In January 2012, they were everywhere. The morning shows, CNN, Fox News. A group of teenage girls from the small town of Le Roy, New York, all exhibiting startling tics, their necks twisting, jaws thrusting, strange barks emanating from their mouths. And the "mystery illness" was spreading -- 10, 12, eventually 18 stricken girls. For several weeks, I found myself following the case compulsively. It wasn't just the disturbing tics that mesmerized me. It was the look of panic in the girls's eyes, and the eyes of their parents. Watching them on my laptop, I felt my own neck start aching, my jaw throbbed. I remember chiding myself: You can't catch it through a computer screen.
Within days, I began writing my novel The Fever, which imagines a similar, fictionalized outbreak in a small town. My version unfolds over less than a week, but for the young women in Le Roy and their families, the crisis continued for a year or more -- compounded, many argue, by the exhaustive news coverage. By the very footage that riveted me: those clips of the girls that spread through social media like a super-virus.
The official diagnosis, accepted by most after a fraught period of speculation and finger-pointing, was that the Le Roy girls were suffering from conversion disorder -- a condition in which we "convert" stress or emotional trauma into physical symptoms. And, despite charges that the girls were "faking it," their symptoms were real and involuntary. While conversion disorder is relatively common, what happened next was not. When conversion disorder affects a group of people, as it did in Le Roy, it is called mass psychogenic illness (MPI), or "mass hysteria."
Traditionally, MPI is spread through sight and sound and depends on proximity, which is why so many previous cases were contained to schools, factories, rural areas. But Le Roy was the first case to unfurl, on a large-scale, in the age of social media. Dr. Laszlo Mechtler, medical director at New York State's Dent Neurological Institute where several of the girls were treated, told the local newspaper that social networking among them was "far more intensive and far more complex than the media [was] aware of." Dr. Jennifer McVige, the neurologist who treated ten of the girls, says that restricting access to each other, including through social media, was critical to their treatment. "A lot of them got off Facebook," she says. "Parents shut it down." But it was an ongoing challenge to prevent the girls from communicating with one another other through digital means. "The texting was forever a problem," she says. "Spreading all this negativism. One of them would say if you don't get this antibiotic, you're going to stay sick forever. It actually hindered our treatment. The texting was brutal."
We all throw around the word "viral" when it comes to social media, but is it possible that some of the Le Roy patients "caught" their illness by watching one another online? And what might that mean for future outbreaks? Might it be true, as Laura Dimon suggested in The Atlantic, that a "major lesson" in Le Roy may have been missed: "the power of social media to spread and exacerbate" an outbreak?
Studying videos of the Le Roy girls for MSNBC, Dr. David Lichter, professor of neurology at the University of Buffalo, observed how one girl would post their unusual movement disorder on Facebook or YouTube, and then the next would post the identical, bizarre movement, noting, "This is the modern way that symptomatology could be spread." Indeed, sociologist Robert Bartholomew, an expert on mass hysteria, suggests we may be entering an era where the primary agent of contagion will be the Internet and social media. Which means MPI may no longer be confined to a school, small town. But could grow as wide as the internet itself.
While more research is needed, Bartholomew says, social media "appears to be a major factor in a recent upsurge in the most serious types of outbreaks involving motor dysfunction" -- as in the Le Roy case. And the risks are greatest for teens -- both because they are the heaviest users of social media and because, historically, MPI is more common among adolescents. It's even more common among female adolescents. "There are some theories about that," says Dr. McVige. "A woman's ability to empathize and the need to fix or the need to care for, or nurture. There's a feeling of sameness, of 'I'm like you.'"
But there are no predictors for MPI. It's a diagnosis made after the fact. So what, if anything, can parents do to "inoculate" their child against such an intangible risk?
As with all social media concerns, foremost is to try to ensure their child's relationship to the online world is thoughtful, monitored and contained, and that communication between parent and child about what they see there is as open as possible.
Easier said than done, perhaps. Parents today face a uniquely challenging generation gap. Whereas they came of age as these new technologies were being introduced, bit by byte, their children have grown up "plugged in." "The use of the new information technology has transformed us into a nation of intimate strangers," Bartholomew says. "Relationships are initiated and carried out online. It's a different world that our children are growing up in."
And while parents are warned regularly of certain online risks -- sexual predators, extreme harassment and bullying. But it may be much harder to see the more common, less conspicuous dangers. Delinah Hurwitz, a California State University at Northridge professor of psychology who has researched the impact of social media, notes the vulnerable space teens are in when they are online: "Social media will pull all on our weaknesses. The need for attention, for reassurance. As adolescents, we're already addicted to feedback and social media facilitates it. Every time we tweet, post a picture, we're waiting for people to like it, to comment on it. But it's an empty feeling. It doesn't last. Then we need more."
In her own household, Hurwitz insists on "detox" periods for her teen daughter, which means time, after school, with no social media at all. "No laptop or no TV in her room," she says. "She can't go to bed with her phone. And we have whole-family disconnects at least one day a week."
But it's not just about what's "out there" -- at the potential triggers crackling in the ether -- but inward. "Adolescence is about secrecy," says Hurwitz. "Parents are far more separated from their kids than they know. They think, my daughter's on a sports team, her grades are good, she's a cheerleader. What they don't know is they have this other secret world and without fully developed faculties to deal with being in there alone."
Indeed, unexpressed and untreated stress is one common thread among the major of cases of MPI and is at the root of conversion disorder. A recent American Psychological Association survey found stress levels among teens exceeding those of adults, though teens were more hesitant to believe it had any impact on their physical or mental health. Which can make it doubly hard for parents to determine something is wrong.
"If you see your child hiding things, and your child is distressed, that's a red flag," Dr. McVige says. "With the girls I treated, the pervasive thing was a level of anxiety. Although they would say everything was fine at school, you really felt like something was wrong." It turned out, all the girls in LeRoy had experienced recent stress -- a sick parent, abuse, emotional turmoil. Yet Dr. McVige would see those same girls on national television, seated next time to their prompting parents, insisting they were fine. "And that's not what was happening," she says. "Because I knew what was going on with them at home. They needed help."
One of the greatest challenges is helping your teens gain, and maintain, perspective. We all remember the intensity of feeling as a teen, and social media means it doesn't go away with the school day ends. It's constant. It can feel like a constant assault to the senses, to feeling. I think back to myself when I first watched those videos of the Le Roy girls. "I was always so active and everybody was always happy to be around me," one of them told the Today Show, stuttering and shaking. "I don't feel like myself anymore." The panic, so real and vivid on her face, I could see how hard it was for her, for all of them. Hard being sick, being a mystery to everyone, most of all to herself. And also, maybe most of all, how hard it now is, harder than ever before, to be a teenager.
Megan Abbott is the author of seven novels, including Dare Me and her latest, The Fever (Little, Brown, June 2014).