Betty lay in a hospital bed, legs spread and knees raised. Her contractions had started three hours earlier, and now the labor pains were almost too much to bear. Her friend, Cathy, held her hand encouraged her to push.
If Betty had been in the maternity ward of the hospital, there would be nothing remarkable about this scene. But she was in the psychiatric ward, where both she and Cathy were patients. Her "pregnancy" had begun just six days earlier, with symptoms of morning sickness, and now she was going through a hysterical delivery, assisted by another patient on the ward. After quite an ordeal, Betty asked the night nurse to inform her doctor that she had given birth.
Two days later, Cathy went through a hysterical delivery herself. Like Betty, she believed that she had delivered both a baby and the afterbirth.
Betty and Cathy's delusional pregnancies are part of a 1958 case report in Psychiatric Quarterly titled "Observation of a hysterical epidemic in a hospital ward: Thoughts on the dynamics of mental epidemics." The mental epidemic began when Anne, one of the most popular patients on the ward, described a dream of being pregnant and giving birth. Ten days later, Betty developed symptoms of pregnancy.
After Betty and Cathy experienced their hysterical deliveries, a third woman, Edith, developed symptoms. At first, she suffered from morning sickness. She then began to eat for two and put on considerable weight around her midsection. A month later, Edith proudly presented the baby she believed she had delivered-a doll made out of black cotton stockings. "My child was real to me," Edith told her doctors. "I wanted to feed it. I had it in bed with me and I was afraid to move in case I hurt it."
Five women in all were infected with the delusion -- 20% of the women who lived on the hospital ward. This unusual case study is a classic example of social contagion -- the spread of an idea, emotion, or behavior among members of a social group.
The psychiatrists who reported the case came to believe that social connection and acceptance was at the root of the epidemic. The "infectious agent" was the Anne's dream of giving birth. The idea spread throughout the ward, exploiting an emotional vulnerability and social need among the women who succumbed. In this case, the shared delusion became a bond that strengthened the patients' friendships.
This case came to mind because The New York Times just published a similar report of a hysterical pregnancy, this time in a nursing home. The writer, Dr. Marc E. Agronin, a geriatric psychiatrist and author of the new book "How We Age," describes two cases that coincided in one nursing home -- an 83-year old woman who believed she was pregnant, and a 90-year-old woman who believed she had recently delivered twin boys.
Argronin interpretation of the delusions provides new insight into the 1958 cases. He sees hysterical pregnancies as evidence of the human brain crying out for connection and meaning in the face of a potentially dehumanizing medical setting. He writes,
"But it is too easy to see pathology in what may actually be a protective mechanism in the aging brain. What a psychiatrist might call a symptom held deep meaning for each woman, and prompted them to focus on recovering from severe illness.
In each case, I had to act in the opposite direction of my instinct as a doctor. Medication might have only sedated them and even taken away a protective cocoon. Instead I let time do its work: the delusions faded, and physical and mental recovery took hold."
In the 1958 epidemic, the delusions similarly faded in time, after the newfound clique had established their social bonds. Surely those women were also experiencing the kind of dehumanization that greets those in nursing homes: losing freedoms, independence, and a sense of self separate from that of "patient."
Both cases - while rare - emphasize the importance of providing those in hospitals and long-term care with opportunities to care for and contribute in meaningful ways, and to maintain an indentity that provides a sense of purpose or connection to others.
Like unusual case reports from the medical literature? Check out the woman who lost the ability to feel fear and disgust.
Original case report: (1958). F. Kräupl Taylor and R. C. A. Hunter. Observation of a hysterical epidemic in a hospital ward: Thoughts on the dynamics of mental epidemics. Psychiatric Quarterly, Volume 32, Number 4, 821-839, DOI: 10.1007/BF01563036