ONE OF FEINBERG'S Capgras-syndrome cases, for example, is eerily reminiscent of Poe's "William Wilson," in which the protagonist is tormented by his double. Feinberg's case involves S. M., a 77-year-old woman who had been deaf since the age of five. She was found signing in front of the mirrors in her home and explained that she was communicating via sign language with "the other S. M." This double, she explained, was identical to her, also deaf -- but not as "bright." As Feinberg writes in Seminars in Neurology, S. M. was "presented with a stimulus that should be quite familiar and that indeed can be verified as being familiar" -- her own image. Yet she "still claims an estrangement, alienation, or disavowal from the object."
The most common perturbation encountered by the neurologist in clinical practice, says Feinberg, is asomatognosia, which literally means "lack of recognition of the body." Asomatognosic patients do not recognize a portion of their bodies -- even more, they often actually disavow those parts and sometimes develop stories to explain their dissociation from their own bodies. Feinberg calls this phenomenon "personal confabulation": a falsification that the falsifier believes to be true.
Since the right side of the brain controls the left side of the body, Feinberg points out, the left arm is by far the most commonly rejected or misidentified part of the body among patients who have suffered damage to the right hemisphere. And some of the brain-damaged patients he videotaped had a condition known as hemispatial neglect, in which they ignore stimuli in the area of space on the side opposite to a brain lesion.
One patient, a 64-year-old construction worker with a right-hemisphere stroke and paralysis of his left arm, even denied he was ill (a condition known as anosognosia). Although Feinberg informed him that he was in Beth Israel Medical Center, the patient insisted he was at his job site. Then he volunteered information that he apparently believed but was subsequently found to be false: "My mother's in the hospital right now ... She had a stroke while she was in the hospital." And when Feinberg lifted the patient's paralyzed left arm and asked what it was, the patient replied: "My mother-in-law's hand. Someone's hand."
To Feinberg, the appearance of the mother and mother-in-law in the patient's account suggests that there are other issues involved besides paralysis from stroke. In similar cases, he says, some health professionals might attribute all the patient's behavior to brain damage; but in Feinberg's view, "the pre-morbid personality is very important." Physicians and family members, he cautions, must try to learn "what the patient brings to the table" before the brain damage.
In a way, Feinberg's willingness to draw upon different disciplines could be seen as a response to the dominant theory when he was an undergraduate. "The big thing in 1973 and '74 was behaviorism," he says. "I couldn't stand it." For all its attempts to be scientific, he found behaviorism terribly reductive. Now, he feels, with the coming together of cognitive psychology and neuroscience, the urge to be scientific in explaining psychological disorders has a stronger foundation.
A particularly haunting case that Feinberg videotaped features a woman in her seventies who was admitted to Mount Sinai Hospital. After an acute stroke involving her right hemisphere, her left arm was paralyzed. She persistently identified her left arm as Feinberg's or as a "breast" or a "deodorant." She also spoke frequently of her fears of being ill and dying, and Feinberg notes that she developed an elaborate personal confabulation regarding her dead husband and his hands. In fact, the patient insisted that her husband had left her his hands in his will: "He just left them like he left his clothes." As a result, she said, she recently put them in the garbage.
Why, she was asked, had she got rid of them after all those years? "Because I got the stroke -- and I thought maybe I'd die here like he did!"
As Feinberg sees it, the patient finds it difficult to talk about her own illness directly; thus, she denies that the paralyzed arm is hers while she confabulates a story about her dead husband's inanimate hands. Her case, says Feinberg, also illustrates the Fregoli syndrome, in which the patient insists that someone who is actually unfamiliar to her is someone whom the patient really knows -- a little like The Wizard of Oz, in which Dorothy receives a blow to the head during the tornado and is "transported" to another world. The unfamiliar -- the Tin Man, the Cowardly Lion, and so on -- seem uncannily familiar, and when Dorothy "returns" to Kansas, she recognizes them among her everyday acquaintances: "You were there, and you were there!" Where the Capgras syndrome suggests a feeling of jamais vu, a sense of never having seen something before, the Fregoli syndrome suggests deja vu.
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Copyright 1998 The Pennsylvania Gazette Last modified 3/13/98