Beware the Travel Syndromes: Just How Many Symptoms Can Come About from Going Places?

January 15, 2018 § Leave a comment

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Have you every heard of “travel syndrome”? Me neither, until I saw a video circulated recently by Newsfare showing a distraught traveler in Qingdao, China. The man rushed off his train, which was stopped at a station, and tried to throw himself over a guardrail to the underpass below. He was spared injury when a policeman and two passengers caught him. The story accompanying the video says that the man had spent 40 hours on the train and was suffering from “travel syndrome,” defined as “a short-time psychotic disorder.” The man reportedly became calm after ten minutes.

I’m still not sure if travel syndrome is a real thing. Maybe there’s something going on with the translation. And maybe there was more to the man’s situation than just a long train ride. A more detailed video and story at CCTV+ doesn’t mention a syndrome but rather says that medical workers think that the man “might have had a hallucination which caused his physical disorders.”

(China.Recorder, “Police Grabs Man Jumping off Guardrails at Train Station,” January 1, 2018; “Police Officer Stops Hallucinated Passenger from Jumping off Railway Platform,” CCTV+, January 1, 2018)

But regardless of the accuracy, or lack thereof, of this gentleman’s diagnosis, there are such things as syndromes associated with travel. And I’m talking not just about made-up maladies, like “rude-tourist syndrome” or “lost-luggage syndrome.” No, these syndromes are real enough to garner serious discussion.

Economy-class syndrome
“Economy-class syndrome,” “second-class-travel syndrome,” and “cheap-airfare syndrome” are all names for deep vein thrombosis, or the formation of blood clots, in the legs, caused by lack of movement by passengers during long flights. Deep vein thrombosis is a real concern, especially if a clot detaches and gets lodged in the lungs (pulmonary embolism), a potentially fatal condition. But in an article at WebMD, the American College of Chest Physicians says that the risks are low for healthy travelers and that sitting in coach does not make the risks higher. Rather, it’s long stretches of immobility that cause the most problems, regardless of where your seat is located—though being trapped in a window seat can limit opportunities to move around.

(Salynn Boyles, “New Guidelines Debunk ‘Economy Class Syndrome,'” WebMD, February 7, 2012)

High-altitude syndrome
A brochure published by the Port Health Travel Centre of Hong Kong’s Department of Health says that high-altitude syndrome is caused by ascending to altitudes above 8,000 feet more rapidly than your body can acclimate. Symptoms begin with a mild headache and can progress to Acute Mountain Sickness—including a headache “similar to a bad hangover” plus nausea, fatigue, dizziness, or difficulty sleeping—High Altitude Cerebral Edema (fluid accumulating in the brain), and High Altitude Pulmonary Edema (fluid accumulating in the lungs). Without treatment, these last two conditions can result in death.

(“High Altitude Syndrome,” Port health Travel Centre, Department of Health, Hong Kong, 2005)

Culture-shock syndrome
You probably know what culture shock is, but adding syndrome after it sounds much more significant, especially with this definition from the Handbook of Psychiatric Education and Faculty Development:

a protean psychodynamic manifestation including mourning of the lost culture, severe anxiety in adapting to the new and consequent identity disturbances.

(Jerald Kay, et al., Handbook of Psychiatric Education and Faculty Development, American Psychiatric, 1999)

Time-zone-change syndrome
Likewise, jet lag has its own “syndrome” name, too. And here’s how time-zone-change (jet-lag) syndrome is described in the  International Classification of Sleep Disorders: Diagnostic and Coding Manual:

varying degrees of difficulties in initiating or maintaining sleep, excessive sleepiness, decrements in subjective daytime alertness and performance, and somatic symptoms (largely related to gastrointestinal function) following rapid travel across multiple time zones.

(American Academy of Sleep Medicine, International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual, American Academy of Sleep Medicine, 2001)

Chinese-restaurant syndrome
So with “gastrointestinal function” as a segue. . . . Not a few people complain of adverse physical reactions after eating food with monosodium glutamate (MSG), which is often used as a flavor enhancer in Chinese cuisine. I don’t think the label “Chinese-restaurant syndrome” is fair, not because I don’t believe in the negative effects of MSG (I’m not going to enter that debate), but rather because Chinese cuisine is far from the only food containing the additive. First introduced in Japan in 1908, MSG has since spread across Asia. But you don’t need to go overseas or even to an Asian restaurant to get your fill. MSG is found naturally in foods such as tomatoes and parmesan cheese; it’s added for flavor to products such as Doritos and Campbell’s Chicken Noodle Soup; and it’s in the recipes at KFC and Chick-fil-A.

Toxic-airline syndrome
“Toxic-airline syndrome” and “aerotoxic syndrome” are names given to symptoms that some believe are caused by breathing airliner cabin air that is contaminated with engine lubricants or noxious fumes. There is disagreement as to the potential dangers:. On the one hand is the UK’s Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT), which states that a valid explanation for the illnesses is that they are manifested in people who perceive cabin air to be hazardous. This is called the “nocebo effect,” as opposed to the “placebo effect.” But on the other hand are those who believe long exposure, such as by flight crew or frequent fliers, has led even to the deaths of their loved ones. Regardless, most agree that the issue is serious enough to warrant further investigation.

(Kate Leahy, “There Are Hundreds of Sick Crew’: Is Toxic Air on Planes Making Frequent Flyers Ill?” The Guardian, August 19, 2017; “Position Paper on Cabin Air,” Committee on Toxicity, 2013)

Airport-assault syndrome
A 1982 issue of The BMJ (formerly British Medical Journal), contains a short article on “airport-assault syndrome.” Those were simpler times, and the assault referenced there isn’t concerning terrorism. Instead it’s the “plague” of luggage trolleys running into the Achilles tendons of innocent passersby. The authors suggest developing shorter, more easily maneuverable trolleys or pulling, rather than pushing, them as ways to “prevent many travelers from grievous bodily harm at the hands of unsuspecting charioteers.”

(Michael Heim, et al., “The Airport Assault Syndrome on the Increase,” The BMJ, December 23, 1989)

Airport syndrome
Sometimes the syndromes are not a result of travel, but traveling, or attempting to travel, is a manifestation of previous disorders. “Airport syndrome,” as referenced in the BJPsych Bulletin, is characterized by “airport wandering,” when “travel to the airport [is] in some way a product of [psychotic] illness.”

Jet-set Munchausen syndrome
The same BJPsych Bulletin article also cites a case of Munchausen syndrome that took place on a plane, causing the flight to be diverted. Munchausen syndrome is a mental disorder in which a person repeatedly pretends to be sick even though the illness is not real. In this “jet-set” case, it happened to occur on a plane.

(Harvey Gordon, et al., Air Travel by Passengers with Mental Disorder,” BJPsych Bulletin, July 30, 2004)

Florence Syndrome, et al.
And then there is a small atlas of syndromes named after travel destinations that overwhelm visitors, with symptoms including anxiety, disorientation, dizziness, fainting, and even convulsions and hallucinations—sometimes leading to hospitalization.

Florence syndrome is also called Stendhal syndrome—after the French author who reported his reaction to visiting Florence in 1817—and can apply to visiting any destination with cultural and artistic significance.

Paris syndrome, most often experienced by Japanese tourists, comes about when the reality of Paris does not meet the romanticized expectations of the visitors. Jerusalem syndrome involves religious delusions or obsessions caused by travel to the city. And India syndrome is a set of psychotic symptoms experienced by outsiders coming to the country on spiritual journeys.

In his book A Death on Diamond Mountain, Scott Carney includes a simple cure for India syndrome, given by Kalyan Sachdev, the medical director of New Delhi’s Privat Hospital: a trip home. “[Y]ou put them on the plane,” Sachdev says, “and they are completely all right.”

(Scott Carney, A Death on Diamond Mountain: A True Story of Obsession, Madness, and the Path to Enlightenment, Penguin, 2015)

Post-travel syndrome
But is going home the answer to travel woes? Though it’s not officially recognized, I’ll include “post-travel syndrome” here because so many people talk about it and claim to experience it. Also called “post-travel depression,” it’s the emotional low one gets after returning from a trip. But as Dr. Sebastian Filep of the University of Otago’s Department of Tourism tells NBC News, “The idea of post-travel depression is largely a myth.” In the same report, Jeroen Nawijn, of the Centre for Sustainable Tourism and Transport, who has studied vacationing’s effect on mood, says he’s “found no proof of post-travel depression,” and labels it “not a legitimate mental health issue.”

And yet it can feel so real.

(Dana McMahan, “Do Well-needed Vacations Actually Bum Us Out?NBC News, May 9, 2013)

So, in light of all this, should we just stay home and never venture beyond the confines of our immediate locales? I guess that’s one solution, but be warned. That would mean giving up on all that can be gained from seeing the world and expanding our horizons. And if you let your concerns about travel consume you, you run the risk of suffering the incapacitating effects of treksyndraphobia syndrome—the fear-of-travel-syndromes syndrome.

Yeah, I made that one up.

(Mike Robinson and David Picard, eds., Emotion in Motion: Tourism, Affect and Transformation, Routledge, 2012)

[photo: “Stranded in Madrid,” by Daniel Gasienica, used under a Creative Commons license]

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