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Quirky Minds: Invasion of the Body Snatchers
By Peter Sergo
Psychology Today, Nov/Dec 2007

Delusions that make people feel dead?or surrounded by imposters.

In 1993, a man was rushed to the hospital for a stab wound he inflicted on himself. Though he was depressed at the time, the act wasn't intended to end his life; it was to prove to his family that he wouldn't bleed?because he was sure he was already dead.

The patient had a rare disorder called Cotard delusion, in which people believe they are dead, or even non-existent. But at the hospital his delusion took a new turn: He now believed his close family members had been replaced with perfect replicas sent by the police to spy on him. These are classic symptoms of another rare disorder, called Capgras delusion, in which a person believes loved ones are actually imposters.

The disorders rarely coincide in the same patient, but depending on this man's mood, he would alternate between them, leading a few researchers to suspect the disorders may be closely related. Both involve off-base interpretations of a flattened emotional response toward people who would normally provoke a sense of warm familiarity. "They're the best explanations sufferers can come up with for very strange feelings," explains Andrew Young, a neuropsychologist at the University of York, in the UK. Young suggests that what separates Cotard from Capgras is attributional style: Cotard patients, who often suffer depression as well, assume that they themselves are dead to explain the disconnect, while Capgras patients conclude that the outside world is altered.

Cotard and Capgras delusions sometimes occur after brain damage and can also accompany other delusions in schizophrenics. Robyn Langdon, a cognitive neuropsychologist at Macquarie University, in Australia, explains that the bizarre theories are often generated when the limbic system, part of the brain that puts an emotional spin on our surroundings, fails to communicate with the visual area that processes faces.

Cognitive behavioral therapy can reduce symptoms, but the human habit of looking for evidence to support a preconceived idea inhibits recovery. Further, accusations of odd behavior often become self-fulfilling. Young quips, "When a Cotard sufferer accuses his wife of being an imposter over the breakfast table, she starts to behave very strangely indeed."

Defense Against Doppelgangers
Most Capgras patients simply accept living among imposters, but not all.

1977: A patient reported to police that her husband had died and was replaced by an identical-looking man. She wore mourning clothes and ordered him back to his own wife.

1989: A psychiatric patient in Missouri wanted to prove that his stepfather was a robot, so he decapitated him, expecting to find batteries and microfilm in his head.

1999: After a fall from a ladder, a lawyer thought a former colleague had replaced his wife. He thought she was crazy and became angered by any display of affection.
 

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