Jerusalem syndrome

The Jerusalem syndrome is a group of mental phenomena involving the presence of either religiously themed obsessive ideas, delusions or other psychosis-like experiences that are triggered by, or lead to, a visit to the city of Jerusalem. It is not endemic to one single religion or denomination but has affected Jews and Christians of many different backgrounds.
The best known, although not the most prevalent, manifestation of the Jerusalem syndrome is the phenomenon whereby a person who seems previously balanced and devoid of any signs of psychopathology becomes psychotic after arriving in Jerusalem. The psychosis is characterised by an intense religious theme and typically resolves to full recovery after a few weeks or after being removed from the area. 
The religious focus of the Jerusalem syndrome distinguishes it from other phenomena, such as the Stendhal syndrome, which is reported in Florence, Italy, or the Paris syndrome, which has been reported predominantly in Japanese individuals.
Dr. Yair Bar El et al. claimedBar-el Y, Durst R, Katz G, Zislin J, Strauss Z, Knobler HY. (2000) Jerusalem syndrome. British Journal of Psychiatry, 176, 86-90. Full text that there is a specific syndrome which emerges in tourists who have no previous psychiatric history. However, this has been disputed, especially by Dr. Moshe Kalian and Prof. Eliezer Witztum.Kalian M, Witztum E. (2000) Comments on Jerusalem syndrome. British Journal of Psychiatry, 176, 492. Full textKalian M, Witztum E. (1999) The Jerusalem syndrome"—fantasy and reality a survey of accounts from the 19th century to the end of the second millennium. Isr. J. Psychiatry Relat Sci., 36(4):260-71. Abstract They stressed that nearly all of the tourists who demonstrated the described behaviours were already mentally ill prior to their arrival to Jerusalem. Further, of the small proportion alleged to have exhibited spontaneous psychosis after arrival in Jerusalem, there was no evidence presented that they had previously been well.
Jerusalem Syndrome is not listed or referenced in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, published by the American Psychiatric Association. The DSM does list Delusional Disorder, 297.1, with a subtype category of Grandiose Type which may share several features of or otherwise encompass Jerusalem Sydrome if symptoms last one month or more. One possible related feature of Delusional Disorder Grandiose Type is a criteria of a delusion of having some special relationship with a deity, such as receiving messages from God or being an agent of God. Delusional Disorder, Grandiose Type, is often noted for onset late in life for people with no history of delusions or mental health issues. An affected individual will likely function quite normally outside of interaction and discussion directly related to the delusion.
==History==
It was previously regarded as a form of hysteria, referred to as "Jerusalem squabble poison," or fièvre Jerusalemmiene.Elon, Amos.Jerusalem, City of Mirrors. Little, Brown, 1989, p. 147. It was first clinically described in the 1930s by Jerusalem psychiatrist Heinz Herman and pertains to behaviors exhibited by some visitors to Jerusalem. Whether or not these behaviors specifically arise from visiting Jerusalem is debated, as similar behaviors have been noted at other places of religious and historical importance such as Mecca and Rome (see Stendhal syndrome). It is known that cases of the syndrome had already been observed during the Middle Ages, since it was described in the itinerary of Felix Fabri and the biography of Margery Kempe. Other cases were described in the vast literature of visitors to Jerusalem during the 19th century.
One case often mentioned in relation to the syndrome occurred in 1969, when an Australian tourist, Denis Michael Rohan, overwhelmed with a feeling of divine mission, set fire to the al-Aqsa Mosque. His act was followed by citywide rioting. These events helped form the premise of a movie called The Jerusalem Syndrome.Traveller interview
Bar-El et al. suggested that at the approach of the year 2000, large numbers of otherwise normal visitors might be affected by a combination of their presence in Jerusalem and the religious significance of the millennium, causing a massive increase in the numbers of Jerusalem syndrome admissions to hospital. Despite a slight increase in tourist hospitalisations with the rise in total tourism to Jerusalem during the year 2000, the feared epidemic of Jerusalem syndrome never materialised.
==Types==
The classic Jerusalem syndrome, where a visit to Jerusalem seems to trigger an intense religious psychosis that resolves quickly or on departure, has been a subject of debate in the medical literature.Fastovsky N, Teitelbaum A, Zislin J, Katz G, Durst R. (2000) Jerusalem syndrome or paranoid schizophrenia? Psychiatric Services, 51 (11), 1454. Full text Most of the discussion has centered on whether this definition of the Jerusalem syndrome is a distinct form of psychosis, or simply a re-expression of a previously existing psychotic illness that was not picked up by the medical authorities in Israel.
In response to this, Bar-El et al. classified the syndrome into three major types to reflect the different types of interactions between a visit to Jerusalem and unusual or psychosis-related thought processes. However Kalian and Witztum have objected, saying that Bar-El et al. presented no evidence to justify the detailed typology and prognosis presented and that the types in fact seem to be unrelated rather than different aspects of a syndrome.
===Type I===
Jerusalem syndrome imposed on a previous psychotic illness. This refers to individuals already diagnosed as having a psychotic illness before their visit to Jerusalem. They have typically gone to the city because of the influence of religious ideas, often with a goal or mission in mind that they believe needs to be completed on arrival or during their stay. For example, an affected person may believe himself to be an important historical religious figure or may be influenced by important religious ideas or concepts (such as causing the coming of the Messiah or the second coming of Christ).
===Type II===
Jerusalem syndrome superimposed on and complicated by idiosyncratic ideas. This does not necessarily take the form of mental illness and may simply be a culturally anomalous obsession with the significance of Jerusalem, either as an individual, or as part of a small religious group with idiosyncratic spiritual beliefs.
===Type III===
Jerusalem syndrome as a discrete form, uncompounded by previous mental illness. This describes the best-known type, whereby a previously mentally balanced person becomes psychotic after arriving in Jerusalem. The psychosis is characterised by an intense religious character and typically resolves to full recovery after a few weeks or after being removed from the locality. It shares some features with the diagnostic category of a "brief psychotic episode", although a distinct pattern of behaviours has been noted:
# Anxiety, agitation, nervousness and tension, plus other unspecified reactions.
# Declaration of the desire to split away from the group or the family and to tour Jerusalem alone. Tourist guides aware of the Jerusalem syndrome and of the significance of such declarations may at this point refer the tourist to an institution for psychiatric evaluation in an attempt to preempt the subsequent stages of the syndrome. If unattended, these stages are usually unavoidable.
# A need to be clean and pure: obsession with taking baths and showers; compulsive fingernail and toenail cutting.
# Preparation, often with the aid of hotel bed-linen, of a long, ankle-length, toga-like gown, which is always white.
# The need to shout psalms or verses from the Bible, or to sing religious hymns or spirituals loudly. Manifestations of this type serve as a warning to hotel personnel and tourist guides, who should then attempt to have the tourist taken for professional treatment. Failing this, the two last stages will develop.
# A procession or march to one of Jerusalem's holy places.
# Delivery of a sermon in a holy place. The sermon is usually very confusing and based on a plea to humankind to adopt a more wholesome, moral, simple way of life.
Bar-El et al. reported 42 such cases over a period of 13 years, but in no case were they able to actually confirm that the condition was temporary.
==Prevalence==
During a period of 13 years (1980-1993) for which admissions to the Kfar Shaul Mental Health Centre in Jerusalem were analysed, it was reported that 1,200 tourists with severe, Jerusalem-themed mental problems were referred to this clinic. Of these, 470 were admitted to hospital. On average, 100 such tourists have been seen annually, 40 of them requiring admission to hospital. About two million tourists visit Jerusalem each year. Kalian and Witztum note that as a proportion of the total numbers of tourists visiting the city, this is not significantly different from any other city.Tannock C, Turner T. (1995) Psychiatric tourism is overloading London beds. BMJ 1995;311:806 Full Text
==References in popular culture==
*Artist Nathan Coley exhibited a piece of video artwork entitled Jerusalem Syndrome, which included two films shot in Jerusalem. The films are played simultaneously and contrast an interview with Dr. Moshe Kalian, the current District Psychiatrist of Jerusalem, discussing the syndrome, and affected individuals, with shots of worshipers at the Western Wall, the Church of the Holy Sepulchre and the Temple Mount.
*The X-Files episode "Revelations" features a character who Fox Mulder and Dana Scully believe suffers from Jerusalem syndrome.
*The syndrome figures in the plot of critically noted author Robert Stone's 1998 novel Damascus Gate. 
*A film named Jerusalem Syndrome, directed by Erin Sax, depicted a fictionalised version of events that led Michael Rohan, an Australian tourist, to set fire to the al-Aqsa Mosque in 1969.
*Eitan Gorlin wrote and directed another film titled The Jerusalem Syndrome in 1999.
*Journalist Louis Theroux did a segment about the syndrome on Michael Moore's TV Nation.
*In Abel Ferrara's Mary, the character played by Juliette Binoche becomes obsessed by Mary Magdalene during the production of a movie set in Jerusalem.
*The Israeli author Joshua Sobol wrote a play named The Jerusalem Syndrome in 1988.
*American stand-up comedian Marc Maron authored a book entitled The Jerusalem Syndrome: My Life as a Reluctant Messiah in 2001.
== See also ==
* Jewish eschatology
* Christian eschatology
* Messiah complex (self-concept)
* Millennialism
* Stendhal (or Florence) syndrome
* Paris syndrome
* Mean world syndrome
* Apocalypticism
==References==
* Kalian, M.; Catinari, S.; Heresco-Levi, U.; Witztum, E. "Spiritual Starvation in a holy space – a form of Jerusalem Syndrome", Mental Health, Religion & Culture 11(2): 161-172, 2008.
* Kalian, M.; Witztum, E. "Facing a Holy Space: Psychiatric hospitalization of tourists in Jerusalem". In: Kedar, Z.B.; Werblowsky, R.J., Eds.: Sacred Space: Shrine, City, Land. MacMillan and The Israel Academy of Sciences and Humanities, 1998. 
* Kalian, M.; Witztum. E. "Jerusalem Syndrome as reflected in the pilgrimage and biographies of four extraordinary women from the 14th century to the end of the 2nd Millennium". Mental Health, Religion and Culture 5, 2002.
* Van der Haven, A. "The holy fool still speaks. The Jerusalem Syndrome as a religious subculture". In: Mayer, T.; Mourad, S.A., Eds.: Jerusalem. Idea and Reality. Routledge, 2008, pp. 103-122.
* Witztum, E.; Kalian, M. "The Quest for redemption: Reality and Fantasy in the Mission to Jerusalem". In: Hare, P.A.; and Kressel, G.M., Eds.: Israel as Center Stage. Bergin and Garvy, 2001.
==External links==
* Article from Project X Magazine
* Jerusalem Syndrome -Article by Ron Peled - www.feeljerusalem.com
Category:Culture-specific syndromes
Category:Messianism
Category:Psychosis
Category:Religious behaviour and experience
Category:Syndromes
ca:Síndrome de Jerusalem
cs:Jeruzalémský syndrom
da:Jerusalem-syndrom
de:Jerusalem-Syndrom
fr:Syndrome du voyageur
it:Sindrome di Gerusalemme
he:סינדרום ירושלים
nl:Jeruzalem-syndroom
pl:Syndrom jerozolimski
pt:Síndrome de Jerusalém
ru:Иерусалимский синдром
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