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COVID-19 and the Political Economy of Mass Hysteria
#1
COVID-19 and the Political Economy of Mass Hysteria


1
Department of Applied Economics I, History and Economic Institutions and Moral Philosophy, Social and Legal Sciences Faculty, Rey Juan Carlos University, 28033 Madrid, Spain
2
Faculty of Social Sciences and Humanities, Universidad Autónoma de Chile, Providencia 7500912, Chile
3
Department of Business Economics (ADO), Applied Economics II, and Fundamentals of Economic Analysis, Social and Legal Sciences Faculty, Rey Juan Carlos University, 28033 Madrid, Spain
*
Authors to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2021, 18(4), 1376; https://doi.org/10.3390/ijerph18041376
Received: 26 December 2020 / Revised: 27 January 2021 / Accepted: 27 January 2021 / Published: 3 February 2021

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Abstract
In this article, we aim to develop a political economy of mass hysteria. Using the background of COVID-19, we study past mass hysteria. Negative information which is spread through mass media repetitively can affect public health negatively in the form of nocebo effects and mass hysteria. We argue that mass and digital media in connection with the state may have had adverse consequences during the COVID-19 crisis. The resulting collective hysteria may have contributed to policy errors by governments not in line with health recommendations. While mass hysteria can occur in societies with a minimal state, we show that there exist certain self-corrective mechanisms and limits to the harm inflicted, such as sacrosanct private property rights. However, mass hysteria can be exacerbated and self-reinforcing when the negative information comes from an authoritative source, when the media are politicized, and social networks make the negative information omnipresent. We conclude that the negative long-term effects of mass hysteria are exacerbated by the size of the state.
Keywords: mass hysteria; nocebo effects; contagion; mass media; social media; public health; law and economics; political economy; groupthink; culture of fear; emotional contagion; anxiety; policy error; COVID-19
1. Introduction
Public healthcare systems form a vital part of the welfare state. Indeed, it is generally taken for granted that one main purpose of the modern welfare state is to improve public health. It is supposed that the state positively contributes to public health. In this article, we question this narrative in relation to the phenomenon of mass hysteria. We analyze how the modern state influences the development and extension of mass hysteria, arguing that the state exacerbates this phenomenon with adverse consequences for public health. By developing a political economy of mass hysteria, we fill an apparent gap in the literature. There have been many illuminating studies on psychological issues related to the phenomena of mass hysteria. As a consequence of the COVID-19 crisis, there have been several studies examining the adverse psychological effects of state-imposed lockdowns [1,2,3,4]. There are also studies that examine the contribution of digital media and the internet to anxiety [5,6], emotional contagion [7,8], anxiety transmissions [9,10], and nocebo effects [11,12]. However, to our knowledge, there has been no study that analyzes how different political institutions and the state affect the development and extension of mass hysteria. The interplay of media, science, politics, and public is a real research gap [13]. Building on the psychology related to the phenomenon of mass hysteria, we develop a political economy of mass hysteria deriving important insights from a public health perspective.
In a multidisciplinary analysis (beyond Law and Economics or Sociological Economics), we show that the size of the state exacerbates the negative consequences of mass hysteria. As a conceptual framework, we use a public choice approach to political institutions and comparative political economy based on economic principals. Developing a political economy of mass hysteria is important because it is important to examine how the political system influences the likelihood and development of mass hysteria. This is because mass hysteria can lead to policy mistakes that have tragic public health consequences. While there are important limits on the potential growth of a mass hysteria in a limited minimal state, the welfare state of the 21st century combined with a sensationalist mass media is likely to increase the havoc created by mass hysteria. In this context, we comment on the illustrative case of the COVID-19 crisis.
In the second section, we present a short history of mass hysteria. In this context, we also review the literature, theoretical and empirical, on mass psychogenic illness. In the following section, we present the importance of nocebo effects, explain how a mass hysteria evolves, and analyze how negative information and anxiety contagion can contribute to mass hysteria in the information age. In the discussion section, we analyze the factors that limit and reduce mass hysteria in a free market setting. Moreover, in the same section, we show that these limiting mechanisms not only are disturbed by state action, but also examine the reasons why the state is likely to foster mass hysteria. We conclude that collective hysteria may have contributed to policy errors during the COVID-19 pandemic that were detrimental to public health. In order to prevent the repetition of such policy errors, one should be aware of the political economy of mass hysteria developed in this article.
2. Literature, History and Methods
In this article, we rely on case studies on mass hysteria, psychological research, and theoretical comparative political economy. Our article focuses on empirical data on mass hysteria and research related to public health and anxiety contagion. We analyze the role of nocebo effects in mass hysteria and research on the negativity bias of the human mind. On this basis, we develop a comparative political economy of mass hysteria. We compare the conditions for a mass hysteria to develop in a modern welfare state with the conditions in a limited, minimal state. Note that these differences between the welfare state and a minimal state apply a fortiori to a comparison between the modern state and a private law society, because in a private law society, the state is non-existent [14,15,16].
In a mass hysteria, people of a group start to believe that they might be exposed to something dangerous, such as a virus or a poison. They believe a threat to be real because someone says so, or because it fits their experience. Due to the threatening delusion, a large group of people gets collectively very upset. In other words, a threat, whether real or imaginary [17], causes collective anxiety [18]. The group members may even start to feel sick. Group members might also get symptoms of sickness including weakness, headaches, or a choking feeling, which are propagated to other persons. When a mass hysteria causes physical symptoms, it is called mass psychogenic illness or epidemic hysteria. The symptoms are caused by the stress and anxiety people experience due to the perceived threat [19]. Mass hysteria is infectious [20] and may be a contributing and amplifying factor in real epidemics.
While there is—to our knowledge—no literature on the political economy of mass hysteria, the literature on mass psychogenic illness is rich and focuses on empirical analyses of specific cases. Kerckhoff [21] analyzed the case of sickness that spread among workers of a plant due to the belief in a poisonous insect. McGrath [22], reviewing cases of mass hysteria, found that persons of low status in high stress situations after a triggering dramatic event are most responsive to mass psychogenic illness. Schmitt and Fitzgerald [23] analyzed eight cases of mass psychogenic illness among workers. They found that low income, dissatisfaction with superiors, lack of support, and unclear work assignments led to a higher average number of reported symptoms. Singer [24] points out that victims of mass psychogenic illness are really sick even though there is no toxin. Singer believes that mass psychogenic illness occurs more often than we recognize as it may appear simultaneously with physical progenitors of illness and we only count “pure” cases of mass psychogenic illness.
There also exists more theoretical orientated literature related to mass psychogenic illness. Pennebaker [25] argued that in order to reduce the possibility of mass psychogenic illness, the true causes of anxiety must be diminished. Singer et al. [26] discussed the role of social comparison as a cause of mass psychogenic illness emphasizing the role of stress. Freedman [27] discussed theories of contagion in reference to mass psychogenic illness claiming that contagion, conformity, and emergent norms may play a role in spreading the hysteria. Stahl [28] used labeling theory, emergent norms, and coping theories to explain and understand mass psychogenic illness. Kerckhoff [29] emphasized the importance of collective tension in the origination of mass psychogenic illness.
As can be seen in the literature review, the literature reviewed deals with outbreaks of mass psychogenic illness mostly in localized settings of schools or companies. Unfortunately, there are no studies on the possibility of more widespread or even global cases of mass hysteria. However, the digital age of a global mass and social media raises the possibility of such a phenomenon. Our study of the political economy of mass hysteria draws on the well-established psychological phenomenon of mass hysteria but applies it to a new and innovative context for which no literature yet exists. More specifically, it analyzes how the political system can influence the likelihood and spread of mass hysteria in a digitized and globalized world.
The empirical evidence of mass hysteria, i.e., collective anxiety due to a perceived threat, dates back at least to the Middle Ages [30,31] and continues to numerous cases in modern times [32,33,34,35]. One of the most famous cases is a hysteria that developed after a radio play written by Orson Welles, War of the Worlds, was broadcasted in 1938. In the radio play, an attack from Martians on the Earth occurs. Some of the listeners, possibly still under the suspense of the recent Munich agreement the same year, allegedly fell to panic, thinking they were really under attack by Martians [36].
Another interesting, more recent case are the effects of an episode of the Portuguese TV show Strawberries with Sugar [37]. In the show, the characters got infected with a life-threatening virus. After the episode had been broadcasted, more than three hundred Portuguese students fell ill. They reported symptoms similar to the ones that the TV show characters had experienced. Among these symptoms were rashes and difficulties to breathe. As a result of these symptoms, several schools in Portugal actually closed. However, an investigation of the Portuguese National Institute for Medical Emergency concluded that the virus did not exist in reality and that the symptoms were caused by the anxiety watching the show, i.e., the symptoms were caused by mass hysteria.
There is another recent case of mass hysteria connected to a virus. On the Emirates flight 203 in September 2018, some passengers were showing flu-like symptoms [38]. When other passengers observed these symptoms, they started to feel sick as well, and a panic broke out. The panic reached such an extent that the whole flight was quarantined once it had reached New York. The investigation after the incident showed that only a few passengers actually had seasonal flu or a common cold. Indeed, diseases are an ideal ground for mass hysteria to develop.
3. Nocebo Effects and the Evolution of Mass Hysteria

3.1. Nocebo Effects

It is well known that in addition to placebo effects, so-called “nocebo” effects also exist [39]. Due to the placebo effect, a person recovers from an illness because they expect to recover. When a person suffers from a nocebo effect, on the contrary, they get ill just because they expect to become ill. An intriguing and famous case of a nocebo effect is the case of a man who tried to commit suicide [40]. The man was involved in a clinical study taking an experimental drug. In order to kill himself, he swallowed twenty-nine capsules of the drug, believing he would not survive. However, the capsules that he was taking were placebos, as he was a member of the control group in the clinical study. Believing that he was going to die, he developed serious symptoms and arrived at the hospital with extremely low blood pressure. When, finally, the doctor directing the medical trial arrived, the doctor told the patient that he had swallowed placebos. As a consequence, the man recovered within fifteen minutes.

Due to the nocebo effect, the expectation to become ill can cause real symptoms in a self-fulfilling prophecy. In this way, a mass hysteria may develop when people believe they will become ill. Anxiety and fear contribute to this process [41]. Indeed, during the Spanish flu in the wake of World War I, panic contributed to a mass hysteria and deaths that otherwise would not have occurred, because panic can have adverse health effects on ill persons [42]. Once some people develop a hysteria, it can easily spread to other people because fear and anxiety are contagious [43].

In principle, pseudo-infectious people could be “cured” by mere information. In this way, a mass hysteria could be prevented from becoming a burden on the health system. As discussed below in detail, the problem in a mass hysteria is that there are reasons both media and the state may actively contribute to the contagion of fear and spread biased information. In other words, the doctor telling the patient that they had swallowed placebos never arrives.

3.2. Mass Hysteria, Irrationality, Biases, and COVID-19

Hysteria can not only cause people to suffer symptoms [44]. Hysteria, be it collective or not, can make people behave in ways that other persons unaffected by the hysteria would likely consider to be irrational. Under the illusion of a non-existing or highly exaggerated threat, people act in ways that in the absence of the illusion would seem absurd. Alternatively, behavior in mass hysteria can be considered biased. Psychological research on risk perception has found that some mental rules that people apply in an uncertain world create persistent and important biases. Biased media coverage, incomplete and asymmetric information, personal experiences, fears, inability to understand and interpret statistics, and other cognitive biases lead to distorted risk judgments. Risk perceptions may be particularly biased when risks are viewed as unfair, uncontrollable, unknown, frightening, potentially catastrophic, and impacting future generations [45,46]. Whether we call people’s behavior in a mass hysteria “irrational” or “biased” is not essential to the purpose of this article, as we purport to develop a political economy of mass hysteria. We examine the extent to which the state influences the development of mass hysteria and the “irrational” or “biased” behavior typical of it.

If, and to what extent, the world has been suffering from mass hysteria or mass psychogenic illness during the COVID-19 crisis is open to future research, even though some observers have made that claim [47]. It is clear, in any case, that the population has been under tremendous psychological strain during the COVID-19 crisis. Especially lockdowns have contributed to a surge in anxiety and stress, which are important ingredients for the development of mass hysteria [48]. In a survey conducted in the US from 24 to 30 June, 40.9% of participants reported at least one adverse mental health condition, and 10.7% reported to have considered suicide seriously in the last 30 days [49]. Additionally, the frequency of alcohol consumption during lockdowns increased 14% in the US [50]. At least some anecdotical evidence points to the possibility of mass hysteria as manifested by the hoarding of toilet paper and other essentials, the masked driving of single persons in their cars, and people virtually not leaving their houses, not even for a walk, even though the risk of being infected outdoors with physical distancing is minuscule. Similarly, some people have been scared by SARS-CoV-2 to an extent not easily explainable by their own miniscule risk of death from it [51]. It seems that many people believed in the existence of a killer virus far more mortal than SARS-CoV-2 actually is, as can be seen in Table 1.

Another indicator of overestimation of the threat is the number of deaths. As of 22 January 2021, 2.1 million deaths have been classified as COVID-19-related [53]. However, other diseases are equally or even far more deadly and do not trigger panic or unprecedented government intervention. In other words, the probability to die from COVID-19 is not only very low in absolute terms, but it is also lower than the probability to die from other diseases. It is true that the majority of these other diseases are not as infectious as SARS-CoV-2. This fact has contributed to the panic and led to government interventions that do not occur with other diseases that are even more deadly than COVID-19. The ten leading causes of death worldwide can be seen in Table 2.

Investigating the possibility and extension of a mass hysteria related to COVID-19 is beyond the scope of this article. In this article, we analyze a more fundamental question, namely, the role of the modern welfare state in mass hysteria. There can certainly be mass hysteria without the state in a private law society or within the context of a minimal state. This possibility exists due to the negativity bias of the human brain [55], which makes people vulnerable to delusions. Due to biological evolution, we focus on bad news as it may represent a possible threat [56]. Focusing on negative news and feeling a loss of control [57] may cause psychological stress that can develop into a hysteria and propagate to a larger group.

In a society with a minimal state, negative news may start such hysteria. Due to the negative news, some people start to believe in a threat. This threat evokes fear and begins to spread in society. Symptoms can also spread. Le Bon [58] called the spread of emotions through groups “contagion”. Once anxiety has spread and the majority of a group behaves in a certain way, there is the phenomenon of conformity, i.e., social pressure makes individuals behave in the same way as other members of the group. In the end, there may be a phenomenon that has been called emergent norms [59]: when a group establishes a norm, everyone ends up following that norm. For example, if a group decides to wear masks, everyone agrees to that norm. Emergent norms may explain the later stages of contagion. Contagion by fear can lead people to overreact strongly in a situation, even in a minimal state. Nonetheless, in a minimal state, there exist certain self-corrective mechanisms and limits that make it less likely for a mass hysteria to run out of control.....

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