Enduring Love (30 page)

Thus the diagnostic criteria for the primary syndrome (i.e., de
Clerambault’s syndrome) as suggested by Enoch & Trethowan would be likely to find general acceptance among those who accept the clinical entity: “a delusional conviction of being in amorous communication with another person, this person is of much higher rank, has been the first to fall in love, and the first to make advances, the onset is sudden, the object of the amorous delusion remains unchanged, the patient gives an explanation for the object’s paradoxical behavior, the course is chronic, hallucinations are absent, and there are no cognitive defects.”

Mullen and Pathe cite Peres (1993), who observes that an increasing awareness of the threat presented by de Clerambault sufferers is bringing about an “explosion” of legislation to protect their victims. Mullen and Pathe highlight the tragedy for patients and victims alike: for the patients, love becomes an “isolating and autistic mode of being, in which any possibility of unity with another is lost. The tragedy for those on whom they fix their unwanted attentions is that, at the very least, they suffer harassment and embarrassment, or the disintegration of their closest relationships, and at the worst they may fall victim to the violent expression of resentment, jealousy, or sexual desire.”

A twenty-eight-year-old unmarried man, P, was referred from the courts following charges arising out of an attempted murder.

P was the second child of an elderly father who died when p was eight and of an unsupportive mother who remarried when P was thirteen. By his own account, P was an intense and lonely child, prone to daydreaming, who did not easily make friends. When his mother remarried he was sent to boarding school, where he was above average academically, but not dramatically so. While he was there, his older sister moved abroad, and he never saw her again. He did not
remember being teased or bullied, but he formed no close friendships and thought the other boys looked down on him because he had “no father to boast about, the way they did.” He gained entrance to university, where the pattern of isolation continued. P felt the students were frivolous. He joined the Student Christian Movement, and though he did not remain a member for long, he began to take comfort in his faith about this time. He left university with a poor degree in history and for the next four years drifted between low-skilled jobs. By now he had virtually no contact with his mother, who had divorced her second husband and had inherited a large house in North London and a sum of money from her sister.

P trained to become a teacher of English to foreigners and was one year into his first job when his mother died and he became the sole beneficiary of her estate, his sister being untraceable. He gave up his job and moved into the house, where both his isolation and his religious beliefs intensified. He meditated “on God’s glory” for long periods of time and went for walks in the country. During this time he became convinced that God was preparing for him a challenge, which he must not fail.

It was while he was on one of his rambles that P assisted at the scene of an accident involving a helium balloon. He exchanged a glance with R, another passerby who was also helping, who appeared to P to fall in love with him at that moment. Late that night P made the first of many phone calls to R to let him know that the love was mutual. P realized that the task set him by God was to return R’s love and to “bring him to God.” This certainty grew when he discovered that R was a well-known science writer who wrote from an atheistic point of view. In P’s various apprehensions of God’s will, he experienced no hallucinations.

There now began the barrage of letters, doorstep confrontations, and street vigils so familiar in the sad literature of this condition. In
an interesting echo of de Clerambault’s famous case, P perceived messages from R in the changing arrangement of the curtains in R’s apartment. P also received information by touching the leaves of a privet hedge and from published articles by R that had appeared in print long before their first meeting. R had been living contentedly with his common-law wife, M, and within days this relationship was under strain from P’s determined onslaught. Later they separated. P was mostly euphoric, certain that despite R’s outward hostility, he would come to accept his fate and live with P in his large house. He believed R was “playing with him” and testing his commitment.

Soon the euphoria turned to resentment. Early on, P had managed to steal M’s appointment diary from her place of work. Using the information he had that R was to be at a certain restaurant, P hired contract killers to shoot R. The attempt ended with a diner at a nearby table being shot in the shoulder. P was overcome with remorse and intended to stab himself to death in front of R. This plan failed too, and P was arrested and charged not only with the restaurant shooting but also for having held M at knifepoint. The court ordered a full psychiatric report.

On interview, the patient presented well, with a normal affect commensurate with having been held on remand in an overcrowded prison. Because an initial examination at the behest of his solicitor had produced a diagnosis of schizophrenia, cognitive, physical, and laboratory examinations were instigated, but proved normal, as was the EEG. There was no disorder of form of thought, and hallucinations were absent. There was no evidence of other Schneiderian front-rank symptoms for schizophrenia (Schneider 1959). P showed above-average visuo-spatial abilities, abstraction, and concentration. His WAIS scores were: verbal 130, performance 110, full-scale 120. In the Benton test he showed no cognitive impairment. On the Weschler Memory
Scale his short-term memory was intact for simple and complex material.

P stated that he knew R still loved him, as was evidenced by his having intervened to save P from killing himself. Also, at a procedural hearing in court, P had received a “message of love” from R. P regretted his attempt on R’s life and felt that whatever lay ahead of him was a test, both of his faith in God and of his love for R. The patient was articulate and coherent in these assertions. The impression formed was of a well-encapsulated delusional system. Chemotherapy (5mg pimozide daily) and gently challenging insight-directed therapy were prescribed, but over a six-month period were observed to have no impact. Eventually the court ruled that P should be held indefinitely at a secure mental hospital. P was seen six months after admission, and despite a change of chemotherapy, the delusions appeared unremitted, P asserting as confidently as before his belief that R’s love for him was undiminished and that through his suffering he would one day bring R to God. P writes daily to R from hospital. His letters are collected by the nursing staff but are not forwarded, in order to protect R from further distress. The patient will continue to be followed.

Ellis & Mellsop (1985) concluded that de Clerambault’s syndrome is an etiologically heterogeneous disorder. Theories of etiology have encompassed alcoholism, abortion, postamphetamine depression, epilepsy, head trauma, and neurological disorders. None of these is relevant in this case. Reviewing various descriptions of the premorbid personality in pure cases, Mullen & Pathe summarize by invoking “a socially inept individual isolated from others, be it by sensitivity, suspiciousness, or assumed superiority. These people tend to be described
as living socially empty lives … the desire for a relationship is balanced by a fear of rejection or a fear of intimacy, both sexual and emotional.”

The important change in this patient’s life was the inheritance of his mother’s house; a lifetime’s failure to form close relationships culminated in a new arrangement whereby P, freed from the necessity of earning his living, was able to sever his remaining contacts with colleagues at the language school and his landlady and withdraw. It was at this time of increased loneliness that he became aware that he faced a test. On a country walk he was initiated into a makeshift community of passersby struggling to tether a balloon caught in strong winds. Such a transformation, from a “socially empty” life to intense teamwork, may have been the dominating factor in precipitating the syndrome, for it was when the drama was over that he became “aware” of R’s love; the inception of a delusional relationship ensured that P would not have to return to his former isolation. Arieti & Meth (1959) have suggested that erotomania may act as a defense against depression and loneliness by creating a full intrapsychic world.

Also relevant to Mullen & Pathe’s profile is the patient’s fear of sexual intimacy. Questioned in interview about his erotic ambitions with regard to R, P was evasive and even offended. Although many male patients have specific and intrusive sexual designs on their subjects, others, as well as many female patients, have self-protectively vague notions of what they actually want from the love-object. Enoch & Trethowan quote Esquirol (1845), who observed that “the subjects of erotomania never pass the limits of propriety, they remain chaste.” And Bucknell & Tuke, writing in the mid-nineteenth century, associated “erotomania proper” with a “sentimental form.”

This case confirms the reports of some commentators (Trethowan 1967; Seeman 1978; Mullen & Pathe) on the relevance of absent or missing fathers. It must remain a matter for conjecture at this stage
whether R, aged forty-seven, represented a father figure to P, or whether, as a successful, socially integrated individual, he represented an ideal to which P aspired.

Strong associations have been made, especially in recent work, between male erotomania and dangerousness (Gagne & Desparois 1995; Harmon, Rosner, & Owens 1995; Menzies, Fedoroff, Green, & Isaacson 1995). Hospitalization may be necessary in order to protect the love-object from assault by the patient (Enoch & Trethowan; Mullen & Pathe). In this case, where criminal charges had been brought, the issue of dangerousness, particularly in regard to outcome, was central. P stationed himself in a restaurant to watch the contract killing of R. When the attack went wrong, he tried to intervene. Later he showed remorse and redirected the violence against himself in the presence of R and M. As long as P’s delusion continued unremitted, his potential for violence remained, and admission to a secure hospital was appropriate.

Lovett Doust & Christie, in their review of eight cases, suggest that “a close relationship may be posited between some pathological aspects of love and the tenets of the church for religious believers.” It is reasonable to assume that the inhibitions placed on sexual expression by certain sects could be implicated in some pathologies. Furthermore, celibate priests, by reason of their unavailability, may be favored subjects for de Clerambault sufferers. Other ministers of the church have been subjects of erotic delusions due to the status they enjoy within congregations (Enoch & Trethowan). However, P belonged to no particular denomination or sect, and the object of his delusion was an atheist. P’s religious beliefs pre-dated the psychopathology, but those beliefs intensified once he had moved into his mother’s house and his isolation was complete. His relationship with God was personal, and served as a substitute for other intimate relationships. The mission to “bring R to God” may be seen as an
attempt to achieve a fully integrated intrapsychic world in which internalized religious sentiment and delusional love became one. In interview, P insisted that he had never heard the voice of God, nor seen any manifestations of his presence. He became “aware” of God’s will or purpose in the generalized fashion of many people of intense religious persuasion. A search of the literature did not reveal another case of pure erotomania in which religious feeling or a love of God is similarly implicated.

P’s condition satisfies all but one of the diagnostic criteria for the primary form of de Clerambault’s syndrome suggested by Enoch & Trethowan and referred to above: P experiences a delusional conviction of being in amorous communication with another person, R, who was the first to fall in love and make advances. The onset was sudden. The object of P’s delusion remains unchanged. He is able to rationalize R’s paradoxical behavior, and the course looks set to be chronic. P suffers no hallucinations or cognitive defects. (However, although it could be said that R is of “higher rank,” P could not have known this at their first meeting.) This degree of diagnostic concurrence, and the fact that P shares a number of premorbid characteristics with other patients, lend weight to the view that the syndrome is a nosological entity.

With regard to outcome, most commentators have leaned toward pessimism. De Clerambault described cases of pure erotomania that lasted without significant change for between seven and thirty-seven years. A review of the literature since suggests that this is indeed a most lasting form of love, often terminated only by the death of the patient.

The victims of de Clerambault patients may endure harassment, stress, physical and sexual assault, and even death. While in this case
R and M were reconciled and later successfully adopted a child, some victims have had to divorce or emigrate, and others have needed psychiatric treatment because of the distress the patients have caused them. It is therefore important to continue to refine the diagnostic criteria and that these become broadly known by professionals. Patients with delusional disorders are unlikely to seek help, since they do not regard themselves as ill. Their friends and family may also be reluctant to see them in these terms, for as Mullen & Pathe observe, “the pathological extensions of love not only touch upon but overlap with normal experience, and it is not always easy to accept that one of our most valued experiences may merge into psychopathology.”