just as in Kranick’s Figure 1) plays a largely significant role in determining which path to physical manifestation the anxiety will take. Emerging neuroscience data suggests this occurrence is something beyond a simple distress or character flaw. Perhaps the neuroscience can illuminate which demons exactly are at work, exposing something less mysterious than a supernatural possession.

References
1. Agnew, Z.K., Wise, R.J.S., & Leech, R. (2012). Dissociating Object Directed and Non-Object Directed Action in the Human Mirror System; Implications for Theories of Motor Simulation. PloS One, 7 (4). doi: 10.1371/journal.pone.0032517. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323585/

2. Dominus, Susan. (2012). What Happened to the girls in Le Roy. The New York Times. Retrieved from
http://www.nytimes.com/2012/03/11/magazine/teenage-girls-twitching-le-roy.html?pagewanted=all&_r=0

3. Kranick, S. M., & Hallett, M. (2013). Neurology of volition. Retrieved from
http://link.springer.com/article/10.1007/s00221-013-3399-2/fulltext.html

4. Kühn, S., Haggard, P., & Brass, M. (2009). Intentional Inhibition: How the “Veto-Area” Exerts Control. Human Brain Mapping, 30, 2834-2843. Retrieved from http://onlinelibrary.wiley.com/store/10.1002/hbm.20711/asset/20711_ftp.pdf;jsessionid=BFC7F45F52CDF163E90524534D335765.d02t01?v=1&t=hg3v2vyh&s=7de6586dff09a4a3240c872e281fa4ccda19792d

5. Moran, Lee. (2013). Dozens of students hospitalized from ‘adverse reactions’ after chemistry class experiment. New York Daily News. Retrieved from http://www.nydailynews.com/news/national/30-sickened-chem-class-villanova-university-article-1.1262919

6. Morri, Mark. (2013). Mystery mass fainting…at mass. The Daily Telegraph. Retrieved from
http://www.dailytelegraph.com.au/news/mystery-mass-fainting-at-church/story-e6freuy9-1226580274412

7. Waller, John. (2009). A forgotten plague: making sense of dancing mania. The Lancet, Volume 373 (Issue 9664). Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60386-X/fulltext

8. Waller, John. (2009). Looking Back: Dancing plagues and mass hysteria. The Psychologist. Volume 22, Part 7. Retrieved from http://www.thepsychologist.org.uk/archive/archive_home.cfm?volumeID=22&editionID=177&ArticleID=1541

Want to cite this post?
McCoyd, C. (2013). Dancing with the devil. The Neuroethics Blog. Retrieved on
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