by Frank Tallis
De Clérambault’s syndrome is difficult to treat. The prognosis is poor, and the illness usually has a chronic course. A combination of medication and enforced separation are supposed to be the most effective treatment, but Megan had taken Pimozide and hadn’t seen Daman Verma for six months and she still yearned to be with him.
One day, I asked Megan if she thought we were making any progress. ‘Yes,’ she said. ‘It’s helpful… talking.’
I flattered myself we were getting somewhere. But I was very much mistaken.
All things being equal, we tend to pair up with an individual of a similar type to us—particularly so with respect to attractiveness. If you want to get an idea of how good looking you are, don’t look in the mirror: take a long hard look at your partner instead. In evolutionary terms, beauty is only one of many fitness indicators but it may be the most important. Everyone wants to find an attractive mate and few are willing to couple with anyone less attractive than themselves. Beautiful people pair with other beautiful people and the not-so-well-endowed must do their best in a depleted market place where they will continue to resist trading down. These imperatives create a hierarchy in which the vast majority of couples have sorted themselves into closely matched pairs. Evolutionary theorists call it assortative mating. Exceptions are relatively rare, and when they do occur they are often attributable to the influence of wealth (another fitness indicator), which tends to facilitate relationships between richer, older men and desirable younger women.
I wondered what Megan’s husband Philip was like. So I asked to see him.
Philip was the same age as Megan and roughly the same build. He had the same coloured hair and was, at most, only one to two inches taller. He dressed in the same way: respectably—a pale blue shirt, a dark blue jumper, grey flannel trousers with a neat crease and polished Oxford brogues—casual, but not so casual as to preclude dropping into the office. His manner was affable and pleasant. I recognised his deferential, self-conscious smile, because it was an exact copy of Megan’s. It was easy to imagine them, as a couple, before the catastrophic entry of Daman Verma into their lives, hand in hand and ideal companions.
‘The last few years must have been very hard for you,’ I said.
‘Yes,’ he replied. ‘It has been quite difficult.’
Here was a man with a gift for understatement.
We talked a little about the nature of his relationship with Megan and how things had changed.
‘I suppose since Daman went to Dubai, things have been better.’ He used the dentist’s first name, just like his wife. ‘I mean, I don’t have to worry about where she is—or what she’s doing. She’s back at work now and she comes straight back home. They’ve been very good, the people who she works for. The head clerk particularly. His daughter suffers from depression and he was very understanding.’
‘Do they know what happened?’
‘Well… not exactly.’ He hurried on, not wishing to dwell upon the fictions he had employed to minimise embarrassment. It was sad that he’d had to lie, and, of course, an indictment of our society. Even when a sympathetic reception was guaranteed, Philip couldn’t tell the truth. It was still too shameful and humiliating.
‘On the face of it, it’s like everything’s normal again. We chat—go to the cinema—go for walks. We went to Cornwall for a few weeks last August and had a really nice time.’
‘Are you still… close?’
‘Yes, I think we are.’
I wanted to know how close. ‘Are you still… intimate?’
‘Intimate? What—having sex?’ I nodded. ‘Yes,’ he continued. ‘Yes we are. It’s so strange,’ he suddenly looked bewildered, boyish. ‘Nothing’s changed—but everything’s different.’
‘How do you mean?’
‘My wife is there—but not there. It’s her—but not her.’
His words reminded me of a clinical phenomenon known as the Capgras Delusion. The sufferer believes that someone to whom they are closely related has been replaced by an identical imposter.
‘I know she’s thinking about him all the time,’ Philip continued. ‘I mean—she’s probably even thinking about him when, you know, we’re in bed.’
‘You think she’s having sexual fantasies about him, while you’re—’
Philip cut in, preventing the sentence from reaching its obvious and explicit conclusion. ‘No, no.’ He took a deep breath, composed himself and added, ‘Well, I can’t say for sure of course. I realise that. Maybe she does think of him while we’re making love. But I don’t think so.’ Philip believed that Megan’s feelings for Verma had become more abstract—more elevated. And he had good reason.
‘Has Megan told you about her…’ His last syllable extended equivocally. He scratched his head, as if he’d been presented with an intractable mathematical problem. ‘I don’t know what to call it really. I suppose it’s like a shrine.’
‘What?’ I sat up, surprised. ‘No, she hasn’t told me.’
‘It’s a box—an ordinary storage box—which she keeps in the bedroom, covered with a white cloth. Inside the box are things she’s collected that have some connection with Daman.’
‘Such as…?’
‘He was in the papers once. He’d attended some big fundraising event for a charity and his photograph had been taken. He’s dressed up—in a tux—standing next to an MP and a TV personality. It all looks quite glitzy. Megan cut the article out of the newspaper and kept it. She also has his old business card, an information pamphlet that she picked up at his clinic and her appointment letters. And there are a few other things. A pen, a paper clip… I can only imagine that they’re things that he touched. She must have stolen them.’
‘What does she do with these things?’
‘She takes them out from time to time.’
‘In front of you?’
‘No. She used to, but not now. She used to sit next to the box and close her eyes. It was as though she was—I don’t know—praying.’
‘How do you feel about this… this shrine?’
Philip looked discomfited by my question. ‘It’s just something I have to put up with, isn’t it?’ The look of boyish bewilderment returned.
‘No. Not necessarily. You could say something.’
‘Could I?’
‘Yes. You could object.’
He shook his head. ‘I couldn’t force her to throw those things away. It would be crushing. Why would I do that? Why would I want to do that?’
I was touched by his compassion. Ordinary, non-pathological love can also be very extraordinary.
The next time I saw Megan, I asked her about her shrine.
‘It’s the closest I’ll ever get to Daman now—physically, I mean.’ Her addendum was a telling qualification. She still believed that the great distance that separated her from Verma could be bridged by non-physical means.
‘How often do you look at those things?’ I asked.
‘Not very often, but it helps—knowing they’re there.’
‘How do you think Philip feels about you keeping these… mementoes?’
‘He doesn’t mind.’
‘Are you sure?’
‘Yes. He doesn’t mind. And it’s not doing any harm.’
‘Maybe if you could let go of those things, it would help you to move on.’
A shadow, something like fear, darkened her face. ‘It’s not doing any harm. And Philip doesn’t mind—really he doesn’t.’ The note of barely concealed panic rang out all too clearly.
Fictional representations of psychotherapy are very misleading. A heroic clinician is summoned to treat an unreachable patient whose symptoms defy understanding. With considerable difficulty, demanding a combination of insightful brilliance and guile, and against all odds, a relationship is established. Dark discoveries are made by the excavation of unconscious memories and the mystery is finally solved. All the pieces of the complex puzzle fit neatly together and the patient is restored to perfect health. Exit hero ther
apist—cue music and titles.
The reality of psychotherapy is very different. It’s actually quite messy and rarely progresses along the satisfying lines of a fictional narrative. There are blind alleys and false turns, periods of stasis and frustration—doubts about whether one is addressing the problem in the right way. Even when attempting to treat a specific anxiety with a straightforward method such as ‘exposure’—which involves persuading patients to confront their fears directly—something can happen which recommends adopting an entirely different approach. I was once conducting an exposure session with a woman who suffered from a horror of door handles because she was afraid of being contaminated. As she anxiously reached out to touch the handle of my office door, she remembered another door handle, the one that had rattled ominously before her father entered her bedroom to sexually abuse her when she was a child. Needless to say, we abandoned exposure and spoke about these memories instead. Theoretically dense therapies, such as psychoanalysis, can easily feel unnavigable; all those memories, dreams and interpretations. The unconscious isn’t always cooperative and it is possible to dig deep into someone’s psyche and uncover nothing of therapeutic value.
The pieces of Megan’s puzzle didn’t fit together neatly. There were no dark discoveries and I couldn’t discern any pleasing, explanatory connections. A staunch biological psychiatrist would probably suggest that this is because de Clérambault’s syndrome is a psychotic illness and best explained by chemical imbalances in the brain. I was looking for things that weren’t there or were merely incidental. The fact that Megan’s medication didn’t work doesn’t compromise this argument. Perhaps we just need better drugs.
I can’t offer a psychological explanation, but I can offer an observation—a kind of contextualisation that has certain implications for how we view patients like Megan.
The more I thought about Megan, the more I was struck by the correspondences between her so-called illness and the behavioural and emotional correlates of romantic love. Her abnormality was quantitative rather than qualitative. She was experiencing the same things that we all experience when we are smitten, only greatly magnified. Even her delusional thinking was, in a sense, normal, because romantic love is often very irrational—love at first sight, ascribing chance meetings to destiny, oceanic feelings and powerful affinities that can transcend time and space are all commonplace. Most love-struck individuals engage in subtle forms of stalking—for example, loitering in places where they are likely to encounter the person whom they’ve fallen in love with. Even Megan’s shrine can be viewed as just an exaggerated version of the photographs and sentimental objects that couples often retain to memorialise their love; relics and talismans that contain residual energies released at the time of a first meeting, dinner, or kiss. The only feature of Megan’s illness that marked a qualitative departure from normality was her absolute conviction that Daman Verma was also smitten, a conviction made even more conspicuous by its survival regardless of overwhelming evidence to the contrary. Other than this delusion of reciprocity, Megan’s psychopathological love was simply romantic love writ large: not abnormal, as such, but supernormal.
It is as if the neural circuitry that serves romantic attachment—the same neural circuitry laid down by natural selection and shared by all humans—suddenly became hyperactive. What this suggests is that what happened to Megan could also happen to any of us. And if you have ever fallen in love, you will, no doubt, have edged closer towards Megan’s location along a continuum. Many—none of whom are ever given a psychiatric diagnosis—travel most of the distance.
Psychologists make a distinction between problem-focused and emotion-focused coping. The former is what we do when a problem is soluble. If you have to sit a difficult exam you can always do more revision. Some problems, however, are insoluble—like bereavement, for example—and then the only option becomes changing one’s response to the problem. This is, of course, a major undertaking—but at least it is theoretically possible.
Did I help Megan? There was no solution to the problem of Megan’s de Clérambault’s syndrome—she was incurable—but she did modify her response to the problem. She came to accept that she would have to live her life separated from Verma, and to the best of my knowledge she never attempted to follow him to Dubai; however, she still loved him—and would love him forever.
Although I saw Megan a long time ago, I still think about her. I imagine her, surreptitiously climbing the stairs to her suburban bedroom, entering and closing the door. I imagine her sitting at her shrine and removing one of the sacred objects from inside. I imagine her, closing her eyes and communing with a man who has probably forgotten that she exists by now.
Chapter 2
The Haunted Bedroom
Ageless passion
A grey, overcast day in autumn. I looked out of the window through streaming rainwater at a grim prospect: a narrow paved pathway, hemmed in by temporary huts, leading towards a cliff face of soulless 1960s architecture—a no-man’s-land between a research institute and a psychiatric hospital. The people who traversed this desolate corridor were mostly psychiatrists and nurses, but occasionally I’d see a stray patient. One of them was a black woman who always covered her face with white makeup because she believed she was an angel. She must have thought it necessary to have white skin in order to qualify as a member of the angelic host. Her appearance was actually quite disturbing, but whenever I encountered her on the street she gave me a friendly smile. It wasn’t always easy to distinguish staff from patients. Another individual I frequently observed through the window was a donnish gentleman in his sixties, dressed in a crumpled polyester suit and incongruous trainers. He was always sprinting and jogged on the spot even when travelling between floors in a lift. Over a period of several years, I never saw him stationary. I later learned that this mercurial eccentric was not only a renowned physiologist, but also a musicologist, composer, former member of the Ratio Club (which included Alan Turing as a member), and the inventor of an electronic wind instrument known as the logical bassoon. He also enjoyed some notoriety on the conference circuit. Once, he injected his penis with an impotence cure and encouraged delegates to admire the strength of his erection. The propriety of his behaviour was never questioned. Obviously, these were different times.
My office was in an Edwardian terraced house next to the hospital grounds. It was used as an outpatient clinic. I was told—before starting work there—that the building had been repeatedly inspected by the local council and condemned. The house always escaped demolition because of the pressing need for more space. I laughed, assuming that the story must be apocryphal, but one morning I opened the door to the consulting room and half of the ceiling had fallen in. There was a massive hole through which I could see floorboards and water pipes. Everything was covered in fragments of plaster and dust.
The house was in a terrible state of dilapidation. Paint was peeling off the woodwork and colonies of black mould climbed up the walls. The furniture was the kind you might find in a junk shop. I can vividly recall a penniless patient (a man who lived in one of the local housing estates) asking if I’d accept a charitable donation.
A gust of wind rattled the window pane, and a nurse, pulling the lapels of her coat over her head to make a cowl, hurried along the path. The bell rang and I went to let Mavis in. We hadn’t met before, but I was familiar with her history from the referral letter: a working-class woman who had lived in the same underprivileged borough all of her life. She was in her early seventies and very depressed; the cause of her depression was the death of her husband. He had suffered a fatal heart attack a year earlier.
When individuals have significant psychological problems after bereavement (lasting more than twelve months) they are said to be suffering from a complicated grief reaction or Persistent Complex Bereavement Disorder. I find the idea of conceptualising prolonged grief as a form of abnormality questionable. People vary in temperament and resilience and come to terms with loss at differe
nt rates. Some never adjust. The fact that such an appalling trauma might cause long-term distress is hardly surprising. I’m inclined to ascribe protracted grief to the human condition. Diagnosis seems a rather arcane consideration in this context.
I opened the door and faced a small, slightly overweight woman holding an umbrella over her head. The colour of her hair matched the sky and her expression suggested vacancy. When people get very depressed, they don’t look sad but exhausted. It’s as though they’ve progressed beyond sadness and have resumed their existence on another, unreachable plane. Mavis looked emotionally numb, but numbness implies anaesthesia and that would be misleading. The numbness of depression is simply pain in another form—like water becoming ice when the temperature drops. Dante knew what he was doing when he characterised the ninth and lowest circle of hell as a frozen waste.
‘Come in,’ I said.
‘What should I do with this?’ She indicated her umbrella.
‘You can leave it here in the hall to dry if you like,’ I tapped the radiator.
She stepped out of the rain, placed her umbrella on the floor and followed me to the consulting room. She didn’t register the shabby state of her surroundings—the small, circular cigarette burns in the carpet, the general atmosphere of decrepitude. She sat down on a worn armchair with noisy springs and faced me with her knees pressed together. She was wearing a pleated blouse, a loose cardigan, a dark skirt and grey woollen tights. I made some introductory remarks, summarised her referral letter, and checked that she understood why she’d been advised to see me.
‘I’m not doing very well. That’s what he said—Dr Patel.’ Her voice sounded querulous. ‘You know, since George died. He—Dr Patel—reckoned I should talk to someone. He said it might help.’