By Joel A. Moskowitz, M.D

Capgras Syndrome is a rare psychiatric condition.  Some (sadistic) examiners in the process of determining a candidate's qualification for Board Certification in Psychiatry will ask them to describe Capgras Syndrome.  Many may argue that it is useless medical minutiae and proves
nothing about the applicant's knowledge of the literature.

Amazingly, the recent awards in fiction praise a book where Capgras Syndrome is the theme. Some 30 years ago, I had an expert's interest in this exotic disorder.

When I learned that a novel, The Echo Maker, was chosen as a finalist in the National Book Awards and its central theme was Capgras Syndrome, I was
fascinated.

This is author, Richard Power's ninth novel.  The novel is complex and complicated. A Nebraska slaughterhouse machine mechanic suffers head injuries and a curious amnesia when his truck turns over at eighty miles an hour.  When he 'awakens', his sister is a stranger to him.  He doesn't
recognize her; feel anything for her; nor for his dog!  He remembers this woman, Karin, but believes it is not his true sister but an imposter.  A cognitive neurologist/psychoanalyst strives to understand and repair this curious deficit.

While on the faculty at The New York State Psychiatric Institute of Columbia University, I was asked by a rabbi to help a young boy who was terror stricken by the belief that his parents were replaced by aliens   He was filled with panic in their presence.  I made the diagnosis of Capgras
Syndrome. That he was soon to be 'a man' with all the responsibilities that are conferred by becoming a bar mitzvah was extremely threatening to him.  Hostile urges and thoughts would then become potentially punishable.

His parents, were they to know of his resentments, anger and hostility, would surely retaliate in the most annihilating way. To avoid this confrontation he retreated into unconscious fantasy and psychosis.

The 'illusion of doubles' (Capgras Syndrome) is described as a rare and exotic condition, more common in adult females and occasionally in association with trauma to the brain. It is seldom noted in children.  I decided that this case, in a young boy, was worthy of being reported:
"Capgras Syndrome in Modern Dress" International Journal of Child Psychiatry, April 1972, pp 45-64. My article offers a review of the initial description of this condition.

The name, Capgras, is credited to a description by French Psychiatrist, Jean Marie Joseph Capgras in 1923, as illusion des sosie - but Valentin Magnan had described the same syndrome as early as 1893 and Robert Bessiere wrote of it in 1913.

My contribution included an extensive case history, psychoanalytic, cognitive and behavioral dynamics and the method whereby I achieved successful treatment, Also see: "Capgras Syndrome in male siblings" American Journal of Psychiatry. 1975.  Jan: 132 (1) and "Communicative Meaning in Capgras Syndrome" American Journal of. Psychiatry 1973, Nov. 130 et seq.

Powers utilizes the mystery of the illusion of doubles, Capgras Syndrome, to invite the reader to consider how we think about life, our environment and our connections with each other.  For the reader whose preferences are limited to CSI, the neuroscience may be too complex.  The author's imagery may present linguistic challenges.  Readers who delight in a tangled web
will probably admire much in this tale of many themes.

If we simply accept that brain trauma shakes up memory traces in thus far unfathomable confusions, what happened to this accident victim is but a stage for Powers to cogitate about parallel concerns such as what is happening to our planet.

Alternatively, my psychoanalytic theses, which strived to explain what caused a 13-year-old boy (and perhaps others afflicted) to experience his paranoid delusion/illusion, may be, as Freud counseled, only our mythology.  But treatment for my patient was achieved, in part,  by
offering religious absolution (using a cooperative Rabbi). What was Power's patient's underlying anxiety remains murky.  And for the purposes of his novel, elucidation may be unnecessary.

What we may agree about is that the brain is our last great frontier. Richard Powers invites his fans to speculate along with him.  The setting of The Echo Maker, namely Nebraska, calls to mind the alarming injunction "Toto, We are not in Kansas anymore!" The intricacies of our mental reason challenge all of us. Read this book.  And, if you have a good medical
library resource, may I respectfully offer my articles as well.