Cases of the syndrome were already observed during the middle ages, as it is 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. Two studies carried out in "Kfar Shaul" hospital raised a debate regarding the initiation of the syndrome. Dr. Yair Bar El claimed that there is a specific syndrome which emerges in tourists who had no previous psychiatric history. Dr. Moshe Kalian and Prof. Eliezer Witztum claimed that there is not enough supporting data for such a conclusion. They stressed that most of the tourists who demonstrate the described behaviours were already mentally ill prior to their arrival to Jerusalem, and that the syndrome caught public and media attention because of the theatrical features of those behaviours. Results of the two studies, which conclude 14 years of referrals to Kfar Shaul since 1979 involved 470 tourists who had become temporarily in need of psychiatric hospitalization.Only 18% of the hospitalized tourists demonstrated symptoms that could be attributed to biblical or messianic ideation, including identification with a biblical figure.The rest were hospitalized due to a variety of other clinical conditions which had no specific connection to the significance of Jerusalem.
By far the majority of Jerusalem Syndrome patients are harmless, and the victims are usually regarded with pity mixed with amusement. However, there have been significant exceptions: most notably, on August 21, 1969 the Australian tourist Dennis Rohan became overwhelmed with the belief that it was his divine mission to 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".
At the approach of the year 2000, concern over the thousands of evangelical Christians who would be coming to the Holy City for millennium celebrations, produced a kind of reverse millennium fever in Jerusalem. Alarmed by the phenomenon of Jerusalem Syndrome, an anxiety began to grow at the prospect of thousands of visitors who otherwise may be normal, stable people, transformed overnight by Jerusalem Syndrome, into a mob of fanatics. Media driven hysteria over Y2K predictions fuelled this anxiety. Although the number of hospitalized tourists in Jerusalem slightly increased due to increase of tourism and pilgrimage to the city as the year 2000 approached, the disaster which some anticipated did not materialize.
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