Capgras Syndrome
Continuing with our ongoing series of fascinating neuroscience facts:
The early 1900s were still the wild west of neurology. Most of what we understood was convoluted with theories from psychologists (mostly Freud, ugh) since we didn’t have ways to image and quantify the brain in real time, like we do today. Unfortunately, this meant that most people suffering from a neurological disorder were relegated to insane asylums, wasting away until their death. A select few, however, have been immortalized in case reports from the time, serving as examples of both brilliant deductive reasoning and the tragedy of the human brain’s enigmatic disease states.
One such legend in the neurology world is Madame M. On June 3, 1918, she burst into a police station in hysterics, claiming that she knew of a huge kidnapping of 28,000 people (mostly children) who were being held and tortured in the catacombs. The conspirators were mummifying some alive, others were being flayed and experimented on, oh the humanity! You can probably imagine how this went with the cops — she was promptly escorted to an asylum.
Joseph Capgras was the lucky doc who examined her.
At first it seemed like a pretty run-of-the-mill delusion. She had a wildly complex background with a long genealogy (evidently she believed that she was descended from Kingry Henri IV, but she was cheated out of a huge inheritance — which included 80 million francs and all of Rio de Janeiro — by a bunch of spies that dyed her hair, used special drops to change the size of her eyes, and “stole her breasts”).
…but this absurd belief wasn’t what got Capgras’ attention. When she was being questioned as to how 28,000 Parisians were missing with no one noticing, she insisted that they had all been replaced by “doubles:” nearly perfect replicas that assumed the original person’s identity.
M. had a fairly sad family life to that day. Of her 5 children, 4 had died as infants. The only remaining immediate family members were her daughter and husband. Unfortunately, even these close family members fell victim to the doubles delusion — she was convinced that her daughter and husband had been killed and replaced. It’s not entirely clear why M. was susceptible to this syndrome, but her background as a seamstress with a good eye probably contributed. She had a fine eye for minute details on a person’s face — wrinkles, extra fat, scars, freckles, hair — and every time she saw someone she previously knew with some minute change to their face, they were registered as a double, an impostor. This was so extreme that she began seeing doubles of doubles as people aged, gained wrinkles, and lost hair. Between 1914 and 1918 her husband had appeared in 80 different impostor forms and her daughter transformed into more than 2000 avatars.
There is no record of what happened to M. at the end of her life, but doctors began recognizing it in more patients after Capgras published his case report. It became known as Capgras Syndrome and patient reports evolved over time. With the rise of new technology, the explanations for the impostors evolved into people being replaced by aliens, androids, and clones. Other people started seeing impostors of their cats and dogs, and another thought his own hair had abandoned him and left him with an impostor wig!
Because there is no cure and patients interact with the doubles over time, they do develop relationships with them. Some patients accept the impostor. One woman began making three cups of tea each afternoon: one for herself, one for the double, and one for the missing husband in case he came back (awwwww). Sometime the relationships became erotic. One Frenchwoman complained that her old husband was a somewhat awkward lover but the double turned out to be a stud. Often, male victims enjoyed that “their wives’ bodies seemed electrifyingly new every few weeks.” Occasionally this led to some confusion, as one dude went to priest complaining that he was now committing polygamy because he was married to his wife and her double. Really rounding out the full gamut of emotions, others become paranoid, and some patients have killed doubles. In the 1980s a Missouri man decapitated his stepfather and “dug through his severed neck looking for the ‘robot’s’ batteries and microfilms.
Yikes.
People can even see doubles of themselves, and this leads to some pretty weird situations. These victims understand what mirrors are and how they work, and yet they will look in one and still insist that they are looking at a double of themselves. People have all kinds of responses to this. One guy was annoyed that his impostor always wanted to shave or brush his teeth at the same time, but “couldn’t really hold a grudge against [him].” Another said his impostor “wasn’t a bad-looking fellow” #humble. Other times, however, patients see the impostor as evil and trying to replace them. Families end up having to cover all reflective surfaces to prevent inadvertent attacks.
Fortunately, Capgras patients can recognize family members over the phone, so there is a way to have an actual emotional response to a loved family member without being accused of being an impostor. Other than that, we don’t know too much about the disease because it’s so rare. The famous neurologist V.S. Ramachandran posited the current leading theory, that it is the inverse of face-blindness. The idea is this: you see a face and there are two rough circuits within the brain: one recognizes a person as “dad,” “brother,” or “mom” by the characteristics of their face, and the other circuit pairs it with an emotional response. In face-blindness, you can’t recognize the person, but another means of identifying them (their voice, for example) elicits the emotional response. So you think “wow, you sound like my dad, but you can’t be my dad.” In Capgras, you correctly identify the person, but you have a blunted emotional response. This isn’t to say that you can’t have other emotional responses — you just don’t have an emotional response to this previously emotional response-eliciting person. There is some more detail that has come to light to explain the syndrome (for example, why do Capgras victims jump to the extreme impostor explanation and not follow a more reasonable logic?), but I won’t go into detail here. I highly recommend the Tale of the Dueling Neurosurgeons or any other scientific paper on the issue for more, if you’re interested.
Sources:
The Tale of the Dueling Neurosurgeons…again
