Introduction
Many therapeutic aspects of pilgrimage have been described, including biological, psychological, social, and spiritual dimensions. In Islamic tradition, the pilgrimage to Mecca, known as Hajj, is an essential spiritual practice and one of the fundamental pillars of the Muslim faith. This event carries deep religious and social significance, allowing individuals to strengthen their connection to spirituality while participating in a collective experience imbued with values such as fraternity, solidarity, and mutual support [1].
Hajj goes far beyond a mere ritual act. It is a transformative journey that engages the mind, body, and emotions. This type of spiritual experience provides an opportunity to break away from daily life, fostering deep reflection and personal renewal [2]; [3]; [4]; [5]; [6]. However, despite its potential benefits, pilgrimage can also be perceived as a significant challenge. Travelling conditions, distance from one's usual environment, the demands of rituals, and the emotional weight of the experience can generate considerable stress, sometimes affecting the mental health of participants.
While certain aspects of pilgrimage are known to ease anxiety and bring a sense of serenity, it is also well established that the intensity of the experience can, in some cases, trigger or exacerbate pre-existing psychological disorders [7]; [8]. These potential impacts, still under-researched, highlight the need to deepen our understanding of the interactions between spirituality, religious travel, and mental health.
Thus, pilgrimage can be seen as an ambivalent experience, oscillating between profoundly healing effects and psychological challenges. This paradox raises essential questions about how spiritual practices influence individuals, particularly in emotionally and physically demanding contexts. This reflection is part of a broader research framework aiming to explore the balance between the psycho-spiritual benefits of religious rituals and the potential vulnerabilities they may reveal or amplify.
Methodology
For this study, we have chosen to illustrate our reflection through the analysis of two representative clinical vignettes. These observations shed the light on the potential psychological effects associated with pilgrimage to Mecca while examining the clinical specificities of each case.
Case Report 1
The first case involves Mrs. S., a 27-year-old woman, married and the mother of three children. She has a secondary school education and works as a skilled laborer in a factory. There was no history of psychiatric disorders in her personal or family medical background. For several years, Mrs. S. and her husband had planned to undertake the pilgrimage to Mecca, a project for which they had diligently saved.
In August, Mrs. S. traveled to Saudi Arabia with her husband to perform this sacred rite. However, upon her arrival to Mecca, she exhibited behavioral disturbances characterized by psychomotor agitation, excessive familiarity, and delusional speech. Given the acute nature of her symptoms, she was administered for sedative treatment. Hospitalization in Saudi Arabia was suggested, but she ultimately returned to Tunisia, where she was admitted to a psychiatric ward under involuntary hospitalization (HDT).
The psychiatric evaluation revealed an acute delusional syndrome, leading to a diagnosis of acute psychotic episode. Treatment with Olanzapine, an antipsychotic, was initiated. The clinical evolution was favorable, with a complete remission of symptoms observed within approximately ten days.
Observation 2
The second case concerns Mr. B., a 28-year-old single man. He has a higher education level and has been working as an interior decoration engineer for three months. Mr. B. has been under medical supervision for two years for type I bipolar disorder, stabilized with sodium valproate at a dose of 1500 mg/day.
Wishing to take advantage of his first professional leave, Mr. B. decided to fulfill his dream of pilgrimage to Mecca, having saved almost his entire salary to finance this journey. However, from the second day of his arrival, he exhibited a marked increase in energy, accompanied by an intense sense of well-being, grandiose ideas, excessive familiarity, significant spending, and almost total insomnia. These disturbances occurred in the context of poor treatment adherence.
As his condition worsened, the trip had to be interrupted, and the patient was hospitalized in a psychiatric ward under an HDT regime. The psychiatric examination revealed a manic syndrome. The treatment with a mood stabilizer, combined with Olanzapine, was initiated. The outcome was favorable, with clinical stabilization observed after two weeks of treatment.
These two observations illustrate the possible psychological repercussions of pilgrimage in a context of pre-existing vulnerability or not. These cases also highlight the importance of appropriate care to prevent or treat potential psychiatric complications associated with this type of intense spiritual experience.
Discussion
The Impacts of Hajj on Mental Health
Hajj is an intense spiritual experience that allows pilgrims to strengthen their faith and establish a deep connection with their religious beliefs. Many among them report a sense of serenity and inner peace after completing the rituals, describing them as a form of soothing meditation [1]; [5]. However, this event can also pose significant challenges to mental health. Overcrowding, jostling, and constant movement can generate anxiety, while the physical and mental exhaustion associated with the journey’s intensity can exacerbate pre-existing disorders. For some individuals, a discrepancy between idealized expectations and reality may lead to emotional or cultural shock, fueling stress and disappointment [7]; [9]; [10].
Studies on Psychiatric Disorders Related to Hajj
The research has helped us better understand the psychiatric disorders observed in some pilgrims. A study conducted in Mecca in 2016 by Ahmad S. Alzahrani and his colleagues [10] diagnosed psychiatric disorders in 7.2% of the 513 pilgrims studied using the MINI scale. The most common pathologies were major depression, agoraphobia, and psychotic disorders, with suicidal risk identified in 6.2% of participants. Women, single individuals, and those under psychiatric treatment were particularly vulnerable.
Other studies reinforce these findings. A study by Khan et al., conducted in 2016 [7] on 136,000 Indian pilgrims, revealed that 1.3% of them had developed psychological issues related to stress, anxiety, and mood disorders. Similarly, a 2008 study by Ozen and collaborators [11] on 130,000 Turkish pilgrims highlighted consultations for similar disorders, although less frequent (0.2%).
Specific Travel-Related Syndromes
The “travel syndrome” encompasses pathologies observed in individuals confronted with unfamiliar or symbolically significant environments. Stendhal syndrome, described by Graziella Magherini [12], illustrates the effects of intense exposure to works of art, disturbing the perception of time and self. India syndrome, documented by Régis Airault [13], reflects the difficulties travelers face in reconciling their idealized expectations with a so called sometimes-disconcerting reality, leading to manifestations of anxiety or depersonalization. Finally, Jerusalem syndrome, identified by Bar-El [14], manifests as psychotic disorders linked to the strong symbolic charge of the location.
Explanatory Factors for Psychological Disorders
To explain these disorders, various hypotheses have been proposed. During the journey, individuals face new physical and psychological challenges that require varying degrees of adaptation. A crucial factor is jet lag; rapidly crossing multiple time zones results in a double desynchronization: that of biological rhythms in relation to new solar coordinates and an internal desynchronization due to the unequal adjustment over time of different biological pacemakers (temperature, cortisol, REM sleep, and the sleep-wake cycle) [15].
Certainly, there is a link between mood episodes and circadian rhythm disturbances, although fewer studies exist regarding psychotic episodes. According to Katz et al. [15], there may be a transient paranoid reaction attributed to environmental change, unfamiliar places, the presence of strangers, inactivity, and the sensation of isolation.
Sociocultural and economic differences—such as changes in language, writing, symbolic systems, social status, administrative procedures, moral values, behaviors, and social codes—add to the stress of travel. The distance from one's usual living environment can trigger anxiety, potentially leading to psychopathological decompensation.
Towards an Appropriate Care Approach
While Hajj remains a profoundly transformative and spiritually enriching experience, it is essential to consider the challenges it may pose to mental health. These observations highlight the importance of appropriate psychological support, including preparation beforehand, assistance during the pilgrimage, and follow-up upon return, to help pilgrims navigate this unique and demanding experience.
Conclusion
Through the illustrations and syndromes described in the literature, it appears that travel, particularly to a place imbued with strong religious symbolism, can generate a variety of psychopathological disturbances. These disorders can range from psychic dissociation to delusional states, highlighting the profound psychological impact that pilgrimages can have on individuals. Although these phenomena affect only a minority of travelers, they underscore the complexity of interactions between spiritual expectations, physical and psychological constraints, and the confrontation with foreign environments.
The studies reviewed highlight several factors contributing to these disorders: the emotional intensity linked to religious experience, the stress of adapting to a new socio-cultural context, psychological isolation, as well as logistical and linguistic challenges. Added to this, is the weight of the disconnect between pilgrims’ idealized expectations and the sometimes demanding and destabilizing reality of rites. These observations reinforce the idea that, while pilgrimage is often experienced as a transformative spiritual quest, it can also be an ordeal capable of exacerbating pre-existing vulnerabilities or triggering disorders in susceptible individuals.
Considering these findings, it seems crucial to implement appropriate psychological support both before and after the journey. Psychological preparation for pilgrims, including awareness of potential challenges and tools to better manage stress, could play a key role in preventing these disorders. Similarly, post-pilgrimage follow-up could help detect signs of psychological decompensation and assist affected individuals in their return to a balanced daily life.
Beyond the individual, such a proactive approach could also include awareness campaigns for religious institutions, specialized travel agencies, and mental health professionals. These actors, working collaboratively, could help reduce the risks of psychological complications while ensuring a more serene and fulfilling spiritual experience.
This reflection highlights the importance of a holistic and humanistic approach to the psychological realities of religious pilgrimages. The goal is not to pathologize such a significant spiritual experience but rather to better understand its implications, to prevent avoidable suffering and support individuals in their personal and spiritual journey.
