Explaining the Factory Faintings

[This story was originally published March 23, 2012]

Chanthul felt darkness fall over her face. Sy Ten became dizzy and asked for some Tiger Balm to dab on her head. Sovanny’s head ached and she almost vomited. Srey Pov’s hands and feet went weak and floppy, then she felt the world fade away.

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A worker from the Heart Enterprise Cambodia garment factory is treated at the Bek Chan Health Center in Kandal province after fainting at work. Fifty workers at the factory fainted over two days in August. (Lauren Crothers/The Cambodia Daily)

These four women, along with dozens of their co-workers at the Anful garment factory in Kompong Speu, which makes clothes for international retailer H&M, fainted at work one Monday in October. They woke up in a local clinic, with intravenous drips in their arms and oxygen masks on their faces. They were terrified. Their supervisor suggested that they were feigning illness to get out of work.

Three days later, they fainted again.

Their terror grew. They became afraid that the ethnic Chinese owner of Anful was not paying proper homage to the local Khmer spirit of the land, known as a Neak Ta. They thought one of their co-workers was possessed by an angry Khmer ghost. They stayed home from work for several days. Finally, the owner paid for an elaborate Buddhist ceremony to be held at the factory, donating 30 cases of bottled water, two cases of Coca Cola, fresh coconuts, cigarettes, bathrobes, toiletries, razors, tea, sugar and soap to the chief monk of a local pagoda, who chain-smoked as he splashed the workers with holy water and chanted a prayer to appease the Neak Ta.

There have been no mass faintings at Anful since that day in late October.

“I feel very excited, very clean, very fresh. My face is clean. I fainted twice. It felt like a disease, like there was darkness all over my face, but now my stress and everything is gone. I think the monks are helping us walk down the dark path we cannot see with our eyes,” said 38-year-old Chanthul after the ceremony.

She, Sovanny, Ten and Srey Pov were just a few of the 1,973 garment workers who fell unconscious in Cambodian factories last year, under circumstances that continue to bewilder workers, unions, garment buyers and labor officials alike. (The Labor Ministry did not deem it necessary to compile statistics on fainting until last year.)

The spate of faintings has, if anything, intensified since the issue captured the attention of local and international media. And recently fainting has affected workers who make clothes for major international companies including H&M, Puma and the US National Football League.

Garment workers’ descriptions of the moments before they fainted are often very similar. Most of them reported smelling a strange, foul odor in the moments before everything went black, attributed from everything to chemical fumes to dirty bathrooms. Most of them saw other workers fainting before their world went black.

But a fact that has often gone unreported in the press is that a surprising number of them believe that they or others at their factories were possessed by spirits. At the Anful factory, several workers described one woman who went into a fit or a trance before she fainted. Although she was Khmer, she broke into fluent Chinese, screamed for raw chicken and rice wine to be offered to the spirit inside her, and loudly demanded that the factory owners organize a religious ceremony to appease the spirit.

At Sangwoo garment factory, a supplier for the American clothing brand Gap, 21-year-old Dorn Somaly smelled something unpleasant coming from her factory’s bathroom before she fainted in October. She started trembling and her hands and feet felt as cold as ice. She broke out into a cold sweat because she saw several co-workers fall into a “fit.” Thirty-two women fainted that day.

“Some people were doubled over in pain, shaking and screaming and having a fit, and their eyes went out of focus and rolled back in their heads,” she remembered. “That day was so strange-we just collapsed against each other gradually, and everyone was trying to hold us up, and then we were in the hospital, and the hospital was full.”

“Our factory fainting was very mysterious. People were shaking so much and having fits. I don’t know why.”

Neither does anyone else. Although buyers, labor experts and the government have been frantically studying the issue for months, nobody has yet been able to point to a clear explanation of why the faintings are occurring. Factory administrators and labor officials have blamed exhaustion, heat, fasting for Ramadan, working overtime, the smell of gas, the smell of chemicals, the smell of pesticides, poor ventilation, an electrical outage, low blood sugar, too much light, and too little light.

But there may be a better explanation.

Over 200 years ago, at the dawn of the Industrial Revolution in England, a girl working at a cotton factory in Lancashire slipped a mouse into the bosom of another girl, who happened to be afraid of mice. The victim collapsed in a fit of violent convulsions that lasted for a full day. Understandable, perhaps, but what came next was not. The following day, three other girls also fell into convulsions. The next day six more were also seized.

“By this time the alarm was so great that the whole work in which 200 or 300 were employed was totally stopped, and an idea prevailed that a particular disease had been introduced by a bag of cotton opened in the house,” said a contemporary account published in Gentleman’s Magazine in 1787. “On Sunday the 18th, Dr. St. Clare was sent for from Preston; before he arrived three more were seized, and during that night and the morning of the 19th, eleven more, making in all twenty-four.” After the doctor assured the workers that the cotton was not dangerous and had nothing to do with the factory’s cotton, their anxiety attacks stopped. Similar episodes occurred at other factories in England, France, Germany, Italy and Russia during periods of industrialization.

Starting in the 1970s, Malaysia made a consented effort to industrialize and liberalize its trade policies. Japanese, European and other foreign-owned factories were built in newly designated Free Trade Zones, and there was a vast migration of young, unmarried Malay women from rural farming villages to factories. They were considered the best source of cheap labor, and promotional brochures for investors boasted of the delicate fingers and manual dexterity of the “Oriental girl.”

Working conditions were strict and unions were not tolerated. But shortly after the factories started opening, a wave of spirit possessions took hold of young female workers in the factories. The women would shake, scream or faint en masse, often shutting down production lines entirely for days on end. The attacks also affected industrial settings in neighboring Singapore, such as cuttlefish and battery factories. In 1978, an American factory in Malaysia had to be shut down for three days due to an epidemic of possessions that lasted until a local healer was hired to slaughter a goat at the factory, according to anthropologist Aihwa Ong, a professor at the University of California at Berkeley.

Anthropologists and psychiatrists studying the phenomenon have suggested that the spirit possessions – which confounded observers at the time – were a way of “ritualizing” rebellion and defying authority through culturally appropriate channels. Although at the time they seemed inexplicable, the possessions grabbed headlines and ultimately led to national debates about working conditions in factories.

“They are acts of rebellion, symbolizing what cannot be spoken directly, calling for a renegotiation of obligations between the management and the workers,” Ms. Ong wrote in the journal American Ethnologist in 1988.

The diagnosis in both the British and Malaysian cases? Mass psychogenic illness, or MPI-also known as mass hysteria or conversion disorder-which also seems to be the most likely culprit for the Cambodian factory faintings, according to scholars and experts consulted over the past few months.

“I strongly agree that the episode is one of mass psychogenic illness,” said Robert Bartholomew, a former psychology professor at James Cook University in Australia who has studied MPI in factories for two decades. “First, no environmental contaminant or toxic agent has been identified. Factories are notorious for outbreaks of mass hysteria, so much so that some researchers use the term ‘factory hysteria.’ You have a captive audience who cannot simply walk out if they are dissatisfied with working conditions or they risk being fired, yet they need the money so they stay.”

Two other experts, Dr. Jennifer McVige of the Dent Neurological Institute in New York, and Nicholas Christakis, a sociologist and physician who heads the Human Nature Lab at Harvard University, agreed that the Cambodian factory faintings are most likely caused by MPI.

MPI affects women in vastly greater proportions than men, and young women even more disproportionately, and poor young women even more disproportionately. This correlation is very strong, although social scientists have not yet come to grips with why.

Hysterical episodes are also most likely to break out in settings where there are strong social connections, and enclosed areas such as factories, according to researchers. In some types of MPI, sufferers are likely to complain of foul odors or smells that are triggering their anxiety, their research shows.

Mass hysterical episodes also tend to reflect the broader concerns of society. In the American Midwest, as mechanization was transforming the nation in the late 19th century, hundreds of people claimed to have spotted a chunky airplane flying across Michigan, Illinois and Missouri, in what has become known as the Airship Hysteria of 1896-97. After the First World War, in which poison gas became a horrific new weapon that killed tens of thousands of soldiers, outbreaks of hysteria over gas attacks cropped up. Some scholars now believe that the witch hunts in Salem, Massachusetts, were also a type of MPI.

Simon Wessely, the head of the department of psychological medicine at King’s College London, and an expert on mass psychogenic illness, said in an email that MPI manifests itself differently in different cultures.

Although conversion disorders involving spirits are no longer common in the West, he said, “the beliefs involved in mass sociogenic illness always represent cultural fears about illness/health.” As societies industrialize, feelings of being oppressed by spirits are slowly replaced by fears of invisible deadly agents such as viruses and toxic chemicals. Still, he said the mechanism was similar.

Advocates for workers rights and opposition leaders have studiously avoided using the terms MPI or mass hysteria to describe the Cambodian factory faintings, possibly out of a fear that the term would delegitimize the very real problems that workers here face.

They do frequent work in hot, stifling, smelly factories, and are often chronically malnourished and suffer from anemia. Many of them feel underpaid and poorly treated. They frequently complain that they are forced to work overtime or on national holidays, that their union leaders are targeted for punishment, and that they barely make enough money to get by. At a protest in Bavet City last month, the powerful city governor allegedly opened fire on a throng of unarmed garment workers, seriously injuring three. He has not yet been arrested.

In a protest song sung by female garment workers in 2007 the women lament their miserable working conditions and describe their longing for their families and the rice fields of their native villages. The workers use a bodily metaphor to describe the dislocation they feel, comparing it to spinning around dizzily.

“Anxious tears, and all alone with/No one to help solve our problems./ Flooded with anguish and suffering,/ Dizzy and fruitless, hoping one day for health;/Spinning, until the day we return to our beloved mothers,” the workers sang, according to a translation by Erik W. Davis, an anthropology professor at Macalester College in Minnesota who studies the labor movement here.

Like Malaysia 40 years ago, Cambodia is pushing hard to industrialize, with government policies designed to encourage factories to move in and take advantage of cheap labor costs. The garment industry barely existed in the mid-1990s, but garments now comprise more than 80 percent of Cambodia’s total exports and around 16 percent of its GDP.

Although it has undoubtedly been a boon to the Cambodian economy, Mr. Davis has written that the garment industry largely functions as one big “export-processing zone,” with almost none of the profits trickling down to Cambodians themselves. There is only a tiny domestic market for the garments made in factories here, and they are almost universally owned by ethnic Chinese businessmen from countries such as Singapore, Hong Kong and Malaysia.

“The labor-added value of Cambodian women enriches the managers and owners of the factories, who either live in the cities or outside of Cambodia entirely,” Mr. Davis wrote in a 2006 paper.

Indeed, at least four recent fainting incidents at two factories involved workers’ anxieties about the neglect of Cambodian spirits by these overseas Chinese owners. At the Nanguo factory in Sihanoukville, where workers have recently fainted twice, once in February and once in March, workers said there was widespread unhappiness that the factory’s owner ignored Khmer spirits. Siek Monika, who fainted on February 13 there, said the factory’s ownership had never paid respect to local spirits until after the fainting, when he agreed to offer a pig’s head and fruit to appease any ghosts and allowed workers to burn incense in a ceremony.

There is no doubt that there are significant breaches of health and safety standards at some garment factories that have experienced faintings. Companies such as Puma have found as much when investigating fainting incidents (one factory, Puma said in a report commissioned after faintings at the Huey Chen factory in Phnom Penh, was exposing pregnant women to chemicals that could cause fetal damage.) But these conditions can affect workers mentally and spiritually as well as physically.

Episodes of MPI in England during the Industrial Revolution, Malaysia in the 1970s and El Salvador in 1997 helped spark national conversations about workers’ rights that ultimately led to more robust labor laws and heightened awareness of factory conditions. Similarly, there has never been as much attention being paid to Cambodian garment workers’ rights as there is at this moment. Buyers worldwide are on high alert about the faintings, worried about bad press. Fainting was the main topic of discussion at the annual Buyers’ Forum in September, a meeting between officials at the International Labor Organization and manufacturers.

A ‘People’s Tribunal’ was convened last month with buyers, workers and unionists coming together to discuss workers’ grievances and factory conditions. Largely because of the faintings, garment workers won a $5 increase to the $61 monthly minimum wage in November. Employers called it a “health bonus.”

Pok Vanthat, the deputy director of vocational safety and health at the Ministry of Labor, heads a new committee formed to explore the cause of the faintings and try to find a solution. He said the group has not yet found the cause, but is considering a new law that would require garment factories to build inexpensive, hygienic and comfortable housing for their workers.

There may, in fact, be no way to stop the fainting episodes short of improving working conditions across the board. Mr. Bartholomew said that MPI had tapered off at factories in England and the US largely due to “an increasing emphasis on worker rights, improved worksite conditions, occupational legislation, and greater union influence.”

“Unless factory owners and administrators make genuine improvements to working conditions, episodes could continue indefinitely,” he said. “The prevalence of future episodes of MPI in factories will hinge on how workers are treated. It is clear that an underlying factor in many outbreaks is related to dehumanizing aspects of certain types of jobs.”

Researchers have found that MPI in factories can be reduced or prevented by, among other tactics, opening more channels of communication between workers and management, raising wages and creating better job security, he said.

“I view what is happening in Cambodia as a form of subconscious negotiation. It also signals to the wider community that something is amiss,” Mr. Bartholomew added.

“Many Cambodians believe that there are spirits in every factory,” said Kuch Sovanny, one of the workers who fainted at Anful. “Maybe they were already there before the factory was built, but still, if we do something wrong they cannot stay peacefully.” All they needed, she said, was someone to recognize their presence and give them respect.

(Additional reporting by Phok Dorn)

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