Folie à deux

by Stan Tatkin, PsyD, MFT,

As a species, we are more herdlike than we are hermetic. Both tendencies exist in our society, but we tend to be happier and healthier when we herd as a group together than when we isolate ourselves. In fact, it has been established that even individuals without a history of mental illness are more likely to develop symptoms if they experience too much isolation, loneliness, or withdrawal from social connections.

Not only do isolated individuals become sicker both in body and mind than do connected individuals, but the same applies to couples. Couples can become isolates who are cut off from social engagement outside their tiny, exclusive orbit. These couples, I have found in my practice, become crazier and crazier the longer they isolate themselves. Sometimes one partner is crazier than the other; however, when they become socially isolated as a couple, both descend into madness together. This is known as folie à deux,* or shared psychosis—a psychiatric syndrome in which symptoms of a delusional belief are transmitted from one individual to another.

I saw one couple who remained isolated from outside social influence for more than 15 years. Individually, they looked perfectly normal, but together both were as mad as Hatters. Another couple remained isolated from outside social influence for more than nine years. No one knew of their existence as a couple. As individuals, they were both hugely successful, but as partners in a couple they were a huge mess. In each folie à deux case, the partners became sicker and crazier over time.

A literary example of folie à deux is George and Martha, the iconoclastic couple at the center of Who’s Afraid of Virginia Woolf? Fused together in a hermetically sealed dyadic system, their private fantasy world was like a cancer in their psyche. Another example is found in David Cronenberg’s nightmarish film, Dead Ringers, about identical twins in a folie à deux.

Famous cases include Leopold and Loeb; the Papin sisters; and more recently, Randy and Evi Quaid. Discussing how the Quaids reinforced each other’s “bizarre hold on reality,” Stuart Fischoff, a senior editor of the Journal of Media Psychology and an expert on celebrity psychology, sheds light on the dynamics of folie à deux: “So long as you stay with each other and you stay insular, it’s a siege mentality. You’re not open to contradictions from the outside world.” University of Pennsylvania psychiatrist Dr. Christos Ballas says the disorder only becomes apparent when one off-kilter person gets involved with another; then everything spirals downward. “Independently, people with folie à deux might not be delusional, but because they have another person to reinforce it, it becomes quasi-real,” says Ballas. “Finally, he [Randy Quaid] met the right person who shared his proclivity for wackiness, and off they went.”

In a previous blog post on partner vetting, I discussed the importance of social networks in determining partners’ appropriateness for a long-term relationship. Although nature and biology are enormous influences on pair bonding and surely are responsible for the outcome of the first stage of courtship, the social vetting process is necessary to weed out inappropriate partners. I worry about couples who avoid this social inspection, evaluative process. I worry even more about couples who create a folie à deux and maintain an isolated stance that prevents them from receiving feedback. I suppose the same problem exists for any individual or group that cuts itself off from social interaction, discourse, criticism, or debate. A pathogenesis ensues. Individuals, couples, and groups, living within their own echo chamber, under their own influence, become weird.

* (fȯ-lē-ä-ˈdœ); from the French, meaning “a madness shared by two”


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