Erotomania or Delusional Love

One of the most bizarre, yet totally fascinating mental illnesses is erotomania.  It is not something a therapist sees often in their practice, so I felt lucky to have had the privilege to have had one of the most intriguing of cases.

It is sometimes known as Clérambault syndrome, named after the French psychiatrist Gaetan Gatian de Clérambault who wrote a book about the illness back in 1921.  The DSM classifies it as a delusional disorder, because of the very nature of the illness does consist of delusional thinking.

You may have read of some sensational cases of erotomania, where someone is convinced that a celebrity or someone deemed well-known  is in love with them.  There can also be stalking behaviour, but that is not  essential for the diagnosis.

The diagnosis is not the same as obsessional love, which generally does have at least initially a base of real contact and or a relationship between the individuals.

The major tenet of erotomania is the absolute conviction held tenaciously that another person is in love with them, though that belief has absolutely no basis of reality. Often the person who is admired and loved has no idea of even the existence of the other person.

This delusion seems to occur more often in women and also can be associated with those who have been diagnosed with Schizophrenia, Schizoaffective disorder and Bipolar mania, but it can occur without any prior recognizable psychiatric history.

Those afflicted with erotomania  all have ideas of reference, which are beliefs that certain elements or means of communication are meant directly and specifically for them alone.   For example, the most common seen in Schizophrenia is feeling that the tv or radio is communicating directly to them.

In erotomania, all sorts of innuendo that are insignificantly displayed by the beloved person are interpreted as signs of devotion or secret love.  Since most of the time the patient feels that his/her beloved must keep their love secret from others, these inconspicuous acts become a focus and obsession.

The case I am going to describe has of course been changed in so far as names and other elements to protect confidentiality.   Perhaps you can better understand my confession to preferring non fiction over novels, in that the lives of patients in my practice are far more intriguing that what most novelists can conjure up as fiction.

Rory was about 63, when first seen, having been brought in out of concern by his wife.  He was initially reluctant to submit to treatment but did so to acquiesce his wife.  He was a successful civil engineer, who was involved in church and other community activities.

He had been recently stressed and somewhat demoralized at his firm by being overlooked on a project given to a younger colleague, and he was looking at possibly retiring in the next couple of years.  Additionally there had been some marital conflict that had recently been intensified secondary to his delusion.

His attractive wife was about 12 years younger than Rory and ran her own successful real estate business.  She was Rory’s second wife, he having divorced his first, with whom he had 3 children.  They had been married for about 3 or 4 years.

All was fairly quiet up until his wife found a very disturbing letter from the husband of a lady she had barely know from their church.   Rory had apparently written to this woman confessing his devout love for her and also described her unknown “involvement” in his delusional scheme.

The lady choir member who, had never really met Rory, perhaps had just seen him in passing at church was spooked to say the least.  She told her husband, who took it upon himself to write and threaten Rory with judicial consequences if he continued to pursue his wife.

Rory and his wife belonged to a rather large and prominent congregation, where this woman sang in the choir for most services.   He told me he had fallen in love with her after God had revealed to him, that she was to be his eternal wife .

He revealed how he felt this woman was conveying her love to him, by certain ways she raised her hands or if she touched her forehead or ear.   These obscure behavioural minutiae( ideas of reference) were interpreted by Rory as her secret conveyances of devotion and love to him.

He was remorseful that he had written the letter, and for hurting his wife, but felt “compelled” to do so in order to follow God’s demands.  According to Rory, God had revealed to him a very complicated and intricate plan for him and this woman to be wed for life and in the “end times” they were to be a part of a specifically chosen tribe to repopulate the world.

Rory was absolutely convinced that God had chosen him for this mission and that for him not to follow through would be sinful as an act of disobedience to God’s order.  He often pondered though with regret, that he had been chosen.

He went through a phase of being very angry at God for putting him through this, which he also considered a test of his devotion. He would often come in telling me that he had another angry tirade with God for ” putting me through the fire”.

Rory’s spiritual scheme was written with ornate details that perhaps only an engineer could do.  The design was extremely intricate with specifics so outlined that it covered a multitude of written pages.  There were multiple hierarchies and lineages with this woman dating practically back to creation.

Although Rory clearly had all the sign and symptoms of erotomania, it was a bit of a puzzle concerning any associative diagnosis.  He had suffered from  bouts of depression before but did not have all of the symptoms that could be characterised as  clearly hypomanic.

Because he was so high functioning professionally and fairly so personally, and lacked other symptomatology, he definitely did not have schizophrenia or  schizoaffective disorder.  Atypical bipolar disorder seemed to be the best fit in regards to his symptoms.

You might ask how does one go about treating such a condition. First and foremost, as in all patients, a strong therapeutic relationship must be established imperatively.  There should be no attempts to “snatch” away any delusions by direct confrontation, which would not only be fruitless and cruel, but would only result in resistance.

It was decided to give him a trial period of a mild neuroleptic, which is an antipsychotic medication, along with psychotherapy.  Along with individual sessions, there was also conjoint therapy with his wife that dealt  with previous conflicts in their relationship.

Attempts to establish increased intimacy with her was somewhat successful, even though Rory still maintained a conviction in his delusion.  He reiterated that he did love his wife, though not in the same way as the other woman; maintaining his belief that  their union was not what God had ordained for him.

From a psychological perspective, Rory was a man who although superficially polite and friendly, was rather shallow and emotionally detached in relationships. His capacity for full emotional intimacy was limited at best.

He like a lot of other left hemispherical oriented people, who make up the ranks of engineering, and computer science for example, are much more comfortable with their thoughts, than feelings.

Some of his emotional avoidance could also be attributed to having been raised by a strict disciplinarian mother who likewise was not affectionate with words nor gestures.   I saw in part his attachment to this other woman as an idealization of a maternal love attachment that he never had, and sadly as unobtainable as his mother.

Each of us has an archetypical model or blueprint of an idealised love object, be it mother, father or spouse in our collective unconscious that can be fixated upon in another being that seemingly is a mirror image of this archetype.

There is nothing wrong with this happening in a real life setting, as it often is the basis of our strong romantical attractions.  Without any concrete reciprocity from the other person though, the persistent immersion in believing a real relationship or attachment exists constitutes a delusion.

Though the medication never completely erased his delusion, he was at least able to put it on a back shelf so to speak, so he could be more present emotionally with his wife.  They were encouraged to participate more in shared activities, which was helpful.

I suggested that Rory consider finding another congregation of worship, so as not to be continuously confronted by this woman’s presence, which he consented to.   We also looked into his feelings of inadequacy and meeting more of his emotional needs with his wife.

Introducing the possibility of doubt with delusional patients must come slowly and with much empathy.  In Rory’s case his delusional attachment did serve a psychic purpose of making him feel significant, even though there was grief over letting go of expectations that his beloved would ever be reciprocal.

The rich romantic overtones in his delusion also provided an outlet for his lack of sentimentality that he was unable to allow for in his real life.  She was probably his archetypical model of the all consuming lover/goddess.

Follow ups were for the most part positive in strengthening his emotional alliance with his wife.  Though he admitted he still thought of his delusional scheme, it had become more “fuzzy”, therefore less problematic for him. By that time some doubt had been achieved ,though he remained extremely puzzled why God could have put him through “the fire” as he called it.

Although Rory certainly presented challenges in treatment, he was personable and delightful to work with as a patient and I always looked forward to our sessions.  Delusions can be construed as total hogwash by some, but they can be purposeful and outline unmet needs as in Rory’s case.

Rory’s delusion was exotic and spiritually fascinating, pondering religious or theological constructs that are often involved in many patients delusions.  His fortunately did not have any elements of paranoia, which makes it really difficult for the therapist.

We still have much to learn about mental illness, especially the incredible confounds of psychosis and their origins.  I for one am open to alternative possibilities, rather than the finite and conservatively held opinion of just neuronal misfiring.  I feel the origin might be more complicated and involve paradigms not yet considered.

 

 

 

 

 

 

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