The heart wants what it wants.

—Emily Dickinson

Content warning: Sexual assault

I thought I was in love with my psychiatrist and acted upon it.

I’ve had approximately fifteen male psychiatrists over the years, but there was only one with whom I developed erotic transference. It occurs when a patient experiences fantasies of a sexual nature toward their psychiatrist and impassioned feelings of love, sometimes overtly as in my case. Erotic transference is a powerful force because you can be madly in love with someone you don’t know. The fact that I didn’t know my psychiatrist did not stop me from propositioning him.

I’ve always felt certain events happen in life because recognizable factors collide at a specific point in time to make that event occur. I think there was a combination of three elements in my situation, which had to be present before erotic transference could happen; all of which were present at the juncture when my psychiatrist met me as his patient for the first time.

The first ingredient in the equation was that I was at an unhappy stage in my life, trapped in a marriage that was rapidly flatlining. Affairs happen all around the world every day when someone neglected by their partner, meets someone kind and understanding.

The second component responsible for erotic transference was that I had mania at the time. I cannot envision it having happened if I were stable, and therefore more in touch with reality. Any attraction I felt toward my psychiatrist—as people feel all the time when they meet someone who catches their eye—I romanticized and sexualized, because I was in a state of constant sexual arousal. I was living in a land where I believed what I wanted to believe. That place Dorothy visited in the Wizard of Oz where she thought she could go all the way back home to Kansas by merely clicking the heels of her magic, red shoes together.

The third ingredient was that I did find my psychiatrist attractive—obviously. But I’d found one other psychiatrist to be exceptionally appealing, and it had gone no further. That is why I think these three elements had to be in place before erotic transference could occur.

As the weeks progressed, my erotic transference grew and grew as did my mania. I developed an obsession of mammoth proportions: my décolleté got lower, my skirts tighter and shorter, my liberally applied perfume became asphyxiating, and my sensible shoes morphed into stilettos. I was living in a fool’s paradise, howling with lust.

My good-looking psychiatrist was God-like, and I was gobsmacked. One day I walked into his office, and with half a glance he said, “You’re high.” I must have been high in the extreme for him to have discerned that in one hundredth of a second without me having uttered a word. My ever-changing attire was a dead giveaway, but I also must have looked like a tomcat prowling in the blackness of night, eyes aglow.

I looked at him and said, “My husband’s away on business and my children are at sleepovers. Do you want to come to my place tonight?” No tell-tale body language from him. He looked as though I had asked him to pass me a cucumber sandwich at a summer fête. Ever the consummate professional.

He could have said he’d made a pledge to the Hippocratic Oath “to do no harm”. I think many psychiatrists would have said that. Instead, he said, “It would be very damaging to you, if I were to sleep with you, Louise.” In one simple phrase he managed to reject me and made me feel he was doing so in my best interest. He appeared to be concerned about my welfare. His rejection was kind and well-thought-out and had not hurt or embarrassed me in the least.

Erotic transference is like driving on a highway on a glorious summer’s day. Up ahead beneath the hot baking sun you can see the heat haze: that horizontal strip of rippling water forever out of reach. No matter how fast we drive, it will always remain in the distance. We will never reach that stretch of water in our lifetime, and erotic transference will never be true love, even though they both feel real to the person being mesmerized by them at the time.

The partnership between patient and psychiatrist can be a confusing one. It can feel like an intimate relationship (even though it’s one-sided) because we share our strong feelings, emotions, and innermost thoughts with them. Erotic transference may happen more commonly than we think because psychiatrists can swiftly become confidants, especially if their patients are vulnerable, lonely, and isolated because of mental illness or feeling misunderstood.

The main problem with hypersexuality is the promiscuity: a behaviour fiercely out-of-character for both sexes. It can cause enormous humiliation and excruciating pain, especially if we’ve had sex with someone we wouldn’t normally have dinner with.

Promiscuity is not a personal failing and, once I acknowledged that, it became easier to accept and forgive myself for my behaviour. Awareness is the first step toward greatly reducing shame of any kind. These days I have a zero-shame policy: refusing to be entombed under the weight of my past promiscuity. I experienced too much mortification in my earlier years to compound it by allowing the pain to drag me down to this day. Sex-shaming only serves to chip away at our sense of self. Let’s try being kinder to ourselves instead.

Hypersexuality is a very dangerous state for some of us because we can lose all inhibition and judgement. I learned the hard way that elevated mood states can lead to promiscuity, sexual assault, and unbearable pain.

In 2004 I was raped—eighteen years before #YouToo’s impact on sexual assault for women—in a time when they were reluctant to come forward with allegations of rape, perhaps because they felt the exercise would be fruitless or blamed themselves. For those with bipolar disorder, self-blame can be hard to bear, especially if they’ve been looking for sex in bars. I experienced both self-blame and shame after the rape, especially after a friend said my devastating experience did not constitute rape, since I had taken this man voluntarily into my home.

Following the rape, I was too frightened to go to the police in case they decided my claim was unsubstantiated. If this happened, I feared the rapist would retaliate, since it would have been obvious I was one who’d implicated him. He was a violent man and had the wrath of the Devil on a bad day. I felt the fear in my bowels. He knew where I lived.

Sex is a private matter making it difficult for some to discuss. Try having a conversation with your partner if you’re experiencing hypersexuality. They’ve probably already noticed a baffling surge in your sex drive: from a person with a ravaged libido caused by depression to someone who wants sex the minute they walk through the door.

When I told a relative and lifelong confidant, I’d picked up a man in a bar due to my hypersexuality and subsequent promiscuity, conditions related to my bipolar disorder, and I’d been raped, they said with great authority as if they knew more about the subject than me, “A mental illness cannot increase libido or cause promiscuity.” And then they added self-righteously, “What did you expect when you’ve been picking up strangers all over the city? We’re all responsible for our actions at all times. I have no sympathy.”

Not all psychiatrists are created equal. I had a psychiatrist many years ago, who was prudish about sex. It was not very encouraging or helpful to me as a patient. Whenever I mentioned sex (which was rarely), he looked as though he would rather be anywhere on planet earth than in the same small room with me. He was also judgemental. When I disclosed I was promiscuous, going to bars looking for “hookups”, he looked at me disapprovingly and said, “You’re almost pathological about sex.” I couldn’t possibility have been his only patient with bipolar disorder to have ever been promiscuous. Besides, promiscuity is a manifestation of my disorder; a fact he knew all too well. It had been emotionally taxing to divulge this information, but I had made the disclosure in exchange for understanding, kindness, empathy, or guidance—anything in return—not an insensitive comment. I was hurting. I knew his standpoint might be true, since I was preoccupied with all things sexual whenever I had hypersexuality, but it did not stop me from being wounded by his callousness. If a psychiatrist can be disparaging toward a patient, how can we expect the public not to be?

And finally, psychiatrists know only as much as we tell them and, only then, can they act accordingly. Thirty-three years ago in 1991, when I was living in England, I had my first depressive episode and was prescribed a first-generation antipsychotic (thioridazine), developed in the 1950’s. This drug seized my personality and destroyed my sex life. At my next appointment, I voiced my outrage and stated this new medication was responsible. My psychiatrist was skeptical. He had to research the subject, only to learn that anorgasmia (the inability to have an orgasm) was indeed a side effect. He had been prescribing this antipsychotic to hundreds of patients over his fifteen-year career, and not one woman had ever complained about sexual problems. On the other hand, he said men were always vocal when a drug decimated their sex lives.

The time is ripe to put shame with regards to hypersexuality and promiscuity to rest. I look forward to the day when these conditions will no longer be a major embarrassment and there will be a drug that can subdue mania and lift depression without negatively impacting our sex lives.

It’s the final frontier.

Louise Dwerryhouse

Louise Dwerryhouse, a retired social worker, who worked in Canada and the UK, is an advocate, and mental health blogger on “lived experience” living in Vancouver, British Columbia. She was diagnosed with bipolar I disorder late in life, over 30 years ago at the age of thirty-five, and has been living well with the disorder for 10+ years. She writes to those alone, frightened and traumatized by volatile mood swings such as she had in her early days post-diagnosis. Louise tries to lead by example, by sharing her journey to recovery, showing it is possible to live well with the disorder. Her dream is to see a society centred on acceptance, inclusion and less stigma in her lifetime.

• Learn more about Louise and read her blogs on her profile page
• Louise’s talkBD episode on My Bipolar Disorder Story