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The cities that need a warning label?

Oliver McAfee was supposed to be home in time for Christmas 2017. But the 29-year-old landscape gardener, originally from Dromore in Northern Ireland’s County Down, hasn’t been seen since 21 November 2017.

来自北爱尔兰唐郡(County Down)德罗莫尔(Dromore),29岁的景观园艺师奥利佛·麦卡菲(Oliver McAfee)本来应该在2017年的圣诞节以前回家过节的,但从2017年11月21日起他就失踪了。

McAfee had been cycling along the Israel National Trail, near the desert city of Mitzpe Ramon, before he vanished. His bicycle and tent were found two months later in the Ramon crater in the southern part of Israel. Travellers have since handed in his wallet, keys, and computer tablet discovered along the trail.

失踪前,他沿着以色列国家步道(Israel National Trail)骑行,最后出现在沙漠城市密支佩拉蒙(Mitzpe Ramon)附近,之后就不见了。两个月后,他的自行车和帐篷在以色列南部的拉蒙地坑被发现,之后他的钱包、钥匙和平板电脑也在游客步道沿途被找到。

Media outlets were quick to raise the possibility of Jerusalem syndrome – a psychotic state (or a break from reality) often linked to religious experiences. Sufferers become paranoid. They see and hear things that aren’t there. They become possessed and obsessed. And sometimes, they disappear.

媒体迅速猜测他可能是出现了耶路撒冷综合症(Jerusalem syndrome)——一种常与宗教经历相关的精神病状态(或是脱离现实)。患者会变得偏执,看到听到并不存在的东西,并且无法摆脱,有时他们还会莫名失踪。

At the turn of the millennium, doctors from Israel’s Kfer Shaul Mental Health Centre reported seeing around 100 tourists a year with the syndrome (40 of whom needed hospital admission), most commonly Christians but also some Jews, and a smaller number of Muslims. Jerusalem syndrome was a form of psychosis, they wrote in the British Journal of Psychiatry, in a city that “conjures up a sense of the holy, the historical and the heavenly”.

进入21世纪,以色列卡法尔·肖心理健康中心(Kfer Shaul Mental Health Centre)的医生们每年能接到大约100位有此症状的游客(有40位需要入院治疗),当中基督徒最多,也有犹太教徒,还有少部分穆斯林教徒。医生们在《英国精神病学杂志》(British Journal of Psychiatry)上将耶路撒冷综合症定义为一种精神病,发生在一个“让人有圣洁感和历史感”的城市。

Many had an existing mental health disorder, such as schizophrenia or bipolar disorder, which had prompted them to embark on their delusional holy mission. The doctors described a US tourist with schizophrenia who began to weight-train at home and increasingly identified with the biblical character Samson. He journeyed to Israel, fixated on moving the giant stone blocks of the Wailing Wall. Intercepted by police, the man was admitted to hospital, treated with antipsychotic medications, and flown back home accompanied by his father.


But others developed psychosis in Jerusalem in the absence of a history of mental illness. It was a relatively small number – 42 of the 470 tourists admitted over 13 years – but the cases were as dramatic as they were unexpected.


Typically, these people became obsessed with cleanliness and purity soon after their arrival to the city, taking countless baths and showers and compulsively cutting their toenails and fingernails.  They fashioned a white toga, often from hotel bed linen. They delivered sermons, shouted psalms and sang religious hymns on the streets or at one of the city’s holy places. This psychosis usually endured for a week or so. Occasionally, they were treated with sedatives or counselling – but the definitive cure was “physically distancing the patients from Jerusalem and its holy places”.


The authors suggest that these tourists (usually from “ultra-religious families’’) experience a discord between their subconscious idealistic image of Jerusalem and the concrete reality of a busy commercial city, leading to the syndrome. One writer has suggested that the city could be a “breeding ground for mass delusion”, referring to centuries of territorial disputes between faiths with resulting “friction, plots, and delusional thinking”. Indeed, Jerusalem syndrome isn’t a new-fangled affliction: descriptions suggestive of it date back to the Middle Ages.


As for the possibility of Jerusalem syndrome in Oliver McAfee, this wasn’t some newfound fascination with religion on his part; he was already said to have been a devout Christian. But soon after his disappearance, his brother expressed concern about pictures from Oliver’s camera: “The nature of them is just a bit out of character and suggests he might not have been quite himself. One of them showed a lot of litter and debris around his camp and that was just not like him at all.” At a later press conference after reviewing more evidence, though, he seemed to have changed his mind, saying they’d spent “hour upon hours going through the photos, going through the journals and everything ties in with this – for Oliver this was a normal, normal trip”.<纽约时报中英文网 http://www.qqenglish.com/>


Investigators have pointed to the discovery of torn passages from the Bible weighed down with rocks where he disappeared, scriptures in his handwriting, written references he made to Jesus fasting in the desert, and according to one report, a “chapel” – an area of sand, flattened by a bicycle tool, within a circle of stones.


A Facebook page (@helpusfindollie) was established in the aftermath of his disappearance. Here’s one of the last posts: “I've been wondering ‘what do I say when there's nothing to say?’ The first anniversary of Oliver's disappearance has come and gone; and sadly, it feels as though answers are still a million miles away.”


Just as doctors in Jerusalem may be more likely to diagnose Jerusalem syndrome because they see it more often, psychiatrists in Florence encounter similar symptoms under different circumstances. It seems that visitors are so consumed by the magnificence of the city’s art and architecture that they are occasionally gripped by psychosis. One 72-year-old artist visiting Ponte Vecchio bridge became convinced within minutes that he was being monitored by international airlines and that his hotel room was bugged. A woman in her 40s believed that figures from the frescoes of the Strozzi Chapel of the Church of Santa Maria Novella were pointing at her: "It seemed to me that they were writing about me in the newspaper, they were talking about me on the radio and they were following me in the streets."

耶路撒冷的医生因为接触此症较多,可能更容易做出诊断,而佛罗伦萨的精神病学家也碰到了类似症状。游客可能因为被佛罗伦萨壮丽的艺术及建筑所深深吸引,偶尔会出现精神病的症状。一位72岁的艺术家来到佛罗伦萨的老桥后,没几分钟就觉得自己被国际航空公司监视了,酒店房间也被装了窃听器。有位40多岁的女性认为,新圣母玛利亚大教堂(Church of Santa Maria Novella)斯特罗齐礼拜堂(Strozzi Chapel)壁画上的人物在对她指指点点:“报纸上写的是我,广播里说的是我,还有人在街上跟踪我。”

Florentine psychiatrist Graziella Magherini described more than 100 tourists who had attended the Santa Maria Nuova hospital between 1977 and 1986 who had experienced palpitations, sweating, chest pain, dizzy spells and even hallucinations, disorientation, a feeling of alienation and loss of identity. Some had tried to destroy works of art. This was all brought on, Magherini said, by “an impressionable personality, the stress of travel and the encounter with a city like Florence haunted by ghosts of the great, death and the perspective of history”. It was just all too much, she suspected, for the sensitive tourist.

佛罗伦萨的精神病医生马盖里尼(Graziella Magherini)说,从1977年到1986年间,新圣母玛利亚医院收治了100多名游客,症状表现为心悸、出汗、胸痛、晕眩乃至幻觉、迷失,感到被他人疏远或迷失身份,有些人还会出现破坏艺术品的举动。马盖里尼说,这都是因为“患者本人容易受周围环境影响,加之旅行的压力以及他们来到佛罗伦萨这样的城市——处处都是伟人及亡者的灵魂,弥漫着历史感”,她认为敏感的游客可能对此招架不住。

She named the condition Stendhal Syndrome after the French author who himself described being “absorbed in the contemplation of sublime beauty” and “seized with a fierce palpitation of the heart” as he emerged from the city’s Santa Croce Basilica during an 1817 visit. “The wellspring of life was dried up within me, and I walked in constant fear of falling to the ground.” 纽约时报中英文网 http://www.qqenglish.com

法国作家司汤达(Stendhal)曾记录自己1817年到访佛罗伦萨,从圣十字教堂(Santa Croce Basilica)出来时“思绪沉浸在超凡的美妙当中,心脏剧烈颤动,生命之泉在我体内枯竭了,我感到随时都要跌倒在地。”马盖里尼就以作家的名字命名了这类症状,称为司汤达综合症(Stendhal Syndrome)。

Although only two or three cases of so-called Stendhal syndrome are seen annually these days, the Uffizi Gallery in Florence continues to see its fair share of emergencies. One man had a seizure as he gazed upon Botticelli’s Primavera recently and another visitor fainted by Caravaggio’s Medusa. Speaking to the Corriere Della Sera newspaper shortly after a visitor had a heart attack in front of another Botticelli (The Birth of Venus), the Uffizi’s gallery director said “I do not propose a diagnosis but I know that facing a museum like ours, so full of absolute masterpieces, certainly constitutes a possible source of emotional, psychological, and even physical stress for the effort of the visit.”

虽然现在每年不过出现两、三例所谓的司汤达综合症,但佛罗伦萨乌菲兹美术馆(Uffizi Gallery)还是会遇到这类紧急情况。最近,有位男子在欣赏波提切利(Botticelli)的画作《春》(Primavera)时发病,还有位观众在卡拉瓦乔(Caravaggio)的作品《美杜莎》(Medusa)前晕倒了。有人在波提切利另一幅作品《维纳斯的诞生》(The Birth of Venus)前犯了心脏病,之后不久,乌菲兹美术馆的馆长对当地的《晚邮报》(Corriere Della Sera)表示说:“我并不是在诊断,但来到我们这样件件都是杰作的博物馆,肯定会让观众受到情感、心理甚至是身体上的冲击。”

In contrast, sometimes a city doesn’t quite live up to expectations. “Paris syndrome” has been named for Japanese tourists who develop psychosis (more than 63 patients were described in this case series), seemingly crushed that Paris is not the city of their dreams. Distressed by the stern faces of locals and the alleged paucity of friendly shop assistants, a breakdown of sorts ensues. “In Japanese shops, the customer is king,” explained a representative from an association that helps Japanese families to settle in France, “whereas here assistants hardly look at them.”


But are these syndromes really specific to Jerusalem, Florence, or Paris? Do these cities merit a warning label of their own?


Mental health issues are among the leading causes of ill health among travellers. According to the World Health Organization, “psychiatric emergency” is one of the most common medical reasons for air evacuation. Specifically, acute psychosis accounts for up to a fifth of all mental health problems in travellers – and most of these aren’t standing in front of Bethlehem’s Church of the Nativity or the Wailing Wall.

游客最容易出现的健康问题就是精神方面的。世界卫生组织表示,在因医疗原因而出动空中救援的案例中,最常见的就是“紧急精神病问题”。具体来讲,急性精神病占到游客精神健康问题的五分之一,而病人大多并不是在伯利恒(Bethlehem)的圣诞教堂(Church of the Nativity)或是哭墙(Wailing Wall)前发病的。

There are plenty of reasons weary travellers are tipped over the edge. Dehydration, insomnia, and jetlag have been implicated in travel psychosis, along with sleeping pills taken or alcohol consumed on a flight or, in some cases, drugs like the anti-malarial mefloquine. The prevalence of fear of flying ranges from 2.5% to 6.5%, and that of acute anxiety among travellers is about 60%. Add in the stress of airport security, long queues outside museums, language barriers and cultural differences, and then perhaps an intensely personal and long-anticipated religious or cultural pilgrimage, and the perfect storm is conjured up.


For many severe cases, it’s likely that travellers had an undiagnosed psychiatric condition or a predisposition to psychosis long before reaching Florence’s Uffizi or Galleria dell’Accademia. More than half of those admitted to hospital in Magherini’s study had previous contact with a psychiatrist of psychologist. And commentators in the British Journal of Psychiatry suggest that “Jerusalem should be not be regarded as a pathogenic factor, since the morbid ideation of the affected travellers started elsewhere”.

在一些比较严重的病例中,游客可能在来到佛罗伦萨的乌菲兹美术馆或是学院美术馆(Galleria dell'Accademia)之前,早就有了精神问题,只是没有被诊断出来,或是已经有精神病倾向很久了。在马盖里尼的研究中,被送进医院的病人中有一半以上之前都曾看过心理医生或是精神科医生。《英国精神病学杂志》的评论员认为:“不应该把耶路撒冷视为病因,发病游客那些病态的想法在其他地方就早已萌芽了。”

There’s even a caveat about Stendhal himself. His detailed contemporaneous diary of his 1817 visit to Florence was prosaic with complaints about his tight-fitting boots but there wasn’t a word of his intense experience at Santa Croce Basilica, even though his published travelogue claimed it was “the profoundest experience” and that he had “reached the point where one encounters celestial sensations”.


Could it be that proclaiming a swooning reaction to Renaissance art serves to assert one’s status, sophistication and superiority? Or should we believe that such splendour, rather than jet lag and long museum queues, can truly prompt a disintegration of the mind?


As one poet wrote nearly 100 years ago:


…for beauty is nothing


but the beginning of terror,


which we can just barely endure,


and we stand in awe of it as it coolly disdains to destroy us. Every angel is terrifying.


Duino Elegies (1923)

——《杜伊诺哀歌》(Duino Elegies,1923年作)



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