A number of psychiatric illnesses, almost by definition, don’t present directly to psychiatrists. They are either not recognised as an illness – “Isn’t that just the way he is, doc?” – or it’s something patients would rather not talk about, to anybody. In the former group comes depression, particularly in middle-aged men, and the delusional disorders (intrinsic paranoia) that grow so subtly inside your head. In the latter it’s sexual abnormalities (colourful but not usually impairing) or entrenched behaviours. A condition notorious for disrupting relationships is morbid jealousy, also known as the “Othello Syndrome”, from Shakespeare’s play with its clinical dissection of the “green-eyed monster”.
About 10 per cent of the general population have strongly “possessive” personality styles and about a third of these exhibit degrees of morbid jealousy, but this rarely presents with someone admitting as much. More often it is the victim who turns up, terrified, assaulted or chronically depressed. The jealousy itself can be fuelled by alcoholism and depression, thus the drunken husband who comes home and beats up his wife and the woman who “walks into doors”. Morbid jealousy is a compound pattern of behaviours that involves checking, watching, controlling and questioning. At the more innocuous end of the scale it’s the husband who always seems to be around, phoning randomly at work or waiting to pick his partner up in the evening. Sometimes it even involves timing the partner as she/he goes to the corner shop followed by suspicious questioning if they are late getting back. Clothes and sheets are secretly checked for smells and stains, and some jealous partners even employ private detectives.
Morbid jealousy is also very dangerous. Mrs A was in her early forties when we saw her following an overdose. She came in with her sister and had never previously attended for mental health problems – it’s unusual for a woman to take an overdose for the first time in middle age. We checked with her sister and the story, little by little, came out. Mrs A was regularly threatened, timed, occasionally punched and slapped, and had now nearly been strangled by her husband. He had apologised for his behaviour but the woman was literally traumatised. His possessiveness had evolved into jealousy and something extremely scary.
Morbid jealousy is unusual in that psychiatrists, who shouldn’t normally advise people how to live their lives, have a duty to warn of potential risks. These are simply too great when there is violence. Jealous people also usually lack insight so do not seek help.
The problem with jealousy is that it is easily aroused in those sensitive to it and difficult to erase. Male-dominated cultures also often celebrate control and possession, with a parallel found in the spy novels of John Le Carré: where once an organisation decides it has “a mole”, the possibility cannot be excluded. Either the mole acts suspiciously (so you follow him more) or seems to act normally (too normally?). The paranoid thought becomes intrinsic to the sufferer’s world.
Mrs A returned to her husband and is still alive. In contrast to steely-eyed surgeons, whose advice to remove a tumour or sew up bleeding arteries is rarely rejected, psychiatrists can only advise, nudge, be sympathetic … and keep in touch, since many patients do get back to us.
Trevor Turner is a consultant psychiatrist working in east London. Some details have been changed to protect identity. Sophie Harrison is on maternity leave