“Traveling is a brutality. It forces you to trust strangers and to lose sight of all that familiar comfort of home and friends. You are constantly off balance. Nothing is yours except the essential things – air, sleep, dreams, the sea, the sky – all things tending towards the eternal or what we imagine of it.” – Cesare Pavese  

Mental disorders affect many millions of people worldwide.  In some cases, the psychological problems experienced are exceedingly rare and/or bizarre.  Continuing with the series of the somewhat unique, today’s column is about the fascinating group of disorders known as Voyager syndrome.

Voyager syndrome is the term used to describe a group of rather rare mental disorders all related to far-away travel.  The syndrome is based upon the anxiety, mood, and other emotions (uncertainty, confusion, disorientation, etc.) often experienced when people find themselves in unknown social environments and cultures, as is often the case when traveling to a foreign country.  It is believed to develop from the challenges the patient has in understanding and adjusting to the socially acceptable “do’s and don’ts” of a new culture.  Most often this is co-mingled with a disdain for certain aspects of the new environment and/or culture.  It is, in a sense, a severe form of “culture shock”.  The three most often described are the Jerusalem syndrome, Paris syndrome, and Florence syndrome.

Jerusalem syndrome is specific to travel to the city of Jerusalem, and involves the acute development of obsessions, delusions (fixed persistent false beliefs that are held with extreme certainty even in the face of significant evidence to the contrary), or other types of psychosis with an extreme religious theme in an individual who seems to have been devoid of any obvious indicators of mental illness prior to arriving in Jerusalem.  It is not particular to a sole religion or religious denomination, and has occurred in individuals from widely varying backgrounds.  The psychiatric symptoms most often resolve fully within a few weeks of leaving the City.  According to a 13-year retrospective study of admissions to the Kfar Shaul Mental Health Center in Jerusalem some 1,200 tourists with significant religiously based psychiatric symptoms were referred to the Center.  Of these, over 35% ended up being admitted to the Center’s hospital.

Paris syndrome too is specific to the unique, beautiful and famous city of Paris, France.  It is a temporary psychological disorder considered to be an exclusive condition of Japanese tourists, and some Japanese nationals, in Paris.  Basically, the syndrome is a severe form of “culture shock” whereby Japanese tourists are unable to separate out their pleasant and tranquil view of the City, as presented in many famous books and movies, and the reality of the bustling urban environment Paris has become.  It is characterized by a number of psychiatric symptoms including:

• Hallucinations.
• Acute onset of persecutory delusions.
• Anxiety.
• Physical manifestations including rapid heart rate, dizziness, and sweating.
• Depersonalization – a state in which one’s thoughts and feelings seem unreal or not to belong to oneself, or in which one loses all sense of identity.
• De-realization – an alteration in the perception or experience of the external world so that it seems strange or unreal.

The primary causative factors of Paris syndrome are:

• Cultural variation – The marked differences in the manner in which Latin-based cultures communicate on an interpersonal basis, especially when compared to the rather stiff and formal style of the Japanese culture, for a rare few individuals proves to be too much.
• Language barrier – Very few Japanese speak French, and even fewer French speak Japanese.  In addition to the obvious differences between Japanese and French languages many of the often used day-to-day phrases and expressions are rather short of substance and meaning when translated, and further add to the confusion for some.
• The romanticized vision of Paris – The person’s inability to resolve the significant discrepancies between the Japanese idealized image and the reality of Paris.
• Fatigue – It is believed that jet lag, along with cramming an excessive amount of tourist activities, contribute to the loss of psychological stability.

In fact, there is a 24-hour hotline maintained by the Japanese embassy in Paris for tourists suffering from extreme culture shock.

Unlike the first two, Florence syndrome, also known as Stendhal syndrome, is not specific to the city of Florence, Italy.  Rather, it is a psychological disorder that causes confusion, lightheadedness, racing heart, dizziness and occasionally hallucinations when a person is exposed to art.  It occurs primarily when there is a large amount of art in a single place, and/or the art of especially captivating.  Florence syndrome is also used when describing these same physical symptoms when they occur amidst a gluttony of choices, or when faced with vast beauty, in other environments as well.  It is named after the 19^th century French author, Marie-Henri Beyle, better known by his pen name Stendhal, who wrote of his experience with such feelings during a visit to Florence in the early 1800’s.  Although first described by Stendhal some two-hundred years ago, and observed in many since that time while they observe Florentine art, the syndrome itself was not diagnosed and coined until about thirty years ago by Graziella Magherini, an Italian psychiatrist.

Next week I will conclude the series on the rare and bizarre with a presentation on the disorders of identification.