Pokemon Contagion: Photosensitive Epilepsy or Mass Psychogenic Illness?

South Med J. 2001;94(2) 

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Massey et al[40] studied "the jerks," a hysterical epidemic in which many attendants of emotionally charged nocturnal religious revival meetings during the 17th and 18th centuries in parts of the southern United States had psychomotor agitation of the arms or limbs and often collapsed afterward. After examining firsthand accounts, they suggested that the jerks may have been triggered by epilepsy, which was then imitated by hypersuggestible group members. They stated that among the throngs of participants "there were perhaps some who had epilepsy. Some meetings were held during the evening with only light from torches flickering in the night. Did this trigger any seizures? Did those few with epilepsy set the stage by example to trigger mass hysterical response from others?"[40]

The outbreak of illness symptoms coinciding with the broadcast of the Pokémon television program fit the profile of mass anxiety hysteria triggered from either observing someone having a genuine seizure or learning of the illness from mass media reports or word of mouth. While epidemics of mass anxiety hysteria are often triggered by the sudden stress and uncertainty surrounding a single index case of real illness, a few mass anxiety hysterias have a viral, bacterial, or toxicologic component that triggers or contributes to the psychogenic illness outbreak. One example is an epidemic collapse in three British secondary schools, which coincided with a viral infection.[41] Radovanovic[42] reports that an influx in respiratory infections accompanied an epidemic hysteria episode in the former Yugoslavia during 1990. Another case involved three fourth-graders at a California school who on September 23, 1998, inadvertently ingested lysergic acid diethylamide (LSD) and were hospitalized. Eleven other students who had sampled a white powder from a vial believed that they too had ingested LSD and were hospitalized. Despite symptoms ranging from violence to hallucinations, test results were negative, and the students were released within a few hours.[43]* In other instances, actual events such as a chemical leak have served as a trigger.[44]

The Pokémon episode meets many of the criteria for epidemic hysteria: many of the children's symptoms had no identifiable organic basis; other than the verified cases of seizures, the symptoms reported were minor and short-lived; the victims were nearly exclusively school children in early adolescence; and anxiety from dramatic media reports of the first wave of illness reports was evident. Most of the Pokémon-induced symptoms, such as headaches, dizziness, and vomiting, are less typical of seizures than of mass hysteria. Conversely, symptoms that are typically associated with seizures (eg, stiffness, tongue biting) were not found in the children. Three symptoms (convulsions, fainting, and nausea) that were found in the Pokémon victims are associated with both seizures and mass hysteria (Table 1).

While the mass media are rarely implicated in triggering epidemic hysteria outbreaks, their reporting of these typically exacerbates the situation. Media reports and publicity fuel the hysteria as news of the affliction spreads, planting the idea or concern in the community while reinforcing and validating the veracity of the illness for the initial victims.[45,46,47] This may result in emotionally charged public meetings and reporting of misinformation[48] or social protest movements that thrive on mass media publicity surrounding a hysteria outbreak.[49] In the Pokémon episode, the jump in the number of reported cases is strong evidence for the role the mass media played (Table 2). According to news accounts of the time, the number of children said to be affected remained around 700 the evening of the Pokémon episode (Tuesday night) and the next day. The next morning, the episode dominated the Japanese news. Japanese children who had not heard about their peers from the news or from their parents learned of it that morning, when the seizures "were the talk of the schoolyards."[8] Once the children had a chance to hear panicky accounts of what had happened through the mass media, their friends, and their schools, the number of children reported the next day to have been initially affected -- 2 days earlier -- increased by 12,000.

One common component of mass hysteria is an exaggerated overestimation of risk to a perceived threat. For a hysteria to spread, those affected must not only perceive the risk as real and present, but also believe they are vulnerable to it. Researchers surveying epileptic patients have found that "more than a quarter of those surveyed indicated that they thought that a substantially greater proportion of people with epilepsy were at risk from [video games] than the estimated real risk suggests. One in 13 perceived that every individual with epilepsy is at risk of a seizure as a result from playing video games. . . . [T]he proportion of individuals with epilepsy surveyed who saw themselves to be at risk from video games is two to three times the estimated real risk."[50] This risk overestimation may have been associated with the cartoon version of Pokémon.

* Oral communication, Solomon Moore, Los Angeles Times, Los Angeles, Calif, March 14, 2000.


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