“Memes” as Infectious Agents in Psychosomatic Illness

• Psychophysiologic disorders
• Disease outbreaks
• Sick role
• Physician's role
• Knowledge, attitudes, practice

Can a mere idea cause medical pathology? Many authors would say yes. It has been claimed, for instance, that fibromyalgia, the irritable bowel syndrome, and the chronic fatigue syndrome are iatrogenic—that these are not simply methods for classifying illness, but that these nosologic constructions actually induce and sustain illness in susceptible persons (1). The contagiousness of eating disorders has also been remarked upon (2). This contagion is not the result of any classic pathogen (a microbe or a toxin)—instead, a socially constructed script of anorexia nervosa or bulimia is transmitted from person to person. Intangible disease constructions also appear to be the communicable pathogens in several contemporary epidemics, from “repetition strain injury” in mid-1980s Australia (3, 4) to instances of “mass psychogenic illness” or “epidemic hysteria” (5-9), such as the recent outbreak of cola-associated illness in Belgium (10, 11).

Thus, it has been asserted that a virulent idea, a maladaptive social construction of disease, can be found at the core of these diverse disorders. In this essay I explore how such disease conceptions, which I term psychosomatic memes, act as transmissible templates. They are analyzed as infectious agents that, like microbes, have virulence factors, affect hosts with particular vulnerabilities, are disseminated through a variety of vectors, and are promoted or inhibited by various components of the social ecology.