In an episode of House, M.D. (“Airborne”) an illness spreads among passengers on a commercial airplane via ostensibly non-biological means, creating a mini-epidemic with purely psychological origins. Could something like this happen in real life? Does the mere conviction that one is becoming physically sick increase one’s chances of contracting genuine symptoms of illness? This article explores this issue and in the process evaluates the realism of the plot from “Airborne.”

House, M.D. (don’t you dare forget the comma) is, at its core, a show about medicine and the logic involved in medically diagnosing patients. Greg House, the show’s central character, is an expert in both respects (in order to be a good diagnostician, he has to be) but, as any frequent viewer will tell you, his genius is in no way restricted by his job description. Owing to House’s seemingly limitless brilliance - his uncanny capacity for meticulous observation and intense analysis, along with his unconventional approach to problem-solving – he also qualifies as an expert on human nature. Again and again, he shows how adept he is at discerning the significant details of people’s behavior, pointing out their true intentions, identifying their irrationalities, and predicting their future actions. He also frequently articulates poignant psychological generalizations, such as, “Everybody lies,” “Humanity is overrated,” and “Overall, drug addicts are idiots,” to list but a few. In short, he is a psychologist of sorts, but technically only an amateur, because he never conducts carefully controlled studies to back up his assertions, the meat of what “real” psychologists do.

That’s where real psychologists and real psychological research come in. These people have the tools to rigorously evaluate many of House’s assumptions about people. Is it true that “people don’t change,” as House claims? How about the idea that “people act in their own self-interests”? Sometimes, when we compare House’s assertions to the findings of psychological research, they fail the test, or appear simplistic, and House is exposed for the amateur that he is. Other times, owing to his instinctive insight, he gets it just right, and we marvel at his brilliance.

To a critical viewer, it can be fun to identify these instances of potential agreement or disagreement between House and scientific findings. One such incident occurred aboard a commercial airplane when Cuddy – House’s boss and future love interest – contracted a set of serious physical symptoms after being exposed to other passengers who were also getting sick. In particular, she was vomiting a lot and her hand was trembling uncontrollably. The interesting thing here was that in the end her symptoms (as well as those of the other passengers) turned out to be wholly psychogenic, or “in the mind.” Apparently, Cuddy and the other passengers had convinced themselves that they were getting sick, and then proceeded to actually exhibit symptoms as a result. Towards the end of the episode, House sensitively addresses Cuddy’s embarrassment over her extreme hypochondriasis:

House: [to Cuddy] “Happens often in high-anxiety situations, especially to women. I know it sounds sexist, but science says you’re weak and soft. What can I do?”

(Airborne Season 3, Episode 18)

In addition to being entertaining, “Airborne” offered a depiction of the interesting and still poorly understood phenomenon House alludes to in the quote above, a factor House implicates in the rapid spread of a strange and brutal ailment throughout the passenger compartment.

Many might wonder: were the major events in this episode - specifically those involving the mass spread of an illness via non-biological means - an accurate depiction of a real phenomenon or did the writers take a few liberties by exaggerating the details for dramatic effect? Could such events ever play out in real life? What about the “sexist” part of House’s remark? Is that accurate?

To answer those questions, we’ll examine a couple of bizarre incidents that have been well-documented and thoroughly analyzed by a whole raft of intelligent people: medical experts, psychologists, sociologists, etc.

The first such incident occurred in Tanzania in 1962, when three female students began laughing uncontrollably for no apparent reason. The laughter persisted, and it quickly spread to other students at the school. Eventually, this “epidemic of laughter” became so widespread that the school was forced to close, sending all the students home. But that only served to transmit the epidemic to the nearby villages where the children were advised to sequester themselves. Paradoxically, this was not the spread of genuine happiness and joy; to the contrary, afflicted individuals reported feeling restless and fearful. This was obviously, albeit paradoxically, no laughing matter.

The incident sparked a large-scale investigation that, just as in “Airborne,” uncovered no biological causes such as environmental contaminants. Nothing seemed out of the ordinary from that standpoint. So, what was the cause? Based on the absence of other obvious causes, Rankin and Philip (1963) concluded that the nature of the problem was psychological rather than biological; specifically, mass hysteria was to blame, a condition that stems from the human propensity to exhibit something called emotional contagion.

This explanation didn’t sit well with everyone, but it was consistent with the scientific study of emotions, which we now know have collective in addition to individual origins (Durkheim, 1912). One insight provided by current research in this area is that people can “catch” emotional states from others, much as they would an illness (e.g., Fowler & Christakis, 2008), a biologically hard-wired human tendency that has served at least one evolutionarily adaptive function: communication. To illustrate, think of facial expressions, a type of emotional gesture that conveys information such as “I’m happy” or “I’m scared.” These emotions have in the past signaled to others when the environment was safe, and when there may have been predators or other hazards worth avoiding (Ekman, 1992). Language is not necessarily better for these purposes, because what emotions lack in specificity, they make up for in speed.

Emotions have the capacity to spread quickly within groups of individuals because of the natural human tendency to mimic the affective reactions of others (Chartrand & Bargh, 1999). Thus, mimicry is one mechanism for emotional contagion. If one person exhibits, say, a fearful expression because of the presence of a nearby predator, the threat will be communicated by others noticing and then reflexively imitated. Through mimicry, the facial cues associated with emotional states transmit important information throughout human groups, as they simultaneously make its members actually feel different than they did before the contagious outbreak.

In turn, the efficacy of mimicry as a mechanism for emotional contagion hinges on the fact that we have difficulties fathoming the true sources of our emotions. Otherwise, how could we truly feel sad, or angry, or whatever, just because the people around us are? The answer lies partly in the very nature of emotions themselves.

Here’s how it works. Any particular emotional experience begins with an initial physiological response to some stimulus in our environment: the pulse quickens, the breath shortens, or something similar occurs. We then have to make sense of that response by applying a label to it. It is only after we have applied this label that we are ready to have an emotional experience. Stanley Schachter and Jerome Singer (1962) called this two-step process – physiological response plus cognitive label - the Dual-Factor Theory of Emotion. According to this theory, it’s not immediately apparent whether those first-date butterflies are due to nerves, or to love at first sight, and amazingly, this sort of ambiguity applies to many instances of experienced emotion. Because the same physiological reaction (e.g., heart palpitations) can serve as the basis for many different potential emotions (e.g., fear, love), these labels can easily become mixed-up and, ultimately, misapplied.

In one classic study (Dutton & Aron, 1974) testing this theory, male participants were asked to cross either a rickety old suspension bridge or a solid, sturdy one. At the end of the bridge, an attractive female experimenter provided these males – at this point either relatively relaxed or experiencing increased arousal, depending on which bridge they had just crossed – her phone number in case they wanted to “talk further.” The results were that the males who had crossed the scary bridge were much more likely to call the woman, presumably because they had misinterpreted their physiological response to the dangerous bridge situation as physical attraction towards the woman. In technical terms, they had misattributed their arousal.

The upshot of all this is that there is a fundamental arbitrariness involved in the construction of emotional experience that makes emotional contagion possible. It turns out that emotions are not quite the intensely personal phenomenon they may seem to be. We can easily be swayed by those around us to interpret our own physical sensations differently than we would in the absence of others and thus to temporarily share their emotional experiences. Partly, this is what makes emotional contagion possible.

Emotional contagion, however, is not exclusively responsible for the events that transpired in “Airborne.” The situation was actually quite a bit worse than that. The passengers became truly ill, with many genuine physical symptoms to show for it. At the end of the episode, we’re led to believe that these ailments had only psychological origins. People became convinced that they were getting sick, which caused them to actually get sick. Mass hysteria had gone beyond the emotional sphere and engendered bona fide physical ailments. Is something like that possible?

Yes, and in fact there’s even a term for it: Mass Psychogenic Illness (MPI), or the outbreak of physical disease with no apparent organic cause.

An article in the New England Journal of Medicine detailed one incidence of MPI that took place at a high school in Tennessee: In November 1998, a teacher noticed a 'gasoline-like' smell in her classroom, and soon thereafter she had a headache, nausea, shortness of breath, and dizziness. The school was evacuated, and 80 students and 19 staff members went to the emergency room at the local hospital; 38 persons were hospitalized overnight. Five days later, after the school had reopened, another 71 persons went to the emergency room. An extensive investigation was performed by several government agencies (Jones et al., 2000).

The most frequent symptoms exhibited by those afflicted were headache, dizziness, nausea, and drowsiness. Importantly, these symptoms all appeared to be real, not invented. As in Tanzania, the investigation found no medical or environmental causes. Rather, the symptoms appeared to be psychogenic; they were positively associated with factors such as female sex and directly observing another afflicted person during the outbreak. That is, those who were female and/or who watched somebody else act sick were more likely to develop symptoms themselves. This is considered a clear case of MPI, one of many similar cases that have been reported in the scientific literature (e.g., Moss & McEvedy, 1966).

Despite the mass of documented cases, MPI remains somewhat of a mystery to experts across a wide variety of disciplines. The etiology is thought to involve some of the psychological factors we discussed earlier: mass hysteria and emotional contagion. But how exactly MPI symptoms bridge the gap between the mental and the physical is still unclear. What is clear is that something like what happened in “Airborne” could indeed occur in real life. So, watch out!

What’s also clear is that, as House correctly asserts, females are indeed more susceptible to MPI effects than males. One might actually assume that there would be many factors that could predispose one to experience such effects (possibly education, or personality), but of those factors that have been studied, only being female (Weir, 2005) and being younger (Jones, 2000) seem to matter very much.

Perhaps to avoid sounding sexist like House, many researchers may be disinclined to contemplate the reasons for this gender disparity. What do you think? Should we consider the conclusion that women are more susceptible to this sort of influence than men subversive and therefore off-limits to discussion? I personally don’t think so. But that’s really neither here nor there. Any way you slice it, “Airborne” scores in the realism department.

Whether that would come as a relief for the writers of House, or something they knew all along, we can’t be sure. One thing we can be sure of is that this single success doesn’t vindicate House (or TV in general) as a reliable medium for factual information. More often than not, rather than conveying accurate knowledge, TV simply magnifies deep-seated sources of bias, such as stereotypes, wishful thinking, and the like. This is where we as viewers have to be careful and do our own independent fact-checking.

Television does, however, have the capacity to raise interesting questions, even if it is not generally in such a good position to definitively answer them. This is where the shows that capture our attention can really show their strength and make a positive impact in our lives. House is particularly good at posing the sorts of intriguing questions that are likely to bolster the intellectual curiosity of its viewers. The next step, seeking scientifically-informed answers to those questions, is up to you…

References

Chartrand, T.L., & Bargh, J.A. (1999). The chameleon effect: The perception-behavior link and social interaction. Journal of Personality and Social Psychology, 76, 893-910.

Durkheim, E. (1912). The Elementary Forms of the Religious Life. London, England: Oxford University Press.

Dutton, D. G. & Aron, A. P. (1974). Some evidence for heightened sexual attraction under conditions of high anxiety. Journal of Personality and Social Psychology, 30, 510–517.

Ekman, P. (1992). An argument for basic emotions. Cognition and Emotion, 6, 169-200.

Fowler, J.H. & Christakis, N.A. (2008). Dynamic spread of happiness in a large social network: Longitudinal analysis over 20 years in the Framingham Heart Study. British Medical Journal, 337, 1-9.

Jones, T.F. (2000). Mass psychogenic illness: Role of the individual physician. American Family Physician, 62, 2649-2653.

Jones, T.F., A.S. Craig, D. Hoy, E.W. Gunter, D.L. Ashley, D.B. Barr, J.W. Brock, & W. Schaffner. (2000). Mass psychogenic illness attributed to toxic exposure at a high school. New England Journal of Medicine, 342, 96-100.

Moss, P.D. & C.P. McEvedy. (1966). An epidemic of over-breathing among schoolgirls. British Medical Journal, 2, 295-300.

Rankin, A.M., & Philip, P.J. (1963). An epidemic of laughing in the Bukoba district of Tanganyika. Central African Journal of Medicine, 9, 167–170.

Schachter, S., & Singer, J. E. (1962). Cognitive, social, and physiological determinants of emotional state. Psychological Review, 69, 379-399.

Weir, E. (2005). Mass sociogenic illness. Canadian Medical Association Journal, 172, 36.