Next time you stop off in Jerusalem, we suggest that you might want to take along some contact information for your favorite shrink back home. The odds are greatly against it, but you may end up thinking you're John the Baptist or the Virgin Mary. There is a rare travel psychosis known as Jerusalem Syndrome and in 1999, more than 50 visitors were diagnosed. The Savvy Traveler's Judie Fein fills us in.

Jerusalem Syndrome
by Judith Fein

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The malady called Jerusalem Syndrome is no joke. Afflicted tourists have been found wandering in the Judean desert wrapped in hotel bed sheets or crouched at the Church of the Holy Sepulcher, waiting to birth the infant Jesus.

I'm here at Kfar Shaul Hospital in Jerusalem, with Dr. Yair Bar-El, who gave the strange disorder its name. Dr. Bar-El looks eerily like Dr. Freud as he leans back in his chair, puffing on a cigar, with his glasses perched on the tip of his nose. He explains that there are three categories of tourists who get Jerusalem syndrome.

Dr. Bar El: "We speak first about clearly mentally ill people in their country. They arrive to Jerusalem with psychotic ideas. The second, the biggest group, tourists, pilgrims with deep religious convictions."

Pilgrims who, in some cases, belong to bizarre fringe groups rather than regular churches. They were also mentally unbalanced before they arrived, and they believe they must do specific things to bring about major events like the coming of the Messiah, the war of Armageddon, or the resurrection of Jesus Christ.

Dr. Bar-El: "We have a little third group, the REAL Jerusalem syndrome. Completely sane persons without psychiatric history, without drugs, and arrive here as normal tourists. Here they develop this specific, imperative psychotic reaction that is the real Jerusalem Syndrome."

The same clinical picture always emerges. It begins with general anxiety and nervousness, and then the tourist feels an imperative need to visit the holy places. First, he undertakes a series of purification rituals, like shaving all his body hair, cutting his nails and washing himself over and over before he dons white clothes. Most often, he lifts the white sheets from his hotel room. Then he begins to cry or to sing Biblical or religious songs in a very loud voice. The next step is an actual visit to the holy places, most often from the life of Jesus. The afflicted tourist begins to deliver a sermon, demanding that humanity become calmer, purer, and less materialistic.

Dr. Bar-El, says that besides their bizarre behavior, everything else about the tourists in normal:

Dr. Bar-El: "These persons develop the same clinical picture. They don't see strange things, they don't hear voices, they remember everything and all the time they know they're John Smith or Yan Huber. They don't think they're another person and this reaction passes completely in five to seven days. "

Sometimes, the afflicted visitor is on a Mediterranean package tour which includes Greece, Egypt and Israel. He may be completely sane in Greece, he develops Jerusalem Syndrome in Israel, it passes in five days, and then he continues on with the group to Egypt.

In Israel, Jerusalem Syndrome is taken very seriously. Everyone involved in security, tourism, or health is on the lookout for afflicted visitors. In an average year, three or four tourists develop real, palpable Jerusalem Syndrome. In l999, more than 50 visitors were diagnosed, the increase possibly attributed to millennial activities.

From a religious point of view, the Syndrome seems to favor Protestants, who account for 97 percent of all cases. Almost all of them were raised in ultra-orthodox homes where the Bible was the book of choice for family reading and problem-solving.

Dr. Bar-El takes a long puff on his cigar and gets down to specific current cases.

Dr. Bar-El: "We have now here a woman, she was picked up by the police after she kicked and beat some persons at the side of the Church of the Holy Sepulchre. They asked why and she says: 'I am the Prophetess of the Olive Tree and I am a very powerful person. I announce the immediate arrival of Jesus Christ.' This woman is here in a terrible anxiety state. She said that she must be out, under the influence of the sun and the moon and by this influence her branches will grow green. This is the symbol of the immediate arrival of Jesus Christ."

She didn't want to be taken inside because under a roof her branches would grow black, and that would be the sign of the anti-Christ. Another seemingly normal man is a teacher from Denmark.

Dr. Bar-El: "He arrives every year to Jerusalem because he said only here he can speak with the Virgin Mary. He doesn't take trips to Lourdes, to Montserrat, no, only here. We speak with the person a lot. A completely sane person only with this idee fixe."

Bar-El talks about a memorable case which actually led to one of the first instances of collaboration between Palestinian and Israeli police. The Palestinians found a man without clothes, money or ID, and, after interrogation, they figured out he wasn't a security risk. They had no idea what to do with him, so they contacted an Israeli officer. The Israeli asked only one question: "Is the guy really completely nude?" "No," answered the Palestinian, "he's wearing an animal skin." "Oh," said the Israeli, "you've got another John the Baptist." It was the sixth John the Baptist the Israelis had run into. They usually did days of purification between Jerusalem and the Galilee before ending up at the Jordan River to baptize Jesus or the first Christians, and part of the trek was through Palestinian territory.

John The Baptist is the most popular Jerusalem syndrome choice for Christian men. Christian women prefer the Virgin Mary. For Jews of both sexes, the identification is generally with the Messiah.

One day, Bar-El decided to perform a classical experiment. He put two would-be Messiahs in a room together for an hour to see if one would prevail.

Dr. Bar-El: "I said, 'Okay, you must make the decision. Who's the real Messiah?' Every person said, after this hour, 'I am the real Messiah. He's an imposter.' "

I am shown around the wards, and then introduced to Russian-born Dr. Gregory Katz, who talks about the treatment:

Dr. Katz: "Sometimes we give some minor tranquilizers and melatonin if the person's also in jet lag. If we see that it's a real psychotic episode, we give anti-psychotic drugs."

Jerusalem Syndrome is posing an unexpected economic problem for Israel. Who is supposed to pay for the treatment of the afflicted tourists?

Dr. Katz: "Some of them, usually that come from Scandinavia, have good insurance. But some of them come from the U.S. and don't have medical insurance or it's not sufficient and doesn't cover psychiatric treatment. Then the State of Israel pays for it, including an escorting person back to the U.S., usually a psychiatrist and all the expenses."

No one is certain about exactly what causes Jerusalem Syndrome. Perhaps it's jarring for a serious Bible student to arrive in modern-day Israel where, instead of prophets in sandals, he hears businessmen discussing profits on cell phones. Or maybe it's the fact that Jerusalem has always been a magnet for messianic messages, and visitors get carried away.

For the moment, there are no clear answers and the emphasis is on rapid and effective diagnosis and treatment.

At Kfar Shaul Hospital in Jerusalem, this is Judie Fein for The Savvy Traveler