© Kamla-Raj 2019 Ethno Med, 13(4): 190-197 (2019) PRINT: ISSN 0973-5070 ONLINE: ISSN 2456-6772 DOI: 10.31901/24566772.2019/13.04.594 Stendhal (Florence) Syndrome as an Unclassified Disorder
Asli Yayak
Bursa Technical University, Bursa, 16330, Turkey E-mail: [email protected]
KEYWORDS Aesthetic. Art. Beauty. City. Psychology
ABSTRACT The first aim of this paper is to discuss human-art relations basically. In this paper, literature related to Stendhal syndrome as pertaining to art psychology will be reviewed and information on the subject will be compiled. The necessity of doing art is widely defined in society as a form of self-disclosure by an individual. The definition of art according to scientists is art as self-actualization. The other discussed concept in this paper is Stendhal (Florence) syndrome. It’s known as a city syndrome. Stendhal syndrome, also known as Florence syndrome, describes a physical disease that afflicts those who behold works of art in Florence, Italy. The symptoms are dizziness, palpitations, hallucinations, orientation disorder, loss of identity and physical burnout.These clinical features manifest in patients who encounter rich Italian culture and historically important characters.
INTRODUCTION the The Diagnostic and Statistical Manual of Mental Disorders (DSM) as a specific psychiat- Over the last few years, a cluster of psycho- ric illness, but in contrast, it is included in Zin- logical symptoms has appeared among tourists garelli, which is one of Italy’s most important due to exposure to artistic and historical master- dictionaries (Hager 2016). According to Magh- pieces. These are known as city syndromes. erini’s research, symptoms of Stendhal syndrome They differ from long-term psychological or psy- are seen especially in Northern Europeans; the chiatric disorders. City syndromes are short-term least affected people are, predictably, Italians disorders and are seen only in the visited cities. (because every street is like an art gallery) and Paris syndrome, Jerusalem syndrome and Stendhal the Japanese (because of their organizing abili- (Florence) syndrome are the most widely known ties). There are also specific works whereby the among city syndromes (Halim 2009). effects have been recorded. According to the Stendhal syndrome is basically a psychoso- data, Michelangelo’s David, Caravaggio’s Bac- matic disorder in which an individual experienc- chus and Botticelli’s Venus are works where symp- es certain reactions when a work of art that is toms of the syndrome have most been recorded listened to or seen. These reactions include heart (Hager 2016). palpitations, dizziness, and even hallucinations Stendhal syndrome does not have a specific (Pinar 2014). treatment method. It is especially seen among Stendhal syndrome was first seen in the Ba- individuals who are fond of art and are more silica of Santa Croce. The name of this syndrome emotionally sensitive. Stendhal explained his was coined by Marie-Henri Beyle, known in lit- feelings in his diary as follows: “I was trapped in erature by his pen name as Stendhal, in Italy in this glory. My life seemed to flash before my 1817. According to experiments conducted an- eyes. So much so that I was afraid to stumble nually, the same regions of the brain were ob- and roll as I walked” (Amancio 2005). served to act with intense emotion during a trip These symptoms are not only seen in Flo- to Florence (Innocenti 2014). Despite these ex- rence, but the syndrome is so named because it periments, Stendhal syndrome is not defined in was first described there. This syndrome is also referred to as “art poisoning” because it occurs Address for correspondence: when exceptional and grandiose works of art are Asli Yayak, Bursa beheld (Pinar 2014). Technical University, 152 Evler Mah. Egitim Cad. No: 80, The symptoms of Stendhal syndrome are the Yildirim-Bursa, Turkey opposite of those observed in Paris syndrome. Telephone: 00905394219688, In Paris syndrome, there is a depression caused Fax: 00902243003830, by high expectations that are not met, whereas E-mail: [email protected] in Stendhal syndrome there is a loss of percep- STENDHAL SYNDROME 191 tion and a loss of consciousness due to the gran- their impact on art are dealt with by art psychol- deur of the works observed (Innocenti 2014). ogy. External factors are an area of interest in the sociology of art (Uludag 1996). Objectives Art psychology basically examines the be- havior of artists in the production-creation pro- This paper will consider what art and art psy- cess and the experiences and behaviors of those chology are and how and why the Stendhal syn- who approach the arts as consumers (Olbrich drome arises as an psychatric disorder. The pa- 2004). In other words, it can be regarded as a per will also review the literature of Stendhal branch of science that examines the attitudes syndrome within the purview of art psychology. and behaviors of any art phenomenon and psy- chological problems related to art. Art Psychology With the establishment of modern psychol- ogy and psychophysics in the 19th century, the To define art psychology, firstly the concept meaning of art is sought in a subject who grasps of art has to be identified and understood. One the artwork and appreciates it because the sub- of the most important features that distinguish- ject is the one who attributes meaning to the es man from other living species in nature is that artwork. If a person is evaluating an artwork, it is man can produce a work of art. If human life because he likes that artwork. It is this emotion- could only be lived out by satisfying physical al interest in the subject that determines the val- needs and through work, it would be very dry, ue of an artwork. To investigate the meaning of uninspired and meaningless. In a life devoid of art is actually to investigate this interest between art, such as cinema, music, sculpture and the- a work of art and an aesthetic subject (Fechner ater, the human spirit would be left hungry (Ezici 1876). 2005). Aristotle made the first definition of the Lipps argues that both art and the beauty of phenomenon of art, which had been attempted art can be explained by analyzing the aesthetic to be defined by different disciplines, as “mime- sense that the object awakens in the subject. sis” 3000 years ago. The French artist and sculp- This feeling is called “Einfuhlung” in German tor Rodin defined art as an effort of thought that which means living something wholeheartedly, wants to understand and tell about the world understanding something wholeheartedly and (Sener 1982). Freud, who has made a great con- hearing it wholeheartedly (Worringer 1953). This tribution to the science of psychology, defined is a feeling of pleasure. Generally, the phenome- art as the attitude of an adult towards life, game non of emotion is related to the subject, but in pleasure of a step taken beyond reality and the Einfuhlung there is a compulsory existence of theatrical portrayal of pain, not the pain itself the object (Lipps 1903). (Lentriccihia and McAuliffe 2004). Although art is something that is produced, As for an art work put forward by the art- discussed, criticized and developed as a con- maker, in the most general signification it can be cept, man fundamentally does art to satisfy an described as an original, single and new pro- important need. That is a need of telling himself duction depending on a creator, telling his tech- nique, style, vision of the world and human un- to others. The necessity of doing art is widely derstanding (Erinc 2004). Not every creative per- defined in society as a form of self-disclosure of son fits the definition of artist as not every prod- an individual. It is defined scientifically as self- uct is a work of art. The person who has been actualization. The theory of self-actualization is accepted as “real artist” since Plato is a person a concept put forth by Jung but is also found in who gives life to a new reality, enlarges human the works of Adler, Rank, Goldstein and Fromm. consciousness and reveals its own existence In universal meaning, this can be defined as re- (May 1994). vealing the potential of being a man which ex- There are two main factors affecting the art ists in a being by itself. According to the hu- and the artist who naturally produces and cre- manistic perspective, human beings have basic ates art. The first of these factors are internal physiological needs such as nutrition, protec- and the second is external. Internal factors and tion and continuation of lineage, and once these
Ethno Med, 13(4): 190-197 (2019) 192 ASLI YAYAK basic needs have been satisfied, higher needs tinues, this internality and necessity will always arise and people try to satisfy them throughout exist because, at the center of art, man and his their lives. These high-level needs, which Maslow relationship with life take part; this shows that calls the “hierarchy of needs”, are requirements unless humanity is dead, art will not die (Fisher such as respect, knowledge and pleasure of beau- 2005). ty. Humanistic psychology asserts that the mo- tive for self-realization is the most important mo- MATERIAL AND METHODS tive that governs human behavior (Kuzgun 1972). The human being in the direction of “self- In this paper, literature related to Stendhal actualization” wants to be recognized, appreci- syndrome and art psychology has been re- ated and loved by everyone around him, hence viewed and information on the subject has been he tries to shape himself in such a way that he compiled. will be accepted in society. Social roles, espe- cially occupational roles, can put pressure on OBSERVATIONS AND DISCUSSION many people’s psychological identities and even make them forget the aforementioned wants. City syndromes are mostly acute, short-term When people do their jobs, they can imperson- disorders, and their symptoms show similarities ate “visible” identities that will enable their so- with their initial and healing patterns. Each is cial acceptance. If an individual becomes bound linked to a specific city that is popular as tourist to their roles, anxiety of fulfilling social roles a destination, and they are named by psychia- may become chronic (Dokmen 2004). trists and psychologists working in these city In the art world, it is a common statement to hospitals. Paris syndrome, Stendhal (Florence) call art work as occupation. It is also a common syndrome and Jerusalem syndrome are the most discourse that artists use their work as a means well known of those (Halim 2009). to express themselves. In parallel with the gen- A syndrome is a specific disease or psycho- eral social perception, although work in the art logical disorder associated with recognizable, recurrent symptoms (American Heritage Dictio- universe is still seen as a criterion for identity nary 2006). It has been a long-standing tradition evaluation, it is expected that the artist, unlike in medicine for a disease to be named for the other professions, will manifest through his work place where it is discovered. For example, Lyme or display his life view or internal universe. The disease was named after the place in the US state concept of “artist identity” is perhaps a mani- of Connecticut where it was first identified (Abel festation of this expectation. The concept of art- 2014). ist identity is perhaps a manifestation of this Stendhal syndrome, also known as Florence expectation. The social status of the artist iden- syndrome, describes a physical disease that tity is quite high. For the sake of owning this occurs when beholding the artwork of Florence high status identity, the artist may tend to fic- (Chouchena 1995). Stendhal syndrome was tionalize an ideal role for himself. As for the anx- named for the world-famous French traveler and iety of pursuing the ideal, it can lead to an in- author Marie-Henri Beyle who used the pseud- crease in the distance between his real person- onym Stendhal (Magherini 1989). Stendhal had ality and the personality reflected in his works an emotional experience while traveling on a visit with a motive of preserving the entirety of his to Santa Croce Cathedral in Florence, Italy, in role. For example, it can lead to triggering psy- 1817. During his visit to the Santa Croce Cathe- chological identification and internalization dral, he found a priest who allowed him to go mechanisms of the human as artist (Gectan 1997). into the church, leaned his head back and looked In every age and under all circumstances, up at the fresco of the Volterrano Sibyls in a people have always been in need of art and have chair. The pleasure was very sharp: “I was un- been involved with art. Therefore, from the mo- der the influence of ecstasy with the thought of ment human beings have existed, there has been being close to the graves of the great people I a strong link between art and humanity, and for saw and being in Florence. While I intended to as long as the existence of human beings con- internalize this magnificent beauty, I came clos-
Ethno Med, 13(4): 190-197 (2019) STENDHAL SYNDROME 193 er, touched him, talked to him. I had a passionate types: 1) disorders of thought (changes in the feeling by accessing to heavenly senses of fine perception of sounds or colours, hallucinations, arts. When I left Santa Croce, my life escaped delirious perception of the external reality, feel- from my control and went out for fear of falling.” ings of persecution or guilt and fear); 2) emo- Stendhal spoke about the rich culture and histo- tional disorders (depressive anxiety and feelings ry of Italy and reported that he had strong feel- of inferiority and worthlessness or, on the con- ings in his heart about art. He experienced en- trary, feelings of superiority, euphoria, exulta- thusiasm, drawing attention to a situation that tion and omnipotent thinking); 3) panic attacks was emotionally intense and alert. This situa- and somatised anxiety (fear of dying or going tion is described by episodes of palpitation, diz- mad, somatic projections of anguish, chest pains, ziness and loss of physical strength (Bamforth arrhythmia and visual disorders). Only 38 per- 2010). cent of patients with type 1 symptoms had had a Stendhal syndrome was born from observa- previous psychiatric history, while 53 percent of tions by a psychiatrist named Graziella Magh- patients with type 2 had had a psychiatric histo- erini (1989) at the Santa Maria Nuova Hospital ry. In most of these cases, shown by Magherini, in Florence. Magherini examined foreign tour- patients reported a feeling of dissolution or dis- ists who were weak and in tears, suffering from integration in their ego. A 53-year-old male pa- dizziness and uneasiness, were obliged to re- tient, after spending a long time in front of Bac- ceive emergency health care service and even chus of Caravaggio, stated that he felt in the had to be kept under doctor’s supervision. The space of an indistinguishable place between two doctor’s thesis is that the source this sudden basic phases of his life. A 20-year-old female and striking behavior lies in traveling to an art patient reported that, after spending time at the city. Magherini produced the expression Uffzi Gallery, she felt shredded as if in a terrorist Stendhal syndrome based on the feelings that act and became agitated, recurrently shouting Stendhal described in his travel books Rome, for help. Magherini considers herself a passion- Naples and Florence (1817), Rides in Rome (1829) ate reader of Stendhal since childhood. Stendhal and Memoirs of a Tourist (1838). In these works, deeply influenced her as a tourist with a modern Stendhal speaks of a series of psychic impulses spirit, and a soulful traveler changing our sense that travel encourages in him. On a page of Rome, of travel and travel writings (Magherini 1989, Naples and Florence, the author associates the 2007). visit to the Santa Croce Cathedral with the crisis Magherini concluded that during the treat- seizure experienced in the church. The author ment of these patients, the disease had an un- had to leave the church to recover after such predictable and unexpected onset. The symp- intense aesthetic emotions. toms persist for 2 to 8 days, triggering thought On January 22, 1817, when Stendhal was in disorders by 66 percent of patients, emotional his 30’s, while he watched the city’s buildings disorders by 29 percent, and anxiety disorders and artifacts as he passed the Apennines in Flo- and panic attacks by 5 percent. Other character- rence, he wrote that his heart was pounding in ized symptoms include sweating, physical weak- the face of past and culture of the city. Psychia- ness, tachycardia, chest tightness, alienation, trist Graziella Magherini (1989, 2007) examined anxiety and confusion. The least reported symp- these physical symptoms including fear of faint- toms are agitation and desire to destroy the work ing, frustration and even fear of death. She named of art (Teive et al. 2014). More than 50 percent of it after him: Stendhal syndrome. The term refers cases had psychiatric disorders, such as sup- to episodes of short, unexpected and severe pressed sexual desire, burnout, inadequate sleep, physical discomfort that last from a few hours to orcoming to an end of a journey, and these con- several days. From July 1977 to December 1986, ditions attribute some potential factors to the these symptoms were observed and examined clinical picture. Although some patients experi- on 106 foreign visitors who had left their home enced change or uncertainty, all patients were country in excellent health and then came to the psychologically attenuated before the onset of Santa Maria Nuova Hospital in Florence for treat- the syndrome. In the comparison between af- ment. Magherini divides the symptoms into 3 fected and unaffected tourists, higher average
Ethno Med, 13(4): 190-197 (2019) 194 ASLI YAYAK age and lower education level are factors that ation. This overwhelming mental state was stim- seem to contribute to vulnerability to the syn- ulated by Freud’s own ideas of the Acropolis drome. Among the affected women, a very small and Greek civilization. percentage consists of managers, business wom- In a recent paper, Magherini focused not only en or professionals (Guerrero et al. 2010). on the clinical features of the patients but also There are many cases similar to Stendhal’s on the stability of the artwork. She chose the experience in the 19th century. While supersensi- famous statue of David for her work,which is a tive Marcel Proust was writing his novel In figure that has triggered many psychological Search of Lost Time, he had constant melancholy reactions in audiences as a symbol of physical and asthma attacks. Dostoyevski was known to and mental energy and a figure of heroism, lust have undergone severe agitation when he saw and intelligence (Zollner et al. 2008). Within this the famous painting about the death of Jesus study, participants gave a series of answers: Christ by Hans Holbein (Amancio 2005). some participants were overly influenced by the According to Magherini (1989), the psycho- excellence of this masterwork, while a few point- pathological dimensions of the shock caused ed out very minor imperfections. The majority of by meeting with artworks are more pronounced the participants reported positive emotions in foreigners who change places both metaphor- about the work and were amazed that it has stood ically and in real terms. Because only a few of for many years and admired him despite his life- the patients afflicted with the syndrome were less body. Some participants at the other extreme Italian, Magherini thought that the determinant emphasized negative associations from dissat- factor of Stendhal syndrome was travel. This isfied experiences: they reported intense painful has been experienced by other visitors in other feelings, hostility, competitiveness and a desire geographies with low and high intensity. This to do damage to the work (Magherini 2007). experience continues in the form of aesthetic Hall and Page (1999) provided an explana- and touristic subconscious symptoms that of- tion for the study of human motivation in tour- ten result in frustration but are always hidden. ism. By using Maslow’s theory of needs, they The case of Freud, who was deeply affected by assert that people will find their true essence by his trip to Greece with his brother, is a particular- travelling and thereby discovering deep feelings. ly good example to mention. In his famous paper Recently, clinically reported cases of Stendhal published in 1919 under the title of “Das Unhe- syndrome have been discussed intensively since imliche”, he examined the disquieting sense of 2005. Amancio (2005), a Brazilian neurosurgeon, alienation caused by travel experience. When- reported a Russian writer who showed symptoms ever this alienation occurs, it eliminates the of Stendhal. In 2009, Nicholson (2009) wrote a boundaries between dream and reality. This kind episode of paranoid psychosis experienced by a of sense of alienation points out the transitional 72-year-old during his visit to Florence. This case, space defined by Winnicott (1975). The relation- published in the British Medical Journal Case ship with artwork or aesthetic objects are estab- Reports, tells of the patient’s orientation disorder lished in this transitional space (Amirou 2000). and visit to the Ponte Veccio Bridge and painful In 2010, Bamforth, in a paper about Stendhal thoughts that he experienced including paranoia syndrome, published similar evidence of symp- involving the delusion that that the international toms based on the experiences of Jung and Freud. airports and the rooms were spied on and many In his autobiography, Jung mentions an event other interesting and unusual ideas. These symp- where he suffered physical and mental distress toms ceased after a 3-week physical rest. The reoc- due to artworks in Pompeii. Under such an in- curence of these symptoms from mild emotional tense experience, he lost his senses of percep- distress to psychosis during visits to certain cities tion and could not continue his journey to Rome. has led many researchers to investigate Stendhal He never visited that destination again. Freud syndrome. reported a similar experience during his visit to Guerrero et al. (2010) examined the frequen- the Acropolis of Athens (Bamforth 2010). This cy of stendhal syndrome and related symptoms confrontation provoked enthusiasm and then by creating a questionnaire in professional work- gave him a feeling of depersonalization and alien- shops consisting of neurologists from Rome,
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Florence, Padua and Venice. The survey sought The assumption as a particular disorder is to determine whether patients seen by neurolo- that “the impairment in personality functioning gists have a complete or partial syndrome. Ad- and the individual’s personality trait significa- ditionally, it aimed to gather positive symptoms, tion are not better understood as normative for such as aesthetic pleasure, excitement, eupho- the individual’s developmental stage or socio- ria, sensations of omnipotence, and unpleasant cultural environment” (Guerrero et al. 2010). somatic symptoms such as change in percep- Stendhal syndrome is not considered a dis- tion, sense of guilt, insecurity and inadequacy. order in the latest version of DSM, but the manu- A total of 48 questionnaires were applied and al with the disease classification invention has the mean age was recorded as 50±9 and the male/ recently shown that it is probably just an instan- female ratio was 17 to 10. Twenty-five percent of taneous problem. In 1989, Magherini, who worked the participants reported a partial form of the at the Santa Maria Nuova Hospital in Florence, syndrome without any panic attacks or thought wrote his book La Sindrome di Stendhal by ob- disorders; however, emotions related to art (83%) serving 106 visitors who had been treated in the and enthusiasm (62%) were substantially report- emergency room and had been hospitalized in ed in the answers. Importantly, no neurologist previous years. All patients were brought to the reported severe symptoms of the syndrome, but hospital upon stretchers from art galleries and some reported mild clinical symptoms. museums in the city. Symptoms are dizziness, In the observations, the syndrome was mostly palpitations, hallucinations, orientation disorder, seen in European tourists and rarely in Asian, loss of identity, and physical burnout (Barnas Italian and North American tourists. Especially, 2008; Magherini 1989). Magerini describes these people living alone with a classic or religious clinical features as profound reactions as a re- education are more proned to develop the syn- sult of an encounter with rich Italian culture and drome (Nicholson et al. 2009). Nicholson et al. historically important characters (Magherini (2009) attributed the emergence of the syndrome 1989). Trigger factors are an impressionable per- to the cultural burden that leads to inappropri- sonality, stress of travel and encountering a ate reactions in tourists. magnificent city full of history such as Florence. One recent example was in the Uffizi Gallery, one of Italy’s most famous museums. An un- Possible treatment might beto leave Italy as soon named man suffered cardiac arrest while behold- as possible and to return to worldly reality (Bar- ing Sandro Botticelli’s painting The Birth of Ve- nas 2008; Magherini 1989). nus. The unnamed male collapsed in front of the There’s no specific treatment for this syn- painting which is considered one of the master- drome. Evidence shows that treatment does not pieces of the Italian Renaissance. The man’s go further than alleviating basic symptoms. Stud- heart required defibrillation (electro-taser) at the ies show that during the syndrome, brain activ- museum in order to start again. Eike Schmidt, ity is normal and the brain is involved in con- director of the Uffizi Gallery, said cases like these sciousness, emotion processing, memory and have happened in front of both Botticelli’s works social interaction (Juarez et al. 2014). and Caravaggio’s Medusa. According to There are some risk factors for this syndrome Schmidt’s narrative, in the Uffizi in 2016, another like other syndromes. Age, sex, marital status, man suffered an epileptic seizure in front of Bot- educational level and stress are the main risk ticelli’s Spring. In 2018, one person also fainted factors. Moreover, living alone, being at the end in front of Caravaggio’s Medusa. Schmidt inter- of the journey and religious upbringing are oth- prets these cases as “proof that art affects reality” er factors (Sanchez et al. 2017). (Pinar 2018). Although many cases of Stendhal syndrome CONCLUSION have been reported, this syndrome has not yet been mentioned in DSM-5. This is probably be- The objective of this paper was to discuss cause such clinical cases do not adequately meet and understand the background of Stendhal dysfunction parameters as a mental health prob- (Florence) syndrome. It’s a city-syndrome and lem according to the revised DSM-5. is named for the city of Florence. While people
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encounter with great artworks and masterpiec- Ezici AK 2005. Personality of artist and psychology es, they report the symptoms of a physical dis- of creativity. Anatolian Journal of Psychiatry, 6: 122-127. ease. It is a behavioral syndrome that shows Fechner GT 1876. Vorschule der Asthetik. Leipzig: indications such as anxiety, confusion, eupho- Breitkopf & Hartel. ria, perception changes and some psychosomat- Fisher E 2005. Necessity of Art. Istanbul: Payel Yayin- ic symptoms. Stendhal syndrome is a short-term lari. Gectan E 1997. Psychodynamic Psychiatry and Ab- and temporary disorder that passes in a short normal Behavior. Istanbul: Remzi Kitabevi. time. There is no specific treatment for this syn- Guerrero AL, Rosselló AB, Ezpeleta D 2010. Stendhal drome; moving away from art galleries and mu- syndrome: Origin, characteristics and presentation seums is the easiest way to cope with it. in a group of neurologists. Neurologia, 25(6): 349- 356. doi: 10.1016/ S2173-5808(10)70066-3. Hager L 2016. Stendhal’s Syndrome: The Disease You RECOMMENDATIONS Can Only Catch in Florence. From
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ing at The Birth of Venus of Botticelli]. From
Ethno Med, 13(4): 190-197 (2019)