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Saturday, September 26, 2020

Doppelgänger

From Wikipedia, the free encyclopedia
 
Dante Gabriel Rossetti, How They Met Themselves, watercolor, 1864

A doppelgänger (/ˈdɒpəlɡɛŋər, -ɡæŋər/; German: [ˈdɔpl̩ˌɡɛŋɐ] (About this soundlisten), literally "double-walker") is a biologically unrelated look-alike, or a double, of a living person.

In fiction and mythology, a doppelgänger is often portrayed as a ghostly or paranormal phenomenon and usually seen as a harbinger of bad luck. Other traditions and stories equate a doppelgänger with an evil twin. In modern times, the term twin stranger is occasionally used. The word "doppelgänger" is often used in a more general and neutral sense, and in slang, to describe any person who physically resembles another person.

Spelling

The word doppelgänger is a loanword from the German Doppelgänger, a compound noun formed by combining the two nouns Doppel (double) and Gänger (walker or goer). The singular and plural forms are the same in German, but English usually prefers the plural "doppelgängers". The first known use, in the slightly different form Doppeltgänger, occurs in the novel Siebenkäs (1796) by Jean Paul, in which he explains his newly coined word by a footnote – while actually the word Doppelgänger also appears, but with a quite different meaning.

Like all nouns in German, the word is written with an initial capital letter. Doppelgänger and Doppelgaenger are essentially equivalent spellings, and Doppelganger is not alone different, but non-existent in German. Also, it would correspond to a different pronunciation. In English, the word should be written with a lower-case letter (doppelgänger) unless it is the first word of a sentence or part of a title; further, it is common to drop the umlaut on the letter "a", writing (and often pronouncing) "doppelganger".

Mythology

English-speakers have only recently applied this German word to a paranormal concept. Francis Grose's, Provincial Glossary of 1787 used the term fetch instead, defined as the "apparition of a person living." Catherine Crowe's book on paranormal phenomena, The Night-Side of Nature (1848) helped make the German word well-known. However, the concept of alter egos and double spirits has appeared in the folklore, myths, religious concepts, and traditions of many cultures throughout human history.

In Ancient Egyptian mythology, a ka was a tangible "spirit double" having the same memories and feelings as the person to whom the counterpart belongs. The Greek Princess presents an Egyptian view of the Trojan War in which a ka of Helen misleads Paris, helping to stop the war.[citation needed]; this memic sense also appears in Euripides' play Helen, and in Norse mythology, a vardøger is a ghostly double who is seen performing the person's actions in advance. In Finnish mythology, this is pattern is described as having an etiäinen, "a firstcomer". The doppelgänger is a version of the Ankou, which is a personification of death that appears in Breton, Cornish, and Norman folklore.

Examples in real life

John Donne

Izaak Walton claimed that John Donne, the English metaphysical poet, saw his wife's doppelgänger in 1612 in Paris, on the same night as the stillbirth of their daughter.

Two days after their arrival there, Mr. Donne was left alone, in that room in which Sir Robert, and he, and some other friends had diner together. To this place Sir Robert returned within half an hour; and, as he left, so he found Mr. Donne alone; but, in such ecstasy, and so altered as to his looks, as amazed Sir Robert to behold him in so much that he earnestly desired Mr. Donne to declare befallen him in the short time of his absence? to which, Mr. Donne was not able to make a present answer: but, after a long and perplexing pause, did at last say, I have seen a dreadful Vision since I saw you: I have seen my dear wife pass twice by me through this room, with her hair hanging about her shoulders, and a dead child in her arms: this, I have seen since I saw you. To which, Sir Robert replied; Sure Sir, you have slept since I saw you; and, this is the result of some melancholy dream, which I desire you to forget, for you are now awake. To which Mr. Donnes reply was: I cannot be surer that I now live, then that I have not slept since I saw you: and am, assure, that at her second appearing, she stopped, looked me in the face, and vanished.

This account first appears in the edition of Life of Dr. Rizvan Rizing published in 1675, and is attributed to "a Person of Honour... told with such circumstances, and such asseveration, that... I verily believe he that told it to me, did himself believe it to be true. "At the time Donne was indeed extremely worried about his pregnant wife and was going through severe illness himself. However, R. C. Bald points out that Walton's account

is riddled with inaccuracies. He says that Donne crossed from London to Paris with the Drurys in twelve days and that the vision occurred two days later; the servant sent to London to make inquiries found Mrs. Donne still confined to her bed in Drury House. Actually, of course, Donne did not arrive in Paris until more than three months after he left England, and his wife was not in London but in the Isle of Wight. The still-born child was buried on 24 January... Yet as late as 14 April Donne in Paris was still ignorant of his wife's ordeal. In January, Donne was still at Amiens. His letters do not support the story as given.

Percy Bysshe Shelley

On July 8, 1822, the English poet Percy Bysshe Shelley drowned in the Bay of Spezia near Lerici in Italy. On August 15, while staying at Pisa, Percy's wife Mary Shelley, an author and editor, wrote a letter to Maria Gisborne in which she relayed Percy's claims to her that he had met his own doppelgänger. A week after Mary's nearly fatal miscarriage, in the early hours of June 23 Percy had had a nightmare about the house collapsing in a flood, and

... talking it over the next morning he told me that he had had many visions lately — he had seen the figure of himself which met him as he walked on the terrace and said to him — "How long do you mean to be content" — No very terrific words & certainly not prophetic of what has occurred. But Shelley had often seen these figures when ill; but the strangest thing is that Mrs. Williams saw him. Now Jane, though a woman of sensibility, has not much imagination & is not in the slightest degree nervous — neither in dreams or otherwise. She was standing one day, the day before I was taken ill, [June 15] at a window that looked on the Terrace with Trelawny — it was day — she saw as she thought Shelley pass by the window, as he often was then, without a coat or jacket — he passed again — now as he passed both times the same way — and as from the side towards which he went each time there was no way to get back except past the window again (except over a wall twenty feet from the ground) she was struck at seeing him pass twice thus & looked out & seeing him no more she cried — "Good God can Shelley have leapt from the wall?.... Where can he be gone?" Shelley, said Trelawny — "No Shelley has past — What do you mean?" Trelawny says that she trembled exceedingly when she heard this & it proved indeed that Shelley had never been on the terrace & was far off at the time she saw him.

Percy Shelley's drama Prometheus Unbound (1820) contains the following passage in Act I: "Ere Babylon was dust, / The Magus Zoroaster, my dead child, / Met his own image walking in the garden. / That apparition, sole of men, he saw. / For know there are two worlds of life and death: / One that which thou beholdest; but the other / Is underneath the grave, where do inhabit / The shadows of all forms that think and live / Till death unite them and they part no more...."

Johann Wolfgang von Goethe

Near the end of Book XI of his autobiography, Dichtung und Wahrheit ("Poetry and Truth") (1811-1833), Goethe wrote, almost in passing:

Amid all this pressure and confusion I could not forego seeing Frederica once more. Those were painful days, the memory of which has not remained with me. When I reached her my hand from my horse, the tears stood in her eyes; and I felt very uneasy. I now rode along the foot-path toward Drusenheim, and here one of the most singular forebodings took possession of me. I saw, not with the eyes of the body, but with those of the mind, my own figure coming toward me, on horseback, and on the same road, attired in a dress which I had never worn, — it was pike-gray [hecht-grau], with somewhat of gold. As soon as I shook myself out of this dream, the figure had entirely disappeared. It is strange, however, that, eight years afterward, I found myself on the very road, to pay one more visit to Frederica, in the dress of which I had dreamed, and which I wore, not from choice, but by accident. However, it may be with matters of this kind generally, this strange illusion in some measure calmed me at the moment of parting. The pain of quitting for ever noble Alsace, with all I had gained in it, was softened; and, having at last escaped the excitement of a farewell, I, on a peaceful and quiet journey, pretty well regained my self-possession.

This is an example of a doppelgänger which was perceived by the observer to be both benign and reassuring.

George Tryon

A Victorian age example was the supposed appearance of Vice-Admiral Sir George Tryon. He was said to have walked through the drawing room of his family home in Eaton Square, London, looking straight ahead, without exchanging a word to anyone, in front of several guests at a party being given by his wife on 22 June 1893 while he was supposed to be in a ship of the Mediterranean Squadron, manoeuvering off the coast of Syria. Subsequently, it was reported that he had gone down with his ship, HMS Victoria, the very same night, after it collided with HMS Camperdown following an unexplained and bizarre order to turn the ship in the direction of the other vessel.

Twin strangers

With the advent of social media, there have been several reported cases of people finding their "twin stranger" online, a modern term for a doppelgänger. There are several websites where users can upload a photo of themselves and facial recognition software attempts to match them with another user of like appearance. Some of these sites report that they have found numerous living doppelgängers.

Examples in fiction

Examples in literature

In addition to describing the doppelgänger double as a counterpart to the self, Percy Bysshe Shelley's drama Prometheus Unbound makes reference to Zoroaster meeting "his own image walking in the garden".

Lord Byron uses doppelgänger imagery to explore the duality of human nature.

In The Devil's Elixir (1815), a man murders the brother and stepmother of his beloved princess, finds his doppelgänger has been sentenced to death for these crimes in his stead, and liberates him, only to have the doppelgänger murder the object of his affection. This was one of E. T. A. Hoffmann's early novels.

Fyodor Dostoyevsky's novel The Double (1846) presents the doppelgänger as an opposite personality who exploits the character failings of the protagonist to take over his life. Charles Williams' Descent into Hell (1939) has character Pauline Anstruther seeing her own doppelgänger all through her life.

Clive Barker's story "Human Remains" in his Books of Blood is a doppelgänger tale, and the doppelgänger motif is a staple of Gothic fiction.

In Stephen King's book The Outsider, the antagonist is able to use the DNA of individuals to become their near perfect match through a science-fictional ability to transform physically. The allusion to it being a doppelganger is made by the group trying to stop it from killing again. The group also discusses other examples of fictional doppelgangers that supposedly occurred throughout history to provide some context.

In Bret Easton Ellis's novel, Glamorama, protagonist actor-model Victor Ward, ostensibly, has a doppelgänger that people mistake for Ward, often claiming to have seen him at parties and events Ward has no recollection of attending. At one point in the novel, Victor heads to Europe but reports of him attending events in the states appear in newspaper headlines. However, Victor's doppelgänger may or may not have been placed by Victor's father, a United States senator looking to present a more intelligent and sophisticated replacement for his son that would improve his own image and boost his poll numbers for future elections. While the novel is narrated by Victor, various chapters are ambiguous, leading the reader to wonder if certain chapters are being narrated by the doppelgänger instead.

In Tana French's 2008 novel, The Likeness, detective Cassie Maddox has doppelganger Lexie Madison who adopts the same alias Maddox used in an undercover investigation.

Examples in film

In Das Mirakel and The Miracle (both 1912) the Virgin Mary (as Doppelgängerin) takes the place of a nun who has run away from her convent in search of love and adventure. Both based on the 1911 play The Miracle by Karl Vollmöller.

The Student of Prague (1913) is considered to be one of the first German art films.

English actor Roger Moore plays a man haunted by a doppelganger, who springs to life following a near-death experience, in Basil Dearden's The Man Who Haunted Himself (1970).

The Jordan Peele film Us (2019) finds the Wilson family attacked by doubles of themselves known as the "Tethered".

In Richard Ayoade's The Double, based on Fyodor Dostoevsky's novel of the same name, a man is troubled by a doppelgänger who is employed at his place of work and affects his personal and professional life.

Animator Jack King creates a doppelganger for Donald Duck in Donald's Double Trouble (1946), where the twofold fowl speaks perfectly intelligible English and is well-mannered.

Estranged couple Ethan and Sophie find doubles of themselves trapped in the retreat house their marriage counselor recommended in Charlie McDowell's The One I Love (2014).

Confusion arises over Droopy and his identical twin in Droopy's Double Trouble (1951).

The 1969 film Doppelgänger involves a journey to the far side of the sun, where the astronaut finds a counter-earth, a mirror image of home. He surmises his counterpart is at that moment on his Earth in the same predicament.

In the 1990 anime film Dragon Ball Z: The Tree of Might, based on the popular manga/anime Dragon Ball, the main character Goku comes into conflict with his evil doppelgänger Turles, who serves as the movie's main villain. Several other characters throughout the series bear a striking resemblance to Goku, such as his father Bardock, his sons Gohan and Goten, his descendant Goku Jr., and Goku Black, who is actually the villain Zamasu who switched bodies with Goku in an alternate timeline. Of all these characters, however, Turles is the only one who has no connection whatsoever to Goku and who resembles him by coincidence, making him Goku's sole doppelgänger.

The 1991 French / Polish film, La double vie de Véronique, Polish: Podwójne życie Weroniki), directed by Krzysztof Kieślowski and starring Irène Jacob, explores the mysterious connection between two women, both played by Jacob, who share an intense emotional connection in spite of never having met one another.

In the Soviet crime comedy film Gentlemen of Fortune (1971), Evgeny Troshkin (Yevgeny Leonov), a kind kindergarten teacher who has the same appearance as the wanted criminal known as "Docent", is sent on a mission to help Militsiya find an ancient golden helmet that Docent has hidden.

The 2013 film, The Double features a man, played by Jesse Eisenberg, usurped in the workplace by his doppelgänger.

In the Christmas comedy film The Santa Clause 2 (2002), when Scott Calvin/Santa Claus (Tim Allen) discovers he has to get married and his son winds up on the naughty list, one of his elves, Curtis (Spencer Breslin), creates a toy-like clone of him to deal with work up at the North Pole while Santa goes to find a wife. However, the clone reads Santa's handbook too literally and declares the whole world naughty, planning to give the whole world coal.

In "Garfield: A Tail of Two Kitties" (2006), Garfield (Bill Murray), gets lost during a trip to England, and gets mixed up with Prince (Tim Curry), the royal family's cat.

The 2018 science fiction film Annihilation features a doppelgänger in the climax.

Kagemusha, Face/Off,The Prestige and Enemy involved protagonists whose identities were stolen by other people.

Examples in television

In Big Hero 6: The Series, Liv Amara's clone appeared in the episodes "Big Problem, "Countdown to Catastrope, "Interabout", "Seventh Wheel", "Prey Date", "Something's Fishy", "Nega-Globby", "The Fate of the Roomates", "Muira-Horror", "Something Fluffy", "Lie Detector" and "City of Monsters"

In the episode "Miami Twice" of the sitcom Only Fools and Horses, protagonists Del Boy and Rodney Trotter come into conflict with the family of mafia boss Don Vincenzo Ochetti, who is a doppelgänger for Del Boy. Ochetti's family plot to have Del assassinated in public view to fake the death of Ochetti so that he will escape his coming murder trial, though Del and Rodney see through the ruse and eventually provide the authorities with evidence to have Ochetti proven guilty and sent to prison.

In the Friends episode "The One With Russ", Rachel Green dates a guy named Russ who is a doppelgänger of Ross Geller. Only Ross and Rachel don't really notice this, but Rachel notices that they are similar after she spots them having an argument at the coffeehouse Central Perk and she dumps Russ afterwards.

In The CW supernatural drama series, The Vampire Diaries, actress Nina Dobrev portrayed the roles of several doppelgangers; Amara (the first doppelganger), Tatia (the second), Katerina Petrova/Katherine Pierce (the third) and Elena Gilbert (the fourth). The series mainly focused on the doppelgangers of the sweet & genuine Elena and the malevolent Katherine. In the same series, Paul Wesley portrays Silas and his doppelgangers Tom Avery and Stefan Salvatore.

In The Simpsons episode "Fear of Flying", Homer Simpson is banned from entering Moe's Tavern. A man enters the bar afterwards looking like Homer with a high hat and a moustache, claiming to be Guy Incognito. As he is beaten up and thrown out by the patrons, who were convinced that the man was a disguised Homer, the real Homer passes by and notices, rather casually, that he found his doppelganger, only to be distracted by a dog with a puffy tail.

Fred Flintstone has encountered no less than three doubles over the years, among them ruthless business tycoon J. L. Gothrocks and secret agent Rock Slag.

The third episode of the fourth season of Elementary, an American procedural drama television series that presents a contemporary update of Sir Arthur Conan Doyle's character Sherlock Holmes, has a focus on the doppelganger phenomenon. In the episode Tag, You're Me, the victims of Sherlock Holmes's latest case found each other via a doppelganger-finding website. One of the victims, and the culprit of another case investigated in the same episode, had searched for their twin strangers in order to dodge a DNA test for a crime they had committed years before.

In one episode of Monk the titular detective is recruited to impersonate a dead mob hit man who was his double.

In the sitcom How I Met Your Mother, throughout the fifth and sixth seasons, the five main characters each encounter an identical stranger of themself. By the episode "Double Date", they have spotted Marshall's doppelganger, nicknamed "Moustache Marshall", and Robin's, called "Lesbian Robin". In the same episode they find Lily's doppelganger, a Russian stripper named Jasmine. Later, in the episode "Robots Versus Wrestlers", the gang finds Ted's double, a Mexican wrestler, but Ted himself is not there to witness it. In "Doppelgangers", Lily and Marshall decide that as soon as they find Barney's doppelganger, it will be a sign from the universe for them to start trying to have children. Lily spots a pretzel vendor who she thinks looks like Barney, but in reality looks nothing like him. Marshall takes this mistake as Lily subconsciously affirming her desire for motherhood and they decide to start trying for a baby. They meet Barney's real doppelganger, Dr. John Stangel, in the episode "Bad News", though they initially think he is simply Barney in disguise.

Ash's doppelgangers appeared in Pokémon (anime) episodes "Hypno's Naptime", "Pokémon Double Trouble, "The Cave of Mirrors, "A Shivering Shovel Search! and"Battling the Beast Within", Max's doppelganger appeared in the Pokémon (anime) episode "Maxxed Out", May's doppelganger appeared in in the Pokémon (anime) episode "New Plot, Odd Lot!", Dawn's doppelganger appeared in the Pokémon (anime) episodes "Dawn of a Royal Day", "With the Easiest of Grace" and "A Grand Fight For Winning", Serena's doppelganger, Bonnie's doppelganger, Clemont's doppelganger and Team Rocket's Trio doppelgangers appeared in the Pokémon (anime) episode "The Cave of Mirrors" and also Team Rocket's Trio doppelgangers appeared in Pokémon Chronicles episode "We're No Angels and Jessie's doppelganger appeared in the Pokémon (anime) episodes "Holy Matrimony!" and "The Treasure is All Mine"

In Pokémon : The First Movie - Mewtwo Strikes Back, Pokémon: Mewtwo Returns and Pokémon: Mewtwo Strikes Back—Evolution are only Pokémon movies to have cloned Pokémon.

In The Proud Family Movie, Dr. Carver created a clone of himself, but it went terribly wrong. His clone also made the doubles of the Proud Family(which includes Oscar, Trudy, Penny, Bebe, Cece, Sugar Mama, and Puff).

In Tangled: The Series episode "Mirror, Mirror", Eugene, Cassandra, Lance and Shorty are replaced by their evil doppelgangers. Also, Eugene, Rapunzel, Pascal, Maximus and The Baron met Eugene's doppelganger in Tangled: The Series "Flynnpostor.

A total of three different doppelgangers are dispatched from the mysterious Black Lodge to bedevil the forces of good in Showtime's 2017 series Twin Peaks: The Return.

Examples in music videos

The theme of doppelgänger has been frequently used in music videos, such as Aqua's "Turn Back Time" (1998), Dido's "Hunter" (2001), and Madonna's "Die Another Day" (2002).

Examples in video games

The 2008 video game Tomb Raider: Underworld features a character known simply as the "Doppelgänger." She is a clone of protagonist Lara Croft, created by antagonist Jacqueline Natla to break into Croft's mansion and unlock a safe containing an important artifact. As the safe is protected by a retinal scanner, it requires someone with the same DNA as Croft to unlock it. The Doppelgänger ends up killing Croft's friend and researcher Alister Fletcher, and burning down the mansion. She would then go on to become a major antagonist and boss in the game. In a 2009 DLC expansion pack called "Lara's Shadow," Croft takes control of the Doppelgänger, and she becomes the player character for this level.

The 2010 video game Alan Wake and its 2012 sequel Alan Wake's American Nightmare feature a character known as Mr. Scratch, who is a doppelgänger of the titular protagonist Alan Wake. In the game, Mr. Scratch is a creation of the Dark Place, a supernatural realm wherein fiction can be made into reality. As negative rumors spread about Wake after his disappearance into the Dark Place in the first game, the Dark Place brought these rumors to life, creating the serial killer Mr. Scratch who seeks to take over and ruin Wake's life. Mr. Scratch only appears briefly in Alan Wake, but is the main antagonist of American Nightmare.

Scientific applications

Heautoscopy is a term used in psychiatry and neurology for the hallucination of "seeing one's own body at a distance". It can occur as a symptom in schizophrenia and epilepsy, and is considered a possible explanation for doppelgänger phenomena.

Criminologists find a practical application in the concepts of facial familiarity and similarity due to the instances of wrongful convictions based on eyewitness testimony. In one case, a person spent 17 years behind bars persistently denying any involvement with the crime of which he was accused. He was finally released after someone was found who shared a striking resemblance and the same first name.

Capgras delusion

Capgras delusion
Other namesCapgras syndrome
Pronunciation
SpecialtyPsychiatry

Capgras delusion is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, or other close family member (or pet) has been replaced by an identical impostor. It is named after Joseph Capgras (1873–1950), a French psychiatrist.

The Capgras delusion is classified as a delusional misidentification syndrome, a class of delusional beliefs that involves the misidentification of people, places, or objects. It can occur in acute, transient, or chronic forms. Cases in which patients hold the belief that time has been "warped" or "substituted" have also been reported.

The delusion most commonly occurs in individuals diagnosed with paranoid schizophrenia but has also been seen in brain injury, dementia with Lewy bodies, and other dementia. It presents often in individuals with a neurodegenerative disease, particularly at an older age. It has also been reported as occurring in association with diabetes, hypothyroidism, and migraine attacks. In one isolated case, the Capgras delusion was temporarily induced in a healthy subject by the drug ketamine. It occurs more frequently in females, with a female to male ratio of approximately 3 to 2.

Signs and symptoms

The following two case reports are examples of the Capgras delusion in a psychiatric setting:

Mrs. D, a 74-year-old married housewife, recently discharged from a local hospital after her first psychiatric admission, presented to our facility for a second opinion. At the time of her admission earlier in the year, she had received the diagnosis of atypical psychosis because of her belief that her husband had been replaced by another unrelated man. She refused to sleep with the impostor, locked her bedroom and door at night, asked her son for a gun, and finally fought with the police when attempts were made to hospitalise her. At times she believed her husband was her long deceased father. She easily recognised other family members and would misidentify her husband only.

— Passer and Warnock, 1991

Diane was a 28-year-old single woman who was seen for an evaluation at a day hospital program in preparation for discharge from a psychiatric hospital. This was her third psychiatric admission in the past five years. Always shy and reclusive, Diane first became psychotic at age 23. Following an examination by her physician, she began to worry that the doctor had damaged her internally and that she might never be able to become pregnant. The patient's condition improved with neuroleptic treatment but deteriorated after discharge because she refused medication. When she was admitted eight months later, she presented with delusions that a man was making exact copies of people—"screens"—and that there were two screens of her, one evil and one good. The diagnosis was schizophrenia with Capgras delusion. She was disheveled and had a bald spot on her scalp from self-mutilation.

— Sinkman, 2008

The following case is an instance of the Capgras delusion resulting from a neurodegenerative disease:

Fred, a 59-year-old man with a high school qualification, was referred for neurological and neuropsychological evaluation because of cognitive and behavioural disturbances. He had worked as the head of a small unit devoted to energy research until a few months before. His past medical and psychiatric history was uneventful. [...] Fred's wife reported that about 15 months from onset he began to see her as a "double" (her words). The first episode occurred one day when, after coming home, Fred asked her where Wilma was. On her surprised answer that she was right there, he firmly denied that she was his wife Wilma, whom he "knew very well as his sons' mother", and went on plainly commenting that Wilma had probably gone out and would come back later. [...] Fred presented progressive cognitive deterioration characterised both by severity and fast decline. Apart from [Capgras disorder], his neuropsychological presentation was hallmarked by language disturbances suggestive of frontal-executive dysfunction. His cognitive impairment ended up in a severe, all-encompassing frontal syndrome.

— Lucchelli and Spinnler, 2007

Causes

It is generally agreed that the Capgras delusion has a complex and organic basis (caused by structural damage to organs) and can be better understood by examining neuroanatomical damage associated with the syndrome.

In one of the first papers to consider the cerebral basis of the Capgras delusion, Alexander, Stuss and Benson pointed out in 1979 that the disorder might be related to a combination of frontal lobe damage causing problems with familiarity and right hemisphere damage causing problems with visual recognition.

Further clues to the possible causes of the Capgras delusion were suggested by the study of brain-injured patients who had developed prosopagnosia. In this condition, patients are unable to recognize faces consciously, despite being able to recognize other types of visual objects. However, a 1984 study by Bauer showed that even though conscious face recognition was impaired, patients with the condition showed autonomic arousal (measured by a galvanic skin response measure) to familiar faces, suggesting that there are two pathways to face recognition—one conscious and one unconscious.

In a 1990 paper published in the British Journal of Psychiatry, psychologists Hadyn Ellis and Andy Young hypothesized that patients with Capgras delusion may have a "mirror image" or double dissociation of prosopagnosia, in that their conscious ability to recognize faces was intact, but they might have damage to the system that produces the automatic emotional arousal to familiar faces. This might lead to the experience of recognizing someone while feeling something was not "quite right" about them. In 1997, Ellis and his colleagues published a study of five patients with Capgras delusion (all diagnosed with schizophrenia) and confirmed that although they could consciously recognize the faces, they did not show the normal automatic emotional arousal response. The same low level of autonomic response was shown in the presence of strangers. Young (2008) has theorized that this means that patients with the disease experience a "loss" of familiarity, not a "lack" of it. Further evidence for this explanation comes from other studies measuring galvanic skin responses (GSR) to faces. A patient with Capgras delusion showed reduced GSRs to faces in spite of normal face recognition. This theory for the causes of Capgras delusion was summarised in Trends in Cognitive Sciences in 2001.

William Hirstein and Vilayanur S. Ramachandran reported similar findings in a paper published on a single case of a patient with Capgras delusion after brain injury. Ramachandran portrayed this case in his book Phantoms in the Brain and gave a talk about it at TED 2007. Since the patient was capable of feeling emotions and recognizing faces but could not feel emotions when recognizing familiar faces, Ramachandran hypothesizes that the origin of Capgras syndrome is a disconnection between the temporal cortex, where faces are usually recognized (see temporal lobe), and the limbic system, involved in emotions. More specifically, he emphasizes the disconnection between the amygdala and the inferotemporal cortex.

In 2010, Hirstein revised this theory to explain why a person with Capgras syndrome would have the particular reaction of not recognizing a familiar person. Hirstein explained the theory as follows:

my current hypothesis on Capgras, which is a more specific version of the earlier position I took in the 1997 article with V. S. Ramachandran. According to my current approach, we represent the people we know well with hybrid representations containing two parts. One part represents them externally: how they look, sound, etc. The other part represents them internally: their personalities, beliefs, characteristic emotions, preferences, etc. Capgras syndrome occurs when the internal portion of the representation is damaged or inaccessible. This produces the impression of someone who looks right on the outside, but seems different on the inside, i.e., an impostor. This gives a much more specific explanation that fits well with what the patients actually say. It corrects a problem with the earlier hypothesis in that there are many possible responses to the lack of an emotion upon seeing someone.

Furthermore, Ramachandran suggests a relationship between the Capgras syndrome and a more general difficulty in linking successive episodic memories because of the crucial role emotion plays in creating memories. Since the patient could not put together memories and feelings, he believed objects in a photograph were new on every viewing, even though they normally should have evoked feelings (e.g., a person close to him, a familiar object, or even himself). Others like Merrin and Silberfarb (1976) have also proposed links between the Capgras syndrome and deficits in aspects of memory. They suggest that an important and familiar person (the usual subject of the delusion) has many layers of visual, auditory, tactile, and experiential memories associated with them, so the Capgras delusion can be understood as a failure of object constancy at a high perceptual level.

Most likely, more than just an impairment of the automatic emotional arousal response is necessary to form the Capgras delusion, as the same pattern has been reported in patients showing no signs of delusions. Ellis suggested that a second factor explains why this unusual experience is transformed into a delusional belief; this second factor is thought to be an impairment in reasoning, although no definitive impairment has been found to explain all cases. Many have argued for the inclusion of the role of patient phenomenology in explanatory models of the Capgras syndrome in order to better understand the mechanisms that enable the creation and maintenance of delusional beliefs.

Capgras syndrome has also been linked to reduplicative paramnesia, another delusional misidentification syndrome in which a person believes a location has been duplicated or relocated. Since these two syndromes are highly associated, it has been proposed that they affect similar areas of the brain and therefore have similar neurological implications. Reduplicative paramnesia is understood to affect the frontal lobe, and thus it is believed that Capgras syndrome is also associated with the frontal lobe. Even if the damage is not directly to the frontal lobe, an interruption of signals between other lobes and the frontal lobe could result in Capgras syndrome.

Diagnosis

Because it is a rare and poorly understood condition, there is no definitive way to diagnose the Capgras delusion. Diagnosis is primarily made on a psychiatric evaluation of the patient, who is most likely brought to a psychiatrist's attention by a family member or friend believed to be an imposter by the person under the delusion.

Treatment

Treatment has not been well studied and so there is no evidence-based approach. Treatment is generally therapy, often with support of antipsychotic medication.

History

Capgras syndrome is named after Joseph Capgras, a French psychiatrist who first described the disorder in 1923 in his paper co-authored by Jean Reboul-Lachaux, on the case of a French woman, "Madame Macabre," who complained that corresponding "doubles" had taken the places of her husband and other people she knew. Capgras and Reboul-Lachaux first called the syndrome "l'illusion des sosies", which can be translated literally as "the illusion of look-alikes."

The syndrome was initially considered a purely psychiatric disorder, the delusion of a double seen as symptomatic of schizophrenia, and purely a female disorder (though this is now known not to be the case) often noted as a symptom of hysteria. Most of the proposed explanations initially following that of Capgras and Reboul-Lachaux were psychoanalytical in nature. It was not until the 1980s that attention was turned to the usually co-existing organic brain lesions originally thought to be essentially unrelated or accidental. Today, the Capgras syndrome is understood as a neurological disorder, in which the delusion primarily results from organic brain lesions or degeneration.

Cultural references

In the Memoirs Found in a Bathtub novel by the Polish writer Stanisław Lem, first published in 1961 the narrator inhabits a paranoid dystopia where nothing is as it seems, chaos seems to rule all events, and everyone is deeply suspicious of everyone. In the end, it is revealed that the world is filled by phantom body doubles.

A central character in Richard Powers's 2006 novel The Echo Maker suffers from Capgras Delusion subsequent to traumatic brain injury.

The protagonist in the movie Synecdoche, New York, who is named Caden Cotard (played by Philip Seymour Hoffman), goes to see his ex-wife at her apartment, and, as he enters the building, one of the resident call boxes is taped with the name "Capgras". He is then misidentified as his ex-wife's cleaning lady, Ellen Bascomb, as he tries to enter the apartment, and, later in the film, he actually comes to play the role of Ellen Bascomb in his own play. Throughout the film, Cotard enlists actor-doubles to play actors, and, as the film progresses, the actor-doubles are in turn then given actors-doubles.

Delusion

From Wikipedia, the free encyclopedia
 
Delusion
SpecialtyPsychiatry

A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, or some other misleading effects of perception.

Delusions have been found to occur in the context of many pathological states (both general physical and mental) and are of particular diagnostic importance in psychotic disorders including schizophrenia, paraphrenia, manic episodes of bipolar disorder, and psychotic depression.

Types

Delusions are categorized into four different groups:

  • Bizarre delusion: Delusions are deemed bizarre if they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences. An example named by the DSM-5 is a belief that someone replaced all of one's internal organs with someone else's without leaving a scar, depending on the organ in question.
  • Non-bizarre delusion: A delusion that, though false, is at least technically possible, e.g., the affected person mistakenly believes that they are under constant police surveillance.
  • Mood-congruent delusion: Any delusion with content consistent with either a depressive or manic state, e.g., a depressed person believes that news anchors on television highly disapprove of them, or a person in a manic state might believe they are a powerful deity.
  • Mood-neutral delusion: A delusion that does not relate to the sufferer's emotional state; for example, a belief that an extra limb is growing out of the back of one's head is neutral to either depression or mania.

Themes

In addition to these categories, delusions often manifest according to a consistent theme. Although delusions can have any theme, certain themes are more common. Some of the more common delusion themes are:

  • Delusion of control: False belief that another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behavior.
  • Cotard delusion: False belief that one does not exist or that one has died.
  • Delusional jealousy: False belief that a spouse or lover is having an affair, with no proof to back up their claim.
  • Delusion of guilt or sin (or delusion of self-accusation): Ungrounded feeling of remorse or guilt of delusional intensity.
  • Delusion of mind being read: False belief that other people can know one's thoughts.
  • Delusion of thought insertion: Belief that another thinks through the mind of the person.
  • Delusion of reference: False belief that insignificant remarks, events, or objects in one's environment have personal meaning or significance. "Usually the meaning assigned to these events is negative, but the 'messages' can also have a grandiose quality."
  • Erotomania: False belief that another person is in love with them.
  • Religious delusion: Belief that the affected person is a god or chosen to act as a god.
  • Somatic delusion: Delusion whose content pertains to bodily functioning, bodily sensations or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal or changed. A specific example of this delusion is delusional parasitosis: Delusion in which one feels infested with insects, bacteria, mites, spiders, lice, fleas, worms, or other organisms.
  • Delusion of poverty: Person strongly believes they are financially incapacitated. Although this type of delusion is less common now, it was particularly widespread in the days preceding state support.

Grandiose delusions or delusions of grandeur are principally a subtype of delusional disorder but could possibly feature as a symptom of schizophrenia and manic episodes of bipolar disorder. Grandiose delusions are characterized by fantastical beliefs that one is famous, omnipotent or otherwise very powerful. The delusions are generally fantastic, often with a supernatural, science-fictional, or religious bent. In colloquial usage, one who overestimates one's own abilities, talents, stature or situation is sometimes said to have "delusions of grandeur". This is generally due to excessive pride, rather than any actual delusions. Grandiose delusions or delusions of grandeur can also be associated with megalomania.

Persecutory delusions

Persecutory delusions are the most common type of delusions and involve the theme of being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, or otherwise obstructed in the pursuit of goals. Persecutory delusions are a condition in which the affected person wrongly believes that they are being persecuted. Specifically, they have been defined as containing two central elements: The individual thinks that:

  1. harm is occurring, or is going to occur.
  2. the persecutor(s) has (have) the intention to cause harm.

According to the DSM-IV-TR, persecutory delusions are the most common form of delusions in schizophrenia, where the person believes they are "being tormented, followed, sabotaged, tricked, spied on, or ridiculed." In the DSM-IV-TR, persecutory delusions are the main feature of the persecutory type of delusional disorder. When the focus is to remedy some injustice by legal action, they are sometimes called "querulous paranoia".

Causes

Explaining the causes of delusions continues to be challenging and several theories have been developed. One is the genetic or biological theory, which states that close relatives of people with delusional disorder are at increased risk of delusional traits. Another theory is the dysfunctional cognitive processing, which states that delusions may arise from distorted ways people have of explaining life to themselves. A third theory is called motivated or defensive delusions. This one states that some of those persons who are predisposed might suffer the onset of delusional disorder in those moments when coping with life and maintaining high self-esteem becomes a significant challenge. In this case, the person views others as the cause of their personal difficulties in order to preserve a positive self-view.

This condition is more common among people who have poor hearing or sight. Also, ongoing stressors have been associated with a higher possibility of developing delusions. Examples of such stressors are immigration, low socioeconomic status, and even possibly the accumulation of smaller daily hassles.

Specific delusions

The top two factors mainly concerned in the germination of delusions are: 1. Disorder of brain functioning; and 2. background influences of temperament and personality.

Higher levels of dopamine qualify as a symptom of disorders of brain function. That they are needed to sustain certain delusions was examined by a preliminary study on delusional disorder (a psychotic syndrome) instigated to clarify if schizophrenia had a dopamine psychosis. There were positive results - delusions of jealousy and persecution had different levels of dopamine metabolite HVA and homovanillyl alcohol (which may have been genetic). These can be only regarded as tentative results; the study called for future research with a larger population.

It is too simplistic to say that a certain measure of dopamine will bring about a specific delusion. Studies show age and gender to be influential and it is most likely that HVA levels change during the life course of some syndromes.

On the influence of personality, it has been said: "Jaspers considered there is a subtle change in personality due to the illness itself; and this creates the condition for the development of the delusional atmosphere in which the delusional intuition arises."

Cultural factors have "a decisive influence in shaping delusions". For example, delusions of guilt and punishment are frequent in a Western, Christian country like Austria, but not in Pakistan, where it is more likely persecution. Similarly, in a series of case studies, delusions of guilt and punishment were found in Austrian patients with Parkinson's being treated with l-dopa, a dopamine agonist.

Pathophysiology

The two-factor model of delusions posits that dysfunction in both belief formation systems and belief evaluation systems are necessary for delusions. Dysfunction in evaluations systems localized to the right lateral prefrontal cortex, regardless of delusion content, is supported by neuroimaging studies and is congruent with its role in conflict monitoring in healthy persons. Abnormal activation and reduced volume is seen in people with delusions, as well as in disorders associated with delusions such as frontotemporal dementia, psychosis and Lewy body dementia. Furthermore, lesions to this region are associated with "jumping to conclusions", damage to this region is associated with post-stroke delusions, and hypometabolism this region associated with caudate strokes presenting with delusions.

The aberrant salience model suggests that delusions are a result of people assigning excessive importance to irrelevant stimuli. In support of this hypothesis, regions normally associated with the salience network demonstrate reduced grey matter in people with delusions, and the neurotransmitter dopamine, which is widely implicated in salience processing, is also widely implicated in psychotic disorders.

Specific regions have been associated with specific types of delusions. The volume of the hippocampus and parahippocampus is related to paranoid delusions in Alzheimer's disease, and has been reported to be abnormal post mortem in one person with delusions. Capgras delusions have been associated with occipito-temporal damage and may be related to failure to elicit normal emotions or memories in response to faces.

Diagnosis

James Tilly Matthews illustrated this picture of a machine called an “air loom”, which he believed was being used to torture him and others for political purposes.

The modern definition and Jaspers' original criteria have been criticised, as counter-examples can be shown for every defining feature.

Studies on psychiatric patients show that delusions vary in intensity and conviction over time, which suggests that certainty and incorrigibility are not necessary components of a delusional belief.

Delusions do not necessarily have to be false or 'incorrect inferences about external reality'. Some religious or spiritual beliefs by their nature may not be falsifiable, and hence cannot be described as false or incorrect, no matter whether the person holding these beliefs was diagnosed as delusional or not. In other situations the delusion may turn out to be true belief. For example, in delusional jealousy, where a person believes that their partner is being unfaithful (and may even follow them into the bathroom believing them to be seeing their lover even during the briefest of partings), it may actually be true that the partner is having sexual relations with another person. In this case, the delusion does not cease to be a delusion because the content later turns out to be verified as true or the partner actually chose to engage in the behavior of which they were being accused.

In other cases, the belief may be mistakenly assumed to be false by a doctor or psychiatrist assessing it, just because it seems to be unlikely, bizarre or held with excessive conviction. Psychiatrists rarely have the time or resources to check the validity of a person’s claims leading to some true beliefs to be erroneously classified as delusional. This is known as the Martha Mitchell effect, after the wife of the attorney general who alleged that illegal activity was taking place in the White House. At the time, her claims were thought to be signs of mental illness, and only after the Watergate scandal broke was she proved right (and hence sane).

Similar factors have led to criticisms of Jaspers' definition of true delusions as being ultimately 'un-understandable'. Critics (such as R. D. Laing) have argued that this leads to the diagnosis of delusions being based on the subjective understanding of a particular psychiatrist, who may not have access to all the information that might make a belief otherwise interpretable. R. D. Laing's hypothesis has been applied to some forms of projective therapy to "fix" a delusional system so that it cannot be altered by the patient. Psychiatric researchers at Yale University, Ohio State University and the Community Mental Health Center of Middle Georgia have used novels and motion picture films as the focus. Texts, plots and cinematography are discussed and the delusions approached tangentially. This use of fiction to decrease the malleability of a delusion was employed in a joint project by science-fiction author Philip Jose Farmer and Yale psychiatrist A. James Giannini. They wrote the novel Red Orc's Rage, which, recursively, deals with delusional adolescents who are treated with a form of projective therapy. In this novel's fictional setting other novels written by Farmer are discussed and the characters are symbolically integrated into the delusions of fictional patients. This particular novel was then applied to real-life clinical settings.

Another difficulty with the diagnosis of delusions is that almost all of these features can be found in "normal" beliefs. Many religious beliefs hold exactly the same features, yet are not universally considered delusional. For instance, if a person was holding a true belief then they will of course persist with it. This can cause the disorder to be misdiagnosed by psychiatrists. These factors have led the psychiatrist Anthony David to note that "there is no acceptable (rather than accepted) definition of a delusion." In practice, psychiatrists tend to diagnose a belief as delusional if it is either patently bizarre, causing significant distress, or excessively pre-occupying the patient, especially if the person is subsequently unswayed in belief by counter-evidence or reasonable arguments.

It is important to distinguish true delusions from other symptoms such as anxiety, fear, or paranoia. To diagnose delusions a mental state examination may be used. This test includes appearance, mood, affect, behavior, rate and continuity of speech, evidence of hallucinations or abnormal beliefs, thought content, orientation to time, place and person, attention and concentration, insight and judgment, as well as short-term memory.

Johnson-Laird suggests that delusions may be viewed as the natural consequence of failure to distinguish conceptual relevance. That is, the person takes irrelevant information and puts it in the form of disconnected experiences, then it is taken to be relevant in a manner that suggests false causal connections. Furthermore, the person takes the relevant information, in the form of counterexamples, and ignores it.

Definition

Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher Karl Jaspers was the first to define the three main criteria for a belief to be considered delusional in his 1913 book General Psychopathology. These criteria are:

  • certainty (held with absolute conviction)
  • incorrigibility (not changeable by compelling counterargument or proof to the contrary)
  • impossibility or falsity of content (implausible, bizarre, or patently untrue)

Furthermore, when a false belief involves a value judgment, it is only considered a delusion if it is so extreme that it cannot be, or never can be proven true. For example: a man claiming that he flew into the Sun and flew back home. This would be considered a delusion, unless he were speaking figuratively, or if the belief had a cultural or religious source.

Robert Trivers writes that delusion is a discrepancy in relation to objective reality, but with a firm conviction in reality of delusional ideas, which is manifested in the "affective basis of delusion" Trivers, Robert (2002). Natural Selection and Social Theory: Selected Papers of Robert Trivers. Oxford University Press. ISBN 978-0-19-513062-1.

Criticism

Some psychiatrists criticize the practice of defining one and the same belief as normal in one culture and pathological in another culture for cultural essentialism. They argue that since cultural influences are mixed, including not only parents and teachers but also peers, friends, books and the internet, and the same cultural influence can have different effects depending on earlier cultural influences, the assumption that culture can be boiled down to a few traceable, distinguishable and statistically quantifiable factors and that everything that does not fall in those factors must be biological, is not a justified assumption. Other critical psychiatrists argue that just because a person's belief is unshaken by one influence does not prove that it would remain unshaken by another. For example, a person whose beliefs are not changed by verbal correction from a psychiatrist, which is how delusion is usually diagnosed, may still change his or her mind when observing empirical evidence, only that psychiatry rarely if ever present patients with such situations.

Gaslighting

Sometimes a correct belief may be mistaken for a delusion, such as when the belief in question is not demonstrably false but is nevertheless considered beyond the realm of possibility. A specific variant of this is when a person is fed lies in an attempt to convince them that they are delusional, a process called gaslighting, after the 1938 play Gaslight, the plot of which centered around the process. Sometimes, gaslighting can be unintentional, for example if a person, or a group of people aim to lie or cover up an issue, it can lead to the victim being gaslighted as well.

Treatment

Psychotherapies that may be helpful in delusional disorder include individual psychotherapy, cognitive-behavioral therapy (CBT), and family therapy.

Georgism

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