What is the Stendhal syndrome, and is it a real psychiatric condition?

What if you were so overwhelmed by the beauty of a work of art that it made you physically and mentally unwell? Some claim that this is a real possibility, and it has a name: the Stendhal syndrome.

Only about 2 years ago, international press headlines tooted that a man had experienced a heart attack while admiring the famous painting by the Renaissance artist Sandro Botticelli, “The Birth of Venus,” which is housed at the Uffizi Gallery in Florence, Italy.

The implication behind the headlines was not that the event had been a coincidence but, in fact, that the artwork’s staggering beauty had caused the heart attack.

Why would anyone suggest this, and is such a phenomenon even possible?

Although it may seem bizarre, there is a fairly long history behind the notion that art can be so overwhelming as to cause physical illness.

This phenomenon is now referred to as the Stendhal syndrome, a term coined by an Italian psychiatrist in 1989. Anecdotes describing the formidable effect of great artworks on the human psyche, however, date back to at least the 19th century.

In this Curiosities of Medical History feature, we look at how this syndrome is defined, what its alleged symptoms are, what role it plays in cultural history, and, of course, whether or not it is a real medical phenomenon.

‘I walked in fear of falling to the ground’

To find out more about the history and definition of the Stendhal syndrome, Medical News Today spoke to Dr. Fabio Camilletti, an associate professor and reader at the School of Modern Languages and Cultures at the University of Warwick in Coventry, United Kingdom.

“[T]he one who coined the expression [was a] psychiatrist working at the [Santa Maria Nuova] hospital in Florence, Graziella Magherini, who […] witnessed over the years the recurrence of a certain kind of patients being treated for similar symptoms,” Dr. Camilletti told us.

He added that Dr. Magherini identified this as a unique phenomenon after noticing that “there was a huge amount of people — for an Italian [institution] — being hospitalized after having experienced feelings of unease in the presence of Florence[‘s] monuments, museums, and art galleries, and she believed that a [similar] experience could be found in Stendhal’s writings about Italy, and so she coined the expression ‘the Stendhal syndrome.’”

Dr. Magherini first described this phenomenon in a book she published in 1989, called La sindrome di Stendhal (The Stendhal Syndrome).

The name alludes to an episode described by the French writer Stendhal in his travel memoir Naples and Florence: A Journey from Milan to Reggio about the journey that he undertook through Italy in 1817.

In it, Stendhal wrote: “My soul, affected by the very notion of being in Florence, and by the proximity of those great men whose tombs I had just beheld, was already in a state of trance. Absorbed in the contemplation of sublime beauty, […] I had attained to that supreme degree of sensibility where the divine intimations of art merge with the impassioned sensuality of emotion.”

The sense of awe experienced by being in the proximity of so many impressive historical and art monuments allegedly gave the writer heart palpitations and made him feel faint.

“As I emerged from the porch of Santa Croce, I was seized with a fierce palpitation of the heart (the same symptom which, in Berlin, is referred to as an attack of nerves); the well-spring of life was dried up within me, and I walked in constant fear of falling to the ground.”

– Stendhal

A syndrome that only affects tourists

“Roughly speaking, the Stendhal syndrome can be defined as the psychosomatic [mental and physical] response experienced while facing esthetic beauty but not natural beauty — beauty as a [human] construct, so art,” Dr. Camilletti explained.

In her original research, Dr. Magherini identified three main types of symptoms in people who apparently had the Stendhal syndrome:

  • altered perception of sounds or colors, as well as an increased sense of anxiety, guilt, or persecution
  • depressive anxiety, a sense of inadequacy, or, conversely, a sense of euphoria or omnipotence
  • panic attacks and physiological symptoms of heightened anxiety, such as chest pain

In an interview she gave in 2019, Dr. Magherini noted that, in her experience, the Stendhal syndrome was a phenomenon that applied exclusively to foreign tourists.

“At some point, some of [our study group members] began to notice people, foreigners who had come to Florence for art tourism, and who, at some point, having left their homes, their home countries, […] finding themselves in the [Italian] city, while in a church or in a museum, or in a [public transport] vehicle, or on a bridge started having psychological symptoms — sometimes camouflaged as physical issues, such as heart problems. In fact, these were just panic attacks caused by the psychological impact of a work of art […] that they had come across during their travels.”

– Dr. Graziella Magherini

Dr. Magherini went on to suggest that this syndrome affects primarily “very sensitive individuals” who become more easily affected by objects of art that they encounter while abroad, in a foreign context.

Stendhal syndrome and ‘the uncanny’

But does the development of the Stendhal syndrome as a concept have any ties with any other concepts or cultural phenomena that we know of?

For Dr. Camilletti, the concept is inextricably linked to other ideas that had been spreading throughout Europe, particularly those of Sigmund Freud, the famous founder of psychoanalysis.

“I think that the coinage of the notion of [the] Stendhal syndrome is [an example] of the episodes of the slow appreciation, throughout the 20th century, of Sigmund Freud’s intuitions about the uncanny, [which is] the idea of some sort of intermediate zone between proportion and disproportion, between absolute beauty and the absolutely intolerable,” Dr. Camilletti told us.

Freud defined his concept of “the uncanny” in a 1919 essay of the same name, in which he described it as an experience of contexts and ideas that seem familiar and at the same time unfamiliar, thus creating a feeling of disturbance.

“The idea there is the kind of esthetic feeling which cannot be subsumed under the categories of [the] pleasing and the displeasing — [it] is rather something else, and Freud called it ‘the uncanny,’ arguing that the uncanny is basically the strange mixture between the familiar and unfamiliar, the homely and the unhomely,” Dr. Camilletti explained.

“And I think that the Stendhal syndrome is in many ways an example of the uncanny, in that Magherini herself, when defining it, said in the first place that was the result of a cultural shock.”

– Dr. Fabio Camilletti

From a cultural point of view, Dr. Camilletti believes that this shock is a symbol of the gap between being familiar with famous artworks thanks to their representation in the media, and seeing the actual works in person.

“The Stendhal syndrome is the moment, in my opinion, when the real thing manages to filter within the boundaries of the mediatized, of the stereotype, if you want. […] It may be the moment when, for the first time, you see “Mona Lisa” not as a pop icon but as an actual object,” he told MNT.

Is the Stendhal syndrome a real disorder?

While Dr. Magherini saw the Stendhal syndrome as a real psychiatric phenomenon, more recent reviews of the existing research on this topic have found that there is not enough conclusive evidence to suggest that such a disorder exists.

The current edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not list the Stendhal syndrome as a phenomenon or condition related to mental health.

Still, alleged cases of the Stendhal syndrome have continued to make the headlines.

A case study published in 2009 in BMJ Case Reports described the situation of a “72-year-old fine-arts graduate and creative artist” who “presented with insomnia and concerns about being followed and monitored.”

These issues had been troubling him since he had traveled to Florence, 8 years earlier, where, “While standing on the Ponte Vecchio bridge, the part of Florence he was most eager to visit, he experienced a panic attack […].”

While, according to the study authors, this patient’s symptoms resolved without requiring much in the way of targeted treatment, the researchers note that, in some people who may already be at risk of mental health issues, overexposure to art may well be a trigger.

“These [intense] experiences [related to travel and exposure to art] seem to interact with an individual’s personal predisposition to mental illness, and these syndromes occur more commonly in, but are not limited to, those with a past psychiatric history,” the researchers write.

“Accordingly, it would be prudent to counsel patients with preexisting mental illness ahead of visits to places of high personal and emotional significance,” they go on to advise.

Prof. Semir Zeki — from University College London in the U.K. — specializes in neuroesthetics, a field that investigates the impact of art and experienced beauty on the human brain.

In a study he co-authored with Dr. Tomohiro Ishizu in 2011, Prof. Zeki found that people who derive pleasure from contemplating artworks do experience heightened activity in specific areas of their brains.

More precisely, the two scientists observed that volunteers who found certain paintings beautiful had increased activity in the medial orbitofrontal cortex, an area that forms part of the brain’s reward circuit.

This is a circuit that becomes active during “desirable” activities that, at their core, help promote survival. These desirable activities include eating and having sex.

Not a stand-alone phenomenon

The overactivation of certain brain areas in individuals who may be predisposed to or at risk of mental health problems may thus help explain phenomena like the Stendhal syndrome.

While this syndrome seems to affect specifically tourists who visit Florence, researchers have observed similar symptoms in tourists who travel to Paris or Jerusalem.

According to a French study published in 2004, as many as 63 Japanese individuals who had been visiting Paris became hospitalized in France between 1988 and 2004.

These tourists required psychiatric treatment after developing delusions or paranoia, seemingly as a result of their disappointment that Paris was not the perfect, dreamy, idealized city they had imagined — a phenomenon now dubbed “Paris syndrome.”

In an interview from 2007, Dr. Yousef Mahmoudia, who worked as a psychologist at the Hotel-Dieu hospital, where some such patients had received treatment, said that “[a] third of patients get better immediately, [while] a third suffer relapses and the rest have psychoses.”

Another related phenomenon, Jerusalem syndrome, refers to the emergence of religious excitement in tourists who visit the holy places found in Jerusalem and its environs.

Researchers have identified three types of Jerusalem syndrome cases:

  • those that develop in individuals who already had a form of psychosis before traveling to Jerusalem
  • those that develop in individuals who already had a personality disorder or experienced “fixed ideas”
  • those that develop in tourists who did not have a diagnosed mental illness before traveling to Jerusalem

Yet overall, in commenting on case studies of Jerusalem syndrome, scientists suggest that the phenomenon is, most likely, “an aggravation of a chronic mental illness and not a transient psychotic episode.”

Like the Stendhal syndrome, neither Paris syndrome nor Jerusalem syndrome are listed in the DSM-5, yet the fascination with cases of “overexposure” to objects, monuments, or places of deep significance remains.

Commenting on the cultural basis and appeal of the Stendhal syndrome, Dr. Camilletti told us: “The Stendhal syndrome is when all this ritual of mass tourism suddenly breaks down, and one discovers that there is something else behind the surface. […] It has been treated as a disease, but sometimes it can also be some sort of a positive factor, in a sense.”

More than a psychological or psychiatric phenomenon, the Stendhal syndrome may be a call to reevaluate our relationship with the world around us, as well as the expectations that we project on it.

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