It could be the man in the Israelite tunic with the flowing beard holding up a placard at the entrance to Jerusalem warning of the looming Armageddon. It could be the Christian tourist walking around the Old City wrapped toga-style in his hotel's bed sheet, proclaiming his newfound identity as a prophet-incarnate to any passerby who will listen. It could be the young man in Chassidic dress hanging around one of the gates to the Temple Mount waiting to take action as per the instructions he believes he's received from Above.

Walking through the winding alleyways of Jerusalem's Old City, you have a pretty good chance of bumping into a self-proclaimed "messiah", incarnated prophet, or Davidic inheritor. What these people have in common is loosely defined as “Jerusalem Syndrome,” a type of religious mania where tourists – or even longtime Jerusalem residents – become so overwhelmed with the spiritual symbols and power of the Holy City that they dissociate from reality and believe themselves to be biblical figures or hand-picked emissaries for a Divine redemptive mission.

In popular articles about Jerusalem Syndrome, the scenario might involve a salesman from Newark or a housewife from Kansas – regular Americans with regular lives – on a tour group headed for Israel. Once the salesman hits Jerusalem, he suddenly begins to exhibit extreme religious behaviors, separating from his group and instead spending his days in prayer, fasting, refusing to bathe (or, conversely, bathing excessively for purification purposes). Then, when the Voices enter his head, he might start to babble about his divine mission, about the imminent Apocalypse, and how he has been ordained to spearhead the redemption. He's harmless, but the hotel manager doesn't want a messiah ranting prophecies in his lobby (bad for business – not to mention those missing bed sheets), and has him carted away to Kfar Shaul or Herzog Hospital, the city's two psychiatric facilities. The tour group picks him up on the way home, and once he's out of Jerusalem and in his familiar environment again, he settles back into reality.

Jerusalem Syndrome was first defined by an Israeli psychiatrist named Heinz Herman in the 1930s, who described a large variety of extreme and excited behaviors and anxiety states exhibited by some visitors to Jerusalem. One of his cases involved an Englishwoman who was so convinced of the imminent Redemption that she climbed to the top of Mount Scopus every morning with a cup of tea to welcome the Redeemer. More recently, writing in the British Journal of Psychiatry, Dr. Yair Bar-El and his colleagues at the Kfar Shaul Mental Health Center in Jerusalem described three types of disturbed tourists. There are those with a psychotic history who feel divinely called to Jerusalem, some thinking they are a messiah or a prophet; those who are non-psychotic eccentrics who get triggered by the religious intensity of the city; and otherwise normal folk who have an intense temporary psychotic episode.

While Jerusalem Syndrome doesn’t exist as a diagnostic entity in any official list of psychiatric diagnoses, “it’s something people speak about because it has a lot of interest,” says Professor Pesach Lichtenberg, director of men’s psychiatry at Jerusalem’s Herzog Hospital and lecturer at the Hebrew University. But Dr. Lichtenberg, who has been interviewed extensively on Jerusalem Syndrome and – receiving dozens of Jerusalem Syndrome cases a year --- is considered somewhat of a world expert on the phenomenon, says the standard scenario is actually a bit of an urban legend.

“You hear the stories about how during his week in Turkey everything was wonderful, during his week in Jerusalem the guy gets checked into Herzog, they pick him up on the way out and after a week in Egypt everything is fine again. This is the story that makes good press, but I’m not sure how accurate it is,” Dr. Lichtenberg explains. “Are there people who come to Israel completely normal and become so bedazzled by the holiness that they suddenly become messianically psychotic? The answer is, probably not. People do sometimes become temporarily psychotic, but most of the people who walk around wrapped in the hotel bed sheets have been ill in the past.”

Furthermore, Dr. Lichtenberg stresses that although much media attention is focused on Christian pilgrims, Jerusalem Syndrome is applied to anyone who has delusional redemptive fantasies, where an important element of that delusion is that it will unfold in Jerusalem.

“Actually, there are probably a lot more Jews with it than Christians,” says the professor. “Most of my patients are Jews, and they are Israelis.”

So while some people might say Jerusalem is so infused with holiness that it makes otherwise sane people snap, others maintain that Jerusalem has nothing to do with it. These people are psychologically challenged wherever they are.

“It seems that the truth is somewhere in the middle,” says Dr. Lichtenberg. “There is something about Jerusalem that, if people have an inclination to have a psychotic episode, the intensity of the city can sometimes be a magnet for that.”

Psychotic or Spiritual?

Several years ago, a Jewish American woman in her thirties came to Israel as a volunteer, and had her epiphany while working in the peach orchards in a settlement outside Jerusalem. The next week, the woman – who called herself Ashrei -- was in the Jerusalem bus station accosting passersby about repentance and waving her shoes and socks in the air, trying to sell them so she could pay bus fare to the holy city of Tzfas. Ashrei was subsequently moved to the Kfar Shaul mental health facility until a flight back to the States could be arranged by the American consulate. “It really shook me up because she was probably the most intensely spiritual person I’ve ever met,” relates Marjorie Katz, another volunteer on the program who was asked to escort Ashrei from the psych unit to the airport.

What fine line separates someone who has had an authentic religious experience from one who has lost his/her grip on reality and needs psychiatric care? How is it that one person is considered a praiseworthy and true ma’amin, waiting daily for Mashiach to arrive, and another is considered over the edge because he thinks he’s been appointed as part of the process?

“Today we’re living in very messianic times,” says Dr. Lichtenberg. “This is not a statement about Mashiach per se, and I’m not privy to any special knowledge of who he is, but it’s in the air. People want redemption, and there’s almost a feverish longing and expectation for something big that’s about to happen.

“For most people, this means a sense of deep belief that redemption will happen and G-d will make a perfect world together with the Jewish people. And many people come to Jerusalem and feel an intensified level of Divine presence. G-d forbid a psychiatrist sticks his nose into that. Bur for some people, the redemption becomes something that’s already happened, or they ‘know’ exactly how it’s going to happen, and they are disconnected from other parts of themselves, becoming lost in the illusion. It’s not easy to say at what point the person has gone too far. Some of these people think all they need to do is pray. So that’s fine. Prayer is always a worthy endeavor. But then there are those who think all they need to do is destroy the Mosque, and that’s a little more problematic.”

The Brooklyn-born psychiatrist, who has degrees from Yeshiva University, Columbia University and the Albert Einstein School of Medicine, didn't know much about Jerusalem Syndrome when he began his psych residency, but after making aliyah in 1986 and attaining a position at Herzog, he developed a certain fascination with this indigenous Israeli psychosis.

"I would say anyone who makes aliyah has a slight case of Jerusalem Syndrome," he quips, maybe only half-jokingly. And, as an Orthodox Jew who is sensitive to the spiritual strivings of the soul, he tries to help his patients navigate what might be those spiritual strivings underlying the seemingly irrational behavior.

He explains that during times of stress or crisis, admissions to his ward spike. On January 1, 2000, when many religious zealots were predicting the End, Israel was on high alert for a flood of messianic fanatics who were expected to flock to Jerusalem for the Apocalypse. During that time, Dr. Lichtenberg was seeing about five new patients every week.

Slippery Slope

Although they may ultimately wind up at Herzog, many of the Jewish “messiahs” first find their way to Jeff Sidell, director of the Jewish Student Information Center in the Old City – a drop-in center that offers classes, free siddurim and Chumashim, and Shabbos meal placements. “They tell me they hear Hashem speaking to them, that the Redemption is coming and they need me to help out,” says Sidell. “A guy came in recently and told me his job is to help get ready, to round up all the Jews and bring them back to Israel, because it’s time to proclaim Hashem as King. He said he heard Hashem tell him this. He wanted me to print flyers and send out an email to my student list. So I told him, ‘You know, it sounds good, but my students aren’t really ready for this yet.’”

Rabbi Moshe Kempinsky of the Shorashim Judaica Shop and Learning Center in Jerusalem's Old City admits that although there is a certain intrigue surrounding Jerusalem Syndrome, it’s actually a tragic, dangerous condition which in the worst case ends in death. Rabbi Kempinsky, a former therapist and kiruv worker, is privy to the inner workings of many tourists to the Old City who come into his shop. “It’s a safe place for people to come in and schmooze,” he says, and describes some of the people afflicted with the condition who have felt comfortable enough to confide their messianic aspirations.

There was the Israeli girl who was convinced she was Miriam the Prophetess. For months she would walk around the Old City filling a pail with water and then spilling it out somewhere else, as if recreating Miriam’s Well on the cobblestones of the Jewish Quarter.

Then there was the man from an extremely wealthy family abroad who was convinced he was the Mashiach. He would only walk in wide, roundabout circuitous routes because he said that “walking straight only gets you in trouble.” This young man refused to sleep indoors – despite his parents' willingness to sponsor the hotel of his choice --- and on one of his nocturnal searches for a spot to spend the night, he fell into a construction pit and died of his injuries.

Rabbi Kempinsky doesn’t deny that those afflicted with Jerusalem Syndrome might have been unstable to begin with, but is convinced that the holiness of Jerusalem plays an integral part in their delusions. “In Jerusalem, they experience something they never felt before. Here religion is so real and so overwhelming that they can’t just be here, they have to be here for a higher purpose. And so the ‘voices’ tell them, ‘Your role is to be this and this… and don’t worry, the more people tell you you’re crazy, the more you’re doing holy work.’ This is the slippery slope that is so all-consuming it unfortunately leads to tragedy.”

One of the most tragic figures he’s come across was a 32-year-old immigrant from the US who called himself Baruch Ben Menachem. Baruch wanted to keep Torah, but he also had a Christian messianic identity that he refused to relinquish. He believed he had a mission to inspire both Jews and non-Jews to the idea of imminent redemption, and that he was an integral part of the master plan. He began rounds of 40-day fasts, which further weakened his faculties, and became so distraught over the expulsion from Gush Katif that one morning he donned tefillin and, siddur in hand, poured gasoline over his body and set himself on fire. He died of his wounds several days later at Hadassah Hospital.

Ruining Their Plans

Dr. Lichtenberg stresses that, thank G-d, gone are the days when a person would be institutionalized for expressing what seem to be irrational thoughts. “Otherwise we’d be inundated. There are a lot of messiahs out there,” he says, but explains that no one comes through his ward unless there is a real danger – to himself or to others.

While about half the patients at Herzog come willingly, most Jerusalem Syndrome sufferers are brought to the hospital against their will, under mandate of the municipal psychiatrist who feels there is some sort of imminent danger. At Herzog, doctors calmly let them recount their personal narrative, however strange it seems, and if they aren't deemed dangerous, they are usually discharged.

“Often they have a sense that we’re ruining their messianic plans and aspirations,” Dr. Lichtenberg says somewhat apologetically.

He can’t give specifics about current cases, and is careful to protect the dignity of past patients as well. But he does share some details about a young Jewish fellow who would spend his days causing a ruckus trying to force his way past the Muslim guards through the Shalsheles gate, which opens onto the Temple Mount just opposite the Dome of the Rock. The Arabs realized it was not some Jewish nationalist trying to make a statement by praying there – this was a majnoon, trying to bring a sacrifice, and they called the police to take him away.

“He was extremely agitated,” says the professor. “He tells me, ‘You don’t understand, I have a holy mission to perform.’ They’ll usually keep their mission under wraps and don’t let us in on their plans. That mission could be to pray, to bring a sacrifice, or to destroy the Mosque, although they don’t usually bother to bring TNT.

"Most of these people actually feel terrible," notes Dr. Lichtenberg, "because it's far more responsibility than they feel capable of handling."

Dr. Lichtenberg says he tries to find out if the messianic patient sees himself as a Mashiach ben Yosef figure or a Mashiach ben David figure. In Talmudic literature, Mashiach ben Yosef will lead the nation into a war with Gog and Magog and then die. “If I have a messiah who’s learned enough to tell me he’s Mashiach ben Yosef, I might want to put him on a suicide watch.”

Treatment often involves anti-psychotic medication, and it always involves trying to establish some rapport, some connection, some discussion in order to help the sufferer get perspective on what’s happening to him. Pesach Lichtenberg’s approach is compassionate and respectful. “We don’t say, ‘Knock that messianic nonsense out of your head.’ That’s certainly not the approach. I’ll say, ‘Okay, you have spiritual strivings and that’s wonderful. I respect that. But let’s think if it’s gotten out of hand. Is this really what you want to be doing? Maybe there’s a better way of expressing these feelings?’

“This doesn’t always help, because he might be stuck in a certain mindset of carrying out his plans, but we hope to establish some rapport, some therapeutic alliance, because we don’t want a situation where we’re just holding him until his release, when he’ll head back to the Old City again to try to actualize his plans.”

Officially at least, no one is interested in seeing another Denis Michael Rohan, an Australian citizen who gained worldwide notoriety in August 1969 when he attempted to set fire to the Al Aksa mosque atop the Temple Mount. Rohan pleased insanity and was institutionalized, then deported from Israel. He died in 1995 under psychiatric care. Rohan stated that he considered himself G-d's emissary and that he tried to destroy the Al Aksa mosque acting on divine instructions to enable the Jews to rebuild the Temple there. His action nearly kicked off a jihad in the Middle East.

Sign of the Times

Professor Lichtenberg says he always gives his patients the benefit of the doubt. "I let my patients unspool their stories, no matter how zany they sound. Every believing Jew hopes daily for Mashiach, and I'll admit that there have been a number of people I've met in the course of my career who have managed to arouse a certain hope that, hey, maybe this is the real one! So far I've been disappointed,  but I remember many cases over the years, when a very intelligent, charismatic person would fill up the room and almost make me forget that I'm in the middle of a psychiatric examination – and I would find myself saying, 'Hold on a second, let's see what this guy has to say.' I could nearly get swept into their reality – 'Okay, where do I sign up?' "

Professor Lichtenberg says one of the most fascinating examples of messianic psychosis was Shabbetai Tzvi, the 17^th century false messiah who was widely accepted in communities from Poland to Morocco to Yemen. In the year 1666, most Jews didn't even fast on Tisha B'Av because they were sure Mashiach had arrived. From a psychiatric perspective, Dr. Lichtenberg says Shabtai Tzvi was manic depressive, and in his manic state, he was able to convince some of the Jewish world's greatest scholars that he was the redeemer.

In his office five flights underground at Herzog Hospital, Dr. Lichtenberg keeps a giant shofar on a bookshelf, a piece of memorabilia from a would-be messiah and former patient who used it to trumpet the “Redeemer's” (his own?) arrival. Screams and rants waft through the air, emanating from behind the secure door on the opposite side of the office.

Are there any messiahs on the ward now?

"Oh, sure," says Dr. Lichtenberg, but that's as far as he will go, invoking the hospital's – and his own -- ethical policy of confidentiality.

While these messianic hopefuls won't hesitate to speak on a soap box in the middle of the city, in the hospital ward, there is a certain social hierarchy and prophets aren't on the top rung. "Here in the ward, the people who outwardly claim they are Mashiach may draw themselves derision from the other patients," Dr. Lichtenberg explains. "Usually they remain quiet about it."

Once a patient started screaming, "I'm the Mashiach!" and another patient turned to him and said, "That's great, just don't say it so loud or you'll get another injection."

Dr. Lichtenberg, who has been at the forefront of advocacy to deinstitutionalize psychologically challenged patients for healthier, more mainstream yet safe alternatives, admits that the damaging stigma of being checked into a psych unit is huge.

"We try to get them out of here as soon as possible," he explains. Whereas the term “mental hospital” might conjure up images of a life sentence, Dr. Lichtenberg is horrified at the thought. "Chas vechalilah -- the average hospitalization is about a month, until they get stabilized in a psycho-social treatment plan." But he admits that manageable is one thing, curable is another. "We help them along; sometimes that might be just getting them calm enough so they can go back home, or, in the case of a tourist, helping him along so he can make his way back to his group."

For all the jokes and off-color remarks about messiah wannabes and mental hospitals, Professor Lichtenberg is a great empathizer with his patients and their pain. "A psych hospital is a place of great suffering and distress," he stresses. "People are suffering from a disease that is in many ways worse than any other disease. They have nowhere to turn. They are sick in their personhood and struggling to find meaning in and sense of the world. We try to help them in their struggle against great odds, because we're usually dealing with a difficult, and often incurable illness."

Dr. Lichtenberg explains that psychoses keep up with the times as well. "Fifty years ago people had psychosis about radio waves going through their brains." And today, it's messianic fervor.

So, are we going to be seeing a lot more self-styled prophets and messiahs until Mashiach actually comes?

"I would say yes. One of the most fascinating historical periods was right before the destruction of the second Beis HaMikdash. At that that time there were also many self-appointed messiahs walking around – one of them, of course, had tremendous success all over the world. I would say that today we're in a similar, if not even more intensive period. I'm not sure if there was ever a time in Jewish history where there was so much Mashiach awareness, where people are so infused with this hope of Redemption."

So, as redemption fever spikes, Dr. Lichtenberg expects to be kept busier than ever.

"No problem," he says. "We're open 24 hours."

(Originally featured in Mishpacha Issue 428)