When looking at someone you know well, have you ever felt like you were seeing the face of someone you didn't know? More confident, angrier, or, on the contrary, colder than usual - in any case, before this you knew someone completely different.
In situations that bring out the most unexpected in people, it is sometimes impossible to recognize even those closest to you. Perhaps you have sometimes said about yourself: “It’s not me, someone has definitely taken possession of me!” Well, then you can imagine in general terms the everyday emotions of people suffering from Capgras syndrome.
Story
The syndrome was first described by Joseph Capgras in 1923. He used the phrase “illusion of doubles” as a name, but it did not catch on because the word “illusion” in psychiatry had a different meaning. As a result, the disorder, in which patients mistook relatives and other people for doubles, received its name - “Capgras syndrome.”
It is more common in people with schizophrenia, head injuries, and in combination with various types of dementia. It may appear with age; there have been cases of Capgras syndrome in children. The disorder was once identified as a result of ketamine abuse. In a ratio of 3 to 2, it occurs more often in women than in men.
Treatment
- Dohn HH, Crews EL Capgras syndrome: a literature review and case series //Hillside Journal of Clinical Psychiatry. – 1986.
- Hines A., Stewart JT, Catalano G. A case of Capgras syndrome related to hypothyroidism //Journal of Psychiatric Practice®. – 2015. – T. 21. – No. 6. – pp. 445-448.
- Hirstein W., Ramachandran VS Capgras syndrome: a novel probe for understanding the neural representation of the identity and familiarity of persons //Proceedings of the Royal Society of London B: Biological Sciences. – 1997. – T. 264. – No. 1380. – pp. 437-444.
- Klein CA, Hirachan S. The masks of identities: who's who? Delusional misidentification syndromes // Journal of the American Academy of Psychiatry and the Law Online. – 2014. – T. 42. – No. 3. – pp. 369-378.
- Lucchelli F., Spinnler H. The case of lost Wilma: a clinical report of Capgras delusion //Neurological Sciences. – 2007. – T. 28. – No. 4. – pp. 188-195.
- Sharma A., Garuba M., Egbert M. Capgras syndrome in a patient with multiple sclerosis: a case report //Primary care companion to the Journal of clinical psychiatry. – 2009. – T. 11. – No. 5. – pp. 274-274.
Doubles of spouses and a doctor with an army of clones
To give you a complete picture of the disease, we will present several clinical cases. The first good example was described by Julia Warnock and Kevin Pusser, MDs, in 1991. Then they encountered Mrs. "D." - an elderly housewife who mistook her husband for an impostor:
“She refused to sleep with the impostor, locked her bedroom and door at night, asked her son for a gun and finally got into a fight with the police when they tried to hospitalize her. Sometimes she believed that her husband was her long-dead father. She easily recognized other family members and was only mistaken about her husband.”
Or another case that does not concern relatives. A precedent in 2008 was described by psychiatrist Arthur Sinkman; a patient named Diana came to see him. She was diagnosed with her first psychosis at the age of 23. She was shy and reserved by nature, and after stopping taking antipsychotics, she began to suspect the doctor that he was allegedly making copies of people:
“When she was hospitalized eight months later, she was under the delusion that the man was making exact copies of people—“screens”—and that she personally had two “screens,” one evil and one good. Diagnosis: schizophrenia with Capgras delusion. She was disheveled and had a bald spot on her head from self-mutilation.”
Obviously, the girl was trying to cope with her “evil” copy. There were precedents when people mistook themselves for doubles. In such cases, patients tended to attribute their bad deeds to their counterparts.
Capgras syndrome can also occur as a result of a neurodegenerative disease. A similar case was described in 2007 by neurologists Lucelli and Spinler. 59-year-old Fred came to see them. The man had a secondary education and was the head of a small division in the energy sector. In his medical history, he had no cognitive or behavioral disorders, but with age he began to mistake his wife for a double:
“Fred’s wife reported that approximately 15 months after the onset of the disease, he began to see her as a “double” (her words). The first episode happened one day when, after returning home, Fred asked her where Wilma was. To her surprised response that she was there, he firmly denied it. By way of argument, he said that he “knew his Wilma very well as the mother of his sons,” and continued to directly comment that Wilma had probably left and would return later.”
Over time, Fred's cognitive problems only worsened. In addition to Capgras syndrome, he also had difficulties with communication. This later progressed to frontal lobe syndrome - when a person retains his knowledge, intelligence, but cannot use it in accordance with a conscious purpose. In other words, Fred lost his will and began to react arbitrarily to the environment.
How does Capgras syndrome occur?
Researchers and practitioners have not yet come to a consensus on the syndrome. There are several theories about its origin:
- Freudian concept. The syndrome is seen as the repression into the unconscious of “unacceptable” feelings and emotions towards a loved one (for example, a feeling of sexual interest in oneself on the part of the family member who has been “replaced”). Thus, the patient “splits” the relative’s personality into “good” and “bad” - that is, the relative himself and the stranger who pretends to be him. The latter bears “responsibility” for the emotional discomfort that causes such a deep intrapersonal conflict in the patient.
- The neuropsychological concept states that Capgras syndrome is often accompanied by pathological changes in the brain (namely, the frontal and temporal lobes of the right hemisphere), which can be caused by head injuries, diseases - dementia, schizophrenia, cerebrovascular disease.
- Vileyanur Ramachandran's concept is one of the most famous and cited theories of the origin of this group of syndromes. The syndrome appears here as a disruption of communication between two key areas of the brain - the fusiform gyrus (face recognition) and the amygdala, which is responsible for the emotional response to faces. Normally, these two areas, interacting with each other, give, for example, the following picture of the world: “This is my husband and I love him.” In patients with Capgras syndrome, according to the researcher, facial recognition does not entail a corresponding emotional response: “This man looks like my husband, but this is not my husband - the face does not evoke in me the feelings that were there before. He must have been replaced by a double" [2].
Ramachandran derived this theory from observations of his own patient, David, who, after suffering a serious head injury, woke up from a five-week coma to believe that his parents had been replaced by doubles. An interesting detail - David believed that the “doubles” were in some ways more skillful than the “real” parents - his father drove a car more skillfully, his mother cooked much more deliciously. This is exactly how, according to him, he determined the fact of substitution [6].
- One of the newest concepts in this area is the concept of psychiatrists Nicola Edelstein and Femi Oyebode. It is an addition to Ramachandran’s theory and consists in detecting pathological changes in patients in the prefrontal cortex of the brain, which is responsible for setting goals, designating behavioral strategies, and making decisions. Edelstein and Oyebode suggested that it is precisely because of the disruption in these processes that the above-described conclusion “This man looks like my husband, but is not him” does not seem strange and unusual to the patient, and there is no criticism of his condition [2].
Agree, even after a detailed analysis, it is not easy to believe in the existence of the syndrome. It is even more difficult to imagine the variety of patterns of its development and symptoms in different people. An example of an even more unusual development of the syndrome is the story of a 71-year-old American man with bipolar affective disorder. After refusing drug treatment, the patient began to have delusional ideas - he believed that the FBI was watching his house. The apotheosis (and at the same time the manifestation of Capgras syndrome) was the moment when the man became convinced that his cat had been replaced. According to him, the “New” cat, in collusion with the FBI, followed him and his family, passing on the information he received. Psychiatrists Darby and Kaplan, of whom the patient was a patient, gave the syndrome a new name “Katgra”.
However, despite the many variations and complexities of the disorder, Professor of Psychiatry N. Edelstein believes that with the passage of time and the advent of more and more scientific research, the picture is becoming clearer, and the syndrome “ceases to be part of the neurological “X-Files” [2]. The syndrome is also interesting in how clearly it manifests the fear of the very phenomenon of duality, the fact of being replaced by a double - another person who exactly copies the “original”. We will talk more about the doppelganger and the unconscious fear of the double in the next article.
How to identify
There is no point in treating Capgras syndrome on your own. At a minimum, because people susceptible to the disorder cannot understand that they are sick. They are characterized by a deep conviction that the person standing in front of them is none other than a double. If you notice a person with Capgras syndrome and, God forbid, he is your relative, then the first thing to do is take him to the doctor.
The first bell is health problems: either physical or mental. The main characteristic of the disorder is the mistaking other people for doubles.
Clinical picture
Capgras syndrome is a paranoid obsessive disorder. It comes in two types:
- The man is sure that in front of him is a double. He sees him, talks to him, argues with his opponent, can touch him, and so on. He shows it to the doctor, that is, the object is visible to everyone without exception.
- The patient does not physically see the twin. But at the same time she constantly feels his presence nearby. In this case, the double remains invisible not only to him, but also to society.
What is most interesting: the patient’s suspicion can fall not only on a specific person, but also on an animal or object. Hallucinations are not observed in a person suffering from a personality disorder. Often a person even realizes that he is sick and his perception of reality is abnormal and false. Doctors have noticed that women are more susceptible to the disease. Sometimes it is accompanied by schizophrenia or injury to the posterior region of the right hemisphere of the brain, which is responsible for recognizing people's faces and inanimate objects.
How to treat
There is currently no specific treatment plan for Capgras syndrome. As a rule, correction is aimed at the root cause of the disease. For example, a person may have schizophrenia, and a syndrome has arisen against it. Treatment for schizophrenia can correct the disorder and relieve symptoms. But when Capgras syndrome occurs in the context of Alzheimer's, treatment options are limited.
The most effective approach is to create a comfortable environment for the patient, where he will feel safe. For example, some institutions use validation therapy, where the patient's misconceptions are supported rather than refuted. This reduces his anxiety and panic in a delirious state. Hence the conclusion follows: under no circumstances should you convince a person of the falsity of his illusions. The consequences are unpredictable, especially if you are a double whom he does not recognize. In this case, you should give the person for examination to specialists, and leave him alone until the symptoms subside. In fact, the doctors’ recommendations in this case apply to any communication. You need to understand the person, not argue with him when this is not necessary, and acknowledge his feelings.
Types of Capgras syndrome
Capgras syndrome includes delusions of intermetamorphosis, delusions of negative/positive double and Fregoli syndrome [7].
- Delusion of intermetamorphosis (or “metabolic delirium”) is a person’s pathological belief that certain persons change their appearance and/or internal essence so that he does not recognize them. This is accompanied by confidence in the evil intentions of these people [4]. Sometimes it is combined with delusions of staging - the perception of a real situation as being played out specifically for the patient (as in the film “The Truman Show”).
- The delusion of a negative double is a person’s belief that his loved ones (and sometimes himself) have been replaced by a double or someone similar, disguised and made up. The patient is sure that his loved ones were killed or kidnapped, but so that no one would guess, they found replacement people. Usually it is this branch that is called Capgras syndrome itself.
- Delusion of a positive double is a person’s false recognition of people they know or are close to him in strangers.
- Fregoli syndrome is a reverse delirium of intermetamorphosis. The patient is firmly convinced that all strangers are “played” by the same person familiar to him and pursues him, taking on the appearance of other people [5].
Modern diagnostic methods
A person with such symptoms requires hospitalization - only in an inpatient setting, with constant monitoring, a psychiatrist can make the correct diagnosis. A distinctive feature of this syndrome is that the patient accurately identifies people’s faces (the results, naturally, do not coincide with reality), names them, but cannot tell by what criteria he recognized this or that person.
Of course, some examinations are also carried out that help supplement the collected anamnesis and determine the possible cause of the development of the disorder. For example, tests are needed to determine the content of alcohol and drugs in the body. Tomography, encephalography and other studies may be performed to help determine the presence of organic lesions in the brain.
Is it possible to cure the disease?
It all depends on what caused Capgras syndrome to develop. For example, if it is found in a patient already suffering from schizophrenia, then he can be quickly helped. Properly prescribed medications suppress even a very anxious state, constantly arising fears and suspicions. If the cause of the syndrome is a head injury, then doctors for some time do not prescribe treatment for the syndrome, giving the brain the opportunity to correct its own work. In most cases, the gray matter independently suppresses the imaginary images that breed in its imagination.
As for the stress experienced, in this case it can be quite difficult to heal the patient. Having survived a tragic event, he becomes so isolated in his fictional world that it is not easy to reach him. Moreover, he himself does not want to be “extracted” from the depths of his fantasies. Despite this, prescribed psychotropic therapy helps control the condition, making the person safe for society. After all, obsessed with constant paranoid fears, he is capable of causing enormous harm not only to his family, but also to many other people. Such patients are potential murderers, maniacs and terrorists.
The first signs of the disease
Like many syndromes in psychiatry, this pathology develops gradually. At first, only short-term problems arise with visual identification of people - they last no more than a few minutes. As the disease progresses, attacks occur more frequently and their duration increases.
In the early stages, the patient may make assumptions that his relatives and even himself have been replaced. Such delusional ideas are often combined with excessive suspicion with which a sick person communicates with loved ones. One may also notice the patient's inability to identify people, whether they are familiar or unfamiliar.
Symptoms
Capgras syndrome begins to progress after the age of 30. Before this, it may be in a sleeping, or latent, state. Although science knows cases where teenagers or even children fell ill. For example, a case was described in psychiatry where the first signs of the disease appeared in a 15-year-old girl. She was sitting with her brother and father in a cafe and suddenly suddenly announced that drugs were being slipped into her food. Already in the medical institution, she mistook her mother for an impostor, and called the night orderly her father, who came only to cause her physical and mental suffering.
From this we can conclude that absolutely unexpectedly a person develops Capgras syndrome. Symptoms, in addition to confusion between people and doubles, also manifest themselves in the form of aggressive behavior. Firstly, a person gets angry because they don’t believe him. Secondly, he becomes enraged at the perceived threat. Being afraid of someone or something, he can also become neurasthenic, intimidated, cautious, depressed and apathetic. Thirdly, the patient begins to use violence against close relatives. Sometimes it even comes to the murder of entire relatives and subsequent suicide.
As exciting as it is terrifying?
This can be said about Capgras syndrome, which is very cinematic in its description. This theme has been repeatedly embodied in films and books. There are many famous masterpieces of literature and cinema that take up this topic.
Capgras Syndrome has also been featured in Criminal Minds, The Stepford Wives and many others - a clear indication of the disorder's appeal, which is certainly due to the fact that it affects people in general, generating great interest in it. . After all, many are concerned about the question of how real the surrounding reality is.
Reasons for appearance
The clinical picture is described in detail by world-famous psychiatrists. They professionally studied Capgras syndrome: photos of difficult patients, videos of the most delusional monologues were analyzed in detail by them, and the correct conclusions were drawn. Instead, the causes of the disease still remain vague and not fully understood. They say that the main impetus is damage to the back of the right hemisphere of the brain, which controls the recognition and recognition of people's faces and the appearance of objects. This can result from a severe head injury or unsuccessful surgery.
Another hypothesis states that the appearance of the syndrome has a psychological rather than a physical basis. That is, very severe stress experienced by the patient can lead to this. Often the disease begins to progress much later than the tragedy has occurred. That is, several months, years, even decades may pass after the accident before the syndrome begins to develop. Some psychiatrists admit that the tendency to illness is inherent in the womb of the mother. Others argue: it becomes a consequence of a difficult childhood or authoritarian upbringing.
