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Cases of the syndrome were already observed during the middle ages, as it is described in the itinerary of Felix Fabri and the biography of Margery Kempe. Other cases were described in the vast literature of visitors to Jerusalem during the 19th century. Two studies carried out in "Kfar Shaul" hospital raised a debate regarding the initiation of the syndrome. Dr. Yair Bar El claimed that there is a specific syndrome which emerges in tourists with no previous psychiatric history. Dr. Moshe Kalian and Prof. Eliezer Witztum claimed that there is not enough supporting data for such a conclusion. They stressed that most of the tourists who demonstrate the described behaviors were already mentally ill prior to their arrival to Jerusalem, and that the syndrome caught public and media attention because of the theatrical features of those behaviors. Results of the two studies, which conclude 14 years of referrals to Kfar Shaul since 1979 involved 470 tourists who had become temporarily in need of psychiatric hospitalization. Only 18% of the hospitalized tourists demonstrated symptoms that could be attributed to biblical or messianic ideation, including identification with a biblical figure. The rest were hospitalized due to a variety of other clinical conditions which had no specific connection to the significance of Jerusalem.
The majority of Jerusalem Syndrome patients are harmless and are usually regarded with pity and/or amusement. The most significant exception occurred in August of 1969, when an Australian tourist, overwhelmed with a feeling of divine mission, set fire to the al-Aqsa Mosque. His act was followed by citywide rioting. These events helped form the premise of a movie called "The Jerusalem Syndrome".
At the approach of the year 2000, there was some concern that thousands of otherwise normal visitors, especially evangelical Christians, might be transformed overnight by Jerusalem Syndrome into an hysterical mob. Despite a slight increase in tourist hospitalizations with the millenium-related rise in total tourism to Jerusalem, no dreaded epidemic of Jerusalem Syndrome ever materialized.
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