Rootsie

http://www.latimes.com/news/printedition/la-fg-sickness10mar10,1,6583819.story?ctrack=1&cset=true

The official diagnosis for 93 violently ill victims, mostly children, is the stress of chronic fear. Parents and some doctors have doubts.

SHELKOVSKAYA, Russia — It started just after the midafternoon recess. As they lined up to return to class, Zareta Chimiyeva saw a girl in front of her collapse and begin convulsing wildly. Only a few minutes later, Zareta was at her desk when she smelled "a bad smell," and started feeling ill.

She rushed out of the classroom but made it only as far as the stairs. "Darkness surrounded me, and there was darkness in my eyes, and I fell," said the 12-year-old from this small town in eastern Chechnya.
 
When Zareta woke up in a hospital, it took three adults to hold her down. She was thrashing and clutching her throat, unable to get a breath, screaming in terror. She wasn't alone. Thirteen other girls were in nearby hospital rooms, also saying they were unable to breathe, many of them shrieking and crying.

The next day, 23 students and seven teachers in a neighboring village fell ill with similar symptoms. About the same time, four dozen children in two towns a little farther away also began clutching their throats, screaming and convulsing.

They have yet to get better. The outbreak began Dec. 16, and doctors and parents say the children are still suffering fits day and night. The list of victims has grown to 93, including several teachers and janitors, with a small number of cases reported as far away as the Chechen capital, Grozny, and Urus-Martan, 60 miles to the southwest.

With the diagnosis caught up in the suspicion, politics and fear that surround most of what happens in this fractured separatist republic, the answer to what happened to Shelkovskaya's children may never be fully known.

What is clear, officials say, is that a new generation has fallen victim to the unexpected and devastating effects of a war that began before many of them were born.

After exhaustive chemical and radiation tests, authorities with the Moscow-backed government announced that the culprit was not poison, but a form of mass hysteria. The whole episode was triggered, most doctors now believe, by the extreme and chronic levels of stress among children who have experienced a war with Moscow that lasted more than 10 years and its devastating economic aftermath.

Yet with Chechen rebel leaders issuing proclamations that the Russian military has secretly poisoned the schools with nerve gas, and public health officials at a loss to explain why after months of treatment the children are only getting worse, parents — and some local physicians — are not ready to accept the official diagnosis. Very few are willing to send their children back to the schools where they were first afflicted.

"The fact is that the children are getting worse. No treatment helps them," said Khazman Bachayeva, principal at School No. 2 here, where only 30 of 998 students showed up for school recently. "And as of today, nobody has given us a concrete explanation. All they say is, it's psychological stress. Well, the parents don't buy that, and I don't buy it either."

Sultan Alimkhadzhiyev, Chechnya's deputy health minister, said it was difficult to explain to parents that their children had become living specimens of what it means to grow up with the constant threat of violence and chronic joblessness and poverty.

"Our children have seen bombings, artillery attacks, large-caliber bombardment. They saw houses, schools and hospitals burning. They lost parents, brothers, sisters, neighbors," he said. "And they still see tanks and armored vehicles every day in the street.

"In this case, what we have seen are not symptoms of poisoning … but of psychosis. A state of panic. Children are feeling constant fear, a premonition of tragedy."

The ability of the human mind to convert psychological stress into physical symptoms, officially known as "mass sociogenic illness" or "conversion disorder," is well documented but not completely understood. Why, for example, are chiefly girls affected? Only four of the Chechen victims were boys. And why were there families in which one girl was afflicted, but a sister who was in the same room with her showed no symptoms?

Through the centuries, mass hysteria has been a medically accepted but publicly doubted diagnosis. Young nuns at convents in medieval France who began twitching and shouting were thought to be diabolically possessed.

In recent years, scientists have recorded cases in Rhode Island, Washington, California and elsewhere in which people exposed to harmless smells or food were suddenly beset with real but baseless symptoms of poisoning, often brought on by hyperventilation.

The most acute outbreaks involve victims who are already suffering unusual levels of stress and living in "intolerable social settings," Australian and British researchers Robert E. Bartholomew and Simon Wessely concluded in a 2001 study published in the British Journal of Psychiatry. The issue of wartime stress was documented during the 1991 Persian Gulf War, they said, when many Israelis reported symptoms of chemical weapons exposure even though the Scud missiles fired at Tel Aviv contained no chemical warheads.

The two researchers also saw a possible link between the respiratory symptoms reported by rescuers and lower Manhattan residents after the Sept. 11 attacks on the World Trade Center and a form of psychogenic illness.

In Grozny, where Shelkovskaya victims were transferred in December, doctors tried music therapy and set up concerts in the basement of the main children's hospital for as long as seven hours a day for two weeks. The fits improved, but when a television journalist began filming one of the sessions, 12 girls immediately fell into new seizures.

Next, the victims were moved to a clinic in Stavropol, outside Chechnya. Doctors there treated some of the patients with medication they refused to identify that caused some of the girls to gain as much as 19 pounds in three weeks. For many patients, the number of fits was substantially reduced, or even eliminated. But many others returned home in mid-February only to begin having nosebleeds and hallucinations, in addition to their twitching and asthmatic fits.

On Feb. 22, just when parents were beginning to feel confident enough to send their children back to School No. 2, three teachers fell ill with symptoms slightly resembling those of the original victims. The school quickly emptied again, and 11 new people showed up at a hospital with breathing difficulties. Three were admitted.

"If it was merely stress, this case would be the starting point for a massive spread of the illness, creating a chain reaction. But it's not spreading to those outside the schools," said Ruslan Kokanayev, regional head of administration. "I think the government doesn't want to get to the bottom of this, because if they do, they know they will be facing a level of public indignation that they're not prepared to handle."
 
Complicating the psychology diagnosis are blood tests showing the presence in five victims — three in Shelkovskaya, two in a neighboring village — of ethylene glycol, a highly toxic substance used in antifreeze, glass sterilization and a variety of industrial processes.

Doctors can't explain how the children might have been exposed to the chemical, although the general level of environmental pollution in Chechnya is so high that it is perhaps not surprising. Still, health officials believe the traces were so small that they could not have been a factor.

Parents are not convinced.

"It's a clear case of chemical poisoning," said Elim Nogamevzuyev, a resident who showed up for a meeting last week with senior Chechen health officials at School No. 2. "They tested new chemical weapons on our children here."

Principal Bachayeva said she was at a loss to explain why nothing was found when investigators pulled up the floorboards, scanned the basement and tested the air around the school.

"I would agree with the psychological diagnosis. But I have just one question: Why didn't children get sick on that day in the first shift? Why did the children get sick only during the second shift?" she said. "That's why I can't agree with that opinion.

"The children went out into the yard for a break between classes, they were healthy. And when they got back, they started to collapse."

Shelkovskaya has escaped much of the war's violence. But health officials say many of its residents are refugees from war elsewhere. The region is one of the most economically depressed in Chechnya, with large numbers of families living on government stipends and handouts from humanitarian organizations.

Fourteen-year-old Dinara Damayeva was 8 when her family fled Grozny under artillery fire during the separatist republic's second war with Moscow. They took refuge in what appeared to be a safe village, only to come under repeated missile attack, including one strike that killed a boy next door.

Uprooted again, Dinara and her six sisters moved with their parents into a rented house in Shelkovskaya.

Dinara was already having frequent epileptic seizures, said her father, Beslan Damayev, but had never experienced anything as violent as the fits that began when she went to school on the afternoon of Dec. 19.

The girl said she felt a powdery substance in her throat after coming in from recess, and smelled an odor in the hallway that resembled a mixture of gasoline and the chlorine-based fluid that is commonly used for washing floors in Chechnya.

"I couldn't breathe, it was so bad. I didn't have enough air," Dinara said.

Some of the other students reported memory loss and hallucinations, along with panic attacks.

"At one point, she didn't recognize her father when he came into the hospital room," said Zareta's mother, Aiza Askhabova. "She asked me, 'Who are you?' And she came out onto the balcony of the hospital with me and she's looking at the street and she sees a dog, and she says, 'What's this?' This lasted four days.

"She was having a fit almost every hour, up to 25 times a day, from 20 to 25 minutes each, and they tell us it's — here, look at this paper they gave us: 'Conversion reaction of psychogenic genesis.'

"Let me tell you, we don't understand head or tail of this diagnosis."

Authorities in Grozny and Moscow say the Shelkovskaya events highlight years of inattention to the psychological effects of the war.

Even now, Chechnya's only children's psychological rehabilitation center lies in a cramped, donated apartment in Grozny with no room for residential care. Its outpatient clients include children who sit in the corner and do not communicate at all, some who have strong aggressive streaks and some who are convinced that they are responsible for the deaths of their loved ones.

"We have children who witnessed the death of their own parents. There are children who were strongly traumatized by the first war, and then they had to live all over again through the second war, which was even worse," said Milana Dashayeva, a psychologist at the center. "It has been layer upon layer of extreme stress."

Doctors at the government-run Serbsky Forensic Psychiatry Institute in Moscow have organized emergency training programs in Moscow for Chechen psychologists and will begin mental health training for regional doctors in Chechnya next month.

"You see, it would have been much easier to have found some toxicological problems," said Zurab Kikalidze, the Serbsky Institute's deputy director, who traveled to Chechnya to help diagnose the victims in the Shelkovskaya area. "Much more difficult is to rebuild the system of psychological support in Chechnya."