title: [A manner of voicing, the mass hysteria].
abstract: BACKGROUND
  Mass hysteria is defined as the epidemic occurrence of a succession of physical symptoms without organic disorder or identifiable illness agents. The hysteria epidemic has been described since the Middle Ages, reported in different cultures and religions and affects different populations throughout the world. Few studies on the subject have been under takenin Madagascar. We aim at describing in this study the clinical and therapeutic aspects of a mass hysteria that has occurred in the South of Madagascar.
  
  
  METHODS
  The study is retrospective and prospective at the same time. It concerns the victims of a mass hysteria that had occurred in a village (Ikalahazo) in the South of Madagascar,from the 6th of April 2009 to the 7th of May 2009. Patients exhibiting clinical symptoms ofconversive behavior and having undergone an assessment in hospital surroundings represent the object of this study. During the study period, 27 cases of young women were reported, 22 ofthem were sent to the University Hospital Center of Fianarantsoa (UHCF), a referring center o fthe region, for a thorough clinical examination. Demographic data, the clinical aspects and thecare and treatment provided are the studied parameters.
  
  
  RESULTS
  During a land ownership dissension that drags on endlessly in Ikalahazo village, exclusively 27 young women, between 8 and 21 years old, presented atypical symptoms, strangedisorders. A first case appeared on the 6th of April 2009, that is to say a month before alarge manifestation of the crisis. A similar case was observed two years ago, but it was an isolated case. The symptoms, primarily with motive manifestation, extended rapidly but remainedhowever limited, susceptible to the "Mpiandry" (literally "shepherds") advice. As the villagers believed that spiteful spirits were at the origin of the deeds, they appealed to the latter. Facing the symptoms persistence, the Neuropsychiatry Unit employees of the CHUF were sent to the village on the 6th of May 2009. The intense adhesion of villagers to a belief in satanic misdeedscomplicated their somatic assessment, the results of which showed no distinctive features. At the end of the land dissension proceedings that was resolved in favor of the villagers, and after the isolation of the "madwomen" in the Mpiandry’s camp, no more pathological cases related to the above occurrence were reported.
  
  
  CONCLUSIONS
  A mass hysteria diagnosis is retained. It is favored and kept up by local dissensions,by the villagers' belief and its large media casting, thanks to the shepherds' presence. It mingles culture, tradition and modern psychiatry. Therefore, care and treatment of the disorder to be appropriate and optimal require the cooperation between these three spheres.
authors.forename: I-H
authors.initials: IH
authors.lastname: Rafehivola
authors.forename: A
authors.initials: A
authors.lastname: Raharivelo
authors.forename: F
authors.initials: F
authors.lastname: Rakotomavo
authors.forename: D-S
authors.initials: DS
authors.lastname: Andriambao
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003291:Conversion Disorder / Q000209:etiology*; D005260:Female; D006801:Humans; D007046:Hysteria / Q000523:psychology*; D008270:Madagascar; D008399:Mass Behavior; D011446:Prospective Studies; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000150:complications; D018599:Witchcraft / Q000523:psychology; D055815:Young Adult