The LeRoy High School Outbreak: “Conversion Disorder” or Environmental Contaminants?

Aerial view of LeRoy Junior/Senior High School

I know everyone has already heard about the outbreak of tics and verbal outbursts (described in the media as “Tourette’s-like symptoms”) in the small town of LeRoy, New York. I thought I’d pull together some information on the case anyway. I have been skeptical about the diagnoses that have been publicized (“conversion disorder” and “mass hysteria”) since I first heard about it.

The media descriptions of conversion disorder haven’t been particularly accurate or helpful, and now that school and county officials are trying to limit investigations into environmental causes for the outbreak, I’m even more suspicious that these symptoms may be caused by exposure to toxins in the environment.

The LeRoy students began having symptoms in September of last year, meaning they have continued for about four months. Here’s a description of the symptoms from CBS News:

Last fall, 12 teenage girls from LeRoy Junior-Senior High School – located in a town about an hour outside of Buffalo, N.Y. – began to show symptoms similar to those of Tourette’s syndrome, including painful shaking and jerking their necks….

The condition was so bad for at least one of the girls that she has yet to return to school. School and state officials investigated the outbreak and school building for several months, and concluded no known environmental substances or infectious agents were found that could have caused the symptoms in the teens.

Dr. Laszlo Mechtler of the Dent Neurologic Institute in Amherst, NY, has seen a number of the girls and has diagnosed them with “conversion disorder,” which is really just more politically correct name for what Sigmund Freud called hysteria. The term is drawn from the Greek word for “uterus,” and of course mostly females receive the diagnosis. Mechler is claiming the symptoms are a result of stress and the students who are affected may have are unconsciously acting out their anxieties through physical symptoms. He’s calling it “mass hysteria,” because a number of girls reported similar symptoms.

Mechtler said today that the media hype is just making the symptoms worse and that students who have kept to themselves have improved while those who went to the media got worse; and now that the national media is focused on the situation, those who had improved are now having increased symptoms. 

So I guess we should all STFU and leave poor little LeRoy alone, then?

Lots more after the jump.

Reportedly, two more girls and one boy from the school have now developed symptoms. Here is a video from a Buffalo, NY TV station that summarizes much of what is currently known about this case.

I don’t know whether this is mass hysteria or something else, but as I said above, I’m skeptical. Conversion disorder is a diagnosis of exclusion, meaning than every other possibility must be exhausted before making the diagnosis, and it’s clear there are still possible causes that haven’t been investigated.

According to the DSM IV-tr, for conversion disorder conversion disorder (PDF) the reported symptoms must be inconsistent with basic anatomy and physiology. The symptoms may look like a particular disorder, but when the suffer is tested, physical responses aren’t consistent with the symptoms. For example, a patient claims to be “blind” but cortical responses are normal. The symptoms tend to reflect the patient’s notions of a particular disorder. It is also important to be sure that the patient isn’t feigning the symptoms. They must be produced unconsciously.

There will probably be changes to this controversial diagnosis in the DSM V.  Frankly, there isn’t much empirical evidence to support it, although it has certainly been observed in practice. Most of us have experienced a headache or stomach ache which we later understood to have resulted from stress. But those kinds of symptoms tend to dissipate pretty quickly.

Other characteristics of conversion disorder are that patients usually only report one symptom at a time and symptoms usually develop after a traumatic event. Once the symptoms appear, the patient should show a reduction in anxiety. Finally, because this is a diagnosis of exclusion and we simply don’t know everything yet, a concrete cause for the symptoms is always a possibility. One possibility that doesn’t seem to have been fully investigated yet is environmental toxins.

The NY Department of Health claims that they have thoroughly investigated all possible environmental causes. School officials say tested for toxins in indoor air and for mold, and they hired a private company to test paints and solvents on the school grounds. Furthermore, parents say they haven’t seen any of the data. From what I’ve read, there has been no testing of the soil on the school grounds or of water. According to the article linked above, the independent company reported that

The study showed if there was high exposure, there could be long-term health effects from these sources that could result in neurological symptoms.

But apparently the school has dismissed those findings. They have also hired a professional spokesman who says:

“We don’t think the sampling methods were inaccurate, or that the sampling results were wrong,” Albert said. “The original sampling was used to identify if there was an obvious indoor or air quality issue.”

No problems were reported in the study, except for a natural gas odor. The results of the study said that problem was easily fixable. Still, a third party will review the findings.

Natural gas odor too? That doesn’t sound like nothing to me. Interestingly, there are five natural gas wells just outside the school athletic field, and last year they were submitted to hydraulic fracturing (AKA fracking) to increase output. Roger Downs of the Sierra Club says:

“We believe that it would be premature to draw any correlation between these tragic and unexplained illnesses and the gas wells on the school’s playing fields…[b]ut we have seen no evidence that these wells were adequately considered by the Department of Health as potential contributing factors to the illnesses in the initial investigation.”

So why hasn’t this been investigated then?

Some frustrated parents contacted environmental activist Erin Brockovich, who agreed to investigate. and she sent some investigators to collect soil and water samples from the school grounds. On Saturday, school officials locked them out of the school buildings, refused to let them take any samples and “escorted them off the school grounds.” From the article:

After researching, Brockovich said she discovered a train derailment in the early 1970′s spilled gallons of toxic chemicals just four miles from the school. According to federal documents, Brockovich said environmental agencies did not investigate the spill for more than 20 years. She said there is also a report that some of the chemicals spread to the school through rainwater runoff.

Brockovich thinks chemicals may already be in the soil of the athletic field. She said parents and students claim that they have seen an orange substance in the air, and on their shoes and sports gear when students play on the field.

“Every year when water rises, the chemicals from the bedrock pulse and come out into the ground water,” Brockovich said.

Brockovich also said that in a nearby creek, chemicals have been dumped there through the years. Students have shared memories of playing in that creek and uncovering barrels of what Brockovich said could be other harmful chemicals.

Here’s more on the chemical spill from USA Today:

The spill was on Dec. 6, 1970, after a train derailment. A report by the U.S. Environmental Protection Agency said 1 ton of cyanide crystals spilled to the ground, along with 35,000 gallons of an industrial solvent called trichloroethene, also known as trichloroethylene, or TCE.

The cyanide crystals were removed and “neutralizers were spread on the ground to counteract the effects of any remaining cyanide,” the EPA report, written in 1999, says.

However the liquid TCE, was absorbed into the ground. Residents later reported smelling the chemical, which has a distinctive sweet odor, in local well water. Testing between 1990 and 1994 found 50 contaminated wells in the area, the EPA says. Residents received filtering systems for their water.

The site was placed on the Superfund National Priorities List in 1999.

Furthermore, according to USA Today,

A report written in 1997 by the New York State Department of Health, together with the Agency for Toxic Substances and Disease Registry (ATSDR) says that early in 1971, people living next to the spill site “complained of solvent-like odors in their drinking water,” which came from wells, the only source of water in the area.

A third possible cause of exposure to toxins recent construction in the area. [UPDATE: the website these quotes came from is advocates for the vaccine theory of autism. I still think the points made here are worth considering, but consider the source.] The school put in new playing fields a year before the symptoms began manifesting. According to Dan Olmsted, editor of a site devoted to studying autism:

in any investigation of a new illness, the question of what’s new in the environment — from medicines a person is taking, to places they have been, to changes in where and how they live — needs to be ruled out first.

Building ballfields within the past two years certainly qualifies as new. That could hypothetically create new risks, either from stirring up toxins such as pesticides on the site, or importing materials such as fill or sod that was previously contaminated. New attention has been given to a railroad derailment several miles away in 1970 that spilled both cyanide and TCE, a highly toxic manufacturing agent. Environmental activist Erin Brockovich has suggested that the school site was contaminated by runoff from that incident, or that dirt from that area was used to construct the school in the early 2000s.

Before the school was built, there were playing fields for students adjacent to the new building. I reported last week that a former student said athletes using those fields in the 1970s succumbed to a mysterious outbreak of sores and rashes. Soil was tested, the cause identified and students successfully treated, She said, though, that she did not know what the results showed.

School officials have refused to speak with me, but the father of one girl attending the school told me today that at a school event Saturday, students were told not to drink water, and to leave the building as soon as the activity was over.

Today the LeRoy superintendent of schools released a statement claiming “the school is safe.”

District leaders say they have been working closely with numerous medical professionals, the New York State Department of Health, the Department of Environmental Conservation and the Environmental Protection Agency. The district also hired an independent environmental expert to review the findings. The statement says no evidence of an environmental cause was found.

Health leaders say they have also ruled out PANDAS, a disorder associated with streptococcal infections, and the Gardasil vaccine, as not all the affected girls received the vaccine.

Nevertheless, another doctor from New Jersey, Rosario Trifiletti, went to LeRoy yesterday to test nine of the students for PANDAS. Results will not be available for a couple of weeks.

In summary, I think more investigation is called for. School officials are clearly in self-protection mode and that to me spells the possibility of cover-up. Now that this case has received so much publicity, I hope that will happen. Parents will probably continue to demand more information and Brockovich probably won’t give up without a fight. Her group did manage to get soil samples from the site of the 1970′s train derailment. Furthermore, the NIH plans to test the students using sophisticated equipment. Apparently, the NIH is doing a study of conversion disorder.

Time will tell, I guess. I’ll certainly be interested to see what happens next.

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29 Comments on “The LeRoy High School Outbreak: “Conversion Disorder” or Environmental Contaminants?”

  1. northwestrain says:

    Reminds me of MDs who can’t figure out what is wrong with a patient and declare the cause to be psychosomatic.

    Sound like a cover-up to me.

    • dakinikat says:

      Law suit avoidance behavior.

      • ralphb says:

        A very well known and well named syndrome. Everybody immediately goes into CYA mode and devil take the truth.

    • foxyladi14 says:

      yepper.

    • Gregory says:

      After reading that I was thinking about how far we’ve come in the medical field since the 1300′s. Mass hysteria? You have got to be joking. Somebody needs to revoke that cracker’s license to practice medicine.

      Just an FYI, I saw a kid at my local Wal-Mart who walked around periodically barking like a dog for about 20 minutes. Could have been tourette’s. Then again, with the strange things these kids are ingesting these days who knows.

  2. Minkoff Minx says:

    Thank you so much for writing this BB!

  3. Fry says:

    Age of Autism is not a “site devoted to studying autism.” It is a site devoted to the proposition that vaccines cause autism, and it is virulently anti-science. I wouldn’t throw your lot in with the quacks and charlatans over there.

    • bostonboomer says:

      Really? I didn’t realize that, thanks and duly noted. I do think the author of the piece I linked made some good points nevertheless. As a psychologist, I think I am capable of opining on the conversion disorder issue though. I’m not “throwing in my lot” with anyone, just gathering ideas.

  4. peggysue22 says:

    This whole thing could turn out to be a nightmare. I read or heard on one of the news outlets that the kids were complaining of ‘stuff’ getting all over there shoes and clothes last year from the ballparks. Then Brockovich had photos of the original reclamation area that looked like a toxic dump in and of itself–rusted out canisters, gunk wide open to the air and water.

    These things always come back to haunt when the original cleanup is done in a half-ass manner. I saw one of the girls who really looked like a Tourette’s patient–the constant tic and shoulder roll.

    I’d be sick if I was a parent up there. Thanks for the update, BB!

    Was there any mention of fracking going on in the area? Nothing like fracturing and upturning a toxic mess that had been buried 40 years ago.

    It never ends!

  5. quixote says:

    What a strange case. If it’s to do with the playing fields, I’d think the students who used them the most would be among the affected. I wonder whether the sick students were on teams that used those fields.

    The other thing is that those are fairly unusual and specific neurological symptoms. If there’s an environmental neurotoxin, or combination of toxins, with that suite of symptoms, it’s maybe been seen elsewhere before? (Search engines’ uselessness for anything but the most scattershot, superficial research is very frustrating!)

    The business of calling the patient crazy, especially when female, is so Victorian. Be nice if there was a class in medical school that taught doctors how to say, “I don’t know.”

    • bostonboomer says:

      It may very well be conversion disorder. Perhaps the NIH researchers will be able to add something. It just seems to me that since the school was built near a toxic spill site and there seem to be issues related to the gas wells and the playing fields, perhaps those need to be eliminated as contributing factors before parents accept a diagnosis of conversion disorder.

      Even if that’s what’s happening, it doesn’t make the patients “crazy” though.

  6. propertius says:

    BB:

    TCE is a known neurotoxin. Exposure to it has been linked to Parkinson-like symptoms.

    See:

    http://www.ncbi.nlm.nih.gov/pubmed/18157908

  7. janicen says:

    Thank you so much for this post, BB. I’ve been wondering what you thought about the conversion disorder diagnosis. I grew up in Western NY in a blue collar neighborhood that is currently undergoing an EPA funded cleanup because of the industrial pollutants that were deposited there. People who grew up in the area are sharing their stories and stories of their family members on a facebook page, and it’s really shocking to read stories about kids finding barrels discarded and pools of sludge in their play areas. It’s also shocking to read their stories about the cancers, particularly thyroid cancer, Hodgkins disease as well as lupus that they and their family members have gotten. The truth is, many parts of that area are severely polluted, so my initial inclination was to doubt the conversion disorder diagnosis.

    • bostonboomer says:

      Wow. Thanks for sharing that, Janicen. That is so sad. I hope the environmental activists keep on this!

  8. CinSC says:

    LeRoy is my husband’s home town. I visit there several times a year. He remembers the train derailment and played baseball all the time on the fields in the area before the new high school was built on it’s current site. There is speculation that contaminated back fill was used during the construction. They aren’t buying the hysteria diagnosis either, thinking that it would show up in other area school districts and kids.

    There’s been a rumor that a few kids north of Albany were passing thru LeRoy over the summer for a baseball tournament or something, and have developed similar symptoms, but I haven’t been able to find any confirmation of that.

    His family feels that the school itself probably doesn’t have a whole lot to do with it, and it’s an overall environmental issue of some sort.

  9. vivian mower says:

    It’s my understanding that a psychiatrist is treating several of the girls for conversion disorder and the girls and their parents report they are much improved. The “mystery” has been solved. Re Erin Brockovich’s claims of an environmental link to this disorder, please keep in mind that the hysteria she created in Hinckley Calif by claiming that the presence of a certain chemical in the town added up to a “cancer cluster” turned out to be false. Epidemiological studies on the citizens there show that they do not have cancer rates higher than normal, and even have lower rates of some types of cancer. Sunny California

  10. Kelly Smith says:

    Fracking on school grounds, what will they think of next? Groton residents, keep an eye on the playground…