by Frank Tallis
De Clérambault’s syndrome (or something very much like it) has been described for centuries and one can find similar cases in works dating back to classical times. So, when he wrote about it in 1921, de Clérambault was not breaking new ground as such, but merely revisiting a condition that had previously been called erotomania. Still, it was his name that became most strongly associated with what is undoubtedly the sovereign affliction among the maladies of love—particularly so in the latter half of the twentieth century. Perhaps this is because his description was more comprehensive, insofar as he emphasised emotional as well as sexual aspects of the condition. In the eighteenth century, for example, erotomaniacs were defined as ‘Those who engage in the furious pursuit of vagrant or illicit lust.’
Today, the terms ‘de Clérambault’s syndrome’ and ‘erotomania’ are used interchangeably. At one point, the condition attracted the somewhat insensitive appellation ‘old maid’s insanity’. In modern diagnostic systems, it has become Delusional Disorder: Erotomanic Type. Even so, de Clérambault continues to haunt the marginalia of psychiatry and many continue to use ‘de Clérambault’s syndrome’ instead of the more correct contemporary alternative, probably because it sounds more pleasing and carries a suggestion of drama. It recalls an exciting period in the past when the mind was a dark continent and largely unexplored.
De Clérambault’s most famous case was a 53-year-old French dressmaker who believed that King George V was in love with her. She visited England several times in order to pursue him and waited outside Buckingham Palace. When she saw a curtain move she concluded that the King was sending her signals. The fact that the King wasn’t very forthcoming didn’t alter the dressmaker’s belief. She concluded that he was in a state of denial: ‘The King might hate me, but he can never forget. I could never be indifferent to him, nor he to me.’
The dressmaker also suffered from a secondary illness, paranoid psychosis. She believed, for example, that the King sometimes meddled in her affairs. De Clérambault’s syndrome is frequently associated with conditions such as schizophrenia or bipolar disorder. What made Megan so interesting was her ordinariness. There was nothing about her life, character, or history which offered the slightest indication of what was to follow. She was proof that, as far as mental health is concerned, we all walk a tight-rope and it really doesn’t take very much to make us lose balance and fall.
In addition to being awarded medals for distinguished service in the First World War, de Clérambault was fêted as a significant artist. Some of his paintings are exhibited in French museums. His most original work is a series of photographic studies of women dressed in veils. While assigned to a military hospital in North Africa he discovered traditional Moroccan garments and became fascinated by drapery as an artistic subject. A traditional Freudian would find the symbolic implications of such an interest telling: concealment, temptation, unwrapping and the promise of revelation. They are strange, uncanny images, vaguely reminiscent of Victorian spirit photography and largely overlooked by cultural historians until only recently.
In 1934, after two unsuccessful cataract operations, de Clérambault sat in front of a mirror and shot himself with his old service revolver. His camera was focused on his own reflection.
He had composed a suicide note in which he endeavoured to explain his behaviour. It had been suggested that a painting he wished to bequeath to the Louvre had been fraudulently acquired in a sale. He had been dishonoured and an episode of melancholia followed. In reality, the prospect of going blind was probably the most significant factor. For years he had studied people from two simultaneous perspectives—with the eyes of an artist and a psychiatrist. He would have registered every swathe, fold and wrinkle of the social fabric and been able to determine what lay beneath. Life without such acute powers of perception wasn’t worth living. He must have been looking closely at himself when he pulled the trigger. I wonder what he saw.
‘How did Philip react?’
‘He was upset. But he didn’t say nasty things—he didn’t accuse me of betraying him. We talked and I tried to explain, but he didn’t understand. Not truly. He told me he loved me—and said he’d always be there for me. It was sad.’
‘Because you didn’t love him any more…’
Megan looked at me aghast: ‘No, no. I’ve always loved Phil. It’s just what I feel for Daman…’ Her sentence trailed off and she looked around the room as if she’d lost something. Then her features hardened around a direct, unnerving stare. ‘It’s something else—something higher.’
‘More spiritual?’
‘I don’t know, maybe. I’m not sure where I stand where God’s concerned. But I do know it feels different to loving Phil, stronger, deeper—like something that was meant to be.’
‘Fated?’
‘Yes. That’s the word. Fated…’
Megan was taken by her husband to see a psychiatrist who decided to put her on Pimozide, an anti-psychotic drug that reduces delusional thinking. It works by blocking dopamine receptors in the brain. The action of the neurotransmitter dopamine has been associated with numerous aspects of behaviour, everything from remembering to vomiting, but there is also a large body of evidence showing that it mediates pleasure and pleasure-seeking. Not surprisingly, it is thought to have an important role in the development of addictions. The dopaminergic circuitry of the brain has also been implicated in biological accounts of what we call romantic love.
Megan took her medication as instructed, even though she wasn’t convinced that her love for Verma was, as the psychiatrist had suggested, the symptom of an illness. The drug had no effect. She felt just the same. The dose was subsequently increased—and still there was no effect. In fact, Megan’s longing seemed to be getting more intense. She waited outside the dentist’s practice with increasing frequency. Sometimes he would see her and send his secretary out with a message: go home. Megan didn’t argue. What was the point? She smiled, nodded and made her way back to the tube station. It didn’t matter, not in the grand scheme of things, because ultimately, her patience would be rewarded. On many occasions she escaped Verma’s notice by hiding in a doorway or standing behind a parked van. Then her vigils might last all day. During the winter months, even when the temperature plummeted, she was warmed by the simple fact of Verma’s proximity.
One late afternoon—around five o’ clock—she observed him leaving his practice and followed him home. She stood beneath a lamp-post, opposite his front door, picturing him inside. When she was discovered by his wife, Angee, who just happened to look out of an upstairs window, Daman stormed out of his house and confronted Megan. He was angry and threatened to call the police. Megan found his performance inauthentic: ‘He was pretending, for his wife’s sake. Really, in his heart, he wanted me to be there.’ Megan didn’t put up any resistance. Whenever she was ordered to go home, she did so, but by this time her behaviour was making everyone—particularly Angee—nervous. The Vermas had two children, a boy aged eight and girl aged ten, and Angee was worried about their safety. To his enormous credit, Daman Verma never called the police. He recognised that Megan was ill and acted accordingly. His wife, however, was less understanding.
‘I know I caused him problems,’ said Megan. ‘And I’m really sorry about that. I wasn’t trying to break up his marriage—because in a sense it was already over. I just wanted things to move on.’
In Ian McEwan’s novel, Enduring Love, the protagonist’s relationship begins to fail when he is stalked by a de Clérambault sufferer. This is exactly what happened to Angee and Daman Verma. Neither of them could cope with the stress. They began to have arguments about what measures should be taken to stop Megan. In due course, Daman Verma opted for a radical solution. He applied for a job in Dubai. The move wasn’t entirely provoked by Megan. It was something that Daman and Angee had discussed before; however, Megan’s harassment certainly made the decision easier. Daman Verma had recognised that Megan’s fierce, pathological love would never die. Ironically
, what we call true love is nowhere near as durable as its pathological variant. Only by interposing a substantial distance between himself and Megan did Verma stand a chance of resuming a normal existence.
Daman Verma and his family had been living in Dubai for six months when Megan was referred to me. She was no longer under the care of a psychiatrist, and her GP believed that she was much improved. Nevertheless, he thought it would be helpful if she was given the opportunity to talk about her experiences with a psychotherapist. She had been traumatised, and like most trauma victims, she would make a better adjustment if she could make sense of her history. But the more I talked to Megan, the more I suspected that she wasn’t very much improved at all. She’d simply become better at hiding her pain.
‘You still miss Daman, don’t you?’
‘Yes. I miss him a lot.’ Megan was studying her hands. Her head was bowed and she didn’t make eye contact. ‘I often think about what he’s doing. You know—in Dubai… I think of him waking up and getting out of bed, brushing his teeth and going to work.’ It was interesting that she didn’t see him surrounded by his family. ‘I imagine him in his car, driving, listening to the radio—the sun shining. I imagine him arriving at his new dental practice and getting ready for his patients. I see him—like I’m watching a film, or documentary—scrubbing, changing into his surgical gown.’ Her finger tips touched. ‘I like to be on my own in the early evening, because I know that in Dubai he’s just gone to bed and he’ll be lying in the dark without any distractions. And it’s then when I feel most that I can reach out to him, and he’ll know that I’m thinking about him—and then he’ll start thinking about me—and we’ll both be thinking of each other—and it’s like…’ She raised her head and her expression was beatific—like a religious visionary. Her eyes were gleaming and her face was flushed. She was slightly breathless when she added: ‘It’s like we’re one.’
I have no doubt that Megan’s merging fantasies produced an ecstatic state similar to that described by mystics. The experience of the soul’s reunification with God is heady and rapturous. So much so, that erotic allegory is often employed in scriptures and religious poetry to capture the intensity of heavenly communion. Orgasm seems to provide the only serviceable precedent.
Freud borrowed the term ‘oceanic feeling’ from one of his correspondents to describe sensations of pleasurable dissolution; however, he never considered the phenomenon anything more than a psychological reversion to the primitive. Indeed, he believed that all symbiotic feelings are influenced by memories formed in early infancy, when the boundary that separates the ego from the rest of the world is still incomplete and porous. In a sense, the ecstasy of lovers and mystics refers back to the womb and breast-feeding. Perhaps we are always striving to recover something of our original state, which was blissfully free from the terrors of isolation. It is often said that we are born alone and die alone (an aphorism attributed to sources as diverse as the fourth-century BCE Indian philosopher Chanakya and the actor Orson Welles). That isn’t strictly true. None of us are born alone—and perhaps we never forget it.
A delusion is a rigidly held belief that is maintained even when there is no evidence to support it; however, what constitutes good evidence differs from person to person. Megan regarded her own feelings as acceptable evidence. This had the effect of strengthening her beliefs. Daman Verma was in love with her. She knew that he loved her because she felt it so deeply—and strong feelings always mean something. The opposite is probably closer to the truth. Feelings are often vague, misleading and inconsistent. They don’t always provide us with reliable information about the world, other people or our circumstances.
I once treated a woman who was terrified of walking. There was nothing wrong with her legs or sense of balance: she was just scared of putting one foot in front of the other in order to get around. She had concluded that walking was dangerous because it felt dangerous.
It’s frustrating when a patient doesn’t get better. I was working on the assumption that if I kept on questioning Megan’s rigid beliefs about Daman Verma, they might change. But that wasn’t happening. My impatience made me more direct, less Socratic.
‘Does it look like Daman loves you?’
‘I think he does.’
‘Still…’
‘Yes.’
‘He moved to Dubai. He’s moved thousands of miles away.’
I let the words resonate in the silence that followed. And then I let the silence thicken and become coercive. Could she hear a whistling in her ears? The accelerating beat of her heart? Silences—long silences—can be very uncomfortable. They make demands. Megan looked at me, a little puzzled, almost certainly hurt.
Many years ago, I attended a psychoanalytic case meeting and the subject under discussion was how it is sometimes necessary for a therapist to let silences curdle. A colleague said: ‘Therapy. It’s like a pressure cooker; if you don’t have pressure the food won’t cook.’ But it’s difficult to watch a patient stewing.
Megan finally spoke. ‘He doesn’t want to upset his wife.’ It had become something of a mantra.
The next time I saw her, Megan looked more tired than usual.
‘I wish I could talk to him on the phone,’ she admitted. ‘Even if it was for five minutes, that would make it so much easier for me. If I could just hear his voice…’
‘Have you tried to get his number?’
‘No. I’ve thought about it—but no.’
‘What about going to Dubai? Have you thought about following him to the Middle East?’
‘Yes. I have.’
‘You’re still here though…’
‘Yes,’ she said. ‘I’m still here.’ Then she sighed, a colossal expulsion of air that created an illusion of shrinkage. Her shoulders curved inwards and her knees ascended slightly as her heels left the ground. This diminution, this closing in, was strongly suggestive of the foetal position. Her hands became fists, held tightly against her stomach. Then she added: ‘I know… I know.’ Her eyes were glistening.
What did she know?
She had allowed herself to contemplate the possibility that Daman Verma didn’t love her, that their love was not fated, and that they would never be together. She had looked into the abyss and the pain she felt was devastating. ‘I know… I know.’ That’s all she said. I can still re-create the sound in my mind, even down to the acoustic properties of the room we were sitting in: hesitant, slightly hoarse—a double cadence—full of sadness and resignation. I had told Megan not to over-interpret, but the register of her voice, her posture, the trembling light in her eyes gave expression to her thoughts with pitiful eloquence. It was plain what she was thinking, and her grief was palpable.
Falling in love is painful. Most of us know what it’s like—the need, the desperation, the longing. And when we aren’t loved in return, the anguish can be unbearable. Time heals, but it isn’t time that gives us the courage and strength to carry on. We carry on because of hope, hope informed by experience and observation. We learn, either directly or indirectly, that love is not always reciprocated, overtures are rejected and relationships full of early promise fail, but we also come to appreciate that opportunities to find love will inevitably come again.
Megan had found the love of her life. She was devoted to him, and her devotion was equal to all the well-worn, extravagant metaphors of poetry and song. She was as constant as the sun, the moon and the northern star. There would never be a transfer of affection. So there was no hope, no future. The distress that most of us might have to tolerate for months or years she was going to have to tolerate for the rest of her life. Imagine it. Remember what it feels like to be desperately and unhappily in love—and now imagine those same agonies sustained without respite, in perpetuity.
‘It’s so unfair,’ Megan whispered.
‘Yes,’ I agreed. ‘It is…’
The tears tumbled down her cheeks and splashed on her skirt. I pushed the box of tissues towards her. She didn’t no
tice my wholly inadequate gesture. She was too far gone—and I was humbled by the sheer magnitude of her agony.
What are the causes of de Clérambault’s syndrome? The most accurate and intellectually honest answer to this question is also probably the least satisfactory. No one really knows. It has been attributed to neurotransmitter imbalances, but the medication employed to correct those imbalances is rarely effective. Dopamine might have a role to play—but Megan’s medication, which worked by blocking dopamine receptors in the brain, had no effect on her mood, thinking or behaviour. Most patients report a dulling of emotion but the underlying fixation persists.
Another possibility is abnormal electrical activity in the temporal lobes—particularly the right temporal lobe. De Clérambault’s syndrome and temporal lobe epilepsy (TLE) share some common features: intensification of emotions, altered sexual interest and transcendent episodes. When the latter occurs the patient is sometimes said to be suffering from ‘Dostoyevsky epilepsy’ because the famous writer was prone to ecstatic seizures. Some individuals with TLE have insisted that strangers have fallen in love with them—although this is extremely unusual.
Psychoanalysts have implicated sexual ambivalence. By choosing an unattainable lover, the sufferer is able to avoid intimacy. Once again, the theory isn’t compelling, particularly with respect to cases like Megan. She had enjoyed a normal sex life before she encountered Daman Verma. She hadn’t been avoiding intimacy at all. Another theory suggests that women afflicted with de Clérambault’s have unaffectionate fathers. That, of course, is true of many women—but they don’t all go on to develop the condition.
