How Harmless Incense Became a Toxic Emergency

Introduction

In 1994, a group of first-year female university students living in a dormitory in the United Arab Emirates suddenly developed breathing difficulties after believing that a nearby fire had released toxic fumes. Twenty-three students were taken to an emergency department with genuine respiratory symptoms and intense anxiety. Medical investigation, however, found that the alarming smell came not from a dangerous chemical but from harmless incense used locally as perfume. The episode has since become one of the best documented cases of mass psychogenic illness in the Gulf and remains an important example of how real physical symptoms can spread through a close-knit community without poisoning or infectious disease.[PubMed]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

Unlike many stories loosely described as “mass hysteria”, this outbreak was investigated by clinicians and later published in a peer-reviewed medical journal. That makes it a valuable case for understanding how perception, stress, group dynamics and credible threats can combine to produce a genuine medical emergency without requiring a toxic exposure.[PubMed]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

What happened in the dormitory?

The incident occurred in a women’s university residence housing first-year students. According to the medical report, panic began when residents believed that smoke from a fire was releasing dangerous fumes into the building. The smell actually came from burning incense, a commonly used local perfume, but at the time students interpreted it as evidence of a hazardous chemical release.[PubMed]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

As anxiety spread, students began experiencing respiratory distress accompanied by strong emotional reactions. In total, twenty-three students attended the emergency department. Their symptoms were treated as genuine medical complaints rather than dismissed as imaginary. Physicians first considered the possibility of an environmental hazard before concluding that no toxic agent was responsible.[PubMed]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

The clinicians’ later report emphasised that the event was rapidly contained once patients were separated from one another and reassurance was provided. They also noted that the absence of widespread media attention prevented additional anxiety from reinforcing the outbreak beyond the immediate group.[PubMed]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

Why the symptoms were real

One of the most persistent misunderstandings about mass psychogenic illness is the belief that people are pretending or exaggerating. Modern medical research rejects that interpretation.

Individuals affected by mass psychogenic illness commonly experience authentic symptoms including:

• Shortness of breath
• Chest tightness
• Dizziness
• Nausea
• Weakness
• Fainting
• Hyperventilation

These symptoms arise through interactions between stress, expectation, heightened attention to bodily sensations and normal physiological responses to fear. They are experienced as real by those affected even though no external poison or infection is present.[nih.gov]pmc.ncbi.nlm.nih.govDecember 1, 2012…Published: December 1, 2012

Fear itself can produce rapid breathing, changes in blood carbon dioxide levels and sensations of breathlessness. Once one person visibly becomes ill, others who believe they face the same danger often begin monitoring their own bodies for similar sensations. Ordinary physical feelings that would otherwise pass unnoticed can suddenly become convincing evidence of illness.[PMC]pmc.ncbi.nlm.nih.govDecember 1, 2012…Published: December 1, 2012

How symptoms spread through the group

The UAE outbreak illustrates several features repeatedly found in school and dormitory outbreaks around the world.

A believable trigger

Mass psychogenic illness almost always begins with something that appears plausible. In this case, an unfamiliar smell combined with the belief that a fire had produced toxic fumes.

Later reviews by psychiatrist and sociologist Robert Bartholomew highlighted this principle: the suspected threat must make sense to those experiencing it. If people find the explanation credible, anxiety can spread rapidly through observation and conversation.[Cambridge University Press & Assessment]cambridge.orgCambridge University Press & AssessmentProtean nature of mass sociogenic illness | The British Journal of Psychiatry | Cambridge Core…

Close social contact

The students lived together, observed one another’s reactions and shared the same environment. Such settings allow fear to spread quickly because people constantly compare their own physical sensations with those of friends and neighbours.

Schools, factories, military barracks and residential institutions appear frequently in medical reviews of mass psychogenic illness for exactly this reason.[PMC]pmc.ncbi.nlm.nih.govDecember 1, 2012…Published: December 1, 2012

Visible emergency responses

Ironically, emergency action can unintentionally reinforce belief that a serious hazard exists.

Ambulances, medical examinations and evacuations are entirely appropriate when a toxic exposure is possible. However, before the true cause becomes clear, these highly visible responses may convince bystanders that the danger has already been confirmed. Similar patterns have been documented in school outbreaks triggered by unusual odours in several countries.[PubMed]pubmed.ncbi.nlm.nih.govA sudden outbreak of illness suggestive of mass hysteria in schoolchildren - PubMed…

Why some students were affected more than others

The original medical paper contains an important nuance that is often overlooked.

Most students recovered once the situation was brought under control, but the researchers observed that those with the most persistent or severe symptoms often had pre-existing physical or psychological difficulties before the incident occurred. They argued that these individual vulnerability factors influenced recovery rather than causing the outbreak itself.[PubMed]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

This distinction matters.

The outbreak was fundamentally a collective event involving social transmission of fear. Individual health differences may have affected how long symptoms lasted, but they do not explain why the episode began or why multiple students became ill within a short period.[PubMed]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

Why doctors rejected a toxic cause

Clinicians did not assume from the outset that the illness was psychological.

A suspected environmental exposure requires careful investigation because overlooking a genuine toxin could have serious consequences. In the UAE incident, medical assessment found no evidence of poisoning, and investigators identified the smell as harmless burning perfume rather than smoke from a dangerous fire.[PubMed]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

Several observations supported the psychogenic explanation:

Rather than indicating deception, these findings pointed towards a self-limiting outbreak driven by perception, stress and social influence.

From “mass hysteria” to “mass psychogenic illness”

The original 1997 paper used the term “mass hysteria”, reflecting the standard psychiatric language of its time. Since then, many researchers have preferred the terms “mass psychogenic illness” or “mass sociogenic illness”.

The change is more than cosmetic.

Historically, “hysteria” accumulated misleading associations with irrationality, especially regarding women. Contemporary terminology shifts attention away from stereotypes and towards the psychological and social mechanisms that generate authentic physical symptoms. Researchers including Robert Bartholomew have also argued that older labels often oversimplified culturally diverse collective responses to perceived threats.[nih.gov]pubmed.ncbi.nlm.nih.govPub Med Ethnocentricity and the social construction of 'mass hysteriaEthnocentricity and the social construction of 'mass hysteria' - PubMed…

Although terminology continues to evolve, there is broad agreement that such outbreaks should be investigated carefully, treated compassionately and distinguished from deliberate fabrication or malingering.[PMC]pmc.ncbi.nlm.nih.govDecember 1, 2012…Published: December 1, 2012

Why this case remains important

The 1994 dormitory outbreak occupies a distinctive place in the history of collective fear in the United Arab Emirates because it is supported by unusually strong evidence.

Many alleged episodes of “mass hysteria” survive only as rumours or retrospective anecdotes. By contrast, this incident was documented by treating clinicians, published in a peer-reviewed journal and later incorporated into broader psychiatric reviews examining mass psychogenic illness across different countries.[PubMed]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

It also demonstrates several enduring lessons:

Within the broader history of contagious fears in the United Arab Emirates, the dormitory incident stands out not because it involved extraordinary supernatural claims or a nationwide panic, but because it shows how ordinary human psychology can transform an ambiguous smell into a convincing emergency—and how careful medical investigation can separate perceived danger from actual toxic risk.[nih.gov]pubmed.ncbi.nlm.nih.govPub Med Mass hysteria in an Arab cultureMass hysteria in an Arab culture - PubMed…

Amazon book picks

Further Reading

Books and field guides related to How Harmless Incense Became a Toxic Emergency. Use these as the next step if you want deeper reading beyond the article.

Book

Extraordinary Popular Delusions and the Madness of Crowds

By Charles Mackay

Rating: 4.0/5 from 5 Google Books ratings

Introduces collective behaviour and social contagion.

See on Amazon

Book

The Inflamed Mind

By Edward Bullmore

First published 2018. Subjects: Depression, mental, Neurosciences, Mind and body, Mental Depression, Etiology.

See on Amazon

Book

The Psychology of Pandemics

By Steven Taylor

First published 2019.

See on Amazon

Book

City of gold

By Jim Krane

First published 2009. Subjects: Capitalism, Economic conditions, History, Dubayy (united arab emirates : emirate), history, United arab e...

See on Amazon

Browse more on Amazon:Extraordinary Popular Delusions and the Madness of CrowdsThe Inflamed MindThe Psychology of Pandemics

As an Amazon Associate I earn from qualifying purchases.

Endnotes

1. Source: cambridge.org
Link:https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/protean-nature-of-mass-sociogenic-illness/2BDC2262E104B8A33F3DD49773DA0D8B

2. Source: pmc.ncbi.nlm.nih.gov
Link:https://pmc.ncbi.nlm.nih.gov/articles/PMC3536509/

Published: December 1, 2012

3. Source: cambridge.org
Link:https://www.cambridge.org/core/journals/modern-intellectual-history/article/abs/sex-sovereignty-and-the-biological-in-the-interwar-arab-east/162E856E81321CB1FD814DD3D1ABFF60

Published: March 30, 2022

4. Source: cambridge.org
Link:https://www.cambridge.org/core/journals/international-journal-of-middle-east-studies/article/abs/new-arab-maids-female-domestic-work-new-arab-women-and-national-memory-in-british-mandate-palestine/7D0F6F18C0A65EA9930B79279E2BE01A

Published: June 29, 2020

5. Source: cambridge.org
Link:https://www.cambridge.org/core/product/7D0F6F18C0A65EA9930B79279E2BE01A

Published: June 29, 2020

6. Source: cambridge.org
Link:https://www.cambridge.org/core/journals/international-journal-of-middle-east-studies/article/new-arab-maids-female-domestic-work-new-arab-women-and-national-memory-in-british-mandate-palestine/7D0F6F18C0A65EA9930B79279E2BE01A

7. Source: cambridge.org
Title: Hysteria, Belief, and Magic | The British Journal of Psychiatry | Cambridge Core
Link:https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/hysteria-belief-and-magic/BE4054C4E0CF05812A9E78291B1C0111

8. Source: cambridge.org
Link:https://www.cambridge.org/core/journals/english-today/article/abs/an-experience-of-teaching-in-the-united-arab-emirates/61C7E60FA42B75748CB0FAA9A0E3A947

9. Source: cambridge.org
Link:https://www.cambridge.org/core/journals/english-today/article/an-experience-of-teaching-in-the-united-arab-emirates/61C7E60FA42B75748CB0FAA9A0E3A947

10. Source: pubmed.ncbi.nlm.nih.gov
Title: Pub Med Mass hysteria in an Arab culture
Link:https://pubmed.ncbi.nlm.nih.gov/9483458/

11. Source: pubmed.ncbi.nlm.nih.gov
Link:https://pubmed.ncbi.nlm.nih.gov/7952258/

12. Source: pubmed.ncbi.nlm.nih.gov
Title: Pub Med Ethnocentricity and the social construction of ‘mass hysteria’
Link:https://pubmed.ncbi.nlm.nih.gov/2276268/

13. Source: pubmed.ncbi.nlm.nih.gov
Link:https://pubmed.ncbi.nlm.nih.gov/8005778/

14. Source: pubmed.ncbi.nlm.nih.gov
Link:https://pubmed.ncbi.nlm.nih.gov/8249649/

15. Source: pubmed.ncbi.nlm.nih.gov
Link:https://pubmed.ncbi.nlm.nih.gov/8201305/

Additional References

16. Source: youtube.com
Title: Stop that! It’s not Tourette’s but a new type of mass sociogenic illness
Link:https://www.youtube.com/watch?v=-nsIZwlHUBM

17. Source: youtube.com
Title: The Razor-Thin Line Between Contagion and Connection | Dan Taberski | TED
Link:https://www.youtube.com/watch?v=u0fFIJapsRY

18. Source: youtube.com
Title: 7 Incredible Mass Hysteria Events | Mental Floss
Link:https://www.youtube.com/watch?v=iSDdntubWls

19. Source: safetylit.org
Link:https://www.safetylit.org/citations/index.php?citationIds%5B%5D=citjournalarticle_254788_38&fuseaction=citations.viewdetails

20. Source: theguardian.com
Link:https://www.theguardian.com/books/2016/jul/14/staircase-girls-catherine-seymour-review

21. Source: research.manchester.ac.uk
Link:https://research.manchester.ac.uk/en/publications/nicely-feminine-yet-learned-student-rooms-at-royal-holloway-and-t

22. Source: knova.um.edu.my
Link:https://knova.um.edu.my/research_publications_pre2000/983/

23. Source: tandfonline.com
Link:https://www.tandfonline.com/doi/abs/10.1080/09612020500440952

24. Source: youtube.com
Title: Going Viral: Is Social Media Making Us Sick?
Link:https://www.youtube.com/watch?v=zlI2FkuJQKY

25. Source: youtube.com
Title: How Mass Hysteria Can Turn a Normal Community Into a Nightmare | Twisted Tales
Link:https://www.youtube.com/watch?v=74QnIJHIyF8