Diseases and Disorders

Capgras Syndrome: An Ethical Review

Divya Venkataraman


Abstract

Imagine waking up one morning to the smell of fresh baked cookies from your loving mother. Now, imagine seeing your mother, but thinking that she is an imposter, someone who looks exactly like your mother, but isn’t. “My parents looked funny the other day… I think they’ve been replaced by imposters,” Janet, a patient of Capgras Syndrome said [1]. Needless to say, this syndrome is surrounded by numerous ethical controversies. This article explores the causes and symptoms of Capgras Syndrome and the possible treatments that have been proposed, to then review the ethical and societal concerns behind this peculiar syndrome.
 

Etiology and Symptomatology

Many patients of Capgras Syndrome have numerous areas of damage in their brain. However, scientists like Dr. VS Ramachandran have realized that the damage in Capgras patients isn’t usually in the specific parts of the brain responsible for face recognition (like the fusiform gyrus), but instead in the connections between those areas (e.g. fusiform gyrus to the amygdala) [2]. In fact, Dr. Ramachandran states that the connection between the fusiform gyrus and amygdala must have been damaged, since the connection allows humans to associate specific emotions to the face recognized (e.g. love for mother). However, because this connection is severed in Capgras patients, as displayed in Figure 1, they can recognize the face as their mother’s, but cannot sense any emotional connection to their mother. To justify this lack of emotion, their brain concludes that their mother is an imposter [3].

As mentioned above, the most astonishing symptom of Capgras Syndrome is the mind believing that all loved ones are imposters. However, patients also tend to think that pets, distant people, or even objects are imposters. This recognition of people and things is so strong that no recorded amount of evidence can tell any patient otherwise. It was thought that this peculiar syndrome stems from violence, but recent research has suggested that this likely originates from other neurological conditions like Alzheimer’s disease [2].

 

Treatment

Unfortunately, there aren’t many treatments for this disease. Some drugs used to treat dementia such as donepezil, rivastigmine, and galantamine have helped with the syndrome by reducing symptoms. Additionally, antipsychotic medications like olanzapine and pimozide can ease delusions. Antidepressants have also helped in some cases [2].

However, the main treatment used is therapy. The first type is habilitation therapy, which is when loved ones try to understand what the patient is going through and be in the patients’ shoes. This allows loved ones to empathize with the patient more, which in turn prevents harsh interactions between the two. Habilitation therapy also says that one should never argue with or correct a Capgras syndrome patient, especially since the patient believes the loved one to be an imposter, and arguing will only emphasize this even more. Finally, the last part of Habilitation therapy is the idea of letting the patient know that you are there for them after understanding what they are going through. However hard this may be, a loved one’s empathy will suppress some of the hatred that patients feel. [6] The second type is validation therapy, which gives the patient a sense of safety. However, this is only used if the patient had previously thought that the imposter was dangerous. Finally, there is family counseling, which has helped in a few reported cases, by reducing the anxiety and fear of the patients [2].

 

Ethical and Social Implications

The most obvious issue is that many people don’t know that Capgras Syndrome exists. To allow this syndrome to reach the medical attention it deserves, more awareness needs to be spread about this psychiatric delusion and how to help [3].

Unfortunately, society tends to disregard diseases that are seen as delusions, and Capgras Syndrome is a victim of this unjust societal and ethical law. Many people and doctors who haven’t seen someone with Capgras Syndrome, which is likely much of the population, categorize Capgras Syndrome as ‘delusional’. This in turn is detrimental to Capgras Syndrome’s progress in society. Delusional diseases like Capgras Syndrome are considered to be treated by only psychotherapeutic methods. Although this has been proven wrong time and time again, since the syndrome doesn’t have much societal awareness, this maintains to be on the ethical radar [4]. Due to this, there is a societal issue surrounding patients with Capgras Syndrome. Because of the rarity of the disease, those who have it tend to be ridiculed or ignored. Not many people are educated about this syndrome and tend to categorize the patient as “crazy”.

The last ethical issue surrounds treatments. Since there aren’t many treatments available, and the ones that are there are multi-purposed (initially meant for something else), many have a hard time believing that Capgras Syndrome needs to be taken seriously [4]. They believe that if scientists aren’t finding treatments for it, it is not worth their attention. What they fail to understand is that scientists are working on treatments, but due to a relatively decreased understanding of Capgras Syndrome, treatments are hard to find. This explains the necessity of spreading awareness of Capgras Syndrome.

 

Discussion

Capgras Syndrome, contrary to popular belief, is a serious disorder that needs more recognition. Patients not only suffer from the medical symptoms of this syndrome, but the consequences due to the ethical and societal issues as well. Yet, the syndrome is not getting the attention it deserves [5]. Due to a lack of emotional ability, kids see their parents as an imposter, out to get them. Adults are unable to love their kids, seeing them as imposters. To a patient, all of their loved ones, who usually help and support them, have been taken over by imposters. This syndrome can be very detrimental, and needs more awareness across the globe.

There are also many ways through which society can help this issue. To begin, people can spread the word about this syndrome by telling someone about it. One person can make a huge difference in the progression of the disease. Also, promote the syndrome rather than putting it down. Capgras Syndrome already has a negative stigma in the community, and society should actively be trying to obliviate that pessimism, one person at a time.


References


  1. Carol W. Berman, M. D. (04/09/2011). Ever Thought Your Loved One Was An Impostor? Understanding Capgras Syndrome. https://www.huffpost.com/entry/capgras-syndrome_b_888854. Retrieved: 04/07/2020.

  2. Bhandari, S. (06/01/2020). Capgras Syndrome (Impostor Syndrome): Symptoms, Treatment & More. WebMD. https://www.webmd.com/mental-health/impostor-syndrome-capgras. Retrieved: 04/07/2020.

  3. Ramachandran, V. S. (03/2007). Transcript of "3 clues to understanding your brain". TED. https://www.ted.com/talks/vs_ramachandran_3_clues_to_understanding_your_brain/transcript. Retrieved: 05/07/2020.

  4. BCA-clinic, & BCA-lab. (01/11/2019). Why Morgellons Disease Is Still Not Taken Seriously... And Why It Really Should Be - BCA-Clinic. https://www.bca-clinic.com/why-morgellons-disease-is-still-not-taken-seriously-and-why-it-really-should-be/. Retrieved: 09/07/2020.

  5. RJ;, B. (08/1983). Capgras' syndrome. https://pubmed.ncbi.nlm.nih.gov/6869616/. Retrieved: 12/07/2020.

  6. Bier, D. (08/10/2018). Dementia and Capgras Syndrome: Handling Behavior and Emotional Fallout. Psych Central. https://psychcentral.com/lib/dementia-and-capgras-syndrome-handling-behavior-and-emotional-fallout/.  Retrieved: 14/12/2020.

Divya Venkataraman

Divya Venkataraman


Divya is a high school sophomore in Monta Vista High School. She has always been incredibly fascinated with biology, neuroscience, and psychology. Her passion lies in research and medicine, and she is especially interested in neurological/neurodegenerative diseases. She enjoys making a positive impact in the world around her, whether it be through research, public speaking, tutoring, leading organizations, or advocating for mental health. In her free time, Divya loves to play the piano, dance, and read!