US flag Cuba
A US flag on the dashboard of a car in Havana, Cuba (H. L. Tam / Flickr)

Robert W. Baloh and Robert E. Bartholomew published “Havana Syndrome: Mass Psychogenic Illness and the Real Story Behind the Embassy Mystery and Hysteria” (Springer) in March 2020. Bartholomew is Honorary Senior Lecturer in the Department of Psychological Medicine at the University of Auckland in New Zealand, and Baloh is a distinguished professor at the David Geffen School of Medicine at University of California, Los Angeles.

Your book makes the argument that so-called “Havana syndrome”, whereby US officials and others claim to be victims of mysterious sonic or “pulsed energy” attacks by Cuba, is in fact nothing more than a mass psychogenic illness – a form of mass hysteria in which symptoms are experienced as if they were real. What makes you so sure of this?

Robert Bartholomew: There is not a shred of credible evidence that there ever were attacks. After five years, no weapon has been found and there is not a single intelligence intercept suggesting there was a weapon. While the US military has researched the use of acoustical and microwave weapons, they have not been able to develop a practical device due to the laws of physics. There is a big difference between researching something and developing a practical weapon.

What therefore do you make of US claims that these “attacks” have produced, among others, brain damage?

Robert Bartholomew: The claims of brain damage, changes to white matter [nerve fibres found in the deep tissue of the brain] and hearing loss are the product of inaccurate reporting. In December 2017, information was leaked to the media about a study that was being conducted on US Embassy patients which showed mysterious white matter tract changes in their brains. Media outlets around the world reported on the strange “brain anomalies”. Then, in February 2018, the study appeared in the Journal of the American Medical Association. Yet only three of the patients exhibited white matter tract changes, which is the same distribution you would expect to find in a normal population because white matter changes are common in everything from depression to migraines to normal ageing.

Then there were the reports of brain damage after the publication of a 2019 study in the same journal. Again, the story made headlines, with many media outlets reporting on the “brain damage” suffered by the diplomats. However, brain anomalies are not the same as brain damage. While they did find anomalies, it is not unusual to find minor anomalies in small patient cohorts due to individual variation, given they can be caused by exposure to long-term stress.

As for reports of hearing loss, that never happened either. In 2018, the results of a study on US diplomats who were reportedly suffering from Havana Syndrome were leaked. The media was soon reporting that one-third of the patients in the study were experiencing hearing loss. However, when the study was published that December, only two patients had hearing loss, and in both cases, it had occurred before they were even posted to Cuba. The remainder thought they had hearing loss, but when given a standard hearing test, it proved to be unfounded.

The head of one US association that represents current and former diplomats and foreign aid workers recently stated that victims have suffered “real trauma and real injury”. If it were indeed psychological, how could the consequences be so severe?

Robert Bartholomew: Mass psychogenic illness symptoms are as real as any other medical condition, but their origin is non-organic. It is not just “all in their heads”. They are experiencing real symptoms and both Professor Baloh and I are sympathetic to their suffering. But telling them they have brain damage only exacerbates their condition.

Robert Baloh: The key difference is that there is no evidence of brain injury or brain damage. MRI scans of the brain have been normal and there are no neurological abnormalities on examination. The non-specific test abnormalities that have been reported are commonly seen in patients with stress-related neurological disorders such as anxiety and post-traumatic stress disorder.

There have now been some 1,000 cases of Havana Syndrome reported worldwide. How is it able to spread across geographies in the way it has?

Robert Baloh: In fact this is strong support for a diagnosis of psychogenic illness. Diplomatic and state department officials were warned to be on the outlook for symptoms and to immediately report them. This caused them to focus and ruminate on routine body symptoms that nearly everyone experiences. They developed negative expectations, called the “nocebo effect”, and by attending to the symptoms, the symptoms were amplified and required less activation for conscious awareness.

Robert Bartholomew: Like all outbreaks of mass psychogenic illness, you need to understand the context. You need to go back to patient zero. It began in a small unit of CIA officers in Havana in late 2016. For weeks they had been hearing mysterious sounds – then one day one of them presented to the US Embassy clinic with a headache and ear pain, and a theory emerged that they were being harassed by a new acoustical weapon. The story then spread through the small CIA unit, and not long after, to the US and Canadian embassies which had a close relationship and were sharing information. The sonic attack hypothesis may seem like an odd assumption at first, but you have to put yourself in their shoes. The notion that they were harassed seemed plausible because there is a long history of Cuban agents harassing diplomats. For instance, during the Cold War, agents would sneak into their houses while they slept and rearrange furniture, leave cigarette butts on their kitchen table and open all the windows so the house would become filled with mosquitos. The diplomats who were sent to the new Embassy in Havana in 2015 had been briefed on this.

However, there’s an old saying: “When you hear the sounds of hoofbeats in the night, first think horses not zebras.” The doctors in the US State Department went for the most exotic hypothesis early on – they were searching for unicorns when they should have stuck to more mundane explanations. Of the first 21 victims in Cuba, eight recorded their “attacks”, and a panel of scientists later concluded that the sounds aligned closely with the mating call of the Indies short-tailed cricket [an insect local to Cuba]!

One alleged cause of “Havana Syndrome” – sound waves – has been seen before in instances of mass psychogenic illness. Can you explain the brief life of “acoustic shock” in the early days of telephones?

Robert Baloh: Acoustic shock, which is discussed in detail in our book, has many parallels with Havana Syndrome. In the early days of telephones, people developed a wide spectrum of symptoms including headache, dizziness, tinnitus and brain fog after hearing a brief disturbing sound on a telephone. Typically, the sound, if recorded, was not that impressive. The condition was initially called an “ear concussion” even though there was no evidence of ear damage.

History is littered with stories of such mass hysterias: the dancing manias of the Middle Ages; the laughter epidemic in Tanzania in 1962; mass fainting at a school in Blackburn, England in 1965. What makes us susceptible to them?

Robert Bartholomew: In a word: plausibility. There is an old saying: “Talk of the devil and he is bound to appear.” In Salem in 1692, a belief in the devil altered the perceptual sets of the local residents whose worldview included the reality of witches and demons. In Salem, when the cry of “Witch!” went up, believers went searching for evidence to confirm it. If someone visited and you fell sick soon after, it was evidence of witchcraft. It’s not that dissimilar to Havana Syndrome because many of the symptoms are so vague as to be experienced by nearly everyone on the planet in any given week: fatigue, difficulty concentrating, forgetfulness, insomnia, dizziness, confusion, disorientation, ear pressure and pain.

Robert Baloh: Although the human brain is a remarkable organ, it has “design flaws” that make it vulnerable to suggestion and manipulation. Advertisers and politicians routinely take advantage of these flaws to influence our behaviour with regards to purchases and voting. These design flaws can be traced to both nature and nurture. Many of our emotions and behaviours are ingrained in the primitive deep brain modules encoded by genes that evolved over millions of years of evolution. We are susceptible to irrational fears that can change the chemistry and physiology of our brain and body, leading to a wide range of symptoms.

US government officials don’t exactly fit the typical profile of victims of mass hysteria, who are often either young or not informed by western science and medicine. What conditions in their line of work might have produced it?

Robert Baloh: First, these are common misperceptions about victims of mass psychogenic illness, in part due to “historical baggage” associated with the word “hysteria”. Mass psychogenic illness can affect anyone regardless of age, gender or level of education. It often begins in close-knit groups living in stressful situations and is amplified by politics and cultural beliefs.

Robert Bartholomew: We do not claim that victims of psychogenic illness are “crazy”, mentally ill or are psychologically weak. It is a collective stress response that is based on a belief. We all have beliefs, and therefore everyone is potentially susceptible. That includes highly trained and well-educated intelligence officers.

While CIA agents appear to have been over-represented as victims, that is readily explainable. In Havana, intelligence agents were viewed as the first targets and intelligence officers around the world were warned that they might be next, thus resulting in agents being hyperaware of their health and creating a self-fulfilling prophecy. It is important to remember that not every victim is experiencing mass psychogenic illness. Many are simply redefining an array of common and uncommon health conditions under a new label: “Havana Syndrome”.

Why might the US government be so resistant to accepting that this could be the work of something other than a hostile state?

Robert Bartholomew: I believe that embarrassment is a big factor. It is embarrassing to think that they have spent five years chasing ghosts, and in the process, wasted tens of millions of taxpayer dollars investigating claims of an imaginary secret weapon that turned out to be the mating calls of crickets.

Robert Baloh: They have also backed themselves into a corner, having strongly supported the notion of an attack by a hostile state from the very onset. Some politicians have demanded retaliation even though we have no idea who to retaliate against. Other politicians have specifically used the foreign attack theory to further their agenda against Cuba. Furthermore, “victims’ groups” have powerful political allies and they refuse to even consider the possibility of psychogenic illness. Even mentioning the term can lead to immediate sanctioning.

There are a range of potentially serious outcomes – both political and scientific – that arise from this. In what ways could it prove consequential beyond just being a matter of intrigue?

Robert Baloh: Obvious political consequences are the breakdown in relations with Cuba and possible future actions against other countries despite the lack of evidence of an “attack”. With regards to the “victims” of the proposed attacks, telling them that they have brain damage caused by some type of mysterious weapon is a prescription for a life with chronic debilitating symptoms. Their symptoms are real but they need to be reassured that they do not have permanent brain damage and that they can be treated and get well.

Robert Bartholomew: The real danger that this case poses is to highlight the potential for politics to become mixed with science. The implications are enormous, from vaccination uptake to global warming. The effectiveness of vaccines and the reality of global warming are settled science, but in the social media and fake news age, misinformation abounds.