{"id":42813,"date":"2018-08-13T14:52:43","date_gmt":"2018-08-13T13:52:43","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=42813"},"modified":"2018-08-21T10:01:52","modified_gmt":"2018-08-21T09:01:52","slug":"richard-smith-modern-doctors-should-pay-more-attention-to-lovesickness","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/13\/richard-smith-modern-doctors-should-pay-more-attention-to-lovesickness\/","title":{"rendered":"Richard Smith: Modern doctors should pay more attention to lovesickness"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-33037\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014-150x150.jpg\" alt=\"richard_smith_2014\" width=\"128\" height=\"128\" \/><\/a><span style=\"font-weight: 400\">In this book <\/span><i><span style=\"font-weight: 400\">The Incurable Romantic: and Other Unsettling Revelations<\/span><\/i><span style=\"font-weight: 400\"> Frank Tallis, a psychotherapist proposes that modern psychotherapists and doctors can learn from the ancients about the disabling conditions of \u201clovesickness.\u201d He thinks that modern culture, a culture that has spawned <\/span><i><span style=\"font-weight: 400\">Love Island<\/span><\/i><span style=\"font-weight: 400\">, has \u201ctrivialised an important aspect of the human condition and at a very high cost.\u201d He continues: \u201cA doctor in ancient Greece or Rome, or in eleventh-century Persia, would have had more to say, for example, about lovesickness\u2014in relative theoretical terms\u2014than would a contemporary psychotherapist.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Tallis\u2019s book reminded me of <\/span><i><span style=\"font-weight: 400\">Do No Harm<\/span><\/i><span style=\"font-weight: 400\"> 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 <a href=\"https:\/\/richardswsmith.wordpress.com\/2018\/07\/06\/how-does-the-way-the-ancient-greeks-thought-of-love-fit-with-the-triangular-theory-of-love\/\">using modern psychology <\/a><\/span><span style=\"font-weight: 400\">and behavioural techniques and referring regularly to neuroanatomy and neuroscience.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Lucretius, the Roman poet and philosopher, wrote about love and love sickness in his great poem <\/span><i><span style=\"font-weight: 400\">On the Nature of Things<\/span><\/i><span style=\"font-weight: 400\">. 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Lovesickness was a legitimate diagnosis from classical times unto the 18<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\"> 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. \u00a0The stories are engaging and often remarkable. \u201cPeople are,\u201d writes Tallis, \u201cliving story books. Talking cures open the covers and let the stories out.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Megan, a contentedly married barrister\u2019s clerk, went to the dentist one day and fell instantly in love with him. What\u2019s 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\u2019t 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\u2014in other words, she \u201cstalked\u201d him. The dentist contacted Megan\u2019s GP, who told her husband and made the referral to Tallis. Life was made uncomfortable for the dentist, and he moved abroad.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Megan was suffering from de Cl\u00e9rambault\u2019s syndrome, which was first described by the French psychiatrist Ga\u0113ten de Cl\u00e9rambault 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 \u201cdelusional disorder: erotomanic type.\u201d It might be caused by \u201cabnormal activity in the right temporal lobes.\u201d But Tallis argues that Megan\u2019s \u201cabnormality was quantitative rather than qualitative\u201d: she was simply suffering from a bad case of what we all suffer. She wasn\u2019t cured but adapted.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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: \u201cdelusional disorder: jealous type.\u201d 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Through these cases Tallis makes a strong case that \u201clove\u201d 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 \u201cbeing a rational animal, a creature that can derive pleasure from the transcendent complexities of a Mozart symphony and anal-oral contact.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">I\u2019m not convinced by that argument, and nor do I think that the bloated psychiatric disease classifications should include new \u201cdiseases\u201d 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\u2019s long poem, which deals of much else of importance apart from lovesickness\u2014including maintaining a balance with nature and having a healthy relationship with death.<\/span><\/p>\n<p><em style=\"font-size: 1rem\"><strong>Richard Smith<\/strong>\u00a0was the editor of <\/em>The BMJ<em style=\"font-size: 1rem\"> until 2004.<\/em><\/p>\n<p><span style=\"font-weight: 400\"><strong>Competing interest:<\/strong>\u00a0None declared.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In 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 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/13\/richard-smith-modern-doctors-should-pay-more-attention-to-lovesickness\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":42814,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955],"tags":[],"class_list":["post-42813","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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