Stendhal Syndrome

Definition of Stendhal syndrome

Stendhal syndrome is a psychosomatic disorder that causes sudden onset of vertigo, rapid heartbeat, confusion and hallucinations. Following initial symptoms patients can experience a feeling of loss and sadness. All of these symptoms occur in a presence of art. There are many different names referring to this syndrome: Florence syndrome, Hyperkulturemia or Art disease ^[1].

Causes

Stendhal syndrome is caused by being psychologically affected by the cultural significance and beauty of art. This syndrome is sometimes referred to as Florence syndrome because many people over the course of history have experienced these psychological symptoms while being in Florence ^[2].

In fact, the French author Stendhal himself reported of having been overwhelmed by the significance and beauty of Florence. Between 1977 and 1986 there were 106 cases reported of people having acute transient psychological symptoms, after viewing the art in Florence. This city is of great cultural significance, but this psychological syndrome is not limited to it.

There are also similar conditions related to popular tourist destinations, for example Paris syndrome. In this case, person is experiencing transient psychological symptoms after realizing Paris is not what they have expected to be. A person can also experience similar reaction when facing something else of great personal significance or beauty, for example nature.

The Uffizi gallery in Florence-a place where many experience the Stendhal Syndrome.
Image source: joyofflorence.com

Adverse life effects can affect mental health, especially for people with predisposition to mental disease. Patients that have experienced Stendhal syndrome often have family or personal medical history of mental illness. Pilgrimages are very likely to induce such mental conditions, because of their high significance to the person ^[3].

Symptoms

Most of the patients experience psychosis and paranoia. Psychosis is a mental disorder, characterized by loss of the sense of reality. People with psychosis can experience hallucinations and delusions. Hallucination is a sensory experience without any obvious stimuli. Hallucinations can be auditory, visual, tactile, taste or smell sensations. Delusions are thoughts conflicting with the reality ^[4].Other patients experience an affective state or anxiety. Anxiety can be very intense and cause feeling of fear and terror, panic attack with sweating, chest pain, irregular heartbeat, and feeling of throat closing ^[5]. Anxiety can be so intense, that it could cause the patient to faint. After experiencing these symptoms, the patient can feel sad and depressed, and even develop clinical depression. In her 1989 book “La Sindrome di Stendahl” psychiatrist Dr. Graziella Magherini, based on her previous observations has categorized all patients in three types

• Type I : patient experiences predominantly psychotic symptoms
• Type II: patient experiences predominantly affective symptoms
• Type III: patient experiences predominately anxiety symptoms

Diagnosis

The diagnosis of Stendhal syndrome is not easy to make. There is still discussion in psychiatric society if this syndrome really exists ^[6].

The diagnosis can be made by observing the patient and his complaints. Some patients experience only minor anxiety or other symptoms and don’t look for medical help. For some people symptoms can be so severe, that they require medical assistance.

Doctor will acquire detailed medical history and do a physical examination. Some laboratory studies also have to be done. Mental illness doesn’t have any laboratory markers, but the doctor has to exclude other possible conditions, that can cause similar symptoms. These can be drug abuse, diabetes, acute respiratory distress syndrome and many other conditions ^[7]. In case all the laboratory studies are normal, mental disorder can be considered. Doctor will have to hold the patient for observation and make a diagnosis based on symptoms. Stendhal syndrome is not listed as a separate entity in the ICD 10 (The International Statistic Classification of Diseases and Related Health Problems), but diagnosis is made based on the predominant symptoms ^[8].

Treatment

The treatment of Stendhal syndrome depends on the symptoms, severity of symptoms and possible other health problems the patient has acquired while being affected by it.

The treatment includes therapy, medications and alternative treatments:

• Cognitive behavioral therapy- a highly effective method that identifies and understands the thinking and behavior of the patient and changes these thinking patterns. The patient has to be actively involved in his own recovery. It gives the patient a sense of control and teaches useful skills to cope with mental disorder.
• Exposure therapy- the patient is exposed to the object or situation causing symptoms, and with time makes the patient less sensitive to them.
• Eye movement desensitization and reprocessing-eye movements can reduce the intensity of bad thoughts and can help the patient to see the feared material in less disturbing way.

Medications are usually used together with therapy:

• Selective Serotonin Reuptake Inhibitors – medications that block the reabsorbtion of Serotonin in the brain, therefore increasing its levels. With increased Serotonin levels the patient’s mood improves.
• Serotonin – Norepinephrine Reuptake Inhibitors increase the level of Serotonin and norepinephine in the same way as SSRI’s. It has dual mechanism of action and can be more efficient in treating the symptoms.
• Benzodiazepines are usually used in case of short-term anxiety. In case of Stendhal syndrome they can be used for patients with no previous history of mental illness in a state of anxiety.
• Tryciclic Antidepressants are better to use for long term treatment of anxiety and depression, because they have lesser side effects than benzodiazepines.

Alternative medicine can also be used to treat symptoms that occur after the initial experience of Stendhal syndrome. These include meditation techniques, yoga and acupuncture ^[9].

Prognosis

Most of the patients recover completely after the initial episode of symptoms. Most cases are minor and do not need medical attention. Some patients may require long term therapy. For patients who are predisposed to mental illness, Stendhal syndrome could be the first episode of the illness and further develop in a serious condition. For example, if patient has experienced hallucinations and/or paranoia it could be a sign of schizophrenia.

References

1. http://www.nytimes.com/1989/05/15/world/florence-s-art-makes-some-go-to-pieces.html
2. https://www.psychologytoday.com/blog/in-excess/201403/having-art-attack
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027955/
4. http://www.healthline.com/health/psychosis#Overview1
5. http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disorders
6. http://www.telegraph.co.uk/news/worldnews/europe/italy/7914746/Scientists-investigate-Stendhal-Syndrome-fainting-caused-by-great-art.html
7. http://emedicine.medscape.com/article/286227
8. http://www.webmd.com/anxiety-panic/guide/mental-health-making-diagnosis
9. https://www.adaa.org/finding-help/treatment/complementary-alternative-treatment