We were interested to read the report by Bar-El et al (Reference Bar-El, Durst and Katz2000), describing the various manifestations of Jerusalem syndrome and in particular the prediction that the passing of the millennium may have been accompanied by a surge in presentations.

In December 1999, we wrote to over 60 general psychiatrists in the North-Western Region, requesting that they provide details of all of their patients who appeared to be affected clinically by the millennium. A sizeable proportion described having encountered one or more patients within this category, although none reported a noticeable increase in workload. There were no reports of patients with new onset of psychosis in whom content appeared to have been strongly influenced by the millennium. However, a number of patients with established psychiatric disorders were reported to have incorporated millennial themes into their psychopathology. These included patients with psychoses of both schizophrenic and affective types. Examples of delusions with a millennial content included becoming the Messiah, being destined to change the world on New Year's Day and the belief that the world would change irrevocably at midnight. Several patients with psychoses appeared to have taken warnings regarding the ‘millennium bug’ rather literally, describing this in terms of physical infestation. Non-psychotic conditions, including both affective and personality disorders, also appeared to have been coloured by the millennium, for example, with ruminations and overvalued ideas regarding the effects of the millennium bug and the possibility of breakdown in the running of society in general.

The influence of social and cultural variables on the content of psychopathology is well-recognised (Reference Fish and HamiltonFish, 1985) and, it would seem, the ‘millennium effect’ is merely the most recent example. Given our local experience, Bar-El et al were right to expect an increase in cases of Jerusalem syndrome over the millennium period.