Folie a Deux: Crazy Love
This week I was teaching the psychotic disorders and on something called “Shared Psychotic Disorder” (which can also have the far sexier title of the Folie a Deux). In the Diagnostic and Statistical Manual of Mental Disorders – IV – Text Revision (DSM-IV-TR) (the Bible/Koran/Gita/Talamud of psychiatric disorders) it is defined as follows:
A. A delusion develops in an individual in the context of a close relationship with another person(s), who has an already-established delusion.
B.The delusion is similar in content to that of the person who already has the established delusion.
C.The disturbance is not better accounted for by another Psychotic disorder, the direct physiological effects of a substance, or a general medical condition.
It’s typically seen in relationships between two people, and with separation between the two people, the delusions disappear.
As I prepared my notes for this lecture I was having a tough time differentiating the Shared Psychotic Disorder from falling in love.
If we apply these diagnostic criteria – falling in love is delusional and psychotic. How can you promise you will always possess a certain feeling for someone? How can you guarantee you will never feel differently? Can you really believe you and the other person are in a special union unlike any other? How can you vow to always be there? No one else shares the belief – just the two people in the relationship. And when the other person in the duo shares these beliefs – aren’t they sharing in the delusion?
Is falling in love a shared psychotic disorder?
It meets all the criteria. One person usually falls in love first – it’s rare for two folks to be in lock-step (like the elusive simultaneous orgasm). So thus you have a person with the already-established delusion, who draws the other in.
In fact this diagnosis is actually intended for beliefs that the average person may find bizarre (e.g. a person believes the government is sending electromagnetic waves that are causing memory loss into his apartment and draws his neighbor into the belief). But I am not sure how much more bizarre this is than believing you will love another forever, that the world looks different for just the two of you, that food tastes better, colors seem brighter, the world was made for just you and yours. Neither of these belief systems has a shred of evidence to support it.
Obviously – we don’t diagnose it for the same reason we don’t diagnose those who believe in water turning into wine or elephant headed gods. Religious beliefs are bizarre beliefs with no support from the material world –but since enough people hold them – majority rules. The only difference between the patients and the doctors is who holds the keys to the ward, and he who holds the key s makes the rules.
Now I see that this is decidedly unromantic and if you had the week I just did – you too would diagnose all those fools in love (thus giving me some zone of superiority in this partnered up world of ours). But I am leery of diagnostic systems that make value judgments about bizarreness based on what most people think is desirable. At the end of the day, as Thomas Szasz pointed out all those years ago – are we as psychiatrists and psychologists diagnosing disease or simply labeling that which makes us uncomfortable? Or maybe I am the psychotic one for dismissing love as a transient, albeit beautiful phase? (and honestly –when I fall in love it tends to be a personal psychotic disorder – without the shared part – I suppose that could be diagnosed as plain old stupidity).
So at the end of the day, perhaps falling in love is just that – psychotic. But it sounds a lot sexier if we call it a folie a deux.
