Literature about the Semai, Zapotec, Nubians, Ifaluk, Paliyans and others describes how folk concepts of illnesses in various ways may help promote the peace and stability of society. The health and wholeness of the individual intertwines with the health, stability, and peacefulness of the community for a number of these societies. Individual illnesses may be the result of unresolved conflicts, and the services of religious healers are frequently needed to restore health for individuals and their communities. Beliefs about illnesses help ensure that people treat each other kindly.

Mental health is also part of this literature, of course, and in some cases, such as the striking works by Catherine Lutz on the Ifaluk, understanding their ethno-psychology is an important key to understanding the peacefulness of the society. For some of the peaceful societies, however, there has not been much literature linking social harmony with individual and social health. A recent medical journal article on an outbreak of conversion disorder among a group of Amish girls is therefore welcome for the additional insights it may provide on the mental health of that society. There is no explicit connection in the article between the illness and Amish peacefulness, but social stresses may have played a role in the disturbance reported.

Beginning in January 2000 some Amish girls in rural Tennessee began to fall ill with a variety of symptoms, many of which were quite similar from patient to patient. By the time of the investigation, late in 2001, five Amish girls ages 9 to 13 had been bedridden for weeks, even months, with their illnesses, which were characterized by extreme physical weakness and an inability to move, especially their lower limbs. Four of them required assistance with eating, moving, dressing, bathing, and using the toilet. Three required feeding tubes.

While all had difficulty moving, some did move while sleeping or when they weren’t conscious of being examined. All had been evaluated in a hospital or an outpatient clinic, and none of the medical personnel who had examined them—physicians, psychiatrists, pediatric neurologists—thought the girls were feigning their illnesses. None believed the problems were substance induced, and no organic etiology was apparent, despite extensive laboratory tests. The illnesses were clearly dangerous, or life-threatening.

The investigators, Cassady et al. (2005), spent months reviewing the medical records, discussing the situation with the medical specialists who had already become involved, and reaching out to the Amish community, where they spent a lot of time building trust. During their repeated visits with the Amish, they met with the local bishops and the parents of the affected girls. They questioned them about family medical histories, the general health of the patients, possible environmental exposures, social issues such as church and school attendance, and major issues in the local Amish community.

The investigators found, perhaps not surprisingly, that all five girls were either related, best friends, or neighbors, and they all lived within a 2.5 mile radius of one another. But the authors found no shared environmental exposure, water supply, chemical exposure, or common medication. Their conclusion was that the girls all suffered from conversion disorder, a potentially very serious illness. Medline Plus defines conversion disorder as “a psychoneurosis in which bodily symptoms (as paralysis of the limbs) appear without physical basis—called also conversion hysteria, conversion reaction.”

The six investigators report that at the time of the outbreak of the illness, that particular Amish community in Tennessee had been under a lot of stress. The members disagreed strongly over church standards and over the rate of compensation that Amish men could charge when they worked for outsiders. These conflicts had resulted, a year earlier, in about 20 percent of the families moving out of state to avoid the tensions of the situation. Another 20 percent of the families that remained were being shunned by the larger community, though none of the families of the five girls were affected by the shunning.

The report does not link, in a cause and effect fashion, the stresses in the community with the illnesses of the five girls. But the authors did meet with the patients’ caregivers and with the church leaders, as they say, “to discuss the social stresses in this community that might have contributed to this outbreak.” They recommended minimizing stress, avoiding any reinforcement of the patients’ “sick role,” and minimizing “unreasonable themes of organic illness.”

Three months later, after they had finished their work, the authors revisited the families. One girl had recovered completely, three had improved, and only one had not shown any improvement. Her family denied the possibility of a psychosocial aspect of her illness, insisting, as they had all along, that the girl’s problems were caused by parasites.

Cassady et al. (2005) indicate that outbreaks of conversion disorders such as this are quite rare, though when they do turn up in the psychiatric literature they occur primarily in rural females from lower economic status groups. The authors speculate that the stresses of early adolescence, when Amish girls cease formal schooling and are expected to increase their homemaking activities, could have put added pressures on these individuals. They also suspect that a contributing factor could be the fact that the Amish girls, “in their strictly regulated milieu,” lack the means for emotional release that are available to other adolescents in America.

Whatever the validity of that suspicion may be, there is little doubt that Amish society can be quite constraining for women and girls. Hostetler (1993) deals briefly with mental illness among the Amish. He describes how some married Amish women, who are not free to express themselves, may have crying spells that their husbands do not understand. Since, in their society, women have to repress their feelings, they often deal with their frustrations by depression, which they may treat by seeking medical help and taking tranquilizers.

Reports of conversion disorders, or mass hysteria, are just as uncommon in the peaceful societies literature as in the literature of psychiatry. One report, Loudon (1966), concerns the Tristan Islanders, a peaceful society that is similar in many ways to the Amish. A highly male-dominated, closed, isolated society, the Tristan Islanders suffered an outbreak of mass hysteria in the late 1930s that affected 21 islanders. Loudon (1966) examined the 19 surviving people, mostly women, over 20 years later, between 1961 and 1963. They still suffered headaches and anxiety—in much higher proportions than the rest of the Islanders. He concluded that the headaches constituted an accepted form of behavior that was especially prevalent among Tristan women who felt stresses “arising from latent conflicts within a most remarkably close-knit homogeneous community.”

There is too little literature to speculate on possible connections between a couple reports of females suffering attacks of mass hysteria and the controlling domination of men in such male-centered, peaceful societies as the Amish and the Tristan Islanders. But articles such as this current report, that provide fascinating clues into the health conditions of the Amish, certainly help enrich our knowledge of their social conditions as well. It is quite possible that mental health and peacefulness are intertwined in all societies, but more research is needed.

Cassady, Joslyn D. et al. 2005. “Case Series: Outbreak of Conversion Disorder among Amish Adolescent Girls.” Journal of the AmericanAcademy of Adolescent Psychiatry 44(3): 291-297.