As the authors of several articles on Jerusalem syndrome (Reference Bal El, Witztum and KalianBar El et al, 1991; Reference Witztum and KalianWitztum & Kalian, 1999), we would like to add our comments to the paper by Bar-El et al (Reference Bar-El, Durst and Katz2000). If epidemiological data supporting Bar-El et al's typology exist, it is regrettable that they were not presented in their article. To our knowledge, such data have not been found in previous studies (Reference Bal El, Witztum and KalianBar El et al, 1991). The psychiatric hospitalisation of tourists in Jerusalem is uncommon (around 50 patients per year, from among almost two million tourists). The condition is much less prominent than problems faced by local services in other major cities (Reference ParshallParshall, 1995; Reference Tannock and TurnerTannock & Turner, 1995). Contrary to some ‘doomsday’ predictions, so far, there has been no significant increase in the rate of tourist hospitalisations due to the new millennium. In our view, perhaps Jerusalem syndrome should be regarded as a unique cultural phenomenon because of its overwhelming theatrical characteristics (Reference Witztum, Kalian, Hare and KresselWitztum & Kalian, 2000). Such dramatic qualities have been reported by various biographers since the establishment of pilgrimage and tourism to the Holy City (Reference Witztum and KalianWitztum & Kalian, 1999). In view of our accumulated data, Jerusalem should not be regarded as a pathogenic factor, since the morbid ideation of the affected travellers started elsewhere. Jerusalem syndrome should be regarded as an aggravation of a chronic mental illness, and not a transient psychotic episode. The eccentric conduct and bizarre behaviour of these colourful yet mainly psychotic visitors became dramatically overt once they reached the Holy City - a geographical locus containing the axis mundi of their religious belief (Reference TurnerTurner, 1973).
We would also like to comment on another inaccurate interpretation, relating to Gogol's pilgrimage. It had nothing to do with Jerusalem syndrome. Nikolai Gogol suffered from manic depression, severe hypochondriasis and physical ailments, and he set out to Jerusalem (acts of pilgrimage were widely encouraged in tsarist Russia) hoping to alleviate his long-standing suffering (Reference Witztum, Lerner and KalianWitztum et al, 2000).