Richard Smith: Modern doctors should pay more attention to lovesickness

richard_smith_2014In this book The Incurable Romantic: and Other Unsettling Revelations Frank Tallis, a psychotherapist proposes that modern psychotherapists and doctors can learn from the ancients about the disabling conditions of “lovesickness.” He thinks that modern culture, a culture that has spawned Love Island, has “trivialised an important aspect of the human condition and at a very high cost.” He continues: “A doctor in ancient Greece or Rome, or in eleventh-century Persia, would have had more to say, for example, about lovesickness—in relative theoretical terms—than would a contemporary psychotherapist.”

Tallis’s book reminded me of Do No Harm by the neurosurgeon Henry Marsh. The obvious similarity is that both books describe a series of cases, but both authors are humbled before the brain. They are very aware of the limitations of how much they can help patients and of the capacity of the brain to play tricks.

Despite Tallis emphasising the difficulties of helping people, I ended the book feeling much more positive about psychotherapy than I had when I began. Tallis does not belong to any particular school of psychotherapy but acknowledges how proponents of one school will be scornful of another school. He uses whatever he thinks might help his patients, explaining and treating problems with the thinking of Freud, Jung, Bauer, Winnicott, and other psychoanalysts but also using modern psychology and behavioural techniques and referring regularly to neuroanatomy and neuroscience.

Lucretius, the Roman poet and philosopher, wrote about love and love sickness in his great poem On the Nature of Things. He suggests that falling in love is like becoming ill or even mad: the lover is agitated, experiences insatiable desires, neglects responsibilities, behaves foolishly, spends excessively on gifts, and may be consumed by jealousy. This is normal love, but when love goes wrong the lover may become delusional, perceive ordinariness as outstanding beauty, be unable to keep away from the one they love, neglect all others, and become abject and helpless. Lucretius, like the Ancient Greeks before him, thought the lovelorn fools, but ironically he killed himself after taking a love potion.

Lovesickness was a legitimate diagnosis from classical times unto the 18th century but has now disappeared, being used, Tallis says, more as a metaphor than a diagnosis. But Tallis builds his case that the ancient were smarter than the moderns by describing a series of cases.  The stories are engaging and often remarkable. “People are,” writes Tallis, “living story books. Talking cures open the covers and let the stories out.”

Megan, a contentedly married barrister’s clerk, went to the dentist one day and fell instantly in love with him. What’s more she knew without any doubt that the dentist was equally in love with her. Megan knew that the dentist could not display his love for her because he didn’t want to upset his wife. She exhibited all the classic signs of love, thinking about the dentist all the time. She wrote to him every day and waited outside his practice—in other words, she “stalked” him. The dentist contacted Megan’s GP, who told her husband and made the referral to Tallis. Life was made uncomfortable for the dentist, and he moved abroad.

Megan was suffering from de Clérambault’s syndrome, which was first described by the French psychiatrist Gaēten de Clérambault in 1921. The patient, more often a woman than a man, falls in love suddenly with somebody, usually of higher status, and is convinced that the other person is equally strongly in love. This is one of the forms of love that does make it into modern diagnostic classifications and is known as “delusional disorder: erotomanic type.” It might be caused by “abnormal activity in the right temporal lobes.” But Tallis argues that Megan’s “abnormality was quantitative rather than qualitative”: she was simply suffering from a bad case of what we all suffer. She wasn’t cured but adapted.

Mavis, an elderly woman, was halted in grieving for her dead husband not because she missed him but because she missed sex. Anita was pathologically jealous, suffering from another condition recognised in modern classifications: “delusional disorder: jealous type.” She destroyed her marriage. Ali was a married, successful businessman who ruined his business with his addiction to prostitutes because what he needed from them was not sex but to hear them say, once he had courted them with expensive gifts, that they loved him; at that point he lost interest. Paul, a high achiever with a beautiful girlfriend, could not accept her ending the relationship and almost ended up being arrested for pursuing her. Mark, a gay man, preferred masturbating watching himself in a mirror to having sex with his partner: he had the same condition as Narcissus in Greek mythology. Gordon was a paedophile who had managed to contain his desires but at the price of living a lonely, empty life.

Through these cases Tallis makes a strong case that “love” can be the cause of great distress in many ways. He intersperses the cases with observations from history, literature, and scientific reports, making for an enjoyable, entertaining, and informative read.

Why might modern medicine have failed to recognise what the ancients recognised? Tallis, perhaps unsurprisingly, thinks Freud may have the answer. We turn away from what makes us anxious, and we are made anxious by “being a rational animal, a creature that can derive pleasure from the transcendent complexities of a Mozart symphony and anal-oral contact.”

I’m not convinced by that argument, and nor do I think that the bloated psychiatric disease classifications should include new “diseases” that result from love. Indeed, Tallis himself never argues for that. Rather he makes a case for thinking and researching more about the ways in which love can cause suffering and might be treated. And certainly I would support all doctors reading Lucretius’s long poem, which deals of much else of importance apart from lovesickness—including maintaining a balance with nature and having a healthy relationship with death.

Richard Smith was the editor of The BMJ until 2004.

Competing interest: None declared.