In Their Hearts and Minds, Anyway, It’s Love

To know of her was to envy her. To know her was to not.

On the surface, what made the San Francisco woman the subject of envy was her grand romance with a man several years her senior, a well-known figure who had once been her teacher. Although he was married, it was a dizzying and passionate affair by her account--the details of which she would tantalize friends with, saying she “couldn’t really talk about it.”

The affair purportedly ended when she abruptly left the country for another job.

Yet, to know her was to feel that these breathless accounts never rang true, and that some of her adventures sounded patently made up, even taking into account the trials of furtive courtships. And to know her well was to be convinced of it, for indeed, the romance was a complete fiction, one ascribed to her imagination, and say psychiatrists, to a bizarre form of mental illness called erotomania.

Her case, they say, is a classic example of erotomania, right down to her denial that the affair was pure fantasy.

Discovered and brought to attention (separately) by psychiatrists Emil Kraepelin and Gaetan de Clerambault around the turn of the century, erotomania is defined as a delusion in which a person believes he or she is loved by someone who can respond only surreptitiously to the erotomanic’s devotion.

There are no numbers on how many people suffer from erotomania, which was recognized as a disorder by the American Psychiatric Assn. in 1987. But using a statistical model that calculates the occurrence of delusional disorders, it is estimated that several thousand people in the United States may be falsely fixated on unwilling objects of desire.

“There are certainly thousands of cases scattered throughout the country, [but] many of them never come to attention,” says Dr. Jonathan Segal, a Palo Alto psychiatrist who has treated erotomanics and published studies on the syndrome. “It is not an everyday occurrence, [but] it’s certainly more common than the number of published cases.”

Several qualities characterize the erotomanic. Mostly, erotomanics fixate on someone of greater standing, authority and attractiveness. They assume that the objects of their desire cannot publicly reciprocate and therefore can respond only by innuendo, such as a meaningful comment or glance; some, lacking any evidence of these “responses,” believe their “lovers” communicate telepathically.

Like all people suffering from delusional behavior, erotomanics cannot be persuaded from their beliefs, and indeed, the denials made by their objects of desire only confirm the perceived relationship. Ironically, erotomania has little to do with sex. What the erotomanic desires, experts say, is an idealized, platonic romance.

“The object of affection becomes an ink blot, a Rohrshach test,” says Stuart Fischoff, professor of psychology at California State University, Los Angeles. “Whatever the object of desire says, the delusional lover brings into it anything he or she wants.”

Yet for the erotomanics themselves, their lot usually is not a happy one. Erotomanics, Segal says, typically are lonely people with empty social lives and little sexual history, and they are saddled with subordinate jobs and overriding disappointments. Mostly, they are middle-age and mostly, they are women, though experts say many more men than previously suspected likely suffer from erotomania.

“Quiet desperation” is a phrase psychiatrists and other therapists frequently use when summing up the lives of the erotomanics under their care.

“The classic profile is someone who lives in a psychologically isolated world . . . with no way to check themselves,” Fischoff says.

At the same time, erotomania can be difficult to detect. Unlike sufferers of other disorders such as schizophrenia, most erotomanics have no history of mental illness and are able to contain their obsession to a singular part of their lives. In the majority of cases, erotomanics conduct themselves in completely normal fashions, holding down jobs and appearing perfectly rational in everything except for their obsession.

Knowing how others are likely to react to their fixations, erotomanics often keep them private from friends and acquaintances, operating with a “reasonable certainty about their belief system,” says Reid Meloy, a forensic psychologist and associate clinical professor of psychiatry at UC San Diego.

“A lot of the times, people can go on with their life, ostensibly normally and not have any perceived psychotic disorder,” says Meloy, who has stumbled across erotomanic behavior in his patients while treating them for other conditions. “It surprises you. You don’t know that it’s there.”

Sometimes it is only when a patient’s mental illness deteriorates that doctors are flagged to the erotomanic’s condition.

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Psychiatrists say such a devolution in mental health is not that common in erotomanics, most of whom simply live with their obsession. Their behavior, Meloy says, more closely resembles that of single-minded stalkers, only about 10% of whom exhibit true erotomanic traits. Mostly, stalkers are violent, unable to function in their day-to-day lives and/or often believe they are acting as “saviors,” rescuing celebrities from danger.

Of the stalkers who do have erotomanic tendencies, says Meloy, who testified in the recent Madonna stalking trial, the overwhelming majority are men.

Yet even if they don’t display overt signs of mental instability, erotomanics can be enraged when they finally grasp that their object of desire is unlikely to return their affection. Then, Meloy says, “The rejection triggers a shame and a rage and instead of the most wonderful person in the world, [the object] becomes the most-hated.”

One former patient of Segal’s, a 65-year-old retired woman, attacked a neighbor in her apartment building after he obtained a restraining order against her.

Other times, the erotomanic’s rage is directed at people the erotomanic believes are obstructing the relationship: a spouse, a significant other or even the police. But in either case, the object of affection remains at the center of the erotomanic’s world.

Psychiatrists acknowledge that treatment for erotomania often is fruitless. While the erotomanic’s behavior may be stabilized through drugs, the core obsession is born from a self-referential logic and consequently is harder to root out. “It’s very difficult to treat them 100%,” Segal says. “In their hearts of hearts, there’s still some delusional thinking.”

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But some psychiatrists and therapists also say that if the erotomanic is comfortable with his or her delusion, and not creating harm to others, treatment may be unnecessary. Although they can linger for years, even decades, before withering, many erotomanic cases are silent obsessions.

“It can be a sad, harmless delusion,” says Meloy, who adds that in such instances, erotomania can provide succor for lonely people who otherwise would have little to occupy their lives.

Fischoff, who believes erotomania is increasing because of greater societal alienation and society’s growing reliance on the media for companionship, knows personally how long such obsessions can last. For 25 years, he has received regular letters from a former student regarding their “relationship.”

While the episodes once were unsettling, Fischoff now is philosophical about being the unwanted object of someone’s fixation. He has determined that the woman is not harmful, but he has not found a way to make her stop.

“You get used to it,” he says. “I’m simply a cherished part of her fantasy life.”