Capgras Delusion

The Capgras Delusion is the belief that a friend or family member has been replaced with an identical impostor. While most cases occur within patients suffering from paranoid schizophrenia, the delusion has also been found in those with brain damage and dementia. There is only one documented case where the patient had no previous diagnosis of mental disorders, and showed no sign of brain injury. Charles Malcolm was, for all intents and purposes, a perfectly healthy and sane man. Many theories have been presented to explain why Malcolm developed this delusion, the most common of which being that he held onto his late wife’s delusional beliefs as a form of mourning.

Harriet Starling-Malcolm developed a Capgras Delusion when an aneurysm severely damaged her brain. She began to believe that her younger brother, of whom she had custody, had been replaced. At first she kept this belief to herself, writing down her observations of her “other” brother in private journals. It was only when a CAT scan revealed the extensive damage the aneurysm had caused did she quietly inform her husband.

The night before her surgery to repair the aneurysm, Harriet asked to speak with her husband alone. The following is from Mr. Malcolm’s personal journal.

''Harriet goes into surgery tomorrow. I know that I should focus on that, on doing everything I can to help her get better, but I can’t stop thinking about what she said last night. It’s crazy. I know it’s crazy. People with this kind of brain damage say weird things all the time. But, I have to admit that I can’t stop wondering “What if?”''

''She held my hand so tight, and her voice shook so hard it took a while for me to understand what she was saying. I thought that she was scared for her surgery at first. I know I am. There’s a big chance she might not make it. I tried to tell her that I was scared too, but that I was there for her, and that everything was gonna be ok, but she just shook her head and beckoned me to come closer. What she whispered in my ear sent chills up my spine.''

“Nolan’s gone, Charlie. That’s someone else. I don’t know who he is, but it’s not him. I’m so sorry.”

''She kept saying “I’m sorry” over and over again. I didn’t understand why and tried to tell her it was ok, but she wouldn’t listen to me. I stayed with her until the nurses told me I had to leave.''

I keep looking at Nolan, wondering what she could have meant, but I just don’t know.

Mrs. Malcolm-Starling did not survive the operation. Charles received custody of then 15 year old Nolan Starling. While they both mourned the loss of of their loved one, grief seemed to push them apart instead of bring them together.

“He kept accusing me of doing things that he thought I normally wouldn’t do,” said Nolan Starling in an interview last year. “Like putting the dishes in the wrong cabinet or tying my shoes the wrong way. He said it was evidence that I wasn’t really me. It freaked me out, and we fought a lot. I would sneak out at night and sleep at a friend’s house sometimes, just to get away from him. He was always watching me, trying to catching me in the act of something. I don’t even know what.”

Malcolm’s paranoia escalated over the course of several months, until he finally had enough of the Other Nolan, and attacked him with a kitchen knife. The teenager suffered three stab wounds to the chest and stomach, and suffered severe blood loss, but managed to survive the attack. When Starling recovered, he was put into a foster home, while Malcolm was placed in a state-run mental institution where he remains today.

Now in his mid-twenties, Starling visits Malcolm regularly.

“I see him on his birthday and on Christmas,” says Starling. “I’ve forgiven him for what happened. I know it wasn’t his fault. He’s sick, you see. He can’t help it. In the end, he’s still my only family. My sister would have wanted me to take care of him.”

In a rare interview given two months ago, Malcolm only had one thing to say: “The real Nolan would never forgive me.”