Wednesday, October 06, 2010

The Tragedy of Othello Syndrome


Benjamin Evett, John Douglas Thompson, and Mirjana Jokovic in the American Repertory Theatre's production of Othello.

O! beware, my lord, of jealousy;
It is the green-ey'd monster which doth mock
The meat it feeds on.

Othello syndrome is a rare psychiatric condition marked by morbid, pathological, or delusional jealousy (Miller et al., 2010). It can occur in the context of schizophrenia, bipolar disorder, alcoholism, or epilepsy, but sometimes it's observed in relative isolation from other delusions (Todd & Dewhurst, 1955). As in the Shakespearean tragedy, the modern day patient with Othello syndrome presents with the potential for violence against his spouse and/or self because of the imagined infidelities.

A recent article by Miller and colleagues (2010) provides a helpful overview of this delusional disorder for nurses and other clinicians. They consider treatment options (antipsychotics for those with psychosis, dialectical behavioral therapy for those without), safety issues, nursing care, and best practices. Although cases from the recent literature were reviewed, a classic article from over 50 yrs ago (Todd & Dewhurst, 1955) is a more entertaining treasure trove of paranoid sexual jealousy. Excerpts from several cases are presented below.
Case 2: A married man, 43 years old, was first admitted to a mental hospital in June 1951. He complained of feeling "tensed up" as a result of the belief that his wife was unfaithful to him. Careful enquiries showed that there was not a scrap of evidence to support his suspicions, which began when a workmate allegedly asked him whether he had ever suspected his wife of having an affair with another man. His suspicions increased considerably when one day she failed to give what he deemed to be a satisfactory explanation for the origin of a smart pair of bootees in her possession. ... Once, he attempted to strangle his wife but was stopped in the nick of time by the intervention of neighbors. Another time, he rushed scantily clad from the house in a fruitless attempt to catch his wife with a paramour.
Although the patient was not deemed to be a chronic alcoholic, his jealousy was closely related to bouts of drinking. His identical twin brother suffered from grand mal epilepsy and committed suicide. The patient's own EEG showed epileptiform discharges, but he never had an overt seizure.

Diagnosis: epilepsy with delusions of infidelity.

Case 3: A married man, 49 years old, was first admitted to a mental hospital in July 1952. He complained of chronic anxiety arising from a belief that his wife was "carrying on" with a number of men. ... At times, his behavior had been distinctly bizarre. One day, which searching her handbag for "evidence", he had chanced upon a discarded pair of knickers which she had pressed into service as a duster. He insisted that the dilapidated and soiled condition of the garment proved beyond doubt that she had been her employer's mistress. He had, on several occasions, attempted to strangle his wife as a result of his delusions.
Diagnosis: paranoid schizophrenia with delusions of infidelity.

Case 7: A married man, 39 years old, was admitted to a mental hospital in May 1951, as the direct result of disorderly behavior arising from delusions concerning his wife's fidelity. During the previous year, he had rendered his wife (a virtuous woman) miserable by repeatedly accusing her of infidelity on an enormous scale. He would use field glasses to spy on her from afar, and, after pretending to leave the house, he was wont to re-enter surreptitiously in an attempt to trap her with a lover. ... He threatened several men in the neighborhood with violence because he suspected them of a liaison with his wife, and developed a sinister habit of going abroad with an open razor in his pocket.
He also had the charming practice of expressing remorse that he couldn't keep his wife perpetually pregnant, he threatened her with violence, and once even grabbed her by the throat. This bad behavior ran in the family. His brothers were drunk, impotent, jealous, and "unfit to be trusted with a dog, never mind a woman." His father was:
a drunkard and libertine, [who] had rendered his wife pregnant on 28 occasions [how can that be possible??]; in addition, he had many extramarital affairs.
Diagnosis: epilepsy with delusions of infidelity.

Case 7 was given "a course of electro-shock therapy" which isn't such a great idea for someone with epilepsy, and it didn't cure his delusions, either. Chlorpromazine wasn't yet widely available in 1951, but the anticonvulsant Dilantin (phenytoin) was on the market in the 1930s.

He was still hospitalized four years later.

In their Study in the Psychopathology of Sexual Jealousy, Drs. Todd and Dewhurst (1955) did not seem to prescribe medications of any sort, but they did give a wonderful literary discussion of Boccaccio, Shakespeare, Tolstoy, and Burton's The Anatomy of Melancholy.


References

Miller, M., Kummerow, A., & Mgutshini, T. (2010). Othello Syndrome. Journal of Psychosocial Nursing and Mental Health Services, 48 (8), 20-27 DOI: 10.3928/02793695-20100701-05

TODD J, & DEWHURST K (1955). The Othello syndrome; a study in the psychopathology of sexual jealousy. The Journal of nervous and mental disease, 122 (4), 367-74 PMID: 13307271


What noise is this? Not dead — not yet quite dead?
I that am cruel am yet merciful;
I would not have the linger in thy pain
So, so.

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4 Comments:

At October 06, 2010 10:22 AM, Anonymous Anonymous said...

There are many, many people whose spouses have Alzheimer's and whose same spouses develop irrational paranoia. Frequently (VERY frequently) it includes the same problems that are set out above.

The fixation could be on the spouse, or it could be a neighbor. Sometimes the claim is that 'someone comes into the house and steals things.'

Not rare, not unusual. Maybe not reported as often as it should be. Although sometimes the police have to be called, and then it certainly gets reported.

 
At October 06, 2010 11:43 PM, Anonymous raverat said...

I guess this fits here:
http://www.youtube.com/watch?v=XppEzopIahs&feature=channel

 
At October 10, 2010 7:14 PM, Anonymous Gender bias? said...

Interesting how all the cases are men... would that be because this condition mainly affects males, or because this condition manifests itself as pathological jealousy in men?

 
At October 10, 2010 7:39 PM, Blogger The Neurocritic said...

Gender bias? - It seems to be more common in men, but actually 2 of the 9 cases were married women.

 

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