What would you do if one day, your spouse didn’t think you were you? Different than dementia, Capgras Syndrome is a type of delusion in which you feel as though a loved one has been replaced by an impostor. It’s a very interesting phenomenon and one that can be exceptionally difficult for families to deal with. In this video, I talk about this obscure disease where everything is actually the same…but nothing feels like it.
See a summary of what I talk about in the video below.
I want you to imagine that you are old. You’re in your seventies or eighties, and you’ve been married to the same person for most of your life. One day, you come home and you see them, but it’s not really them. It’s an impostor. They look the same, but you know that they are not your spouse even though they look very similar.
You roll with that for a bit and notice a few things about this person. They’re nice to you, they’re attractive, they’re very happy to see you. They’re still not your husband or wife, but they are someone you like spending time with. So you get intimate with them. After the fact, you feel like you are in a crisis because you don’t want your real spouse to find out that you slept with this stranger. Pretty crazy scenario, right?
This is actually something that I’ve encountered in a patient of mine recently. They have Capgras syndrome, which is technically known as a delusional misidentification syndrome.
To read more about how I diagnose a patient with things like Capgras syndrome or dementia, see my post all about neuropsychological assessment.
Basically, it’s a type of delusion. It’s something that you believe to be true. In this case, Capgras syndrome is when you see a person that you have a close relationship with, and you recognize that they are similar to the person that you are thinking of. But it doesn’t exactly feel like the right person. It feels like they’ve been replaced by an impostor, or that this is a different version of them. It can also happen with places; many times, a person will go to their house and say this looks exactly the same, but it’s not my home. It’s not right.
I’m sure you can see how this can be really difficult for family members to deal with. Especially when dealing with someone like a spouse or parent, to have to say “I am that person, what are you talking about? I’m still your wife, I’ve been your wife this whole time.”
We understand Capgras to be a symptom, not necessarily a disorder in its own right. Basically it’s something that can come up as a result of something else. People with different sorts of dementia conditions like Alzheimer’s disease can get Capgras delusion, as well as people who have had certain types of brain damage or other types of neurological defect that causes a specific sort of defect in the brain. We don’t really know why it happens, and we don’t fully understand Capgras syndrome at this time. It’s something that is currently being researched but still we are taking our best guesses at it.
There are two prevalent theories. One is that it has to do with the way we process faces. So, the way we recognize somebody and the way we process their facial information. But there’s actually another theory that I think makes a lot of sense.
If you think about the way our brain works when we store memories. When we take short term information and put it into our long term storage, we store that fact based information with sensory and emotional information.
If you look at the brain, there’s this thing called the hippocampus. That thing is responsible for consolidating your memories from short term to long term, which typically happens in your sleep. And that thing that helps to consolidate your memories happens to be wrapped around the part of the brain called the limbic system. The limbic system is your sensory center, and it’s also your emotional sensor in your brain. The sights, the sounds, the other senses, the feeling that’s going on emotionally in the situation, and your memory gets stored along with those cues.
It’s because we store our fact based information along with all of these cues that helps us to recall it. But with Capgras Syndrome, one of the theories is that those things get separated. So the facts of who someone is, the fact based information of who they look like, how they present, all of the aspects of them, is in one place. The emotional part that connection that you feel is in another. It’s really important because if you think about a loved one, you have a certain feeling that comes up with them.
This is important because if you think about a loved one, you have certain feelings and emotions that come with them. It would be weird if you were to picture that person and not feel any of those things. And I think that’s really what goes on with Capgras Syndrome. You see the fact based information of that person, but your gut tells you that it doesn’t feel right for some reason. That’s really hard to reconcile.
Capgras Syndrome is a delusion, so it’s something that this person thinks is true. With delusions, you cannot usually reason somebody out of that. It’s not really a logical deduction when they decided that this is the wrong version of a particular person. It’s just something that comes up in the brain when these things are separated. With any delusion, usually trying to reason with the person doesn’t help them get out of it because it’s just a reality for them.
In working with someone who has Capgras syndrome, or any other delusion, it’s not helpful to face it head on and deny their delusion by showing them photos, etc., because in their world, all of that is going to be true, but that’s still not you in that picture and that’s still not you saying it.
Interestingly, with Capgras in particular, there is some variation that happens where sometimes there’s fluctuation. The patient I saw recently was a male, married to a female, and he thought there were multiple versions of his wife. And he had a closer affinity to different versions of his wife. He would be excited to see the “real” version of his wife.
What can be helpful with those with Capgras syndrome is to enter into the delusional realm with them and identify what their fear really is. For example, I also worked with someone who was going on a trip with their family, and thought they needed to pay for everyone’s flight. I helped his wife figure out that his fear was running out of money, so instead of trying to convince him that they didn’t need to pay for everyone, she told him that they didn’t need to worry about the money. This is instead of trying to face it head on.
It’s often more helpful to just empathize and just say “wow, that’s hard, and I’m sorry that’s causing you problem and you’re not feeling good about that, you can trust me though.”
Or you can say something to the effect of, “Well, let’s set it to the side for now and focus on this instead.” That would be an example of redirection, where instead of entering into the delusion with them, you’re simply deflecting.
In keeping with the facial recognition theory, there’s a trick that works sometimes where you take the face out of the equation and they can make that connection. In some situations it works to call out from the other room, and say “Hey honey, it’s me,” and when they recognize you, keep talking as you enter the room.
Any of these things are going to be only partially effective. Unfortunately, Capgras syndrome is not something we have a solution for right now. There’s no medication or surgery that can change it. It’s how to work with it, not cure it.
It can be something that starts off as something fairly mild and continues to progress, because a lot of times it’s part of progressive disorder. So while it’s kind of a grim prospect, it’s actually something that in isolation is possible to work with. You can talk to somebody that has some sort of insight about their situation, but there will still be this fundamental disconnect. They’re not going to be able to fully understand that they have this delusion. That’s just the nature of a delusion.