Having an Art Attack

One of the more unusual psychological disorders that I have come across is the psychosomatic illness Stendhal Syndrome – also known as Florence Syndrome and hyperkulturemia. The trigger for the condition is works of art that are perceived by the individual to be beautiful and all housed in one place (e.g., an art gallery).

When exposed to the concentrated works of art, affected individuals experience a wide range of symptoms including physical and emotional anxiety (rapid heart rate and intense dizziness, that often results in panic attacks and/or fainting), feelings of confusion and disorientation, nausea, dissociative episodes, temporary amnesia, paranoia, and – in extreme cases – hallucinations and temporary ‘madness’. The syndrome has also been applied to other situations where individuals feel totally overwhelmed when in the presence of what they perceive to be immense beauty (such as something in the natural world like a beautiful sunset). The effects are relatively short-lived and do not seem to require medical intervention.

The condition was named after the 19th century French author Henri-Marie Beyle (1783–1842) – better known by his penname ‘Stendhal’ – who at the age of 34 years (in 1817) described in detail his negative experiences (in his book Naples and Florence: A Journey from Milan to Reggio) of viewing Florentine art of the Italian Renaissance (and hence it’s alternative name as Florence Syndrome). When Stendhal visited Florence’s Santa Croce Cathedral and first witnessed Giotto's famous ceiling frescoes he became overly emotional about what he saw:

"I was in a sort of ecstasy, from the idea of being in Florence, close to the great men whose tombs I had seen. Absorbed in the contemplation of sublime beauty...I reached the point where one encounters celestial sensations ... Everything spoke so vividly to my soul. Ah, if I could only forget. I had palpitations of the heart, what in Berlin they call 'nerves.' Life was drained from me. I walked with the fear of falling”.'

Since Stendhal’s published account, there have been hundreds of cases of people experiencing similar effects – particularly at the famous Uffizi Gallery in Florence, and had often been referred to as the ‘Tourist’s Disease’. (I also noted that in online self-confessions that some people call it ‘Art Disease’). However, it wasn’t until 1979 that the condition was given the name Stendhal Syndrome by the Italian psychiatrist Dr. Graziella Magherini (who at the time was the chief of psychiatry at Florence's Santa Maria Nuova Hospital). She began to observe that many tourists visiting Florence appeared to be overcome with a range of symptoms including temporary panic attacks to seeming bouts madness lasting two or three days.

Based on her recollection of reading Stenhal’s account, she named the condition Stendhal's syndrome. She later documented 106 similar cases admitted to the hospital in Florence between 1977 and 1986 in her 1989 book La Sindrome di Stendhahl. Her book described detailed accounts of people (including many Americans) who after viewing famous paintings or sculptures had severe emotional reactions leading to high anxiety and/or psychotic episodes. She believed the psychological disturbances were typically associated with “a latent mental or psychiatric disturbance that manifests itself as a reaction to paintings of battles or other masterpieces”. The 106 cases were classed into three types:

• Type I: Patients (n=70) with predominantly psychotic symptoms (e.g., paranoid psychoses).

• Type II: Patients (n=31) with predominantly affective symptoms.

• Type III: Patients (n=5) whose predominant symptoms are somatic expressions of anxiety (e.g., panic attacks).

She also reported that 38 percent of Type 1 individuals had a prior psychiatric history, while over half (53 percent) of Type 2 individuals did. To date, there are relatively few cases published in the academic literature. The most recent case I came across was from 2009. Dr. Timothy Nicholson and his colleagues published a case report in the journal British Medical Journal Case Reports. Their case involved a 72-year-old who developed a transient paranoid psychosis following a cultural tour of Florence. More specifically, they reported:

“While standing on the Ponte Vecchio bridge, the part of Florence he was most eager to visit, he experienced a panic attack and was also observed to have become disorientated in time. This lasted several minutes and was followed by florid persecutory ideation, involving him being monitored by international airlines, the bugging of his hotel room and multiple ideas of reference. These symptoms resolved gradually over the following 3 weeks”.

In 2005, Edson Amâncio, a Brazilian neurosurgeon published a paper arguing that there was evidence that Russian novelist Fyodor Dostoevsky suffered from Stendhal Syndrome, particularly when viewing Hans Holbein’s masterpiece, Dead Christ, during a visit to the museum in Basle. In a 2010 issue of the British Journal of General Practice, Dr. Iain Bamforth claimed that Marcel Proust also suffered from the condition and also suggested that psychologists Sigmund Freud and Carl Jung both wrote about experiences suggestive of Stendhal Syndrome. Despite hundreds of documented cases, the condition does not – as yet – appear in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. According to an article in the Daily Telegraph, a team in Italy is currently examining the phenomenon more systematically by measuring tourist’s reactions (heart rate, blood pressure, respiration rate, etc.) as they view the artworks inside the Palazzo Medici Riccardi in Florence. As far as I am aware, they have yet to publish their findings, but when they do, I’ll update this blog.

References and further reading

Amâncio, E.J. (2005). Dostoevsky and Stendhal’s Syndrome, Arq Neuropsiquiatr, 63, 1099-1103.

Bamforth, I. (2010). Stendhal’s Syndrome. British Journal of General Practice, December, 945-946.

Bogousslavskya, J. & Assal, G. (2010). Stendhal’s aphasic spells: The first report of transient ischemic attacks followed by stroke. In J. Bogousslavsky, M.G. Hennerici, H. Bäzner & C. Bassetti (Eds), Neurological Disorders in Famous Artists – Part 3 (pp-130-143). Basel, Karger.

Fried, R.I. (1998). The Stendhal syndrome: Hyperkulturemia. Ohio Medicine, 84, 519–20.

Freud, S. (1936). A disturbance of memory on the Acropolis. Reprinted (1953-1974) in the Standard Edition of the Complete Psychological Works of Sigmund Freud (trans. and ed. J. Strachey), vol. 22, p. 239. London: Hogarth Press.

Guy, M. (2003). The shock of the old. Frieze (Volume 72). Located at: http://www.frieze.com/issue/article/the_shock_of_the_old/

Magherini, G. (1989). La Sindrome di Stendhahl. Firenze: Ponte Alle Grazie.

Munsey, C. (2005). Bottles make me sick (Stendhal’s Syndrome). Bottles and Extras, Spring, 72-75. 

Nicholson, T. R. J., Pariante, C., & McLoughlin, D. (2009). Reminder of important clinical lesson: Stendhal syndrome: a case of cultural overload. BMJ Case Reports, doi:10.1136/bcr.06.2008.0317.

Squires, N. (2010). Scientists investigate Stendhal Syndrome – fainting caused by great art. Daily Telegraph, July 28. Located at: http://www.telegraph.co.uk/news/worldnews/europe/italy/7914746/Scientist...