Mass illness at a small town high school: McMinnville, Tenn., 1998
The Le Roy illnesses may not have one single cause, according to a Tennessee health official who has seen this kind of thing before.
Dr. Timothy Jones, state epidemiologist for the Tennessee Department of Health, was lead author of a paper for the New England Journal of Medicine examining an outbreak of an illness in 1998 at a high school in McMinnville, Tenn.
It turned out, for at least 90 percent of the cases, there was no environmental cause for the illness, which in this event included rashes, vomiting, nausea and headaches. Some of the people involved just happened to be sick at the time of a rumored gas leak and one girl turned out to be pregnant, causing morning sickness, though she didn't know it at the time.
The diagnosis -- which was hard for the community to accept -- was psychogenic or sociogenic illness.
For most of the sick kids and teachers, the illness was a matter of adopting symptoms from people around them.
Jones hasn't been involved in the Le Roy case and only knows about the situation thorough media reports, but he said there are some similarities to the Le Roy and McMinnville situations.
- Most of the patients are adolescent and disportionately female;
- The groups tend to know each other or be socially related;
- There is a line-of-sight transmission or direct knowledge of a previous patient's symptoms;
- There is no other apparent medical explanation for the illness.
There are also some things, Jones said, that are not entirely classic psychogenic in the Le Roy situation.
Most importantly, in most psychogenic cases, the symptoms are short lived. They usually involve dizziness, fainting, vomiting and rapid heart rate, for example. The symptons usually disappear when patients are separated.
In the McMinnville case, for example, after the initial outbreak, everybody went home for the weekend and were fine until they returned to school on Monday.
Typically, Jones said, these kinds of outbreaks start with one person who has an actual physical problem -- the student becomes woozy or the choir member who faints -- but over the course of the illness spreading, additional cases may be psychogenic or there may be infectious or environmental causes for some patients.
In the Le Roy case, it's possible, if not probable, that the the initial student with a tic sympton -- the trigger case -- has a non-psychogenic disorder.
One of the problems public health officials have in such a situation is explaining who might be ill because of an infectious or environmental condition and who might be showing psychogenic symptoms.
HIPPA prevents officials from discussing a specific patient diagnosis.
While a public state health official might be able to talk about a diagnosis for a group of patients under HIPPA, Jones said, the doctor who has actually treated the patients is prevented by HIPPA from discussing the cases, even as a group, because that could lead to public knowledge of individual diagnosis.
"No matter what, these are incredibilty senstive things to discuss and there are good reasons for that," Jones said. "When you have the word 'psych' attached to any conversation or diagnosis, people think they're being told they're crazy, or they're faking it or they're malingering. It's a hard thing to convince them and other people reading about it that it's real. The symptoms are real."
Jones said actual mass conversion disorder is a very rare thing and he knows of only two such cases in recent history, one in Colombia and one right in Tennessee.
In the Tennessee case, girls at a closed religious community stopped eating and were suffering severe weight loss.
"It certainly can happen, but it's at the severe end of the spectrum for sure."
Public attention doesn't help matters, either, Jones said.
While things like a lot of ambulances and fire trucks showing up at a school can spread an outbreak of psychogenic illness, so can the appearance of the media, and reports in the media reinforce the message of an illness spreading.
Getting people to accept the diagnosis is very difficult, Jones said.
In the McMinnville case, self-proclaimed experts and actual experts from all over the country were popping up with test suggestions and ideas for investigation.
In all, public health officials ended up spending close to $100,000 trying to find an environmental cause for an illness that, in the end, had no environmental cause.
Telling the community at a public meeting that the cause was psychogenic was "one of the most stressful things I've done in my entire career," Jones said.
"It's not because people were being mean," Jones said. "They were well meaning. This is scary. It's scary for the kids. It's terrifying for the parents. Many times people don't want to hear the answer."
Recommended reading: Mass Psychogenic Illness Attributed to Toxic Exposure at a High School.
"While a public state health official might be able to talk about a diagnosis for a group of patients under HIPPA, Jones said, the doctor who has actually treated the patients is prevented by HIPPA from discussing the cases, even as a group, because that could lead to public knowledge of individual diagnosis."
Something that Dr. Wechtler and his associate are unaware of I guess.
I am sure Dr. Wechtler and his associates know the rules governing HIPPA. All they need is a consent form and they can talk about it. Do you know for a fact that they haven't received this or are you just assuming?
Jerry, from the Buffalo News, Jan. 29:
Mechtler and McVige initially were reluctant to state or defend their diagnosis, worried that public attention would exacerbate symptoms. But after the media frenzy began and some families refused to return for treatment, Mechtler changed his mind.
"I have to defend my patients by offering sanity," Mechtler said.
That still doesn't prove that he doesn't have consent or have knowledge of HIPPA. I'm just saying we sit her and complain that we aren't getting all the information that's needed and then we're going to complain when the doctor gives the diagnosis. Which is it do we want to know or don't we. Are we protecting the kids or do we want transparency. Best i can tell we can't have it both ways or is it because we don't agree with the diagnosis that we don't like that they didn't follow HIPPA. I would be she wouldn't have questioned if the Doctor was aware of HIPPA if he came out and said they had some sort of infection.
I expect the government to be transparent. I don't expect a doctor to discuss patient care.
You may not have noticed, throughout this ordeal, I've not once sought out an interview with patient or parent. I've been more interested in government response.
I wouldn't have sought an interview with Mechtler other than the fact the DoH referred me to him for my questions.
I shouldn't have used transparent because that made you assume i was talking about you and i wasn't. In earlier post people were complaining that the school and the doctors were hiding behind HIPPA and then when they come out with a diagnosis and don't like it they say that the doctor doesn't know anything about HIPPA. Besides that i don't know if any HIPPA regulations were actually broken because this is the first time I've heard anyone mention it besides when people were complaining they were hiding behind it and we also don't know if they signed any sort of consent form. It's probably something you could find out rather easily.
I'm not terribly interested in whether Mechtler had patients sign consents. I rather suspect not, based on my following the case; however, my larger concern is how the government has handled this. It's rather to the point that on Jan. 11, the DOH hid behind HIPPA to argue it couldn't disclose much information, and then come Feb. 3, the DOH is releasing a detailed report on the diagnosis of the original 12.
Either DOH was lying on Jan. 11, or it's breaking the law now.
I lean toward the former.
As for what other people said in the past -- I think a lot of people were confused by the differing handling of information as it related to HIPPA, and some readers -- as I recall the comments -- don't fully understand HIPPA (not that I'm an expert, but it's always been my contention that the DOH isn't a non-disclosing party under HIPPA).
I believe, under HIPPA, that a doctor or other provider is unable to talk about specifics or give any identifying information regarding a patient. This doctor is not saying that so and so has this diagnosis, he has said in general terms that the patients he has has seen have this diagnosis. He's not saying which are his patients, but in a small town I think some people can figure it out.
In my experience, I spent three years as a Mental Health Specialist in the Army and in that time we had an officer with conversion disorder, and she was experiencing significant life stressors too....and her symptoms were very obvious too...she was unable to speak English any longer (she could only speak in Spanish). Its hard to comprehend the impact a disorder can have, because its sometimes doesn't seem logical. However, the treating physician is right...the symptoms will correct themselves if given time and the proper mental health treatment. It took some time but the officer was able to return to duty.
Interesting that it's easier to accept an environmental reason (tainted water, etc) rather than someone might have a transient mental health condition. I would rather deal with mental health issues than any environmental, any day.