Shortly after his 40th birthday, the life of a man we'll call Ronald Hodge took a strange turn. He still looked pretty good for his age. He had a well-paying job and a devoted wife. Or so he thought. Then, one morning, Hodge's wife told him she no longer loved him. She moved out the next day. A few weeks later, he was informed that his company was downsizing and that he would be let go. Not knowing where to turn, Hodge started going to church again.

Even though he'd been raised in an evangelical household, it had been years since Hodge had thought much about God. But now that everything seemed to be falling apart around him, he began attending services every week. Then every day. One night, while lying in bed, he opened the Bible and began reading. He'd been doing this every night since his wife left. And every time he did, he would see the same word staring back at him—the same four syllables that seemed to jump off the page as if they were printed in buzzing neon: Jerusalem. Hodge wasn't a superstitious man, he didn't believe in signs, but the frequency of it certainly felt like ... something. A week later, he was 30,000 feet over the Atlantic on an El Al jet to Israel.

When Hodge arrived in Jerusalem, he told the taxi driver to drop him off at the entrance to the Old City. He walked through the ancient, labyrinthine streets until he found a cheap hostel near the Church of the Holy Sepulchre. He had a feeling that this was important. Supposedly built on top of the spot where Jesus Christ was crucified and three days later rose from the dead, the domed cathedral is the holiest site in Christendom. And Hodge knew that whatever called him to the Holy Land was emanating from there.

During his first few days in Jerusalem, Hodge rose early and headed straight to the church to pray. He got so lost in meditation that morning would slip into afternoon, afternoon into evening, until one of the bearded priests tapped him on the shoulder and told him it was time to go home. When he returned to his hostel, he would lie in bed unable to sleep. Thoughts raced through his head. Holy thoughts. That's when Hodge first heard the Voice.

Actually, heard is the wrong word. He felt it, resonating in his chest. It was like his body had become a giant tuning fork or a dowsing rod. Taking a cue from the sign of the cross that Catholics make when they pray, Hodge decided that if the vibrations came from the right side of his chest, it was the Holy Ghost communicating with him. If he felt them farther down, near the base of his sternum, it was the voice of Jesus. And if he felt the voice humming inside his head, it was the Holy Father, God himself, calling.

Soon, the vibrations turned into words, commanding him to fast for 40 days and 40 nights. None of this scared him. If anything, he felt a warm, soothing peace wash over him because he was finally being guided.

Not eating or drinking came easily at first. But after a week or so, the other backpackers at his hostel began to grow concerned. With good reason: Hodge's clothes were dirty and falling off of him. He had begun to emit a pungent, off-putting funk. He was acting erratically, hallucinating and singing the word Jesus over and over in a high-pitched chirp.

Photo: Ziv Koren

"Jesus ... Jesus ... Jesus ..."

Hodge camped out in the hostel's lobby and began introducing himself to one and all as the Messiah. Eventually, the manager of the hostel couldn't take it anymore. He didn't think the American calling himself Jesus was dangerous, but the guy was scaring away customers. Plus, he'd seen this kind of thing before. And he knew there was a man who could help.

Herzog Hospital sits on a steep, sun-baked hill on the outskirts of Jerusalem. Its sprawling grounds are dotted with tall cedars and aromatic olive trees. Five floors below the main level is the office of Pesach Lichtenberg, head of the men's division of psychiatry at Herzog.

Lichtenberg is 52 years old and thin, with glasses and a neatly trimmed beard. Born into an Orthodox Jewish family in Crown Heights, Brooklyn, he moved to Israel in 1986 after graduating from Albert Einstein College of Medicine in the Bronx and has worked at Herzog more or less ever since. It's here that he has become one of the world's leading experts on the peculiar form of madness that struck Ronald Hodge—a psychiatric phenomenon known as Jerusalem syndrome.

On a bright, late summer morning, Lichtenberg greets me in the chaotic lobby of the hospital, smiling and extending his hand. "You missed it!" he says. "We had a new Chosen One brought into the ward this morning." We go down to Lichtenberg's office; on top of a bookcase is a giant shofar, a curved ram's horn that religious Jews sound on the high holidays. A middle-aged British man under the doctor's care had used it to trumpet the Messiah's—that is to say, his own—coming. Lichtenberg explains that allowing me to meet his latest patient would violate hospital policy, and he can't discuss ongoing cases. He'll talk about past patients as long as I agree to de-identify them, as I did with Hodge. "But," he adds, "that doesn't mean we can't try to find a messiah of our own. In a few days, we'll take a walk around the Old City and maybe we'll find one for you there."

There's a joke in psychiatry: If you talk to God, it's called praying; if God talks to you, you're nuts. In Jerusalem, God seems to be particularly chatty around Easter, Passover, and Christmas—the peak seasons for the syndrome. It affects an estimated 50 to 100 tourists each year, the overwhelming majority of whom are evangelical Christians. Some of these cases simply involve tourists becoming momentarily overwhelmed by the religious history of the Holy City, finding themselves discombobulated after an afternoon at the Wailing Wall or experiencing a tsunami of obsessive thoughts after walking the Stations of the Cross. But more severe cases can lead otherwise normal housewives from Dallas or healthy tool-and-die manufacturers from Toledo to hear the voices of angels or fashion the bedsheets of their hotel rooms into makeshift togas and disappear into the Old City babbling prophecy.

Lichtenberg estimates that, in two decades at Herzog, the number of false prophets and self-appointed redeemers he has treated is in the low three figures. In other words, if and when the true Messiah does return (or show up for the first time, depending on what you believe), Lichtenberg is in an ideal spot to be the guy who greets Him.

“Jerusalem is an insane place,” one anthropologist says. “It overwhelms people.”

Photo: Ziv Koren Ziv Koren

While it's tempting to blame the syndrome on Israel's holiest city, that wouldn't be fair. At least, not completely. "It's just the trigger," says Yoram Bilu, an Israeli psychological anthropologist at the University of Chicago Divinity School. "The majority of people who suffer from Jerusalem syndrome have some psychiatric history before they get here." The syndrome doesn't show up in the Diagnostic and Statistical Manual of Mental Disorders, but it and its kissing cousins are well-known to clinicians. For example, there's Stendhal syndrome, in which visitors to Florence are overwhelmed by powerful works of art. First described in the early 19th century in Stendhal's Naples and Florence: A Journey from Milan to Reggio, the disorder can lead to spontaneous fainting, confusion, and hallucinations. Paris syndrome, first described in 1986, is characterized by acute delusions in visitors to the City of Light and for some reason seems to preferentially affect Japanese tourists. Place, it seems, can have a profound effect on the mind.

What's actually happening in the brain, though, isn't completely clear. Faith isn't easy to categorize or study. Andrew Newberg, a neuroscientist at Thomas Jefferson University in Philadelphia, has conducted several brain-imaging studies of people in moments of extreme devotion. The limbic system, the center for our emotions, begins to show much higher activity, while the frontal lobes, which might ordinarily calm people, start to shut down. "In extreme cases, that can lead to hallucinations, where someone might believe they're seeing the face of God or hearing voices," Newberg says. "Your frontal lobe isn't there to say, 'Hey, this doesn't sound like a good idea.' And the person winds up engaging in behaviors that are not their norm."

>She would rub her temples, desperate to dial in the voice of God like someone trying to tune in a far-off radio station.

The psychosis typical of Jerusalem syndrome develops gradually. At first the victim may begin to feel symptoms of anxiety, nervousness, and insomnia. The next day, there may be a compulsive urge to break away from the rest of the tour group and visit holy places like the Church of the Holy Sepulchre or the Church of the Nativity in Bethlehem. Sufferers might follow this with a series of purification rituals such as shaving all of their body hair, clipping their nails, or washing themselves free of earthly impurities. The afflicted may then venture into the Old City to shout confused sermons claiming that redemption is at hand. In some cases, victims believe they are merely a cog in an ineffable process, helping to set the stage for the Messiah's return with some small task they've been given. In more extreme cases, they can be swept up by psychotic delusions so intense, so ornate, that they become convinced they are Jesus Christ. "Jerusalem is an insane place in some ways. It overwhelms people, and it has for centuries," Bilu says. "The city is seductive, and people who are highly suggestible can succumb to this seduction. I'm always envious of people who live in San Diego, where history barely exists."

In other words, what you can blame Jerusalem for is looking like, well, Jerusalem. The Old City is a mosaic of sacred spaces, from the al-Aqsa Mosque to the Western Wall of the Temple Mount to the well-trodden stones on which Jesus supposedly walked. Like every city, it's the combination of architecture and storytelling that makes Jerusalem more than just a crossroads. Great cities, the places that feel significant and important when you walk their streets, always rely on stagecraft—a deftly curving road, finely wrought facades, or a high concentration of light-up signage can all impart a sense of place, of significance. This architectural trickery can even instill a feeling of the sacred. The colonnades around St. Peter's Square at the Vatican, the rock garden at Ryoanji temple in Kyoto, and the pillars at the Jamarat Bridge near Mecca all shoot laser beams of transcendence into the brain of a properly primed visitor. "Part of the experience of going to these places is the interweaving of past and present," says Karla Britton, an architectural historian at the Yale School of Architecture. "There's a collapse of time. And for some people who visit these sacred sights and spaces, this collapse can be psychologically disorienting. The whole act of pilgrimage is deliberately intended as a kind of disorientation."

That in and of itself doesn't make someone crazy. "There are a lot of people who come to Israel and feel God's presence, and there's nothing wrong with that," Lichtenberg says. "That's called, at the very least, a good vacation. God forbid a psychiatrist sticks his nose into something like that." He smiles and rubs his beard. "But the question is, at what point is belief OK and at what point is it not OK? If someone says, 'I believe in God,' OK. And if they say, 'I believe the Messiah will come,' fine. And if they say, 'I believe His coming is imminent,' you think, well, that's a man of real faith. But if they then say, 'And I know who it is! I can name names!' you go, wait a second—hold on!"

When people with Jerusalem syndrome show up at the hospital, doctors often just let them unspool their stories, however strange the narratives may seem. If the people aren't dangerous, they are usually discharged. Violent patients might be medicated and kept under observation pending contact with their family or consulate. After all, the most effective treatment when it comes to Jerusalem syndrome is often pretty simple: Get the person the hell out of Jerusalem. "The syndrome is a brief but intense break with reality that is place-related," Bilu says. "When the person leaves Jerusalem, the symptoms subside."

Lichtenberg didn't know any of this when he started at Herzog. Then, shortly after he began his residency in the late 1980s, he met a 35-year-old Christian woman from Germany. She was single and traveling alone in Israel. He remembers her as being gaunt, prematurely gray, and highly educated. The police had picked her up in the Old City for badgering tourists about the Lord's return. "She arrived in a state of bliss because she believed the Messiah was coming," Lichtenberg says. "I probably thought, she's just meshuggeneh."

Over the next few days, Lichtenberg underwent a transformation of his own. He became obsessed with the German woman's case. He thought about how she would ricochet from periods of giddy rapture to moments of outright hostility and confusion. During her more manic moments, she wanted to share the Good News with the doctor. In her more depressive ones, she wandered the psychiatric ward desperately trying to hear the voices in her head that had gone momentarily silent. She would rub her temples as if she could dial in the voice of God, like someone trying to tune in a far-off radio station.

The woman stayed at the hospital for a month, until the doctor could arrange for her to be sent home. Lichtenberg has no idea what happened to her after she returned to Germany, but more than 20 years later he can still recall the smallest details of her case. "It was so interesting talking to her, but I was also a little embarrassed because there was no one at the hospital to encourage that sort of thing back then. At the time, the thinking here was more like, OK, what dosage is she getting? Should we increase it?"

This way of thinking is more sympathetic than many psychiatrists would call for. Actually, it wasn't that long ago that one respected Israeli physician put two patients who both claimed to be the Messiah in a room together just to see what would happen. Each rabidly accused the other of being an impostor, barking fire-and-brimstone threats.

“People come to Israel and feel God's presence,” Pesach Lichtenberg says. “There's nothing wrong with that.”

Photo: Ziv Koren Ziv Koren

Self-styled prophets have been journeying to Jerusalem on messianic vision quests for centuries. A certain Nazarene carpenter was merely the most charismatic and most written about. But it wasn't until the 1930s that an Israeli psychiatrist named Heinz Herman clinically described Jerusalem syndrome for the first time. One of his early cases involved an Englishwoman who was so convinced the Second Coming was at hand that she climbed to the top of Jerusalem's Mt. Scopus every morning with a cup of tea to welcome the Lord.

Most cases are harmless, but there have been disturbing exceptions. In 1969 an Australian tourist named Denis Michael Rohan was so overwhelmed by what he believed to be his God-given mission that he set fire to the al-Aqsa Mosque, one of Islam's most sacred sites, which sits atop the Temple Mount directly above the Wailing Wall. The blaze led to rioting throughout the city. Rohan later said that he had to clear the site of "abominations" so it would be cleansed for the Second Coming. (The mosque was rebuilt by a Saudi construction company owned by Osama bin Laden's father.)

More recently, an American man became so convinced he was Samson that he tried—and failed—to move a block of the Wailing Wall. An American woman came to believe she was the Virgin Mary and went to nearby Bethlehem to search for her baby, Jesus. And a few years ago, the Israeli press reported on a 38-year-old American tourist who, after spending 10 days in Israel, began roaming the surrounding hills muttering about Jesus. Shortly after being hospitalized, he jumped off a 13-foot-high walkway near the emergency room, breaking several ribs and puncturing his lung.

Lichtenberg says that during times of uncertainty and conflict (not infrequent in Israel), admissions to his ward spike. For example, in late 1999, when the rest of the world quaintly panicked about the Y2K bug and whether they'd be able to use their ATMs on January 1, Israel was on high alert, afraid that deranged religious crazies would flock to Jerusalem in anticipation of a millennial apocalypse. At the peak, five patients a week were brought into Lichtenberg's ward. The country's defense forces were concerned that someone would try to blow up the al-Aqsa Mosque, finishing the job Rohan started 30 years earlier.

One of the patients brought into Herzog at the time was an old man who sold novelty wooden back-scratchers near Lichtenberg's home. The doctor knew him. He also knew that the man firmly believed he was King David. "Was he psychotic? Yeah, OK," the doctor says with a shrug. "But I didn't see any need to keep him. Unfortunately, he passed away recently. Otherwise, I would have loved for you to meet him. He would have been happy to talk to you."

At 9 the next morning, the doctor and I are walking the narrow streets of the Old City. It seems like a good way to conduct an interview, outside the sterile confines of the hospital. Plus, we are still hoping to meet a messiah.

The scents of cumin and turmeric and cardamom are so overwhelming that my eyes begin to water. And even though the doctor has lived in Jerusalem for 25 years, his sense of direction in the winding alleys of the Muslim Quarter seems sketchy at best. After several embarrassing wrong turns and switchbacks, we find ourselves standing face-to-face with an Arab butcher skinning a goat that hangs on a giant rusty hook. We detour left down a dark passageway and nearly crash into a dozen elderly Italian women dressed in the black clothes of mourning, carrying a 6-foot wooden cross on their hunched backs. They're huddled together like a rugby scrum, chanting in Latin as they take plodding steps along the Stations of the Cross, reenacting Jesus' bloody march to his crucifixion.

We move aside to let them slowly pass. Neither one of us says a word. And as soon as they turn the corner and disappear from view, he turns to me. "I've got chills. Do you?"

I have to admit I do.

The doctor asks me to try to describe what I'm feeling as if I am one of his patients, and I stammer a response about going to Sunday School as a kid and the thick smell of incense I remember at Easter Mass at my father's Syrian Orthodox church. But, really, as soon as I try to put the sentiment into words, the chills subside and trickle away.

This is essentially what happened to the patient I've called Ronald Hodge. After a month of taking antipsychotic drugs under Lichtenberg's care at Herzog, he gradually came to accept the hazy reality of what he'd been through. He was still confused, but he was calmer, more cooperative, and he no longer felt voices thrumming through his body. The American consulate arranged for his discharge and put him on a flight back to the States. He went back to his old life.

Lichtenberg and I come to the Church of the Holy Sepulchre. Inside the entrance is the Stone of Unction, symbolizing the spot where Jesus' body was anointed and wrapped in a shroud after he was taken down from the cross. Men are kneeling with lit candles. Women are kissing the stone and running their rosaries along the top of it. Many are crying. It's profoundly moving.

We head east toward the Wailing Wall. There, rows of men dressed in black and wearing sidecurls are rocking back and forth as they pray. Lichtenberg grows quiet and slowly approaches the wall, rubbing his hand on one of the giant stones. He leans forward and softly kisses it. After a few minutes, he looks around and says, "No messiahs here today. Sorry." He seems honestly apologetic.

Later, over a cold drink, Lichtenberg confesses that he sometimes views his patients with less-than-scientific eyes. "I guess when someone comes into the hospital claiming to be the Messiah, my interest is not just clinical," he says. "Sometimes you can see right away that the patient isn't the charismatic type. They're just a sick patient. But, OK, yes, I'll admit it. There have been a number of people over the years who managed to arouse a certain hope that, hey, wouldn't it be great if this person really is the One? So far I've been disappointed. But you never know who will walk through that door tomorrow." His cell phone buzzes on the table. He's needed back at Herzog.

As Lichtenberg walks off toward the hospital, the drone of the muezzin's call to prayer crackles and hisses over a loudspeaker. The hairs on the back of my neck stand up. Is this the strange power of Jerusalem? Or just the result of an overactive limbic system? It feels deeper than that—more holy. But then again, what is deeper than neurochemistry?

Chris Nashawaty (chris_nashawaty@ew.com) is a senior writer at Entertainment Weekly.