Havana syndrome

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It's unexplainable.

I'm Noam Hasenfeld.

Remember a few years ago when those invisible attacks were messing with U.S.

diplomats in Cuba?

The Trump administration announced that it is pulling more than half of its staff out of the American embassy in Havana.

This comes after diplomats and staff suffered mysterious health attacks that caused minor brain injuries.

These symptoms have been called Havana syndrome, and new incidents are still being reported.

Except they're not just happening in Cuba anymore.

Incidents have been reported in Russia, China, the US, and just in the last few months, there were reports of incidents in Austria, Germany, and Vietnam.

About 200 incidents of Havana syndrome have now been reported around the world, with many requiring hospitalization or outpatient treatment.

But what's causing Havana syndrome is still a mystery.

On this week's episode, a potential reason why.

we may have been looking for the wrong kind of answers.

We'll start from the beginning.

So in late 2016, two intelligence operatives who recently arrived at the United States Embassy in Cuba, they hear what they consider to be a bizarre noise.

This sound is a recording obtained by the AP of what some diplomats claimed they heard.

It's a very bizarre, otherworldly noise.

Journalist Dan Hurley wrote about the science behind Havana syndrome for the New York Times magazine.

And they begin to develop headaches, fatigue, dizziness, hearing loss, nausea.

Word reaches the head U.S.

diplomat in Cuba, who eventually calls a meeting of his senior staff.

And he tells them, there's these weird noises, makes people feel sick.

We're trying to figure out what's going on.

And if any of you feel it, please let us know.

But don't tell anybody.

This is confidential.

But more and more people start reporting these strange symptoms.

So the head diplomat starts telling other countries' ambassadors who are also in Cuba.

And once he tells the Canadian ambassador,

12 of the people who are in the Canadian embassy say, I'm feeling the same thing.

Cases continue to rise, and the State Department's medical director sends patients to get examined at the University of Pennsylvania.

So I'm Douglas Smith.

I'm a professor of neurosurgery and director of the Center for Brain Injury and Repair at the University of Pennsylvania.

Douglas first examined the patients in 2017.

I have to tell you, the patients have a kind of a great sense of humor despite the suffering they had.

And some call this immaculate concussion.

because it sure seemed like concussion symptoms, but without the actual head impact.

It was intense pressure on both of my temples.

I mean, the room is spinning.

I can't stand up.

I'm falling over.

I feel physically sick.

You're dizzy.

Your head is splitting.

The majority of them heard sounds, but not all the sounds were the same.

Some were high-pitched, kind of a trilling type of sound.

A very high-pitched sound in Catherine's bedroom.

You know, akin to a cicada, some said.

Actually, scientists who later analyzed the AP recording concluded that at least that particular sound was was likely generated by Caribbean crickets.

But not everybody had those sounds.

Some didn't hear anything and some heard entirely different sounds.

So they weren't all consistent.

Some reported sounds that were kind of low grinding metal type sounds.

At the same time, I heard this low humming sound and it was oscillating.

And others even reported sounds like, you know, this baffling noise when you had the back window of a car open on the highway, that kind of woo-woo-whoa kind of sound.

And they could actually sense what what direction this phenomena was coming from.

Something I felt like hit me from the left side and it paralyzed me so I was not able to move or speak.

Some of them would even duck behind a concrete wall and the feeling would go away.

They come back again like to a window for example and the symptoms would return.

And I remember looking around for where this sound was coming from because it was painful.

It made them feel kind of like they're dizzy or raining in their ears or visual problems.

I'm able to function for two or three hours a day and concentrating, but that's about it.

You're in a fog.

It's as if everything is moving in slow motion.

But nobody in our group had ever heard of sound hurting the brain.

In 2018, Douglas and his team at Penn published a study which found that these government officials did appear to have sustained brain injuries, but they didn't know what could have caused them.

The team left that open, claiming the symptoms were due to a, quote, unknown energy source associated with auditory and sensory phenomena.

Meanwhile, the U.S.

government seemed split on how to refer to the episodes.

While some called them incidents, others, like former Secretary of State Rex Tillerson, started calling them attacks.

We hold the Cuban authorities responsible for finding out who is carrying out these health attacks on not just our diplomats, but as you've seen now, there are other cases with other diplomats.

The U.S.

ended up withdrawing most of its staff from the Cuban embassy, but more and more incidents kept being reported, this time outside of Cuba.

First, it was in Moscow.

An invisible attack in a Moscow hotel.

Then it was in China.

Abnormal sound left a consulate worker with a mild brain injury.

It was in Australia.

Two senior CIA agents may have been attacked.

In Washington, D.C., on the National Mall.

We want to turn now to a mystery right here in the nation's capital.

The reports kept on coming.

It's been reported in Poland, London, and Taiwan.

And even this past summer, there were incidents in Vienna.

So this is a big issue for the Austrian authorities and clearly for the United States.

Next thing you know, it's NBC, the New York Times, 60 Minutes, science journalist Dan Hurley again.

They're all saying Americans are being attacked.

And Scott Pelley tonight on 60 Minutes.

In his classic signature rumble.

I'm Scott Pelley.

I'm Scott Pelley.

There appears to be a hostile foreign government's plan to target Americans serving abroad and their families.

At first, the U.S.

blamed Cuba.

The Cubans were saying, we don't even know what you're talking about.

This is not us.

Then the U.S.

blamed the Russians.

They blamed the Chinese.

But incidents have continued to be reported.

As of now, it's up to around 200 people.

But, you know, the truth is, there is

no evidence of any foreign government being involved.

Is there any type of sonic weapon that could do this?

Like, could cicadas be weaponized?

No.

And it's not.

No, no, no.

So there is this strange effect that's called the Frey effect.

Okay.

Back in the 60s, a scientist named Alan Frey

found that microwaves aimed at the head could cause a clicking sound.

You had to be in a very quiet room to even notice it.

But the Frey effect cannot cause brain damage.

It's just something people grabbed on.

One of the engineers I spoke to who did a study of the Frey effect, Kenneth Foster, professor of bioengineering, he said.

The kind of effect that is being talked about about with the embassy is purely a fairy tale.

He said, you might as well be talking about little green men from Mars throwing darts of energy.

I can't conceive of a microwave weapon as it's being thought about in this case.

No one has measured microwaves in the embassy, as far as I know.

It's just purely speculation that there's anything at all involving microwaves in this case.

And if you take that low level of energy that gets you to fray effect and just turn it up a lot, could that be a possible cause here?

Like shoot a lot of microwaves?

So there's something else called an active denial system, which the U.S.

government, the military has used to disperse a crowd.

It's called millimeter waves instead of microwaves.

It's 95 gigahertz instead of two and a half gigahertz.

Okay, so like higher frequency than microwaves.

Yeah, and it only goes skin deep.

So it makes you feel like you've got a burning sensation on your skin, and it's never been known to produce any sounds or to cause chronic brain damage.

What if you did this with actual microwaves and not millimeter waves?

Well, that would be exactly like...

climbing inside a microwave oven.

And it wouldn't be something that they hear a noise and go, gee, what's that?

No, it would be like getting microwaved.

It heats up your body and it would be a painful experience.

Okay.

Outside of microwaves or millimeter waves, are there any other possible causes here?

Ultrasound.

And that, I guess, is very high-pitched frequencies?

Yes.

Now, apparently, if you took an ultrasound generator and you put it in a bucket of water, you could make little bubbles appear.

And I talked to Timothy Layton, who's a professor of ultrasonics.

And he told me, you know, if you send it through the air, you will never get that effect.

You know, with the pregnant woman, the reason they use the slippery gel is you can't have an air gap.

So essentially, the idea here is that you couldn't get this effect from far away, right?

Someone would have to sneak up behind them and touch them with an ultrasound machine or something.

Yeah.

You know, what Layton said was, we have no evidence and no theories of how it could do that.

And he said, the idea of some kind of secret ultrasonic death ray going through the air to hit you, it's nonsensical.

And that's a quote.

And one of the key things is, even if you got a concussion, it is unusual for people to develop chronic long-term sickness from that.

And yet most of the people with this syndrome do seem to have chronic symptoms.

I mean, it just doesn't fit with what's known about mild traumatic brain injuries.

None of it makes sense by any physical means.

To this day, neither the penn doctors who examined the patients nor other experts have been able to point to a definitive cause for Havana syndrome.

While some scientists have claimed that certain high-frequency radio waves could be a conceivable

The science is far from resolved.

But Dan is one of many people who think there could be another option here.

There is a simple explanation that is entirely consistent with what neurologists know, and nobody wants to believe it.

That's after the break.

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This is the strange story of Fred Strong, a normal, happy man who usually enjoys life.

But suddenly, without warning, Fred is on his way to all the terror, all the worry, all the pain of an ailment, commonly known as Unexplainable from the Vox Media Podcast Network.

Unexplainable, we're back.

We've been hearing about Havana syndrome, this mysterious condition that's affected about 200 diplomats around the world.

Patients are still suffering, and scientists haven't been able to come to a consensus on what kind of energy source could cause this syndrome.

But there's another possible theory.

Havana syndrome could be an example of something called a functional disorder.

These kinds of disorders are just beginning to be understood because they don't usually involve observable structural damage in the brain.

A functional disorder is less about how the brain looks than about how it works, how it's communicating.

I mean, a structural brain injury would be having a stroke or a brain tumor or, you know, difference in the brain anatomy, essentially.

But functional difference or change is really just how the different parts of a brain interact with each other.

Catherine LeFavre is a neurologist specializing in functional disorders.

We don't understand all the underlying pathophysiology, but we understand it reasonably well.

So here's an example of how one kind of functional disorder could play out.

Someone might have an episode of vertigo, which could have been caused by a virus or a bit of loose calcium in the ear.

And what can happen is this initial event provokes so much anxiety and sort of expectatory fear in people that there's this chronic dizziness that develops.

Essentially, the hypothesis here is that the brain gets overstimulated and locks in a new unhelpful pathway, which can lead to continued physical symptoms long after the initial cause is gone.

To kind of conceptualize this, you can think of the brain as a city center.

There's neural pathways snaking through it like streets.

And once in a while, there's an accident or there's a construction project that creates some detours.

But with a functional disorder, it's almost like a worker forgets to take down these detour signs once the construction is done.

So even though the city's repaired, the cars keep driving along the detours.

Since there's no easy way to just take those signs down in the brain, the only way to treat functional disorders is often slowly, patiently retraining the brain to take the correct pathway.

And until the brain can get its traffic corrected, people with functional disorders can experience problems with movement, weakness in the limbs, or a whole host of other symptoms that sound a lot like Havana syndrome.

Fatigue, brain fog, dizziness, speech problem, vision problems.

It really can sometimes be quite a big list of symptoms that people are dealing with.

This is why some neurologists were surprised when the study from the University of Pennsylvania attributed Havana syndrome to a, quote, unknown energy source without including a functional disorder as a possible cause.

I think it should just be on the table and it should be on the table without assumptions that people seem to be making about it.

John Stone is a neurology professor at the University of Edinburgh in Scotland and runs a clinic for functional disorders.

If you came to my clinic in Edinburgh and sat in the room, you would watch me interview lots of people who've been nowhere near an embassy, who have persistent dizziness and cognitive problems, fatigue.

which means they have to leave their jobs.

After reading the pen study, he wrote a letter to the editor of the medical journal claiming functional disorders should be in the conversation.

To me, when I read about these patients, I'm reading about patients who are just people I would see every time I do a clinic.

These are not unusual illnesses.

But it's not like you can easily do a brain scan and just point to the functional disorder.

It's sometimes possible with something called a functional MRI, but they're most often diagnosed based on symptoms.

And it's very much a topic of active research.

It's really very poorly taught, if taught at all, at medical school.

But in the last 10 or 20 years, a sort of flowering of research in this area has helped to understand these disorders as ones that are the interface between neurology and psychiatry, where it is reasonable to talk about them as clinical brain disorders.

So here's how a functional disorder might have been involved with Havana syndrome.

Functional disorders are pretty common to start with.

John actually did a study which found that they're one of the most common diagnoses given by neurologists.

Then, diplomats might be especially susceptible because of the added stress that comes with life as a foreign official.

And then on top of that, they're hearing stories or reading reports about other officials being attacked by invisible weapons.

I think it is possible a lot of anxiety may be caused about the possibility of having a brain injury from a sonic attack, and that that concern is heightening people's vigilance for events that might be consistent with a sonic attack, and then symptoms that might be consistent with a sonic attack.

Basically, John is saying that there may have been no energy source at all.

Some have gone even further.

According to reporting from The New Yorker, the FBI initially concluded that this was all a mass psychogenic illness.

In a mass psychogenic illness, which is also sometimes called mass hysteria, the anxiety or the physical symptoms themselves are contagious, and they aren't already present in the general population.

And there have been examples of this throughout history.

Things like sudden, contagious outbreaks of laughter or fainting at schools.

But John says that while mass psychogenic illness could be understood as a type of functional disorder, he doesn't think there's enough evidence for Havana syndrome to qualify as a mass psychogenic illness.

Plus, this term carries some troubling connotations.

I personally don't use the word psychogenic because it suggests that the problem is all psychological.

When patients hear the word psychogenic, they think that's a doctor accusing me of imagining my symptoms or making them up.

But Douglas Smith, the pen neurologist who examined the Havana syndrome patients, he says that regardless of the explanation, the suggestion that there may have been no attack, it's been difficult for patients.

There became a debate out there from outside experts, quote unquote, who really upset the patients by just being absolutely certain that this was a kind of a mass psychogenic illness or some other psychological issue.

And they caused a lot of stress to these patients who felt they had a crazy story.

So who's going to believe them to begin with?

Douglas's team actually included tests specifically designed to show that Havana syndrome wasn't just psychological.

We had the equivalent of that knee-jerk test, you know, eye tracking and eye movements, and how your eyes converge as you move an object closer to the middle of your nose.

Somebody can't fake these, even if it's psychological, you can't create these types of neurological symptoms just out of thin air.

And the team later supported these tests with functional MRI results.

We selected a MRI sequence that takes a look at the connectivity of the brain and the areas that had loss of connectivity could account for the neurological symptoms that the patients displayed.

But John says this still doesn't rule out a functional disorder.

I agree with him that one can see changes in the brain and one can start to see changes on testing, but that's the case with functional disorders as well.

We may just need to rethink this seemingly hard division between what's neurological and what's psychological.

Neurological and psychological refer to the same organ.

And this is why it's so hard, I think, to report these things or help people get their head around them because everything is telling us that there are these two categories when I think neuroscience is telling us that there aren't.

These are disorders that are actually forcing us to have a whole new way of thinking about what is the brain, what is the mind.

Think of phantom leg syndrome, for example.

A soldier has their leg amputated, but the brain still believes it to be there, and they experience very distressing phantoms of the limb being there or it's painful.

Is that a psychological problem?

You wouldn't necessarily say so.

You would say, well, that's a kind of brain problem.

And in a sense, a functional disorder is kind of like reverse phantom limb syndrome.

The brain is functioning like something's wrong, even when nothing is structurally wrong.

But when it comes to applying this idea to Havana syndrome, it's just a hypothesis.

It's very different from actually examining patients.

The only people who are saying that this is primarily a psychological issue are people who have never examined the patients.

University of Pennsylvania neurologist Douglas Smith again.

Individuals who examine the patients believe that this is a neurological issue.

People from the outside feel very confident in their diagnosis of patients they have never seen.

I have never met any of these patients with Havana syndrome.

I do not know what they have.

My only interest in this is that I see functional functional disorders being thoroughly misrepresented.

I completely understand that what he's seeing in front of him are patients with genuine conditions, but that is not a reason to dismiss the possibility of functional disorders playing at least a part in what's happening.

A functional disorder is a genuine disorder, just as much as a brain injury.

I see this all the time in my clinical practice.

So I see people who have had minor head injuries.

They've had concussion symptoms for a while and then they gradually get worse because they develop a functional disorder and it becomes very harmful to them if they're caught in a medical system that's telling them this is all brain damage.

Now it's very validating for the patient but if they do have a functional disorder it's potentially very harmful because you're denying them the opportunity to consider treatment of their condition through other means.

Now, thinking of Havana syndrome as a functional disorder could mean that it wasn't caused by an outside energy source.

But at the same time, it doesn't necessarily rule out the possibility.

John is still open to the idea that an energy source could be part of the equation here.

Perhaps there is a sonic weapon.

If someone said that that has been built and it's possible to direct it, I would absolutely accept that.

But even if there is a sonic weapon, is it the case that some people had a sonic attack that affected their brain and then they improved again, whereas other people gradually got worse because they developed a functional disorder?

These are scientific hypotheses to be tested without dismissing out of hand because of someone's prejudice about what a functional disorder is.

This last idea that Havana syndrome could have been caused by an initial energy source and then it could have become chronic because of a functional disorder, John's not the only one suggesting it.

In late 2020, the National Academies of Sciences put out a report along the same lines.

But still, they equivocated and they said that other causes couldn't be ruled out.

Because the truth is that right now, there's still no way to definitively say what happened to these patients.

We can rely on imaging to an extent, but even that requires interpretation.

And that's largely because the brain is just absurdly, ridiculously complicated.

So in the end, we're left with a pretty giant unknown here.

We can locate that unknown outside the brain, but we can also locate it within the brain itself.

I don't understand how my brain works.

I don't understand how I do anything.

Science journalist Dan Hurley again.

Nobody understands how our brain works.

He's only slightly exaggerating.

How does your brain, right now, create the impression that you are here, that this is your body, that that's the clock on the wall, you know where you are, who you are.

Your brain is this incredible organ that creates your reality.

It creates your reality.

So maybe it's created a reality that isn't actually consistent with the physical body.

You know, we need to be humble in our appreciation of what we don't know about the brain.

This episode was produced and scored by Noam Hassenfeld.

There were edits from Meredith Hodenaught and Brian Resnick with some help from Daniel Gross and Julian Weinberger.

The mixing and sound design was done by Christian Ayala, and the fact-checking was done by me, Mandy Nguyen.

Special thanks to Adam Entis, Afim Shapiro, Julia Beloos, and Emily Sen.

Bert Pinkerton is very noisy, but not in a mysterious way.

Lauren Katz heads up by our newsletter, and Liz Kelly Nelson is the VP of Vox Audio.

You can sign up for our newsletter or read our articles or look at our show transcripts at vox.com/slash unexplainable.

Unexplainable is a part of the Vox Media Podcast Network, and we're taking next week to work on future episodes.

So, we'll be back in your feed on Wednesday, September 15th.

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