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CCrraazzyy ffoorr yyoouuTRULY, madly, deeply. If you

haven’t actually said those words,you’ve probably thought them –

and they are very revealing. They suggestthat, as a society, we consider ‘madness’to be as significant an indicator of love’sauthenticity as honesty and depth. We donot expect love to be rational – we expect it to be overwhelming, improvident andunpredictable. We expect to ‘go crazy’.

The similarities between passionate love and mental illness have been notedsince classical times. The ancient Greeksemployed the term theia mania (ormadness from the gods) to describe thesudden overthrow of reason associated with falling in love, and the principles ofHippocratic medicine provide a mechanismthat explains why lovers are prone toemotional distress. According to thehumoural model, if love becomes too‘heated’, vital fluids evaporate creating acold, dry state known as love melancholy(Babb, 1951; Burton, 1621/2001). Thesymptoms of love melancholy (orlovesickness) have been celebrated bypoets and songwriters from classical timesto the present day.

Although we now associate

lovesickness with adolescent crushes and romantic fiction, it is in fact one of the most successful of all psychiatricdiagnoses. Lovesickness was used bydoctors for nearly two thousand years(compared with current ICD-10 or DSM-IV diagnoses, most of which are less than a hundred years old). It wasn’t until thecollapse of the humoural model in the 18thcentury that the diagnosis finally fell out offavour among medical practitioners (seePorter, 2002).

The idea that love is somehow a close cousin of mental illness was never decisively rejected, and it resurfacedagain in the work of many contemporarypsychologists. Indeed, most extanttypologies of love, theories of love anddescriptions of love acknowledge at leastone feature or mechanism that might bedescribed as ‘psychopathological’. Thinkfor example of John Lee’s (1973) mania,Dorothy Tennov’s (1979) limerence andRobert Sternberg’s (1986) infatuation, allof which are characterised by obsession,irrational idealisation, emotional instabilityor emotional dependency.

More recently, the taxonomic approachto love has been simplified, with many

theorists favouring a single distinction – that made between passionate love(experienced at the beginning of arelationship) and companionate love(experienced after the passion subsides).Yet, this simplification has not excluded or attenuated the role of pathologicalcomponents. On the contrary, they havenow been fully consolidated.

Passionate love is generally described as a state of intense longing for thebeloved. When reciprocated, passionatelove is associated with joy, euphoria andecstasy; however, these feelings are almostinvariably shadowed by darker emotionssuch as anxiety, jealousy and sadness(Hatfield, 1988). Therefore, it is difficult toexperience passionate love in the absenceof at least some psychological pain. Whenunrequited (or frustrated), passionate lovewill reliably engender a sense of emptiness– and even despair.

When people fall in love, theyfrequently exhibit symptom clusters thatappear under several DSM-IV and ICD-10diagnostic headings – mania, depressionand obsessive compulsive disorder (see boxopposite). Moreover, some contemporarydiagnoses comprise symptom clusters that

FRANK TALLIS asks whether psychologists should take

lovesickness more seriously.

WEBLINKSFrank Tallis’s website: www.franktallis.com

Accessible information about the science of love:

www.bbc.co.uk/science/hottopics/love

were originally subsumed under the ancientrubric of love melancholy (e.g. delusionaldisorder – erotomanic and jealous types).

The similarity between lovesickness andcertain types of mental illness may not besuperficial. For example, Italianpsychiatrist Donatella Marazitti found thatwhen people fall in love their estimatedserotonin levels drop to levels found inpatients with OCD (Marazitti et al., 1999).Further, in a brain scan investigationconducted by Semir Zeki and AndreasBartels, people who profess to be ‘truly,deeply and madly’ in love, show activity in several structures implicated in theneuroanatomy of OCD, for example theanterior cingulate cortex and caudatenucleus (e.g. Bartels & Zeki, 2000). Suchfindings bear interesting comparison withthe writings of the 10th-century Iranianphysician Ibn Sena (known morecommonly in the West as Avicenna),who identified obsession as the principalsymptom and cause of lovesickness.

The relentless poetic linkage of loveand madness often raises a knowing smileand moment of embarrassed self-reflection;however, perhaps it deserves more thancynical dismissal. The historical success oflovesickness as a diagnosis, the findings ofcontemporary psychologists, and recentbiological evidence, all suggest aphenomenon worthy of more seriousscientific scrutiny. If the state of being inlove often resembles a mental illness, thenwe must surely ask the question why?

Nature’s dirty trick?To discover why we can fall so head over heels in love we must look to theburgeoning science of evolutionarypsychology. Human babies are bornuniquely weak and vulnerable, requiring a massive amount of care from twocommitted parents. Unfortunately, our large brains allow us to rebel against ourreproductive instincts, permitting us toavoid the labour of raising children (andsharing resources) in order to pursue moreselfish goals (Dawkins, 1999). It is asobering thought that marital satisfactionfalls with the arrival of children and doesnot improve again until they have left home(Rollins & Feldman, 1970). Lovenecessarily overthrows reason to ensureevolutionary objectives. Writers have longsuspected that love’s madness might havesomething to do with Darwinian principles.For example, W. Somerset Maughamruefully observed: ‘Love is only the dirty

trick played on us to achieve continuationof the species.’

The conflict between intellect andevolutionary objectives does not arise in animals for obvious reasons. Animalssimply follow their instincts. When itcomes to sexual reproduction, they aresimply automata. And to a very large extent,so are we; however, the very fact that wecan self-reflect, and rebel, has perhapsnecessitated the evolution of a safetymechanism – an emotional swamping of the mental apparatus to ensure thatfundamental evolutionary objectives aremet. We call this safety mechanism love.

Love must be – by its very nature – theantithesis of reason. This is probably why it is so frequently described as a form ofmadness. Indeed, for many, the authenticityof love is determined according to thedegree to which it is experienced asirrational – a position succinctly capturedby Robert Mallet’s witty aphorism: ‘I have

every reason to love you. What I lack is theunreason.’

Committing to a single human being isa momentous investment – particularly formen. The male of the species must resisthis natural instinct to mate with more thanone partner (Trivers, 1972) and be willingto share his resources (at least initially)with his family. This would suggest that –from an evolutionary perspective – it ismore important for men to fall in love thanwomen. Consequently, evolutionarypressures should have made men morelove-prone – which does seem to be thecase.

This disposition is exemplified byresearch into the phenomenon of love atfirst sight. A large-scale American surveyconducted by Earl Naumann found that ofthose individuals who profess to believe inlove at first sight, some 62.3 per cent ofmen claim to have experienced it,compared with 55.7 per cent of women(Naumann, 2001). Although these figuresseem close, the difference is in factstatistically significant. Similarly, men aresignificantly more likely to experience loveat first sight on more than one occasion. It is also worth remembering that men aremuch more likely to remarry than women

(showing scant regard for Dr Johnson’ssardonic observation that a secondmarriage demonstrates ‘the triumph ofhope over experience’).

The force with which love assaults theintellect in men is also reflected in literary,philosophical and medical writings, whichgenerally contain more references tolovesick men than lovesick women. Indeed,in many early medical texts it is almostassumed that the lovesick patient will bemale (for example, Ibn Sina’s 10th-centuryThe Canon of Medicine and Ibn Hazm’s11th-century The Ring of the Dove).

Women, on the other hand, tend to beless passionate and more pragmatic – beingmore inclined, for example, to marry forincreased status or money rather than love.In a major study of sex differencesconducted by American evolutionarypsychologist David Buss – examining 37samples drawn from 33 countries on sixcontinents – women were much morelikely than men to select partners on thebasis of their financial prospects (Buss etal., 1990).

Evolutionary theory also explainsanother puzzling feature of passionate love– its relative brevity. Although when in thethroes of love, we think that love will lastfor ever, this is rarely the case. Lovediminishes, dies or becomes – over time –something closer to friendship (i.e.

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‘Although we think love will last for ever, this is

rarely the case’

LOVESICK?We are not always rational in love, particularly inthe early stages – do any of these look familiar?

mania – abnormally elevated mood, inflated self-esteem, extravagant gift giving

depression – tearfulness, insomnia, loss ofconcentration

obsessive compulsive disorder – preoccupation,checking (e.g. text messages) hygiene rituals(prior to dating), and hoarding valueless butsuperstitiously resonant items

companionate love). Evolution isparsimonious. Love, on the other hand, isflorid and wasteful. Geoffrey Miller (2001)notes: ‘The wastefulness of courtship iswhat makes it romantic. The wastefuldancing, the wasteful gift-giving, thewasteful adventures.’ (p.128.) Perhaps,because love is so wasteful, evolutionarypressures have ensured that we fall in loveonly for as long as it is necessary toachieve evolutionary goals – but nolonger.

To ensure reproductive success,the pair-bond that keeps men andwomen together does not need tolast for ever. It only needs to lastlong enough for one or twochildren to be produced andraised (of course, theevolutionary foundations of thisargument – which giveconsiderable emphasis to thedynamics of reproduction – do notinvalidate or depreciate lovebetween people of the same sex). In theancestral environment, the earliest cut-offpoint would probably have been linkedwith the termination of breast-feeding.Thus, intense, passionate love might onlybe sustainable for a few years.

Back to the future for therapyAlthough the medical establishment hasdecided that lovesickness no longer exists,the world doesn’t seem to have taken muchnotice. People still experience love as a‘sickness’, and poets and songwriters retaina deep affection for the illness metaphor(Tallis, 2004). The pop charts aredominated by young men and women whoare ‘crazy’ in love, ‘mad’ for love, who aregoing ‘out of their heads’ for love.

The average clinical psychologist willnot receive referral letters from GPs andpsychiatrists mentioning lovesickness;however, careful examination of thesanitised language will reveal thatlovesickness may well be the underlyingproblem. Many people are referred for helpwho cannot cope with the intensity of love,have been destabilised by falling in love, orwho suffer on account of their love beingunrequited (a consequence of which mightbe attempted suicide, thus dramatising theancient contention that love can be fatal).Although there are numerous textsavailable on the treatment of relationshipand psychosexual problems, few grapplewith the thorny problem of love and itssickness.

Interestingly, the treatment methodsespoused by the likes of Ibn Sina – over a thousand years ago – resemblecontemporary cognitive behaviour therapy(CBT). The principal symptom oflovesickness is obsession with the beloved.

Therefore, Ibn Sina suggests that thelovesick individual might benefit fromdistraction. This can be achieved byengaging in demanding tasks (he gives the example of hunting) or intellectualactivities such as disputations and quarrels.This advice seems perfectly reasonable.Obsessions are now understood to be self-perpetuating in the manner of a vicious

circle. Thus, anything that might interruptthe process of obsessing is potentiallyhelpful. It is also possible that engaging in cerebral activities such as disputationsmight confer a secondary advantage;namely, the exercise of the patient’s facultyof reason: the faculty most overwhelmedby love’s madness.

The treating physician is alsoencouraged by Ibn Sena to rebuke the

lovesick patient and to raise doubtsabout the beloved’s character. Thepurpose of this manoeuvre is to

undermine idealisation. Ibn Senastates: ‘The image that he [the lover]has within himself is nothing but adelusion.’ Thus, the patient’s mindcontains a mental picture of hisbeloved that is sublimely enhanced:employing the vocabulary of CBT

we might speculate on the presenceof positive processing biases. By

attacking the idealised image, IbnSena is clearly seeking to weaken one

of the most significant factors sustaininglove’s madness.

Excessive idealisation and rigid,absolute beliefs concerning love and itsmeaning are endorsed by a culture steepedin romantic literature and creative products.An understanding of the assumptive worldof the lovesick patient might prove asuseful to the contemporary clinician as itdid to his or her ancient progenitors.

■ Frank Tallis is a clinical psychologistworking in London. E-mail:franktallis@blueyonder.co.uk.

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Babb, L. (1951). The Elizabethanmalady:A study of melancholia inEnglish literature from 1580 to1642. East Lansing, MI: MichiganState College Press.

Bartels,A. & Zeki, S. (2000).Theneural basis of romantic love.Neuroreport, 17, 3829–3834.

Burton, R. (2001).The anatomy ofmelancholy. New York: New YorkReview Books. (Original workpublished 1621)

Buss, D.M.,Abbott, M.,Angleitner,A.,Asherian,A., Biaggio,A., Blanco-Villasenor,A. et al. (1990).International preferences inselecting mates:A study of 37cultures. Journal of Cross-CulturalPsychology, 21, 5–47.

Dawkins, R. (1999). The selfish gene.Oxford: Oxford University Press.

Hatfield, E. (1988). Passionate and

companionate love. In R.J.Sternberg & M.L. Barnes (Eds.)The psychology of romantic love(pp.191–217). New York: YaleUniversity Press.

Lee, J.A. (1973). Colors of love.Toronto: New Press.

Marazziti, D.,Akiskal, H.S., Rossi,A. &Cassano, G.B. (1999).Alterationof the platelet serotonintransporter in romantic love.Psychological Medicine, 29,741–745.

Miller, G. (2001). The mating mind:How sexual choice shaped theevolution of human nature.London:Vintage.

Naumann, E. (2001). Love at first sight:The stories and science behindinstant attraction. Naperville, IL:Sourcebooks.

Porter, R. (2002). Madness:A brief

history. Oxford: Oxford UniversityPress.

Rollins, B.C. & Feldman, H. (1970).Marital satisfaction over thefamily life cycle. Journal ofMarriage and the Family, 32,20–28.

Sternberg, R. (1986).A triangulartheory of love. PsychologicalReview, 93, 119–135.

Tallis, F. (2004). Love sick: Love as amental illness. London: Random/Century.

Tennov, D. (1979). Love and limerence:The experience of being in love.New York: Stein & Day.

Trivers, R. (1972). Parentalinvestment and sexual selection.In B. Campbell (Ed.) Sexualselection and the descent of man(pp.136–264). Chicago:Aldine deGruyter.

References

Hunting – A distraction for the lovesick?

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