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The Pathological Extensions of Love

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The Pathological Extensions of Love British Journal of Psychiatry (1994), 165, 614—623 The Pathological Extensions of Love PAUL E. MULLEN and MICHELE PATHE Background.Clarificationis still requiredof the nature of pathologicallove. Method. A series is presentedof 16 personallyassessedcases with pathologiesof love (erotomania). Results.The pathologiesof loveusuallyinvolvea mixtureof morbidinfatuationanda morbid beliefin beingloved.They occurbothin a symptomaticform, as partof an underlyingmental illness,as well as in a pure form, where their emergenceis to some extent understandable in a vulnerablepersonality.Thesedisordersoften go unrecognisedto the detrimentof clinical management. Conclusions.Pathologiesof lovecreate distressand disruptionto the patient, and placethe objectsof their unwarrantedaffection at risk of at best harassmentand at worst violence. Although this series of cases, which is drawn predominantly from forensic practice, overemphasisesthe riskof overtviolence,the distressoccasionedby pursuitandharassment alone shouldnot be underestimated. The pathological extensions of love have appeared The nature of love has tended to be the province under various guises in the literature, including the of poets, novelists and artists, although it has monomania of Esquirol (1845), Krafft-Ebing's attracted a scholarly literature (Singer, 1966, 1987; (1879) erotic paranoia, Kraepelin's (1913) Barthes, 1977; Scruton, 1986; Solomons, 1981; erotomania, Kretschmer's (1918) erotic self-reference Fisher, 1990). There would appear to be general delusions, Hart's (1921) old maid's insanity, de agreement that the infatuation of faffing in love and Clérambault'ssyndrome (1942), and Seeman's (1978) being in love are separable states of affairs. delusional loving. ‘¿Erotomania'is the term which Infatuation does not necessarily require any has come to dominate psychiatric discourse. In response, let alone intentional encouragement, from addition to describing a pure or primary disorder, the object of affection. Sympathy and identification the literature documents this syndrome in association can similarly flourish at least for a time in a one with schizophrenia (Hayes & O'Shea, 1985), affective sided relationship. The state of being in love requires disorders (Rudden et a!, 1990; Raskin & Sullivan, some mutuality of attraction, desire and benevolent 1974), schizoaffective disorder (Gillet et al, 1990), concern, and without a positive response from the and a variety of organic psychosyndromes (Lovett beloved the progress from infatuation to being in Doust & Christie, 1978; Drevets & Rubin, 1987; love is blocked. Singer & Cummings, 1987; Gaddall, 1989). Unrequited love usually withers but occasionally Pathologies of love occur in men and women, the the lover, by an act of self-abnegation, continues to homosexual and the heterosexual, in both Western love without demanding any return (Fisher, 1990). and non-Western cultures (Taylor et a!, 1983; The other way forward from a lonely, idiopathic Dunlop, 1988; Eminson eta!, 1988; El-Assra, 1989). erotic fixation is to resort to fantasy or delusion to They are regarded as a rarity, being reported in 0.3% replace the lack of response from the beloved. It is of in-patients (Retterstol & Opjordsmoen, 1991)and here we begin to move into the traditional area of in some 10% of delusional disorders (Rudden et a!, erotomania. The tragedy for the patients described 1983), but this may reflect as much a failure of in this paper is that love has become an isolating and recognition as a paucity of cases. autistic mode of being, in which any possibility of The history of the term ‘¿erotomania'has been unity with another is lost. The tragedy for those on traced, and such analysis helps place any current whom they fix their unwanted attentions is that, at debate in context, but dissecting the manner in which the very least, they suffer harassment and a word has been used in the past cannot resolve embarrassment, and at worst they may fall victim clinical issues. The nosological assumptions about to the violent expression of resentment, jealousy, or erotomania, bequeathed to us by history, need to be sexual desire. The increasing awareness of the exposed to the tests of adequacy and clinical value. potential threat presented by these disorders is 614 @ I@o a THE PATHOLOGICALEXTENSIONSOF LOVE 615 C I .@ ‘¿@s@8++ +++ ++ ++÷+ V 0 C .2 + + ++++++++ ++++++ .c +++±+++++++++++++ .5 + + .2 9.2.2.2.9.9.9.2.9.9 C EEEEEEEEEEE ..-@°E 00000000000 &@ !!!!!EEEEEEEEEEE @ >.2 >. >. >. >. >. a>.>. >. @ I— @@@U)U)U)CflCflCflU)CflCflCflU) —¿@ ,- Co C') C@1 oE @CONN00b,@CONd) 0 @ —¿0 C@1C') C@'1o C') C') C') ! CO@ C'4 C@1 C U) .@a .@ V 00 0 > OC 0EE O .2@ U)@ U)22 i@@j H @ i•@@cD.C .t,,U) @6 @, ØCI)U)@. 0v 2 @ @U) C @ :@s [email protected]. .@. ‘¿@ .2 —¿ @ 0 V < I I I I Cl) I Cl)00 I U) U) .8 V 0 E @ C') C'4 ‘¿-CO t' 0 CO CO CO 00 CO CO @ C'9C') C@'1C'.I@—¿C'4 C') C@d ‘¿â€”C'4 C'4 C') C <0 0 C .9 .2 C 0 ‘¿@U) 00000 0 E c E !!!!@!!u.n!o .@ @ •¿U) CCCCC@@D.C.cDV.C U) C S C b C U) U) K + + + @ < I― (“4(0 CO @Co@')Co(―4('4C')0 C') CO CO 00 CO CO (“1 + ‘¿4 + + + 0 + @Co@COaO@-C―4C'@Coco 4: 616 MULLEN & PATH1@ Table2 Personalhistories Patien Relationshipwith of adaptation sexual no.torientation1Close siblingsBirthorderSchool status'EmploymentPredominant mother fatherNo. academicsocialMarital clerkProblematic2DistantDistant44Good PoorMAccounts PoorMTypistHeterosexual3CloseDistant01Good GoodSSalesmanHeterosexual4ClosePoor73Average PoorSTradesmanProblematic5CloseDistant01Average PoorSClerkProblematic6Close?21Average PoorSNoneHeterosexual7AbsentClose31Poor ReasonableDLabourerHeterosexual8AbsentDistant33Poor ReasonableDNoneHeterosexual9?Absent21Good PoorSProfessionalHeterosexual10Poor?01Poor PoorSUnemployedProblematic11PoorPoor01Poor PoorSUnemployedHeterosexual12CloseAbsent22Poor AverageSUnemployedHomosexual13PoorPoor12Average PoorSClerkHeterosexual14DistantPoor42Good GoodMProfessionalHeterosexual15PoorGood51Good AverageSUnemployedHeterosexual16Close?12Good guardHeterosexual1.Absent31Average AverageDSecurity Sa for single, M for currentlymarriedand Dfor divorced or separated. leading to an explosion in legislation designed to objects of the patients' unwanted attentions, often protect victims from such unwanted attention (Perez, in the form of victim impact reports or statements 1993). of complaint. This paper critically examines the current Tables I to 3 provide the basic information on the formulations of the pathologies of love, and in patients' clinical characteristics, personal history and particular the centrality accorded an erotomania personality, while Table 4 describes those upon constructed around a delusion of being loved. whom they fixed their attention. The information Pathologies of love are most often found embedded provided omits or alters those potentially identifying in a psychotic illness such as schizophrenia. Although aspects not central to an understanding of the case most commentators accept the existence of a pure to protect the identities of the patients and their syndrome, others question this (Ellis & Meilsop, victims. The diagnostic grouping for the discrete 1985). Some of our cases are properly regarded as syndromes is that of delusional disorder, as they all primary pathologies of love. The spectrum of clinical fulfilled the DSM—III—Rcriteria (American characteristics found in the pathologies of love are Psychiatric Association, 1987)for this condition but, discussed. as discussed below, this needs to be interpreted with caution. Method The clinical material comprises 16patients personally Morbid infatuations and morbid beliefs in assessed, and in most instances managed, by the being loved authors between 1990 and 1993. All these subjects had at least one extended episode of disturbance in Morbid beliefs of being loved are characterised by: which the central clinical feature was a pathology of love. We work predominantly in a forensic context, (a) a conviction of being loved which imparts a bias to the case material. Most of (b) the supposed lover doing nothing to our patients are men, and were referred either via encourage or sustain the belief, but on the the justice system or from the general psychiatric contrary usually making clear a lack of services because they raised issues of dangerousness. interest and concern Cases 13 and 14 were the only ones encountered (c) the words and actions of the supposed lover outside of our forensic practice. The case material being reinterpreted to maintain the belief in usually included extensive data gathered from the requited love THE PATHOLOGICAL EXTENSIONS OF LOVE 617 Table3 Previouspersonality Patient disorder(DSM—lll-Rcriteria)Sensitive no.Personality ideasof dependentnarcissistic incompe tence1AvoidantYesYesNoNoYes2Avoidant referenceMarkedtraitsMarked traitsGrandiositySocial traitsYesYesNoNoYes3NarcissisticYesNoYesYesNo4ParanoidYesYesYesYesYes5Narcissisticwithobsessive-compulsive traitsYesYesYesYesYes6-YesYesYesYesYes7AntisocialYesNoYesNoNo8AntisocialYesNoNoYesNo9-YesNoNoNoYes10AntisocialNoNoNoYesNo11SchizoidYesNoNoNoYes12-NoNoYesYesNo13-NoNoNoNoYes14-NoNoNoNoNo15ParanoidYesNoNoNoYes16Paranoid,with obsessive-compulsive andantisocialYesNoYesYesYes (d) a belief that the supposed relationship will expressed by the way a young lady patted her eventually be crowned by a permanent and handbag while sitting in a bus. In contrast, it is loving relationship difficult, if not impossible, to falsify a statement that (e) preoccupations with the supposed love forming
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