When jealousy messes up your mind
What do Agatha Christie’s ‘Curtain’, Daphne de Maurier’s ‘My Cousin Rachel’ and William Shakespeare’s ‘Othello’ have in common? They are all wonderful stories and their common theme is jealousy. In all three somebody dies as a consequence of jealousy. The first two stories are not so well known and I will not reveal their plot and spoil your pleasure of reading them yourself. But the story of Othello, the Moor of Venice is well known and it is standard reading in many schools. Othello, the brave soldier marries Desdemona who is much younger to him. Iago, Othello’s lieutenant is envious of his superior’s success and plots to bring about his downfall by making him believe that Desdemona is unfaithful to him. He succeeds only too well and Othello kills his wife and later commits suicide when he realizes his mistake. The warning by Desdemona comes too late to save them.
“O, beware, my lord, of jealousy;
It is the green-ey’d monster, which doth mock
The meat it feeds on.”
Jealousy carried to extreme is pathological and psychiatrists call it a delusion. A delusion by definition is an unshakeable belief held by a person without evidence or justification. It should also be in keeping with the person’s culture and social background. Common general themes of delusions include; persecution, jealousy (as described at the beginning), love, grandiosity, somatic, ill health, guilt, nihilism and poverty. The first five are called paranoid delusions. The term paranoia from which the adjective paranoid is derived, has a long history. It is derived from the Greek para (beside) and nous (mind). It was used in Greek literature to mean ‘out of mind’ or insane. In modern usage it means that the person’s beliefs or attitudes concerning relationships between oneself and other people are morbidly distorted.
The commonest type of paranoid delusion is persecutory. Here the person believes that persons or organisations are plotting to harm him in some way. The perceived harm can range from damage to his reputation to causing his death. The plots can range from the simple to the complex or bizarre. For example a person may believe that his neighbours are plotting to evict him from his house. Another might have the delusion that his spouse is attempting to poison him. One of my patients firmly believed that an eye surgeon who operated on his eye had implanted an electronic device which enabled to the surgeon to read the patient’s thoughts. He repeatedly met the surgeon and requested him to remove the device.
Delusions of jealousy are also called pathological jealousy or morbid jealousy. It is called the Othello syndrome after Shakespeare’s play. The main feature is the delusional belief that the marital partner is being unfaithful. Being a delusion, the belief is held on inadequate grounds and cannot be shaken by rational argument. Jealousy is a widespread feeling and within certain limits may be regarded as normal. Perhaps in our culture the threshold for normality may be higher than in the west. However, in most cases it is quite clear when jealousy is pathological.
There is intensive searching for evidence of the partner’s infidelity including monitoring of cell phones, and watching or following the partner surreptitiously at home or in the workplace. Typically there is persistent cross questioning of the partner by the jealous spouse and sometimes the exhausted partner may make a false confession that further aggravates the jealousy and validates the jealous spouse’s suspicions. Sometimes there are violent quarrels with paroxysms of rage in the patient leading to physical injury to the partner.
Delusions of love are interesting though rare (contrary to popular belief!). It is also known as De Clérambault’s Syndrome after the person who first described it in 1921. It is mainly a disorder of women. The patient, usually a single woman, believes that an exalted person is in love with her. The person concerned is usually inaccessible, of much higher social status or a public figure or entertainer.
Delusions of grandiosity is of two types: grandiose ability and grandiose identity. In delusions of grandiose ability the person believes that he or she is specially chosen, has a special mission or destiny and has unusual talents. Some may believe that they could read people’s thoughts, are much cleverer than others and have invented unique machines. Persons with delusions of grandiose identity believe that they are relatives of famous people, rich or even descended from royalty.
Bodily functions and sensations is the central theme of somatic delusions. This can occur in several forms. The commonest is the belief that the person concerned is emitting a foul odour. This causes social distress as such persons avoid situations where they feel their odour would cause embarrassment. Some with this delusion believe that their skin is infested with insects. The belief that certain parts of the body are misshapen or ugly or that some organs in the body are non-functioning may also be seen.
We are still not certain as to why delusions occur and as they are not amenable to rational argument cannot be treated with psychotherapy. The same medicines that are used in the treatment of schizophrenia and psychotic illnesses may work in some. The biggest barrier to therapy is the patient’s refusal to seek medical help. This is understandable as the patient firmly believes in his or her interpretation of events and does not attribute it to an illness. However, as especially delusions of jealousy can lead to physical harm it is important for the family to make all efforts to obtain medical help for patients with paranoid delusions.