havana syndrome

The Big Misunderstanding About Havana Syndrome

High-level diplomats are as prone to sociogenic illness as anyone else.

Photo-Illustration: Konstantin Sergeyev/Intelligencer. Photo: Archive Holdings/Getty Images
Photo-Illustration: Konstantin Sergeyev/Intelligencer. Photo: Archive Holdings/Getty Images

By now you’ve likely heard of Havana syndrome, the frightening illness spreading among diplomats and spies across the globe. First documented in Cuba in 2016, the ailment, which is typically marked by sometimes-incapacitating headaches, dizziness, vertigo, and brain fog, has reportedly afflicted federal employees stationed on four continents, in locales ranging from Austria to Vietnam to a Trader Joe’s in Arlington, Virginia. It has led to probes conducted by both the Trump and Biden administrations, and a steady stream of thorough journalistic investigations. But five years after the first cases, the matter of what, exactly, is causing people to get sick remains unclear. The most popular theory among politicians and intelligence officials: Havana syndrome is the result of “directed energy weapons” developed and deployed by a hostile foreign actor (Russia is the leading candidate) that have somehow evaded all detection by U.S. investigators.

If you think this sounds too far-fetched a plot even for a B-movie thriller, you’ve got a point. Indeed, there has been little solid evidence presented to date that any individual has been attacked, much less by a yet-to-be-invented ray gun. Yet the leading countervailing theory — that Havana syndrome represents a mass sociogenic illness (a phenomenon sometimes previously known as “mass hysteria,” an outdated term with misogynistic undertones) — remains a controversial one. Though the idea has gained increasing traction among mainstream media outlets in recent weeks (after kicking around at the edge of the debate for years), it is still often cast as ridiculous or offensive. In large part, this is due to the occupation of the affected individuals. As one Hill staffer told Puck News reporter Julia Ioffe, “Why would we question the sanity of people who are highly trained to handle some of the government’s most sensitive information and negotiations?”

Yet this type of thinking stigmatizes mental illness while reflecting exactly what the national-security community, and much of the reporting that has parroted its point of view, has gotten wrong about Havana syndrome. Trying to separate suffering of the “mind” and the “body” is a fool’s errand. Every symptom, after all, is “all in our heads.” And this goes for everyone: young or old, more or less educated, high-level diplomat or otherwise.

Sociogenic illnesses among various populations have been a constant for hundreds of years. A 2002 review by sociologist Robert E. Bartholomew and psychiatrist Simon Wessely traced episodes beginning in the 15th century, with outbreaks of bizarre motor behaviors among groups of nuns living under bleak and highly oppressive religious orders. Such epidemics were often attributed to demonic possession. As societal fears shifted, so did the “cause” of the cases. For instance, Bartholomew and Wessely note that the use of chemical gas in World War I led to outbreaks of shortness of breath and dizziness in numerous communities that were initially attributed to nonexistent noxious gases.  Importantly, they conclude that “there is no particular predisposition to mass sociogenic illness.” In other words, it is something that can afflict any of us under the right conditions.

And Havana syndrome fits into the historical pattern. The high-pressure setting in Havana in 2016-17 — with Donald Trump incoming and détente between Cuba and the U.S. on ice — provided ripe conditions for an outbreak. As news of a shadowy threat spread quickly among the tight-knit diplomatic community, and as media coverage depicted a foreign menace (and invisible weapon) behind the attacks, it’s plausible that a sociogenic illness went global. (Bartholomew, along with the neurologist Robert Baloh, have most prominently made this case, in articles and a 2020 book.)

This chain of events may conjure up images of Havana syndrome as a frenzied panic, whereas the reality is no doubt more complex — and quotidian. I cannot determine the cause of symptoms in any one individual. However, it seems likely that a multitude of factors could be at work in producing the manifestations of Havana syndrome (potentially including undiagnosed conditions for some), and that these may vary widely among individuals. It is the spreading conviction of attack by microwave that should be seen as socially contagious, not the underlying illness itself.

After all, as any physician would attest, the symptoms associated with Havana syndrome are debilitating but not uncommon: According to one comprehensive study in New Zealand, 89 percent of the general population suffers from one or more symptoms, and 23 percent from ten or more. This includes many people with the same sorts of constitutional and neurologic problems described by ill spies and diplomats: 35.5 percent with fatigue, 35.4 percent headache, 15.2 percent difficulty concentrating, 12.4 percent numbness or tingling, and 12.1 percent memory problems. Such symptoms are sometimes associated with specific medical diagnoses (say, dementia), but often they are not. They can also be driven or exacerbated by stressors, anxiety, and depression.

Moreover, every one of us is susceptible to “nocebo” effects — uncommon experiences we errantly associate with particular stimuli, but that are real nevertheless. For instance, in the placebo arm of the Pfizer COVID-19 vaccine trial, 47.4 percent suffered fatigue, 41.9 percent headache, and 11.0 percent new or worsening joint pain. Similarly, new research has found that the muscle pains commonly attributed to cholesterol-lowering statin medications are mostly, if not entirely, nocebo effects. Indeed, I suspect that such experiences are simply a part of being alive. Early in the pandemic, I developed a fear of contracting COVID-19 and infecting the patients and staff at the ICU where I work as a physician. With that anxiety emerged physical symptoms I’d vaguely define as sore throat and chest heaviness. After testing negative, I slowly came to realize that these were sensations I had always experienced from time to time, but which had become more intense due to this fear — and the focus it engendered. This kind of brain-body connection might explain Havana syndrome symptoms for some.

For others, Havana syndrome might be better characterized as a variety of a condition called Functional Neurological Disorder, or FND. in which people experience a disordered and enhanced feedback loop between their sensations, perceptions, and suffering. Symptoms can be numerous, severe, chronic, and debilitating, although many improve with physical rehabilitation, muscular retraining, and psychological support.

Are such symptoms “all in our heads?” Of course — just like every symptom.  A severed arm suffers nothing by itself. As human beings, all pain is computed and processed and generated in and by our brains — and this is equally true whether severe fatigue or brain fog stems from, say, a shattering wave of debilitating depression or occult pulmonary tuberculosis.  An understanding of this reality led to the development of the “biopsychosocial model” of medicine in the 1970s — the idea that, fundamentally, a complex interaction of internal and external factors conspire in the production of illness.  This is an idea too often forgotten today.

Indeed, commentators and even researchers have again and again demonstrated a confused and sometimes even offensive misunderstanding of how sickness works, describing Havana syndrome as “real” or “fake,” or of the “mind” or “body.” For instance, in a heavily influential investigation published in the Journal of the American Medical Association, University of Pennsylvania researchers argued against the sociogenic hypothesis on the grounds that patients were “largely determined to continue to work,” as if laziness was the culprit behind FND or nocebo-related suffering. Other commentators have similarly emphasized the occupation or security clearances of the patients, as if spies do not suffer the same spectrum of neuropsychiatric ailments as us mere mortals.

None of this is to argue that the etiology (or underlying cause) of illnesses do not matter: They do, both to direct proper treatment and to ensure that we do not, say, go to war with Russia based on a risible theory. But etiology can be elusive, and very often, a multitude of causes drive our symptoms and suffering. In any event, the proximate reason for someone’s pain should never serve as a reason to deny empathetic and thorough evaluation, treatment, and social support. Havana syndrome may have nothing to do with a sonic death ray, but it is quite real. And for the people experiencing it, that’s all that matters.

The Big Misunderstanding About Havana Syndrome