- Two case reports from SL show that not every break in is meant for destruction
Though the origins of delusions of love can be traced back to the time of Hippocrates, French psychiatrist Gaëtan Henri Alfred Edouard Léon Marie Gatian de Clérambault in 1942 was the first to delineate features methodically and to isolate the syndrome, and it was referred to, as explained in H.W. Jordan, E.W. Lockert, M. Johnson-Warren, C. Cabell, T. Cooke, W. Greer, and G. Howe’s “Erotomania revisited: 34 years later”, as “psychose passionelle”.
We describe two cases of delusions of love found in a forensic unit, who exhibited stalking behaviour by acting up on their delusions and were arrested on the charges of breaking into the houses of the alleged lovers.
Case 1
Mr. A, a 49-year-old divorced security officer, was referred from the remand prison over the charge of breaking into a house.
Mr. A strongly believed that Mrs. P, who lived adjacent to his working place, was in love with him for three years. They continued their relationship through the telephone where they had engaged in some intimate behaviours while communicating through the mobile phone. Mrs. P has never expressed her love for him verbatim, but has given many clues to Mr. A to convey the message. She has frequently smiled and waved at him while passing by and has given him food at times to show her affection for him. Mrs. P has watered the plants in her balcony, so that Mr. A could have a glimpse of her from his working place. Mrs. P has even given him the responsibility of taking care of her house when she and her husband are away from home. Three months before the admission, Mr. A was seen by neighbours while trying to look over the wall of Mrs. P’s house and her husband had taken action to set up surveillance cameras in and around the house.
Meanwhile, under the influence of alcohol, Mr. A has tried to keep a gift on the wall of Mrs. P and the incident was recorded on the surveillance cameras, which alerted Mrs. P and her husband to take measures to inform his employer about his behaviour. Mr. A. was sacked three months later and he was arrested by the Police when he had broken into the house of Mrs. P on a night when they were away from home. He claimed that he had paid the visit on the invitation of Mr. P to do so.
The case history and the examination of the mental state only revealed delusions of love in Mr. A. There was no evidence of any other psychotic or mood disorder. Treatment with a second generation antipsychotic was initiated while in the forensic unit and, in parallel, appropriate communication was made with the relevant parties.
Case 2
Mr. R, a 48-year-old single, manual worker, was referred by courts on the charge of breaking into a house of a celebrity singer. He strongly believed that she was in love with him. It was about 15 years ago that he started to believe that Mrs. N was in love with him, following the incident of taking a selfie with her during a musical show held in Galle. Mr. R then changed his residence from Galle to Kandana where Mrs. N resided. His life became dominated by the quest, and all his other interests were subordinated. He was employed as a manual worker in a place near where Mrs. N lived. The unremitting pursuit of his love object, by means of stalking, caused great distress to Mrs. N over the course of many years. He had written letters to her and placed them in her letter box on several occasions. He had waited for hours in front of her house and on a few occasions, attempted to open the door of the car of Mrs. N. On a few occasions, he was found behind the stages where Mrs. N went for singing. Mr. R was complained against and arrested on the day he tried to break into her house, following his failed attempt to open the car lock and reach for her.
He was diagnosed as having resistant schizophrenia for 22 years, for which he was started on clozapine (an atypical antipsychotic) to which his primary mental illness responded well, but his delusions of love persisted, proving the fact that the delusions of love can persist for as long as more than 30 years.
Discussion
Delusions of love are found in two main instances: The primary instance is in which the onset is sudden and the disorder is limited entirely to the erotomania, and the secondary instance is in which the onset is gradual and the process is superimposed on a pre-existing psychosis of a paranoid type.
Mr. A was diagnosed to have only the delusions of love as his psychopathology, whereas Mr. R had delusions of love as part of his pre-existing psychotic illness of schizophrenia.
The genetic basis and neuro-chemical basis are postulated as aetiology with some interesting psychodynamic explanations.
Forensic implications
If a patient’s romantic ideas shape their private fantasies instead of determined public behaviour, there would be little cause for concern. The situation becomes critical when the fantasies are dramatised in real life with an unsuspecting and usually unwilling man or woman cast in the role of the lover.
A grotesque drama often ensues when erotomanic patients act on their delusions, relentlessly bombarding their victims with telephone calls, letters, gifts and visits. Persistent surveillance and stalking, which is a course of conduct in which one individual repeatedly intrudes upon another, producing fear and distress, may occur.
Treatment
Recommendations for treatment include staged interventions, first establishing a therapeutic alliance with a focus on understanding the psychological factors contributing to the origin and maintenance of the delusion. The next stage is the provision of social support and strategies directed at the restoration of self-esteem. The third stage, as explained by M.V. Seeman in “Erotomania and recommendations for treatment”, is the gradual introduction of techniques to correct cognitive biases. Medication and risk management form an integral part of the overall management.
Conclusion
Delusions of love are not an uncommon occurrence among both genders, either as a primary phenomenon or as secondary to another psychotic illness. The identification of the presence of delusions of love is of importance as it has important social, psychological, and forensic implications.
(T.M. Ranasinghe is a Registrar in Psychiatry at the National Institute of Mental Health [NIMH], A. Ellepola is a Consultant Psychiatrist at the Anuradhapura Teaching Hospital, and L.V. Hettiarachchige is a Consultant Forensic Psychiatrist at the NIMH)