“Jerusalem Syndrome” Inspires Psychotic Breaks and Makes Visitors Paranoid

What is the ‘Jerusalem syndrome’?

We are sometimes overwhelmed by the ambience of a religious or historic site that we visit. Some of it may even persist with us in the form of fond memories¹. But what if someone becomes so engrossed in the symbolic importance of the location that they enter a psychotic state?

Jerusalem is one such city that has a holy and historical appeal for people of several faiths. It is the center of three major religions – Jewish, Christian, and Islamic – and has significant historical and political significance^1,2. While the wonder of the place may stay with many tourists visiting Jerusalem, for some the experience may trigger something new. This psychological phenomenon, known as “Jerusalem Syndrome,” involves psychotic episodes that visiting this historic city brings about in some people¹.

Prevalence and types^1,2,3

Since 1980, psychiatrists in Jerusalem have seen an increase in the number of tourists who arrive with psychotic decompensation. On an average, 100 such tourists are seen every year, with 40 of them requiring hospitalization. Between 1980 and 1993, nearly 1200 tourists with severe case of the syndrome were reported, among whom 470 were admitted to the hospital.

Table 1: Types of Jerusalem syndrome²

Delusions and psychosis are the hallmark of the condition. Disoriented tourists who become overwhelmed by the religious history of Jerusalem are spotted at different locations in the city. They may be seen at the Wailing Wall or seen experiencing some divine indulgence². More severe cases of people hearing angelic voices and following prophecies have also been reported¹. One such case that has become famous since being reported in 2017 is that of a young British man who reportedly rode through the Negev Desert in southern Israel and then vanished, leaving behind a trail of torn Bible pages and personal belongings. Investigators believe this to be triggered by delusions inspired by the Biblical story of Jesus going into the desert for 40 days and 40 nights³.

Causes

The majority of people who develop Jerusalem syndrome may already be suffering from a psychotic disorder or have had ultrareligious childhoods4. Other plausible causes include²:

• Change in travel routine, which has a significant impact on one’s mental state
• Unfamiliar surroundings, being in vicinity to foreigners or strangers that bring about a shift of culture
• The city’s special significance may contribute to an acute psychotic episode
• The ‘existential’ mode of travel²

Neuroscientists have even proposed that extreme devotion may involve an increasingly active “limbic system,” which is the center of our emotions⁵.

Symptoms

The seven clinical stages or symptoms of the Jerusalem syndrome are:

• Anxiety, discontent, nervousness, stress, and other similar emotions
• Intention of travelling to Jerusalem alone without a group or family
• Obsessive bathing and cleaning
• Preparing white toga-like gowns made of bedsheets
• The desire to scream or sing aloud hymns or Bible verses
• March or procession to holy sites
• Delivering a sermon, appealing to people to adopt a simpler way of life

Treatment²

It is usually recommended to physically remove the patient from Jerusalem and its holy sites. Returning the patient to the family might be helpful. A medical intervention is usually not required except administration of minor tranquillizers or melatonin. Psychotherapy may be indicated as part of the recovery process.

Conclusion

Visiting sacred cities such as Jerusalem can be psychologically disorienting for some people. It is therefore critical to consider the psychotic state of an affected individual, as an attempt to bridge the gap between the cause and treatment. Unfortunately, attempts to obtain information from patients have mostly been unsuccessful because patients are hesitant to divulge their experiences².

In the absence of a precise clinical definition, the Jerusalem syndrome will continue to be a controversial subject and is unlikely to appear in any psychiatric association’s handbook of mental disorders anytime soon.

References

1. Explained: What Is Jerusalem Syndrome? Why Some People Hear ‘Voices Of Angels’ [Internet]. IndiaTimes. 2022 [accessed 2022 Sep 19]. Available from: https://www.indiatimes.com/explainers/news/jerusalem-syndrome-559621.html
2. Bar-El Y, Durst R, Katz G, Zislin J, Strauss Z, Knobler H. Jerusalem syndrome. British Journal of Psychiatry. 2000;176(1):86-90.
3. What is Jerusalem syndrome? [Internet]. the Guardian. 2022 [accessed 2022 Sep 16]. Available from: https://www.theguardian.com/society/shortcuts/2018/jan/16/jerusalem-syndrome-psychiatric-condition-oliver-mcafee-british-tourist
4. HowStuffWorks, Science. How Jerusalem Syndrome Works [Internet]. HowStuffWorks. 2022 [accessed 2022 Sep 16]. Available from: https://science.howstuffworks.com/life/inside-the-mind/human-brain/jerusalem-syndrome.htm
5. Nast C. The Jerusalem Syndrome: Why Some Religious Tourists Believe They Are the Messiah [Internet]. WIRED. 2022 [accessed 2022 Sep 16]. Available from: https://www.wired.com/2012/02/ff-jerusalemsyndrome/