Erotomania

   Erotomania is the delusional belief that one’s love for someone else is reciprocated. In the non-French world today, it is considered to be part of paranoia or schizophrenia, but in France, "Clérambault’s syndrome" retains the status of an independent psychiatric diagnosis. The term "erotomania" in the sense of excessive sexual desire has a long history, going back at least to the seventeenth century. In the early nineteenth century, Étienne Esquirol gave it a second meaning, the delusional belief that one is loved by someone else: In his 1838 essay on "monomania," he wrote that, "Erotomania belongs to the medical disorders. It is a chronic cerebral disorder , characterized by excessive love, either for a known object or for an imaginary object. In this disorder, only the imagination is troubled; there is no lesion of thought" (Des maladies mentales, II, 32). In his Clinical Lectures on Mental Diseases (1883), Thomas S. Clouston (1840–1915), superintendent of the Edinburgh asylum, called it "old maids’ insanity" and deemed it of ovarian origin. Emil Kraepelin, in his 1896 textbook, considered erotomania a form of "paranoia." The international literature of the time regarded excessive sex desire and delusional sexual ideas both to be forms of erotomania.

   With the work of Parisian psychiatrists Paul Sérieux (1864–1947) and Joseph Capgras (1873–1950) on "Les folies raisonnantes" (intelligent insanity) in 1909 (see French Chronic Delusional States), French writing on the subject of erotomania diverged from the international literature: "erotic delusions" (le délire érotique) became a distinctive form of delusional thinking ("délire d’interprétation") without hallucinations and without progressing to madness. The French version became sharply chiseled by the beginning of the First World War: patients with incurable, well-tailored delusional systems about romancing a victim and who are neither demented, nor "paranoid" schizophrenics, nor any other kind of schizophrenic. In 1920, Gaétan Gatian de Clérambault (1872–1934), head of the psychiatric emergency service of the Paris Prefecture of Police, assigned erotomania to the "passional psychoses," meaning any paranoid conviction held with intense feeling; thereafter, erotomania also became known as "Clérambault’s syndrome" (written sometimes as "De Clérambault’s syndrome). (See French Chronic Delusional States: mental automatism [1920].) (Note that Gatian de Clérambault is the correct form of Clérambault’s family name, but it is seldom used.) He described the case of a woman who believed that the King of England was in love with her. Clérambault proposed a mechanism for the disorder—a toxic insult to the brain that he called "mental automatism." In making erotomania part of an autonomous category of psychiatric illness—the "passional psychoses" (les délires passionnels)—he asserted that they possessed their own distinctive laws of evolution separate from those of delusional thinking. In doing so, he aligned himself with the tradition of Paris neurologist Jean-Martin Charcot, who sought to identify the iron laws governing such presumably natural disorders as hysteria. (Clérambault gave his first account of an erotomania case in the December 1920 issue of the Bulletin of the [Paris] Society of Clinical Mental Medicine [Bulletin de la Socíeté Clinique de Médecine Mentale], but only in the February 1921 issue did he spell out his ideas about the inevitable evolution of the disorder.)

   Since Clérambault, erotomania has been seen as a form of schizophrenia or paranoia in Anglo-Saxon circles. It surfaced in DSM-III-R (1987) as "delusional disorder: erotomanic type," yet remains a distinctive illness entity in France. The disorder itself tends to be much in the media as stalkers of various public personalities—including such figures as Brad Pitt, Madonna, Gwyneth Paltrow, and Steven Spielberg—make the lives of their prey miserable until they become objects of a court order or confinement.