Chapter 6 - Love

Feeling loved is a basic human need, yet 'love' is hard to define. There are many different kinds of love: the powerful unconditional love of a parent for their child, the erotically charged drive of a couple in the first passionate throes of romance and the mature commitment of partners who have spent many years together. Love can be reciprocated, unrequited, abusive or healing. A loving family can protect us against depression later in life, just as a supportive, loving relationship in adulthood can counteract the harmful effects of emotional adversity in childhood. However, disappointment in love or the breakdown of important relationships are life events that often trigger depression and can reignite the pain of earlier losses in our lives.

My patient Theresa was absolutely certain that a man who lived down the street was in love with her.

'How do you know this?' I asked. She had agreed to come into hospital after being seen urgently at the outpatient clinic.

'Well, there are lots of things…'

'OK but can you explain a bit more? What things?' I needed to try to understand on what exactly she based this belief. My consultant had thought her reasoning was far from lucid.

'Well, I know he is thinking about me when I go past his house.'

Theresa was Spanish and in her late forties. She had come to England, she told me, to marry an Englishman, but after a few years they divorced and she was living alone, working as a cleaner. As she spoke, she passionately waved her hands around, enacting her words for me. Almost every day for the last six months or so, when she was not at work, she had been spending time hanging about on the pavement outside her neighbour's house, leaning against a lamppost and catching glimpses of him as he moved past the windows in his flat. He had already complained to the police about her behaviour several times but this did not deter her.

'So tell me, how do you know he is thinking about you?'

'Well… Well, you see,' she looked up and framed the shape of a window with her fingers and thumbs. She was smiling broadly, as she was about to reveal to me how it was all very simple and straightforward. 'When the venetian blinds are open, that means he is thinking about how much he loves me and how he can't wait to see me.'

'And when they are closed?'

'He is doing something else, something he has to get done and out of the way,' she shrugged. 'But they always open again and then I know he wants me. Really wants me but he just can't say.'

'Are you sure? I mean he has just applied to the court for an injunction against you, hasn't he?'

'This isn't really what he wants to do. I mean, his wife… She made him do it. I know…' she whispered. Then she banged her fist down on the desktop beside her. 'I know it isn't how he really feels about me. I know it here.' She jabbed the middle finger of her left hand at her head. 'And here, I know it here.' Her fist slammed against her chest with ferocious certainty. 'I love him very much too, very much!'

There are curious parallels between being 'in love' and being 'deluded'. The accepted medical definition of a delusion is a false unshakeable belief out of keeping with a person's social, cultural or religious background. It sounds almost straightforward but in practice it's much harder, for example, to judge what is 'in keeping' with that background if you don't know the mores of a particular culture, religion or society. Those who are in love and the deluded both inhabit worlds fraught with misunderstanding and apparently irrational behaviour. However, being in love isn't defined as a delusion by psychiatrists, except in the case of 'erotomania', where the affected person firmly believes that somebody – usually a stranger, as in the case of Theresa's neighbour, and sometimes a celebrity – is in love with them.

But how do we know if someone really loves us? Doesn't that also, just like being deluded, require an act of faith to read those signs and interpret them the way we want to? Not signs as clear-cut as the opening and closing of venetian blinds – much subtler signs. We learn how to read the socially sanctioned cues, which don't generally include signalling with the window cords, but it's a process fraught with misperceptions at the best of times.

By the beginning of 1985 I was working in the suburbs of Manchester in one of the first community mental health centres in England. It was an ordinary-looking stone and red-brick building on the corner of a terrace where people who needed help could drop in and ask to see a mental health worker. There was no sign outside saying 'mental health service', just a simple house name. The atmosphere was very different from the one in the psychiatric unit where I had worked before. We worked in the community, as a multidisciplinary team, and Dr Lyle, my new consultant, had blue twinkly eyes and a Geordie accent. He wore a shirt and sweater, rather than a pin-striped suit, and I thought he didn't look at all like a consultant psychiatrist.

I was, or so I believed, finally starting to get to where I wanted in life. I dressed conservatively, in tweed skirts and buttoned shirts, and was about to move into a semi-detached house in one of the better neighbourhoods of South Manchester. I would soon be a consultant too. My life script was written. Jim was moving on in his job as a research scientist and seemed to have a vision of where he wanted our lives to be, modelled on his senior colleague, whose wife was an obstetrician.

James and Julia regularly ate at restaurants recommended by the Good Food Guide. Sometimes they even sent in their own views for acknowledgement in future editions; I always looked for their names at the back of the book where they listed all the correspondents. We too seemed to be working our way through the establishments listed in the North Cheshire section. James and Julia didn't have children. Jim and I had not discussed this particular topic but I felt sure it would be brought up sooner or later. It was something in which I thought Jim would want to differ from his role models. However, I could never imagine myself in the role of mother.

I told myself I was happy in my marriage, but somewhere deep inside I was still struggling with my personal demons and trying to achieve a sense of contentment with a life where my role was becoming that of dinner party hostess first and professional woman second. The problem was that at dinner parties I usually drank too much to cope with both the anxiety about my culinary performance and the boredom with the interminable conversation about nursery schools and soft furnishings. I was occasionally known to slip sideways off my chair with 'fatigue'.

I remember the first time he smiled at me. I wondered what he was thinking, but he remained, for the moment, something of a mystery. He was a community psychiatric nurse and I hadn't known him long so I wasn't sure what to make of him. He drove an old sports car which was always breaking down, hinting at vulnerability. I thought it would be a good experience to be one of his patients. No, not patients – he, like everyone else in the multidisciplinary team, had clients. I was still holding out against the political correctness police. For me, the term patient didn't mean so much that I had power over a person, but an obligation to them greater than if they were merely my client.

'How are you?' E asked, after a long silence in the therapy session. I visited him every week in a dingy outpatient clinic in an old former workhouse, an hour's drive north of Manchester.

'I'm lonely.' My eyes pricked but I didn't cry.

I really would have wanted you, I thought to myself, but I couldn't say it. My therapist was out of bounds. My colleagues, well, they should have been too, but…

'I think, maybe you do…' he gently insisted.

'I want someone to love me,' I finally admitted.

He said nothing, just waited for me to go on.

'You know what I mean,' I added, irritability in my voice.

He looked straight at me and I noticed that his eyes were bloodshot. He looked very tired and sad. This observation filled me with anxiety rather than simple concern. I knew I did not want to lose him. I had developed a close bond with him. He had helped me to learn how to relax and even to feel confident enough to pass the examination. But now that this hurdle was crossed, I did not understand what else I needed to work on.

I did not know then what I know now. To put it simply, the human psyche is, in one way at least, rather like an onion. You can peel away one layer of problems, but you may simply uncover another layer underneath, which then also demands to be addressed sooner or later.

Let's say, just to clarify what I mean, that a person – let's say she is a woman – becomes very depressed and anxious about what she thinks is the problem in her life. She cannot decide whether to give up a high-pressure job in which she appears to be, on the surface at least, very unhappy and stressed. For some reason she can't quite make the move, which is causing even more difficulties with her boss, who is in turn concerned about her 'commitment'. In trying to do some simple 'problem-solving' with her – getting her to brainstorm the different solutions open to her and to consider the reasons for and against each of these options – it becomes clear to her therapist that the job isn't the biggest problem. It's something else: her husband, who is putting pressure on her to have a child, and how this would relate to how she views her place in the world – her loss of independence and her own professional role outside the home. The job does stress her, but not because it is inherently wrong for her; it is because there is a serious failure of fit between the roles she plays at work and at home. She begins to see that she needs to address the tensions at home before she can make any meaningful decisions about her job. The situation at home, in her marriage, has emerged as the real problem. The whole thing becomes even more complicated if she then embarks on a love affair with one of her colleagues rather than addressing the difficulties at home or at work.

But it isn't always easy to acknowledge problems in relationships we have invested so much of our lives in building, and repairing them takes time and a willingness to try from both parties.

A few months after we had started working together, the community psychiatric nurse and I were seeing a couple together, Mr and Mrs Brown, for marital therapy. Mr Brown had been referred for depression, and it had become clear that there were underlying problems in his relationship with his wife. They found it increasingly difficult to talk through the issues they disagreed about in their family life. The male nurse and I were trying to demonstrate, in the way we interacted with each other, how it was possible to have good communication between the sexes. We looked at each other as we spoke and checked out our ideas with each other.

'We can see that you still really do have some deep affection and care for each other,' my colleague began. I caught his eye, trying not to show my doubts.

'The problem is in the way you show those feelings to each other. It isn't easy for each of you to see how much the other still cares about you. I can see how you, Anne,' he looked at Mrs Brown and gestured towards her, palm upwards, the sunlight glinting off his wedding ring, 'show how strongly you feel about Steve staying out late by getting angry. Steve copes with his feelings of rejection and hurt by refusing to talk, going drinking and staying out even later, because he still cares so much.' He sounded so reasonable. 'Positive connotation' is what they call it, making the negative sound positive: hurting each other because their relationship still mattered, failing to provide each other with those vital signals of affection and love. The Browns exchanged cautious glances. My colleague smiled at me. I smiled back.

By the end of the session not only were they eating out of his hand, but they were also touching hands, for a second or two anyway. They both acknowledged that they did still have strong feelings for each other. I watched my colleague as he spoke. I noticed his mouth, the fullness of his lips, his slightly hooked nose. I can still smell the lingering scent of the aftershave he used. Once or twice, as he glanced in my direction, I noticed how blue his eyes were.

After the Browns left the room, we sat together in silence in the twilight. Then he took my hand, lifted it to his lips and kissed it. I was overwhelmed by a rush of emotion of a kind I had never before felt with such immediacy and intensity. It was exciting yet also very frightening. I was beginning to fall in love.

'I think we communicate very well, don't you?' he said.

I could rarely work out what E was thinking. He steepled his fingers together and looked at me. I looked at the fish in his aquarium; there were five of them.

'Have you been to bed with him yet?' he asked me.

By now I was accustomed to E's directness.

'Yes, I think it's inevitable now. I didn't think so before.'

'What would you say if I told you that I thought you were trying to make me jealous?'

'You know you are acting out, don't you?' E said. 'Maybe this new relationship has something to do with what is happening here in these sessions, something you don't want to deal with or face up to.'

'You mean it isn't real?'

'I didn't say that.'

'But you implied it. Look, you've really helped me. I don't think I would still be able to do this job – hell, I wouldn't be here at all! – if I hadn't been seeing you but I need, I want, more than this.' I gestured to the dusty office with its piles of books and dog-eared case notes.

'I want to take a risk, fall in love for real.'

'This is real too, you know.'

And I believed him. I looked at him and smiled as the tears pricked my eyes. I saw myself reflected in the windowpane against the night sky. Another lamp, another me, beyond the glass, just within reach.

'Maybe it's real for him too,' said E. 'I hope for your sake that he doesn't just have a thing for women doctors.'

There were times when E could be very cruel – we shared the same twisted sense of humour – but it turned out that he had been right to warn me.

And he could see that I was not only failing to address the problems at home, but also the powerful feelings that therapy was stirring up within me.

A few weeks passed. Within a brief period of time almost everything in my life changed. Midsummer 1985 found me sitting alone in my newly rented apartment in Manchester. The sun was fading and the evening light was reflected diagonally across the windowpane. On the new stereo system – the only piece of furniture apart from the TV which belonged to me – a saxophonist improvised in a minor key. The music touched something raw inside me and I thought about how I had come to be here alone. There were times when I replayed everything in my head, trying to work out what I had failed to recognise or see in all the conversations and liaisons. How could things have turned out differently? This wasn't how I planned it. When I had first viewed this apartment, it had seemed perfect. He liked it too, my colleague – the man for whom I had finally ended my seven years of marriage. But he never moved in. On the Saturday night after I collected the keys, we went out to celebrate. When we got back to the flat, we were weeping tears of happiness as we collapsed into bed.

Jim wrote to me and asked if we could start again, but I knew, despite the desire to return to the comfort of the familiar, that it would be wrong for both of us if I went back. I had to come to terms not only with the fact that my marriage was over, and all the guilt associated with this decision, but also with the knowledge that I missed my lover of three months more than I regretted the loss of my husband. But I did call E at those times when I felt I could no longer go on. He was there for me when I needed him.

And now at last I understood what passion was about: the excitement of stolen kisses on a secret lunchtime tryst; the exquisite pain of saying goodbye and 'this has to end' in the middle of an empty Manchester street at midnight; the declaration of 'I'm going to leave him!' on a windswept hillside one Sunday afternoon; the final consummation of the affair on a joyous weekend by the sea. And, finally, the sense of utter, painful despair and rejection when he left me – where had I gone wrong?

I drove north towards Scotland. I needed to return to a place where I had been before – before I had made those fateful decisions about marriage and love, before my father had been ill, before I even went to university. Somewhere I had taken a wrong turning on the road, and I thought that if I could simply go back, maybe I could find a route back through the years.

The experience of therapy with E was allowing me, in some way, to start again, to move forward in time from a reference point. I have seen this in my own patients: there may be past issues which have to be dealt with so they can begin to be able to move forwards in their lives, and this might mean retracing their lives back to the point where key decisions were made. Lives cannot be lived over but, with insights gained from the past, more emotionally satisfying and truthful choices can be made about the future.

I knew what my reference point would be. When I was 18, the summer before going up to Edinburgh, I spent two weeks travelling around Scotland alone. There was a magical moment I always remembered, when I was en route by bus to the youth hostel on the east side of the Isle of Harris. It had been a day of almost white sunlight and as the bus came down the hill towards the west side of the island, across the rather lunar landscape of rock – unbroken apart from the ribbon of road – the horizon shone with woven strands of silver and azure. As the mirage began to focus and form into shimmering shapes, I could see this was a beach – a vast, white sandy beach fringed with purple mountains.

Returning to the white sands of Harris more than a decade later, feeling older but no wiser than when I was 18, little had changed from what I remembered, apart from the weather. For the first couple of days sheets of horizontal rain wrapped the whitewashed hotel in a grey impenetrable fog. I sat in my bedroom and stared at myself critically in the mirror: once again a little thinner and paler, with large, sad green eyes that seemed only to judge the source of their reflection.

Then, on the third day, the sun shone out clear and bright in the sky. As I walked across the meadows encrusted with wild flowers, called machair, and through the weathered gate on to the beach, rabbits scurried in all directions in front of me, eager to reach their burrows before I could glimpse them. I pulled off my shoes, luxuriated in the feel of the cool, wet sand between my toes, and tiptoed in the fringes of the surf. The water was ice-cold, clear and sparkling like a thousand manyfaceted diamonds. I knew that no matter what happened in my relationships with people, I would always love this place. This was a place and a moment to which I could always return, a link to the person I had been before experiencing marriage, death and disappointment in love.

I can see now that this was the moment when I began to sense the importance of accepting myself as I was, with all my flaws and failings, before I could move forwards in life again. Psychotherapists talk about self-love, and some people misinterpret it as selfishness, but it isn't. However clichéd this may sound, in order to really be able to care for others, you do need to be able to love yourself first: to acknowledge your own strengths, admit and accept your weaknesses, and begin to make peace with them. I had begun to recognise the need to take some responsibility for the life choices I had made thus far, in order to avoid repeating the same mistakes again. This awareness didn't mean that I no longer made the wrong choices, of course, particularly where rushing rapidly into relationships was concerned, but it was a beginning.

Sometimes when a person has been convinced of a delusional idea, they gradually begin to realise that what they believed to be true was never really the case. They accept that they did indeed misinterpret or misunderstand what was happening to them. Other times, though, as was the case with Theresa, the delusion remains encapsulated in a moment in time.

'He did love me,' she told me. 'I know he did; he's just changed his mind now. His wife has made him change it, I bet. I think she controls everything; he had no choice. He didn't want to lose his home and his children – otherwise he would have come to me.'

'So you won't go back to the house again?' I asked.

'No, there's no point at the moment. I really think he has changed his mind, but…' Theresa paused.

'And the police would be called and you would be charged this time.'

'Well you never know. He might change it back again.' Theresa looked at me and laughed. 'Yes, I know I have to take the medication.'

I didn't believe her.

I know why it is important to hold on to those beliefs, even in the face of so much evidence to the contrary: it is a way human beings cope with disappointment and loss, and it is sometimes necessary for survival. I had to convince myself that the love I had experienced had been real but not sustainable. Like everything else in my life, ultimately it was transitory; at the end of their treatment my patients eventually said goodbye to me and I would at some point in the future have to stop seeing E. I could not bear the thought of ending my therapy with him. I knew the difficult conversations I had had with E helped me to move on in my life and in many ways he had been right about my actions.

So, on my return from Scotland, as I sat in the new apartment at sunset, with music playing, I reflected on what I had lost. I began to weep, but after a short while I realised that it wasn't my lover or even my husband I was crying about, even though both of them were gone. These were very different tears from those I had shed since the end of the affair. It was someone else whom I had loved, whom I was missing more than anyone else. A new loss had reopened an unhealed wound and after five long years I was finally starting to grieve for my father.