The impostor’s delirium and our everyday mistakes – 03/04/2023 – Luciano Melo

If we were perfect, we would always update our ideas in response to facts. If the evidence changes, we would change our thoughts accordingly. But we, of imperfect matrix, often underutilize the news and insist on fixed convictions.

Thanks to mental biases, we miss opportunities again and again to realize that a subjective concept would be better classified as an opaque idea. A delusion is an extreme error of judgment in the face of available information. It is believing firmly in something despite all evidence to the contrary. Below, skeptical person reading me, I present three stories to demonstrate the complexity of the subject.

The first has as its protagonist an 83-year-old woman who, one morning, when looking at her husband, did not recognize him as such. For her, ahead of her was an imitation. Nervously, she shooed away the would-be forger. No one in the family knew yet, but the cause of the confusion was a brain tumor sitting in her right frontal lobe.

The second makes references to a 31-year-old man who spent a sleepless night consuming cocaine. He was furious and shouted insults at his wife, calling her a crook. For him, the wife was not the wife, but someone who tried to take the place of his true and “disappeared” companion. The situation was transitory, it lasted until the intoxication disappeared.

Both plots exemplify a specific delusion, whose theme is the replacement of someone very close by an identical imposter. This psychosis is recognized as Capgras Syndrome, a name that pays homage to Jean Marie Capgras (1873-1950), a French physician who studied with the best alienists of his time in Paris. In 1923, he identified “the doppelganger illusion” and described its clinical aspects in detail.

Capgras resorted to Freudian theories to point out the causes of this disorder. In his day, this was almost always how doctors explained the origins of mental illness. He taught that the anomaly was the consequence of determining factors, which included emotional shocks, psychic traumas and sociological conflicts. Delirium would be a mental construction to protect the individual from some danger.

With this perspective, the alienist admitted that one of his patients suffered from the “double illusion” due to an invention of the unconscious, forged to hide incestuous desires directed towards her father. If the male figure were disconnected from paternity, she would be morally free to desire whatever she wanted.

To arrive at conclusions of this kind, Capgras is said to have considered even the smallest details of his long conversations with the sick. Paradoxically, while claiming to care even about these subtle subtleties, he ignored that his patients struggled with illnesses such as syphilis and cognitive dysfunction. He didn’t even consider that these pains could be the cause of the disorder he revealed. My promise is fulfilled, I have just given you the third story.

However, clinical experiences accumulated decade by decade point out which diseases cause Capgras Syndrome. At first, it was thought that the culprits were just certain psychiatric illnesses, such as schizophrenia and mood disorders. We now know that degenerative disorders, such as Parkinson’s and Alzheimer’s diseases, cerebral ischemia, brain tumors, intoxication, among others, can cause such delirium.

If these conditions interrupt certain flows of information processed in the brain, Capgras Syndrome will emerge. In this way, visual systems identify a given human figure, then create data that partially activate memory elements. There is a failure to remember emotional and some cognitive aspects. The brain reaches the image but not its meaning, the familiarity becomes intangible.

There is also another flaw, the mind loses criticism and ratifies a bizarre concept. I remind you that it is not necessary to have an injury, since intoxications can harm the aforementioned information traffic. For people with this delusion, there is something intuitively perceptible, though not nameable, that betrays the replacement of someone by a fake double.

In summary, the Capgras Syndrome implies that relevant evidence fails to affect a belief. At the same time, a relentless and inconsistent distrust overwhelms other perceptions and blurs the framework of understanding. In an unhealthy and exaggerated way, the brain fails to use the evidence in front of it to update its concepts. Quite simply, we do this all the time.

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