How Jerusalem Syndrome Works

Samson is a Biblical character known for his superhuman strength -- the Hercules of the Old Testament. A middle-aged American decided that he himself was actually Samson. The modern-day strongman got an idea that part of the Western Wall needed to be moved. He spent time bodybuilding and came to Israel to move it. After a skirmish with authorities, he landed in a psychiatric hospital.

While at the hospital, one of the mental health professionals inadvisedly told the man that he was not, in fact, Samson. "Samson" smashed through a window and escaped the hospital. A nurse found him at a bus stop and praised his Samson-like strength, at which point he cooperated.

There's also the Virgin Mary, or a woman who thinks she's the Virgin Mary. Every day, she walks to the Church of the Holy Sepulchre, and every day she sobs at the altar of Golgotha, mourning the death of her son, Jesus. There's another Virgin Mary who invited everyone to her son Jesus' birthday party in Bethlehem. Israeli police come across multiple John the Baptists running around in animal skins, wanting to baptize people.

According to Dr. Yair Bar-El, these are the symptoms of Jerusalem Syndrome:

Tour guides in Jerusalem watch for these first two symptoms: Agitated, tense people who fall behind the group and want to go off alone should be observed carefully. Once they get to the bed sheet stage, there's no stopping them.

"Samson" also happened to be a paranoid schizophrenic. So what's the back story of your average person with Jerusalem Syndrome?

The majority of the people (about 80 percent) who get Jerusalem Syndrome have some form of mental illness [source: Kezwer, Lee]. They may already have some form of psychotic disorder -- "Samson" falls into this group -- or they may have some sort of personality disorder or fixation.

A large percentage of the people in this group are Jewish, some are Christian and very few are Muslim. Local residents fall into this group as well. Jews with the syndrome tend to identify with Old Testament figures, Christians with the New Testament. Men identify with male characters and women with female characters.

But the most interesting group is also the smallest group -- the people with no history of mental illness, who come to Jerusalem, come down with the symptoms of Jerusalem Syndrome and recover quickly. Some experts claim that this group doesn't exist, that no one without some sort of disorder spontaneously suffers a psychotic episode like this. But others disagree.

Who gets this type of Jerusalem Syndrome? Men and women seem to get the syndrome in equal numbers, although some estimates skew the number toward men. The majority of people who get the syndrome are:

Reports indicate that people who come down with Jerusalem Syndrome had very religious childhoods, but renounced their religion sometime during adolescence or young adulthood. So what they expect when they come to Jerusalem is how they pictured Jerusalem as children, not a bustling modern city.

Why is it that Protestant Christians from the United States are the most susceptible to being overcome by this sudden religious fervor? Bar-El has suggested that they're more susceptible because unlike Jews or Catholics, who have rituals, traditions and an intermediary to the divine (like a priest), Protestants connect directly to God [source: Lee]. Rituals may serve as something to ground a person -- the person can connect to God, but in a safe, prescribed manner, in a way that has parameters.

Why the United States, Canada and parts of Western Europe? Maybe because religion has an uncertain place in the Western world today. Think of watching the news: On one hand, you hear about religious extremists carrying out suicide bombings in the name of a higher power. On the other hand, you hear about skirmishes over labels on textbooks denouncing evolution or whether you can say "Christmas" in a school newsletter. It seems to be a question of scale, and the modern, Westernized world doesn't know quite where to put its beliefs. For someone who grew up devout and steeped in the word of God, the world today doesn't match up to the tenets of the Bible. Perhaps he or she thinks that a return to the roots of the religion will be a return to purity and simplicity.

For some people, a visit to Jerusalem turns their world upside down. But is Jerusalem Syndrome even real? Or is it just some disappointed people going a little batty on their Mediterranean tour?

We've established that many people with Jerusalem Syndrome have a history of mental illness. For them, Jerusalem Syndrome is an extension of their illness. If you're already mentally ill, you might tend to fix your ideas on a certain subject. It could be UFOs, it could be conspiracy theories -- it might as well be Jerusalem and a return to purity. For these people, Jerusalem is a culturally and historically symbolic place to attach one's delusions and ideas to.

So we can conclude that in these cases, Jerusalem Syndrome is not a particular defined abnormality -- it's a symptom of a larger condition. But what about Jerusalem Syndrome proper, the disorder that occurs in people whose mental health is sound?

People with the syndrome proper generally aren't ranting and raving like mad people. They're anxious and even worried -- "What if I'm the Messiah?" "What if I am pregnant with the Messiah?" "What will I do?" They're polite. They describe their experience as being disorienting and somewhat like being intoxicated. They don't hallucinate. They know who they are ("I know I'm Joe Smith, but what if Joe Smith is the Messiah?"). They remember the details of their experience and are ashamed and reluctant to discuss them. They say that they felt something opening up within them [source: Bar-El].

Experts well-versed in Jerusalem Syndrome don't believe that it's a true psychosis. It's a reaction to a place, a reaction that comes from one's deepest self.

Eliezer Witztum, a professor of psychiatry, described this group of people as pilgrims instead of tourists. People on vacation are leaving their lives behind -- they move away from the center of themselves to a more remote place, both physically and emotionally. What we want when we go on vacation is to forget the things that anchor us. Pilgrims travel toward the center of their world, the core of it, instead of moving away from it. It's this nearness to the center of their lives, this deep well of meaning, that leads to an experience these people can't quite grasp. It's simply too much for them [source: Lee].

So does Jerusalem cause delusions? Not quite. You could say that the city is a catalyst for an intense reaction in people predisposed by their religious background to have such a reaction.

Of course, some doctors think that the idea of Jerusalem Syndrome as an actual clinically defined syndrome is hogwash. Admittedly, there are no good studies to prove the syndrome as such. People who supposedly had the syndrome proper are reluctant to fill out surveys and would generally prefer to go on living their lives as if the incident never happened. In other words, you're not likely to see Jerusalem Syndrome in the DSM-IV, the American Psychiatric Association's handbook of mental disorders, anytime soon.

Read on to find out how doctors treat Jerusalem Syndrome.

When people exhibit signs of Jerusalem Syndrome, authorities know to bring them to Kfar Shaul, a psychiatric hospital. Doctors don't tell "King David" that he isn't King David -- it doesn't help to invalidate the patient's notion of himself and his mission. Doctors sometimes give patients mild antipsychotic medications or tranquilizers.

The best way to help, say the doctors at Kfar Shaul, is to get the patients out of the city and to their families. Once the people are out of Jerusalem and around their families and people who know them, they return to normal. They walk right back into their lives, and not a trace of mental illness seems to follow them. The whole process of Jerusalem Syndrome, from start to finish, takes from five to seven days. It's as if it never happened.

Many people who get Jerusalem Syndrome don't get treated at all. In a year, maybe 100 strangely behaving tourists are referred to Kfar Shaul, but only 40 or so are deemed in need of admission.

Because of people like David Koresh and Michael Rohan -- a Christian tourist said to have Jerusalem Syndrome who tried to burn down the al-Aksa Mosque -- Israeli authorities take Jerusalem Syndrome seriously. Before the year 2000 hit, Israeli doctors and authorities and even the FBI were worried about millennial violence that might take place in Jerusalem. They feared that apocalyptic cults and dangerous charismatic leaders would commit terrorist acts in an attempt to bring about Armageddon -- and take impressionable tourists along for the ride. Fortunately, there was no rise in people admitted to Kfar Shaul for Jerusalem Syndrome.

For more information about Jerusalem Syndrome and related topics, check out the links on the next page.