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Traumatic Brain Injury

Major New Study on "Sonic Attack" Is Alarmingly Inaccurate

Report is badly flawed — how can they get it so wrong?

The physicians treating the 21 or 24 patients involved in the so-called ‘sonic attack’ on staff at the U.S. Embassy in Cuba have released their preliminary findings in one of the world’s top medical journals.

The study appears in the Journal of the American Medical Association and was published on February 15, 2018. While the authors claim that all 21 suffered concussion-like symptoms, their study is highly descriptive, remarkably vague, and makes claims that are not supported by the data. To their credit, the JAMA editors published an accompanying editorial by neurologists Dr. Christopher Muth and Steven Lewis, and a separate commentary by medical reporter Rita Rubin. Both are very cautious and highlight serious criticisms of the study’s claims. The study is inconclusive at best; all of the symptoms have plausible alternative explanations.

Please do not write comments telling me I don’t know what I am talking about, because "white matter tract" changes and "concussion-like symptoms" cannot cause "mass hysteria." Read the articles first (they are available online). For instance, claims of "white matter tract" changes and "concussion-like symptoms" are very much open to alternative interpretations. The evidence is far from clear-cut.

There are a host of problems with this study, not the least of which is their dismissal of the possibility of mass psychogenic illness (MPI). This is Psychological Medicine 101, and they got it badly wrong. The authors of the study demonstrate an alarming lack of understanding of this literature. For instance, they eliminate psychogenic illness in part because the patients were keen to return to work, and hence were not malingering. This word comes from the French malinger, and refers to the feigning of illness or injury to avoid work or responsibility. It is not appropriate in this instance. They also eliminated this possibility, because there was no rapid onset and recovery. Some types of mass psychogenic illness begin slowly and persist for months or years. Curiously enough, these tend to be characterized by neurological symptoms that often appear puzzling.

These are glaring oversights, and quite frankly, are hard to believe.

It is being claimed that some patients were unaware of the illness in the others. Study co-author Douglas Smith told Rita Rubin that mass psychogenic illness was unlikely, because not everyone knew everyone else in the cohort, and “There were cases where some individuals had no idea that anyone else was affected.” However, as British psychiatrist Simon Wessely reminded me, MPI can spread without meeting people. The key is whether or not they knew that others were becoming ill and/or knew that there was a suspicion that sonic weapons, etc., were involved.

I find it curious that the social networking aspect of the cohort was left out of their study, as well as who knew what, when. This would have been illuminating, even though there would have been some memory distortion after having been interviewed so long after the onset of symptoms — an average of 203 days. Why not give the percentage of those who knew or did not know each other — or claimed to be unaware? Why say “some”? Was it one or 21? I bet you if it was 21, they would have mentioned it. To me, it’s a red flag, and a microcosm of the entire study, which is overly descriptive and vague.

The article has many flaws. Here is one from the abstract, which states that the purpose of their study was to "describe the neurological manifestations that followed exposure to an unknown energy source associated with auditory and sensory phenomena." How about being more objective and writing about investigating "the possible" or "alleged" exposure to an unknown energy source?

For my money, mass psychogenic illness remains the firm favorite.


Bartholomew, Robert E. (2017). “Politics, Scapegoating and Mass Psychogenic Illness: Claims of an ‘Acoustical Attack’ in Cuba are Unsound.” Journal of the Royal Society of Medicine 110(12): 474-475 (December)

Muth, C. C., Lewis, SL. Editorial. Neurological symptoms among US diplomats in Cuba [published online February 15, 2018]. JAMA. doi:10.1001/jama.2018.1780

Rubin, R. More questions raised by concussion-like symptoms found in US diplomats who served in Havana [published online February 15, 2018]. JAMA. doi:10.1001/jama.2018.1751

Swanson, R. L., Hampton, S., Green-McKenzie, J., Diaz-Arrastia, R., Grady, M. S., Verma, R., Biester, R., Duda, D., Wolf, R. L. & Smith, D. H. Neurological manifestations among US government personnel reporting directional audible and sensory phenomena in Havana, Cuba [published online February 15, 2018]. JAMA. doi:10.1001/jama.2018.1742

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