It Could Just Be Stress: The Teens of LeRoy and Conversion Disorder

By Nicholas Jackson

More than a dozen girls in this tiny New York town have started displaying Tourette's-like symptoms, but nobody seems to know why.

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In the tiny town of LeRoy, New York (population 7,641), more than a dozen high school-aged girls have been displaying unusual jerks and stutters -- symptoms similar to those of Tourette's Syndrome -- for about three months. More than a dozen is, at the time of this writing, as specific as one can get because the number continues to climb. (A teenage boy and a 36-year-old women have also started displaying these symptoms.) Before the breakout, Le Roy, first settled way back in the 18th century, was best known as the birthplace of Jell-O.

More unsettling than the tics and twitches themselves is the fact that nobody seems to know what is causing them. There are a couple of theories, though, the most prominent of which is that a 41-year-old toxic spill has contaminated the groundwater used by LeRoy Junior-Senior High School (enrollment 460). All of the individuals currently affected aside from the 36-year-old woman, Marge Fitzsimmons, who remembers swimming as child in a quarry near the toxic spill site, attend LeRoy. This possibility has received the most attention because, in January, Erin Brockovich and her longtime associate Bob Bowcock, a water treatment and testing engineer, visited the town to conduct their own environmental tests.

Best known as the woman portrayed by Julia Roberts in the eponymous 2000 movie, Brockovich is the mastermind behind the largest settlement ever paid in a direct-action lawsuit in U.S. history. After years of work as a legal clerk to Edward L. Masry, Brockovich received $333 million for hundreds of clients affected by a harmful chemical compound used to prevent rust in machinery was released into the drinking water of Hinkley, California, by Pacific Gas & Electric.

Criticized as a diagnosis of exclusion, meaning all other possibilities must be exhausted, conversion disorder dates back to Sigmund Freud and was formerly known, more controversially, as hysteria.

Brockovich, who came to LeRoy after receiving an email from a parent of one of the teenagers, believes that this case could be similar to the one that made her famous. She has spent her time in LeRoy around the site of a December 1970 train wreck located about 3 1/2 miles from the school. That month, a train operated by Lehigh Valley Railroad derailed, spilling about 30,000 gallons of trichloroethylene (TCE) and 2,000 pounds of cyanide crystals. Lehigh Valley worked to flush the chemicals -- and accompanying odors -- into trenches by spraying 1,000,000 gallons of water on them over four months, according to a 1999 report from the EPA.

TCE has been linked to cancer, toxicologist Dr. LuAnn White told CNN. But it's not a proven carcinogen. Besides, White said, TCE would be cleared quickly from the body. After a few days, it wouldn't even show up in urine or blood tests -- and any symptoms would disappear. White, the director of the Tulane Center for Applied Environmental Public Health Sciences, said the students would have had to have been exposed to huge amounts of TCE for an extended period of time to show symptoms, and none of them, not even 36-year-old Marge Fitzsimmons, had been born when the TCE left behind by the derailed train cars was as its strongest.

And the Environmental Protection Agency (EPA), the New York departments of environmental conservation and health, and an independent firm hired in December by the high school have already tested the grounds and determined that the spill was cleaned up properly. "All of these agencies and professionals from these agencies have assured us that our school is safe," LeRoy school district superintendent Kim M. Cox wrote in a letter distributed to the community this past week, according to CNN. "There is no evidence of an environmental or infectious cause. Environmental causes would not discriminate (regarding who becomes infected)."

There is at least one other theory, though. On Friday, a pediatric neurologist working out of Buffalo diagnosed three more of the young girls with conversion disorder, bringing the total number to which he has given this diagnosis to eight. "These eight cases all had significant life stressors, a common factor with conversion disorder," he told the Messenger Post. "Tic-like symptoms may be a sign of conversion disorder and conversion disorder is more prevalent in females. Symptoms can be severe." Physicians working out of the DENT Neurological Institute have also diagnosed some of the affected girls with conversion disorder. Among medical professionals -- though, granted, not environmental activists -- there seems to be agreement that conversion disorder is, in fact, the culprit.

And yet many continue to question the diagnosis; they can't seem to take conversion disorder seriously. That could be partly due to conflicting agendas -- Erin Brockovich doesn't lose: If the girls do have conversion disorder -- a kind of neurological condition that has a wide variety of symptoms, including tics, verbal outbursts, and even loss of vision and paralysis -- it would mean that it's due to nothing more than stress. "What happens is there [is] traditionally some kind of stress or multiple stressors that provoke a physical reaction within the body," Dr. Jennifer McVige, a neurologist who has worked with several of the teenagers, told CNN. And it's partly due to the disorder's complicated history.

Criticized because it is a diagnosis of exclusion, meaning that all other possibilities must be exhausted before the diagnosis is made, conversion disorder dates back to Sigmund Freud and was formerly known, more controversially, as hysteria. The term comes from the Greek word for uterus and, of course, was a once-common diagnosis for females said to be suffering from a variety of symptoms, including fluid retention, nervousness, and loss of appetite for sex, before Freud started reclassifying these diagnoses as anxiety neuroses. Female hysteria is no longer recognized, but you'll find conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard text used by all psychiatrists, and it includes manifestations of hysteria (as does schizophrenia, anxiety attacks, and other DSM-classified disorders).

One argument used against conversion disorder as a diagnosis for what's currently going on in tiny LeRoy is that the diagnosis is uncommon and it doesn't make sense to see it in so many teenagers at once. "It's very unusual to have conversion symptoms that are 'contagious,' Dr. Jay Salpekar, director of the Neurobehavioral Program at Children's National Medical Center in Washington, told CNN. But could that simple be because individuals seek individual treatment? Groups are rarely diagnosed together.

But this wouldn't be the first time. Thirty-one chorus members in Lockport, New York, fell ill around the same time in 2004 and then quickly recovered. Fourteen Florida high school students all developed loud breathing problems at the same time in 2007. Thirty years ago, in 1982, about 100 people in Los Angeles all believed they had contracted food poisoning, but they hadn't. Dozens of factory workers at a plant in West Virginia passed out before a conversion diagnosis was made.

And let's not forget the most famous mass hysteria case of them all, a case that the teenagers at LeRoy Junior-Senior High School probably only just recently learned about: The demonically possessed women of Salem, Massachusetts, involved in the infamous Salem witch trials of the 1600s. Like late 17th-century America, many African and Caribbean cultures blame the expression of conversion disorders in groups on witchcraft and other malicious magic. (As recently as 2010, students in Trinidad were thought to be possessed when they started screaming and collapsing in groups.)

But we're not in Salem anymore. Conversion disorder can be treated with anti-anxiety drugs for stress, physical therapy for uncontrollable movements, and counseling to resolve any underlying medical or psychological issues. Interested parties may disagree about what's troubling the girls of LeRoy but almost everybody believes they will each make a full recovery.

Image: Aeriel view of LeRoy Junior-Senior High School.

This article available online at:

http://www.theatlantic.com/health/archive/2012/02/it-could-just-be-stress-the-teens-of-leroy-and-conversion-disorder/252582/