Capgras Syndrome

Imagine you have a decent life. A life that is stable, not so regular but has enough dynamic within. Let’s say, you have a family, and a lovely partner in this sufficient level of life. One day, you came back home from work. A work that you always wanted, or at least it is close work that you desired. You expect your partner to be home, waiting for you, for a plan that you arranged a few days ago. You enter your house, move forward to the kitchen, and see your partner cooking for the night. You smell the dish, and you immediately recognize that it is your favorite one. Just before you breathe with relief, you sense that something is not right. You feel unexpectedly odd, and you are trying to figure out why. You glance at your partner and glaze up with surprise. You are looking at the source of your odd feeling, your partner. The shape, the face, and the body language of your partner are all the same as you remember. But there is not enough evidence for you, there is definitely something wrong with your partner. It feels… It feels like someone replaced your partner with the exact looking body, voice, and movements. It looks exactly like your partner, but you know that it is not. What would be your first reaction? You might try to understand the situation why this, almost, identical person that replaced your partner is here. A prank or a conspiracy move that is in progress against you. Maybe your partner was kidnapped and went missing, and maybe this stranger was responsible. Do you think something like this can be real? A duplicate took your partner’s place, with the exact specialties of it. Unfortunately, the answer is yes. There is a syndrome that is called “Capgras Syndrome” and it causes you to have these thoughts of flow in your mind. Even though the person you see is your partner, you somehow believe that this person is a duplicate.

The syndrome was first added to the literature by Capgras and Reboul-Lachaux1. It is one of the most studied types of delusional misidentification syndrome. This delusion is not only consisting of the misidentification of a partner or a family member. It can be friends, some material objects, pets, or certain places2. It was observed in research that this syndrome is related to multiple neuropsychiatric conditions and neurological disorders. Examples can be extended such as schizophrenia, affective disorder, severe closed head injury, Parkinson’s disease, etc3. The people diagnosed with Capgras Syndrome tend to show physical or verbal violence against their so called “duplicate”. A review article summarized the cases of Capgras Syndrome with violence included3. The main reason behind these violent cases is that people with the syndrome no longer see the person in front of them as a close relative or lover. Their description of “duplicate” means that the person they see is not the person that they knew or loved before. They are completely different people for them, which is increasing the possibility of encountering violence in the cases. The reason behind these can be explained externally as the person is unable to match the feelings with the visual structure they observe. By mean that is, the figure knows that the person they see exists, but visual processing is not cooperating with the feeling’s processing so they cannot declare that the person is their “known” one. The conflict created by this contradiction causes different scenarios for the individuals and concludes each scenario as the person they know is not there, even though it is known that they are not completely gone.

Figure 1: Areas of decreased density in the frontal region from the case1.

To better understand, here is the case report in January 19741. A 44 year old man had a traffic accident. In the hospital, the brain films revealed that it has a hematoma in the right frontal with temporal swelling. Some treatments were applied but after a couple of weeks, a craniotomy operation showed subdural hematoma and necrotic right frontal lobe within the patient’s brain (especially on the right side). The patient was discharged from the hospital after the surgery was completed. Ten months later, the patient was informed of an interesting situation. He claimed that he is living with a different family in a different house. But the house and the family are looking the same as the first family he had. He was able to recognize his friends, but not his family. During a conversation, the patient himself commented that it would be hard to believe if another person told him the exact situation. He added that he feels like he is making up that story when telling someone.

To add, a 59 year old man named Fred with cognitive and behavioral disturbances showed a similar case4. Removing the details, many disturbances occurred within the individual. Finally, the person’s wife, named Wilma, claimed that Fred asked Wilma where his wife was.  When his wife answered the question “I am right here”, Fred denied the answer and the fact that the person he sees is not Wilma that he knows. Surprisingly, with Wilma’s confusion, after 15 minutes, Fred showed normal behavior against Wilma. Sometime later, these symptoms showed frequently, every day, and sometimes more than once a day. She claimed that in some cases Fred goes to the streets to look for his “real” wife, as keeps insisting that Wilma was not his real wife. In further investigation, Fred showed no aggressive behavior or hesitancy to share his life with this “other” person. In return, he insisted that she cannot possibly be his real wife and was unable to explain his judgment.

Due to a lack of data and understanding of the situation, there is no certain evidence or explanation of these cases. Multiple figures about the connection between recognition of a person and description of this abnormality with the perspective of neuroscience were published2.  For example, a term for Capgras Syndrome was described in 19865. The syndrome is mentioned as a form of hemispheric disconnection. The explanation is similar to the way that I explained the situation as feelings not matching the visuality in the past paragraph. It says that the known faces are found in both hemispheres, and they are unable to fuse so delusion occurs. Of course, the model had some conditions that were unable to explain, so it is wrong to call this term completely true. Another debate5 suggested that damage occurred in the right hemisphere system. It is further explained as the ability to access memories for these individuals’ faces is unable to be recognized. Compared with the first term, this definition is far more supported, still, it is not hundred percent to be true. One true thing is that there are cognitive dysfunctions in these individuals’ brains, and the most common belief is involved in the right frontal part of the lobe, as mentioned before. But some other data conflicts with these common beliefs. Both the data from different perspectives conclude that the reason might be a disconnect between the frontal lobe and the other lobes6. Since one of the functions of the frontal lobe is emotional processing and expression7, this conclusion is not far from the reality of this situation.

Capgras Syndrome is indeed an interesting condition waiting to be discovered. Due to its rarity, any case that interacts with this syndrome is so valuable. Still, even though it is limited, many conditions are further investigated and trying to find a connection with Capgras Syndrome. The findings of the future might reveal this uncommon condition’s background in a detailed perspective. Until then, Capgras Syndrome will preserve its quaintness in the literature.

References:

  1. Alexander MP, Stuss DT, Benson DF. Capgras syndrome: A reduplicative phenomenon. Neurology. 1979;29(3):334-339. doi:10.1212/wnl.29.3.334
  2. Barrelle A, Luauté JP. Capgras Syndrome and Other Delusional Misidentification Syndromes. Front Neurol Neurosci. 2017;42:35-43. doi:10.1159/000475680
  3. Bourget D, Whitehurst L. Capgras syndrome: a review of the neurophysiological correlates and presenting clinical features in cases involving physical violence. Can J Psychiatry. 2004;49(11):719-725. doi:10.1177/070674370404901102
  4. Lucchelli F, Spinnler H. The case of lost Wilma: A clinical report of Capgras delusion. Neurol Sci. 2007;28(4):188-195. doi:10.1007/s10072-007-0819-8
  5. Edelstyn NMJ, Oyebode F. A review of the phenomenology and cognitive neuropsychological origins of the Capgras syndrome. Int J Geriatr Psychiatry. 1999;14(1):48-59. doi:10.1002/(SICI)1099-1166(199901)14:1<48::AID-GPS891>3.0.CO;2-0
  6. Josephs KA. Capgras syndrome and its relationship to neurodegenerative disease. Arch Neurol. 2007;64(12):1762-1766. doi:10.1001/archneur.64.12.1762
  7. Fellows LK. The Functions of the Frontal Lobes: Evidence from Patients with Focal Brain Damage. Vol 163. 1st ed. Elsevier B.V.; 2019. doi:10.1016/B978-0-12-804281-6.00002-1

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