Book Review ‘Havana Syndrome’: New Theory about Illness Among American Diplomats in Cuba

The U.S. embassy in Havana, Cuba, in 2015. (Alexandre Meneghini/Reuters)

A new book argues that a stress reaction, not a sonic weapon, caused the mysterious symptoms experienced by American diplomats in Cuba.

Beginning in 2017, a number of American diplomats in Cuba suddenly fell ill with a variety of complaints such as dizziness, headache, insomnia, and imbalance. A strange noise often assailed them. One diplomat saw an unmarked van speeding away when she tried to investigate the source of the sound. Was this some new sonic weapon aimed at the American embassy? Perhaps microwaves or irradiation? What about pesticides? Some American officials, such as Senator Marco Rubio and Secretary of State Rex Tillerson, were adamant that the Cubans, perhaps abetted by the Russians, should be held responsible, despite no tangible evidence of these attacks having been found.

Havana Syndrome, by Robert Baloh and Robert Bartholomew, is a comprehensive and coherent interpretation that offers one explanation of this strange saga. It is a must-read for anyone interested in the interplay of medicine, psychology, and international relations. Baloh, a leading neuro-otologist, and Bartholomew, a world-renowned expert in mass delusions, conclude that the experience of the diplomats, that is, the enormous strain of living and working under the surveillance of a hostile regime, provoked a stress reaction of bodily symptoms of psychiatric origin: In other words, the explanation for Havana Syndrome is mass delusion, not malfeasance. They argue that the tight-knit nature and relative isolation of the diplomats’ social networks allowed this reaction to spread, reinforced by a ready explanation proffered by superiors, however unsubstantiated or improbable, that a hitherto unknown sonic weapon had wounded them.

Baloh and Bartholomew’s careful consideration of the scientific literature demonstrates the implausibility of a sonic or microwave source for the diplomats’ symptoms and refutes the possible explanations of poisoning or infection by pointing out that the epidemiological patterns one would expect to see in toxic exposures weren’t present in Havana. And that strange sound diplomats heard? Analysis of recordings disclosed only cicadas and crickets. According to Baloh and Bartholomew, there was no science-fiction ray-gun, no Communist subterfuge — only crickets and a crisis of subconscious. The authors provide a history of sonic-related hysteria — from illnesses tied to Ben Franklin’s glass harmonica to wind-turbine sickness — and couch this peculiar story within the larger phenomena of mass delusion, somatoform illness, and functional neurological disorder.

One wonders if sometimes the more colorful digressions the authors take into other examples of mass hysteria and delusion — from classics such as the panic started by Orson Welles’s radio broadcast of War of the Worlds to more modern examples such as a Coca-Cola catastrophe in Belgium in which deluded children’s gastric complaints were falsely attributed to contaminated soda — are there to provide tantalizing fodder to keep the audience stimulated through the more mundane medical explanation of what they think really happened in Havana.

Havana Syndrome is a scholarly work easily accessible to a nonmedical audience. What it lacks in an exciting narrative voice (it does not read like a medical-mystery whodunit), it makes up for in its measured tone, clear assembly of the facts, sober interpretation of those facts, and assiduous sensitivity to the disease itself. (Conversion disorders, somatoform disorders, functional neurological disorders, and other so-called “hysterical disorders” can make up as much as 30 percent of the referrals to a neurologist’s office. These patients are not faking or mentally “weak.” They experience physical manifestations of psychological stress reactions.) That is the understated strength of the book — its quiet, dutiful approach to the condition of mass delusion and the politically charged circumstances in which that condition unfolds. From the American Civil War’s “soldier’s heart” to World War I’s shell shock and World War II’s battle fatigue, concussive-like syndromes without a demonstrated concussive force have been described when humans face stressful circumstances, and the authors contextualize Havana Syndrome within that tradition.

Just as in these previous cases, medical science today stumbles along, and the public struggles to interpret seemingly mysterious conditions, as we grope towards the truth. In the case of Havana Syndrome, the authors argue, medical publications such as the Journal of the American Medical Association drew conclusions outstripping the data that could support their claims, and media sources such as 60 Minutes and The New Yorker amplified those conclusions — such as by reporting that brain damage and hearing loss had occurred in the diplomats. Baloh and Bartholomew contend, pointing to published rebuttals of the JAMA study in the literature, that in fact there was no causal relationship demonstrated for commonly occurring changes that were observed in the brains of some diplomats, and that the hearing loss reported was preexisting, not new. However, the matter is still far from settled. State Department officials have expressed skepticism at the idea that the diplomats’ illness could be psychogenic. Researchers at the NIH continue to investigate, the U.S. government has not yet made public a definitive account of the events (and has said that we may never get one), and much of the diplomats’ medical data remain redacted or classified.

In a little under 200 pages, Havana Syndrome chronicles what may be one of the most intriguing cases of a major mass delusion we have seen, one that threw the international community into hysterics.

Michael P. H. Stanley, M.D., is a poet, historian, and neurology resident of the Harvard BWH-MGH Neurology Program.

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