Epidemic of Hysteria in a School of Rural Eastern Nepal: A Case Report

IntroductionThe headmaster of a school (NRMV) in rural eastern Nepal, pleaded for help from the public health Departmentof Psychiatry, BKIHS, Dharan, Nepal, to prevent closure of his school as guardians of many students refused tosend their children to his school, which was supposedly haunted by evil spirits. The author, along with his staff,from Department of Psychiatry, BKIHS, visited the school and investigated the matter.FindingsThe first case involved a 16 years old girl, daughter of the head master of a school. After hearing the death of a“mad” (psychotic) woman, whom she had met 2 weeks ago, the girl developed a brief spell of disorganisedbehaviour beside the tube well in her school. Soon after, other girls manifested almost similar behaviour inschool at different places. In all 70 girls out 300 were afflicted with problem. Boys were spared. Out of 15 suchincidents investigated, only 3 cases were precipitated by stressful events. Even though they were heterogenousin terms of diagnosis, the victims and carers believed that they were all the same, the effect of the evil spirit ofthe “mad woman”.Education was the main intervention strategy. It focused on the nature of the problem (medical illness) and itsmanagement. This was done by delivering a series of lectures, distributing pamphlets, and appropriate coverageof the events in the local newspaper and radio stations. 6 months later, follow-up was undertaken. There wereonly 4 new incidents. Thus there was a marked reduction in the incidence of new cases by 3.4 / month.Conclusion: Classical mass hysteria still occurs in rural setting of developing countries. Planned psychoeducationis an effective intervention.