When a ?Duplicate? Family Moves In

[ladylore]

New York Times

By CAROL W. BERMAN, M.D.
Published: September 11, 2007

My patient, a 37-year-old homemaker, gazed at the man in the red plaid shirt as he sat on the couch in her living room.

Fernanda Cohen
?Who are you?? she asked.

There was something familiar about him. He wore her husband?s boots, but the shirt made him look like a truck driver.

?Yeah, and who are you?? the man replied with a laugh. ?Come here and give me a kiss.?

She gave the man a peck on the cheek, but she felt guilty, fearing that her husband would arrive at any moment and admonish her. Not only did the man want a kiss ? he also wanted sex!

Discouraging him, she sat down to talk. The man spoke just like her husband and knew personal facts about her. It occurred to her that her husband had been mysteriously replaced by this fellow. How it happened she had no idea; she knew only that it had.

My patient had a history of schizoaffective disorder, similar to schizophrenia, but with more emotional range. And when she told me of this incident at her weekly visit the next day, I worried that her psychosis was recurring. ?Have you been taking your medicine?? I asked.

She admitted that she had not taken her antipsychotic, Clozaril, for a few days because of a side effect, excessive salivation.

?With your condition, it?s important to take your medicine every day,? I said gently.

She liked and respected me, but she could not stand it when I gave her orders. ?If you knew how embarrassing it is to drool all over yourself, you wouldn?t make me take that medicine,? she told me.

As I tried to extract a promise that she would restart her medicine, she suddenly sat back and stared at me.

?What?s wrong?? I asked.

There was a pause. I saw her composing herself before she spoke. ?You have the same voice, but your nose is bigger and your face longer.?

She excused herself 10 minutes early. I allowed her to go, because I knew she could not stand being with me any longer.

Days later, her husband called to say she was going ?crazy? again, believing that I and, now, her parents had been replaced by duplicates. I had to hospitalize her and restart her medication.

My patient suffered from a variation of Capgras syndrome, in which people are replaced by inexact duplicates. It has been considered rare, but the more I work with geriatric patients, the more I am diagnosing it.

The disorder was first described in 1923 by the French psychiatrists Joseph Capgras and Jean Reboul-Lachaux. They treated a 53-year-old who believed that her husband, her children, her neighbors and even she had been replaced by exact ?doubles? in a plot to steal her property.

In Capgras, there is an uncoupling of perception and recognition that leads many investigators to theorize that there may be a neurological, organic cause that remains unknown. Psychoanalysts have seen Capgras as an unusual form of displacement in which the patient rejects the loved one whenever negative features have to be attributed.

Yet guilt and ambivalence prevent the patient from becoming conscious of the rejection. The bad feelings are displaced to a double, who is an impostor and may safely be rejected. Anna Freud thought this delusion allowed patients to defend themselves against loss and distress about changes in close relationships.

After resuming her medicine, my patient quickly lost her belief that her husband, parents and psychiatrist were doubles. When she was healthy enough to return to outpatient treatment, I asked whether she had ever seen the movie ?Invasion of the Body Snatchers.? She said no.

I thought I?d better not explain the plot to her.

Carol W. Berman, a psychiatrist in Manhattan, is a clinical instructor at the N.Y.U. Medical Center.

 

[bbjjre]

that is very interesting and it must be very frightening for the patient and the family of the patient. I have never heard of this condition before although I did read once about a man that thought his loved ones were being replaced by robots? I wonder if this is a similar condition?

 

[Daniel E.]

I saw this on TV but it was an even more rare case in which the patient was in his 20s or 30s with some type of brain injury. In his case, the problem went away within a few years or so, probably sooner. He thought his parents -- who were taking care of him after his injury -- were the imposters who were not his real parents though he believed they resembled them ("inexact duplicates"). He tended to think whenever he saw his parents, that this real parents were somewhere else. The problem was that something in his brain was temporarily unable to provide the emotional aspects of facial recognition.

 

[ladylore]

The condition sounds scary to me - one moment my husband is there - next moment an imposter has taken his place...yikes. But if medication can reverse it, that's great.

 

[HA]

Capgras syndrome is a form of schizophrenia according to psychiatrists who treat schziophrenia. Below are other threads about this severe form of psychotic delusion.

I recently listened to a 20 mt documentary on CBC radio Metro Morning show. The psychiatrist there said that he has treated a number of people with this condition and like many with schizophrenia, when medication is taken as prescribed the delusions fade.


http://forum.psychlinks.ca/showthread.php?p=39507#post39507
http://forum.psychlinks.ca/showthread.php?t=8707&highlight=capgras
http://forum.psychlinks.ca/showthread.php?t=8759&highlight=capgras

 

[Into The Light]

from the descriptions i've read about this condition it doesn't seem as if people are frightened by what they are experiencing. am i mistaken?

 

[HA]

Ladybug,

The families I know (two separate families) who are dealing with this condition have lost a loved at the hands of the person with this severe delusion.

The people who had the illness were very frightened and sure that the "imposter/imposters" were somehow going to harm them or had harmed the "real parents" so they acted on their delsuion and got rid of the imposters.

Not all people with this delusion would have the same outcome but if left untreated then the risk is certainly there.

 

[Daniel E.]

BTW, some more info about the rare case I saw on TV in which the Capgras syndrome was due to a traumatic brain injury:

A patient I saw not long ago who had been in a car accident, had sustained a head injury and was in a coma for about a couple of weeks. Then he came out of this coma and he was quite intact neurologically when I examined him. But he had one profound delusion - he would look at his mother and say "Doctor, this woman looks exactly like my mother but she isn't, she is an imposter".

Now why would this happen? Now the important thing is this patient who I will call David is completely intact in other respects. Now to understand this disorder, you have to first realise that vision is not a simple process. When you open your eyes in the morning, it's all out there in front of you. It's easy to assume that it's effortless and instantaneous but in fact you have this distorted upside down image in your retina exciting the photoreceptors and the messages then go through the optic nerve to the brain and then they are analysed in thirty different visual areas, in the back of your brain. And then you finally after analysing all the individual features, you identify what you're looking at. Is it your mother, is it a snake, is it a pig, what is it? And that process of identification takes place in a place which we call the fusiform gyrus which as we have seen is damaged in patients with face blindness or prosopognosia.

So once the image is recognised, then the message goes to a structure called the amygdala which is sometimes called the gateway to the limbic system which is the emotional core of your brain, which allows you to gauge the emotional significance of what you are looking at. Is this a predator, is it a lion or a tiger? Is it a prey which I can chase? Is it a mate that I can chase? Or is it my departmental chairman I have to worry about, or is it a stranger who is not important to me, or something utterly trivial like a piece of driftwood? What is it?

Now what's happened in this patient? What we suggest is that maybe what's gone wrong is that the fusiform gyrus and all the visual areas are completely normal in this patient. That's why when he looks at his mother, he says "oh yeah, it looks like my mother", but the wire, to put it crudely, the wire that goes from the amygdala to the limbic system, to the emotional centres, is cut by the accident. So he looks at his mother and he says - "hey, it looks just like my mother, but if it's my mother why is it I don't experience this warm glow of affection (or terror, as the case may be). There's something strange here, this can't possibly be my mother, it's some other strange woman pretending to be my mother". It's the only interpretation that makes sense to his brain given the peculiar disconnection.

http://www.bbc.co.uk/radio4/reith2003/lecture1.shtml

 

[HA]

I went into the the first link of other articles here on capgras at psychlinks that I posted above and got the full article from Mind: Scientific American

http://forum.psychlinks.ca/showthread.php?p=39507#post39507

Qouted from the article:
Unfortunately, an unshakably distorted picture of the external world can sometimes lead to terrible consequences. Many Capgras sufferers consider their doubles to be evil, feel threatened by the impostors and react accordingly. Arturo Silva, a psychiatrist then at the Veterans Affairs Medical Center in Palo Alto, Calif., compiled 80 cases in which patients attacked a presumed double verbally or physically. Two of the attacks ended in death. Other research shows that most victims are family members.

 

[ladylore]

Thanks for posting those other articles HeartArt. So, now it has me wondering: my mother was formally diagnosed with schizophrinia but I remember a time just before her first hospitalization when she started referring to me as god and all other family members as the devil.

Now I am wondering if this was a form of Capgras?

Ladlore

 

[Into The Light]

thanks for the insight heartart. it sounds quite terrifying to me to suffer from capgras.

 

[HA]

Thanks for posting those other articles HeartArt. So, now it has me wondering: my mother was formally diagnosed with schizophrinia but I remember a time just before her first hospitalization when she started referring to me as god and all other family members as the devil.

Now I am wondering if this was a form of Capgras?

Ladlore

Thank you for this most recent article as well, Ladylore. The families are always interested in reading articles written about capgras so I will pass it on to them.

Gee, Ladylore-I'm really sorry to hear about your mom having schizophrenia. That must have been really tough for you. I have a few close friends who had mothers with schizophrenia as well.

About your mom, I believe the central feature to capgras is that the imposters are similar to the orginal people but have slight differences seen by the person with the illness as the "evidence" for them being an imposter.

It is not uncommon for people with schizophrenia to have delusions related to religious themes. Someone being the devil or evil. The person with the illness themselves being the second coming of Christ is another common delusion.

Like LadyBug syas, any of these kinds of delsuions would be scarry for the person. What a terrible thing to have to live and cope with. It's sad.

:heart:
:friends: