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What do we know About Jerusalem Syndrome? And what remains a mystery?

10 Insights on Psychosis in the Holy City Jerusalem




Jerusalem is an amazing city, Between its compressed history, politics, and spirituality, Jerusalem evokes a deep sense of sanctity and is, therefore, a huge attraction, especially for people who hold a religious faith - Jews, Muslims, and Christians.


When tourists visit Jerusalem, they do not usually meet our modern capital as it is today. More than once they imagine the biblical city, sacred and religious, for all its spiritual potential.




What is Jerusalem Syndrome?

Jerusalem Syndrome is manifested in an acute psychotic condition observed in tourists and pilgrims visiting Jerusalem. The main symptom of the syndrome is identification with a biblical figure and demonstration of behaviors that are characteristic of this figure.


Even as Israelis and even Jerusalemites, one can connect to the idea that Jerusalem has extraordinary spiritual powers.



There is such a thing as Jerusalem Syndrome, and there are even studies Beginning in the early 1980s, psychiatrists and psychologists began to notice a growing number of tourists from around the world, who during their visit to Jerusalem suffered an outbreak of a psychotic episode.

Because of the high prevalence of the phenomenon, it was decided to refer all cases to one medical center:

Kfar Shaul, where the contestants met with psychiatrists and psychologists. Today, the village's activities are integrated with the Eitanim Center, and the two units together are called the Jerusalem Center for Mental Health.

In fact, during 13 years (1980-1993), 1,200 candidates suffering from the Jerusalem Syndrome were referred to Kfar Shaul, 470 of whom were hospitalized.

On average, to date, about 100 patients are referred there each year, about 40 of whom need psychiatric hospitalization.

Based on clinical experience, 3 main groups of patients with Jerusalem syndrome were identified:


1. Visitors with previous psychotic episodes.


2. People with previously diagnosed mental disorders and the visit ignited a psychosis in them.


3. Tourists without any background of mental problems.



Even "normal" people can go crazy in Jerusalem


What is Pure Jerusalem Syndrome?

Cases in which normative people get into a psychotic episode in Jerusalem are perhaps the most fascinating. They treat tourists without a history of mental disorders, who usually recover spontaneously (without treatment) and seem to enjoy a normal return to a healthy routine after leaving Israel. This group is called the "pure type" of Jerusalem syndrome.


Statistically, this group is less common among the cases of the syndrome: from 1980 to 1993 only 43 cases were diagnosed in this category.


This group of contestants has 3 main criteria for diagnosis


1. A person has no history of illness or mental disorders, does not suffer from significant functional or work problems, and does not use drugs. That is a person who can be defined as a "healthy" person.

2. Arrived in Jerusalem as a tourist who came to travel, without a mission or a specially planned goal. This is usually a person who comes with family, and friends, or on an organized trip with a group of tourists.

3. Upon arrival in Jerusalem, an acute psychotic reaction erupts, which develops consistently over a sequence of 7 stages:


Anxiety, irritability, and stress, plus other unreported reactions.


A declared desire to get away from family and friends and walk around the city alone. By the way, tour guides in Jerusalem are well aware of the syndrome and its signs. They will usually refer the contestant at this stage to Kfar Shaul for observation to prevent escalation and aggravation.


Symptoms of OCD - Obsessive-compulsive disorder, need to cleanse, wash and compulsively take nails

Preparation of white toga (long dress), usually with the help of the hotel sheets.

Need to scream, or at least sing aloud, hymns or verses from the Bible. Such revelations can also serve as warning lights for tour guides and hotel staff.

A procession or parade to one of the holy places in Jerusalem.

Delivering a "sermon" in a holy place - a sermon is usually very confused and based on not the most rational arguments. But the message is positive: it appeals to humanity and seeks to adopt a healthier, more moral, and simpler lifestyle.


 Recovery - time does its thing and fast

What is the course of the disease typical of Jerusalem Syndrome?

Patients with no previous mental background do not usually experience hearing or vision hallucinations (hallucinations), they always know exactly what their true identity is and do not think they are "another person".

They do ask, however, not to be hindered in carrying out their mission. They usually return to the beneficiary after five days to a week.

In other words, they experience a transient episode and fully recover. Although they definitely need psychological intervention and also usually receive it, recovery usually occurs naturally and is not directly attributed to the effect of the treatment.



Far from the eye, far from the heart

Experience shows that improvement usually involves physically removing the patient from Jerusalem.

As mentioned, no significant medical intervention is indicated in the treatment of sufferers of the syndrome, and sedatives or melatonin are provided.


The main treatment strategy is usually accessibility to return to a safe group or renewal of family ties, or if necessary, referral to a pastor (we will get to the religious characteristics of the contestants).

Psychotherapy which includes intervention in a crisis is also an important part of recovery.


After recovery, patients usually remember every detail of their behavior.


It is not a simple story and inevitably they are ashamed of what happened or feel stupid, embarrassed, and full of remorse.


They will often describe their behavior as reminiscent of drug addicts or clowns.


There needs to be someone who will attack the feelings of shame, the difficulty, and the desired progress to get life back on track.



A feeling that "something is opening inside me"


How do those dealing with Jerusalem Syndrome feel?

Recoverers from Jerusalem Syndrome are not happy to describe the inner experience they went through and therefore there is a difficulty in gaining a deeper understanding of it.

Those who do share describe a feeling, that "something opens up within them" and that their body movements move them outwards…

After this feeling, an understanding arises in them that they must act and convey a message to us an unparalleled important message.

Isn't it amazing that there is a uniform pattern here?



It all begins with Luther's revolution, The vast majority of those dealing with Jerusalem Syndrome are Protestant Christians.

All Protestants dealing with the syndrome came from "ultra-religious", fundamentalist families, in which the patriarch believes that the Bible is the ultimate source of problem-solving (even those that are not solvable).

Psychologically, it is possible that an ideal representation of Jerusalem was built here as the Holy City, the city of Christ, the city of the resurrection.

It can be assumed that when they come to Jerusalem, those dealing with the syndrome fail to properly reconcile the internal gap between the unconscious image of Jerusalem and the reality outside.

One can present the psychotic state and in particular, the need to preach to others and convey a universal message to humanity, as an attempt to bridge the gap between these two representations of Jerusalem.

To arrive at empirical research results, the researchers of the phenomenon located samples of recoverers from Jerusalem Syndrome.

They asked them to fill out questionnaires and conduct structured telephone interviews, but the results were disappointing - the patients only thanked them for the treatment they had received in the past and were not interested in talking about the Jerusalem Syndrome experience.

Lots of question marks.

Deciphered ...


 Other places in the world can derail you


Do psychotic syndromes also occur in other cities around the world?


There is and there is.

There is quite a bit of documentation about hysterical or psychotic revelations related to unique places of spiritual value:

The city strikes in Saudi Arabia for example, or religious temples in India.

There are also non-religious conditions, such as Stendhal syndrome, also known as Florence Syndrome.

People with the syndrome present with a mental manifestation very similar to the Jerusalem Syndrome.

They experience an acute psychotic attack that erupts among art lovers visiting Florence (the syndrome is named after a French writer, who reported feelings of De Ja Vu and restlessness, after an in-depth look at art objects in the city).


According to Magrini, who first identified the syndrome, the psychotic response is usually associated with a latent or creeping mental disorder that manifests itself in response to paintings of battles, or other masterpieces, and reaches its peak in the eruption of the stand.

So sometimes we probably need more sublimation to stay in the line of sanity…

And yet, the proportion of contestants points to Jerusalem Syndrome as a unique phenomenon that deserves thorough evaluation.



Freud also had the syndrome, Only it happened in the Acropolis in Greece

Several explanations have been suggested to explain the psychotic attack among travelers.

Some of them suggest that changing the routine involved in traveling, affects the mental state considerably.

Flynn and China suggested several causes for Jerusalem Syndrome:


1. Unfamiliar environment


2. Proximity to strangers


3. Lack of activity


4. A feeling of loneliness


5.Intercultural conflict


These factors are further amplified in the context of Jerusalem's significance to the various religions and thus may trigger a psychotic attack.

According to Cohen, and the theory he wrote about the five states of travel, the "existential state," the fifth state, describes a journey to a spiritual center and constitutes a modern metamorphosis of pilgrimage.

Freud also reported a dissociation experience when he visited the city of Acropolis in Greece. The possibility of having a common, in the context of the syndrome, between certain places and Jerusalem should not be ruled out.


There are many examples of "aviation", or aviation syndrome, a rare condition in which tourists get lost at an airport and experience a psychotic episode.


Well, there's something a little delusional about airports. Some argue that they symbolically represent "pre-existent experiences."


And yet, unlike the Jerusalem Syndrome experience, people who experience "dissociative aviation syndrome" fly there completely - they temporarily forget their identity and are unaware of where they are coming from and where they are going.

As with Jerusalemites, recovery from this syndrome is usually spontaneous (without treatment) and requires minimal assistance, such as a good night's sleep and a few hours of rest.


To Meir Ariel, the doctors recommended, when he was released, a monthly visit to the airport :-):



The creative falls between the cracks

Some people have suffered from the syndrome after being previously diagnosed with a mental disorder, such as a schizotypal personality disorder, with an obsession or fixation but do not have a clear diagnosis of a mental disorder. Their strange thoughts and ideas fall short of delusions.

Many of those suffering from Jerusalem Syndrome are included in this type.

They can be seen in groups, and public places (especially in holy places), and they occasionally appear in the media, but they usually refrain from seeking professional psychiatric help.


They can be divided into two:


Belong to the group: Christian groups located in Jerusalem and the surrounding area, united around the idea of ​​the resurrection of the dead or the resurrection of Christ. The members of the group wear strange and unique clothes, which they claim are similar to the style of dress in the days of Christ. There are also Jewish groups in this style: for example, a group trying to create a red cow just like in the Bible. These people are usually not hospitalized, as they are not dangerous to the public, or breaking the law. Only 3 people from this group were hospitalized, by court order, following Violent confrontations with neighbors, all three were diagnosed with a personality disorder.


Individuals: A German tourist who has not been diagnosed before, and is not recognized as suffering from a mental problem, has developed an obsession with finding the "true religion". He spent years studying religions: various streams of Christianity, Chinese, Japanese, etc. but was unable to choose any of them as the true religion. Then he left his job, went to Jerusalem, and began studying Judaism at university and yeshiva. But even in Judaism, he did not find his consolation - it was not the true religion for him. At the end of the process, he concluded that ancient Christianity is the truth and there is no end to it. This opened the way for the preaching of the truth to the residents of Jerusalem. In one of the speeches, he came to the church and started shouting at the priests there, that they were pagan and that they were destroying and desecrating the religion ... The shouts developed into a violent event and our informants even started destroying paintings and statues. By court order, he was referred to Kfar Shaul. Surprisingly, the psychiatrists who treated him were unable to indicate a mental disorder, even when the case recurred after 3 years.



Tourists who have suffered from Jerusalem Syndrome and have suffered from psychosis in the past

These are tourists who were previously diagnosed with psychosis, even before they visited Israel.


The motivation to come to Israel was directly related to their mental state and the influence of religious ideas.

They often came to a psychiatric examination in Kfar Shaul following delusions (false thoughts that are inconsistent with reality), begging them to come to Jerusalem and "do something there."


This group can be divided into four sub-types:


1. Psychotic identification with biblical figures - People of this type strongly identify with figures from the Bible or the New Testament (depending on whether they are Jews or Christians) or believe that they are these figures.

2. Men will usually identify with male figures, while women will identify with female figures.

An article on the Jerusalem Syndrome documents an American tourist who suffered from paranoid schizophrenia, who as part of his rehabilitation began working on body image, healthy eating, and exercise.

As time went on he began to identify himself with a relevant biblical figure. Who?

The hero Samson of course.

Eventually, a disturbing urge arose in him to ascend to Jerusalem to move one of the stones, which in his opinion was not placed at the right angle.

During his brave attempt to move the stone (Sela, to be exact) police were called and he was hospitalized at the Kfar Shaul Mental Health Center.

Contrary to popular practice, psychiatrists there tried to argue with his delusions and prove to him that he was not Samson, and he responded with unbridled rage, to the point of smashing objects and escaping from the hospital.

Only after receiving antipsychotic medication did he calm down and was able to fly home accompanied by his father.


Psychotic identification with an idea

Patients of this type identify with a political or religious idea and come to Jerusalem to work to realize the idea.

The article provides a case study of a Protestant from America who deeply identified with the idea of ​​destroying holy places for Muslims to replace them with holy places for Jews.

The second phase of his plan was, no less and no more, to ignite the Gog and Magog war. He managed to provoke quite a stir in one of the sites sacred to Islam. When he was hospitalized, a psychiatrist diagnosed him as irresponsible for his actions.


"Magical ideas" about the connection between health and a sacred place, People of this sub-type attribute healing powers to Jerusalem.

It is interesting to note that the famous Russian writer Gogol after psychosis ended his writing career, experienced a revelation, in which he was told that he would do well to visit Jerusalem and pray there in the holy places so that he could recover and return to writing again.

He did arrive in Jerusalem, years later, but starved himself to death.


Family problems that reached their peak in Jerusalem

This sub-type refers to people whose mental state is expressed in the context of family problems.

This type is problematic because, under the influence of psychosis, it is usually impossible to discover the main meaning of Jerusalem for the patient and his motivation to visit Jerusalem.

And yet, we see that in any case, they continue to ascend again and again to the Holy City, while they develop a complex psychosis.

The article brings a case of an African-American man suffering from bipolar disorder, who came to Jerusalem 4 times and each time experienced a psychotic manic attack that caused him to be hospitalized.

The man claimed to have come to Jerusalem to kill the man who raped his daughter (apparently referring to her husband).

His family would have notified the authorities in advance of his arrival and as a result, he was hospitalized.

After being treated he was able to show a certain level of insight, recognize that he experienced a share, and admit that he respects his son-in-law.

His therapists described this as an oedipal conflict experienced during the manic episodes, but the connection to Jerusalem and the shaking to it to solve an imaginary problem remains unclear.


What did we learn?

First of all, Jerusalem Syndrome is a unique psychiatric phenomenon, typical of those who visit here.

Second, it is important to become more familiar with psychopathology that is based on proximity to holy places, because early detection and intervention may stop and regulate the severity of a psychotic episode.

Finally, comprehensive knowledge of the religious-cultural background and beliefs of contestants is an essential part of crisis intervention.




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