Restating the role of phenomenal experiencein the formation and maintenanceof the Capgras delusion

Garry Young

Published online: 13 February 2007# Springer Science + Business Media B.V. 2007

Abstract In recent times, explanations of the Capgras delusion have tended toemphasise the cognitive dysfunction that is believed to occur at the second stage oftwo-stage models. This is generally viewed as a response to the inadequacies of theone-stage account. Whilst accepting that some form of cognitive disruption is anecessary part of the aetiology of the Capgras delusion, I nevertheless argue that theemphasis placed on this second-stage is to the detriment of the important role playedby the phenomenology underlying the disorder, both in terms of the formation andmaintenance of the delusional belief. This paper therefore proposes an interactionisttwo-stage model in which the phenomenal experience of the Capgras patient isexamined, emphasised, and its relation to top-down processing discussed.

Key words Capgras delusion . phenomenal experience . lack and loss of familiarity .

recognition . experiential reorientation . bottom-up and top-down processing

Introduction

First described by Capgras and Reboul-Lachaux (1923), the Capgras delusion can bedefined as “a delusional belief in the existence of doubles of others or of oneself orof both” (Berson, 1983, 970). Moreover, such a belief usually involve thereplacement of one or more close relatives and/or friends by exact doubles. Thus,the belief that the relative (etc.) has been replaced indicates that the patient does notperceive both individuals simultaneously: the ‘real’ person is always absent, leavingjust a single yet identical impostor.

There appears to exist within the Capgras patient a conflict of recognition; aseeming paradox in which the object of perception is and yet is not recognised by

Phenom Cogn Sci (2008) 7:177–189DOI 10.1007/s11097-007-9048-0

G. Young (*)Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, UKe-mail: G.M.Young@leeds.ac.uk

the subject. Physically, including all mannerisms and voice patterns, the impostor issaid to be just like the real person, yet at the same time is not recognised as beingthat person.1 There exists, then, what Christodoulou (1977, 1991) referred to as thedelusional negation of the identity of a familiar person.

At present, preferred explanations of the Capgras delusion tend to centre around atwo-stage model in which an anomalous phenomenal experience at the first stage,and some form of reasoning and/or attribution bias or deficit at the second stage aresaid to account for the formation and maintenance of delusional beliefs (seeBortolotti, 2005; Davies & Coltheart, 2000; Ellis & Young, 1990; Klee, 2004; Stone& Young, 1997; Young & de Pauw, 2002). As Stone and Young (1997) state:

First, the patient experiences a perceptual disorder. The world looks different tothem, and this difference demands explanation... [But] in addition to theperceptual deficit, we need to understand the second factor, the reasoning styleof people who experience these delusions, in order to see why they arrive at andare satisfied with explanations that others find so bizarre. (346)

The two-stage model is seen as a response to the inadequacies of the one-stage model– proposed by Maher (1974) (see also Maher, 1988, 1999 and Gerrans, 2002) – inwhich delusional beliefs are seen as a rational response to the unusual and oftenbizarre experiences of the subject. Whilst it is generally accepted that anomalousexperience plays a part in the Capgras delusion, critics have been quick to point outthat the one-stage model has difficulty explaining the specific content of thedelusional belief, and add that it is implausible that “raw perceptual experiencecontains its own intrinsic thematic content” (Klee, 2004, p.26). In other words, it isunlikely that the (delusional) belief that one’s wife is an impostor is derived solelyfrom an experience with intrinsic ‘wife is an impostor’ properties. More recentdiscussion has therefore focused on the particulars of the additional second stage (seeDavies & Coltheart, 2000; Langdon & Coltheart, 2000; Young, 2000; Bermúdez,2001; Bayne and Pacherie, 2005). However, as a consequence, it is my view that thefirst stage of the model, although accepted as necessary, is often neglected and reducedto a simple description such as ‘an anomalous experience that the subject often findsdistressing and therefore needs to explain’; perhaps with an additional commentreferring to the experience’s neuropathlogical grounding. Emphasis is placed, instead,on the degree and nature of the cognitive disruption as it occurs at the second stage,which is then used to explain why the subject, as a means of accounting for hisanomalous experience, adopts the delusional belief that this significant other (be itspouse, sibling, or offspring, etc.) is an impostor, rather than settling for a moreplausible explanation.

Unlike more recent discussions involving two-stage models, this paper willconcentrate on the phenomenology underlying the Capgras delusion. As mentionedabove, the problem with the one-stage account is the implied need for neural damageto cause directly an ‘impostor’ experience from which the subject responds rationally(according to Maher). Like its critics, then, I share the view that a rational responseto an anomalous experience is insufficient to explain the Capgras delusion. However,

1 There are reports of Capgras patients who claim to perceive differences in the impostor. However, whenpressed on what exactly these differences are, they have difficulty pointing them out (see Young, 1999).

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I do believe that the Capgras patient has a specific ‘impostor,’ rather than a non-specific anomalous, experience; but, importantly, this is not the direct nor the soleresult of some form of experience-distorting, bottom-up neuropathology. Instead, itis the product of both a dysfunctional bottom-up and top-down process.

What I am proposing differs from the standard two-stage model in so much as itemphasises the underlying phenomenology of the disorder. I am thereforeadvocating not just that the husband (for example) experiences something unusualin relation to his wife – which he then needs, and tries, to explain – but that heexperiences his wife as an impostor; and, to reiterate, this ‘impostor’ experience isthe product of a dynamic interaction between different dysfunctional processes.

My account is compatible with the mirror-image model proposed by Ellis andYoung (1990), which forms the basis for most, if not all, two-stage models (andwhich I will discuss briefly in “Is an affective deficit sufficient to explain theanomalous experience?” section). Suffice it to say, for now, that neurologicaldamage in the Capgras patient is said to ‘mirror’ that of prosopagnosia. I thereforeaccept that specific neurological damage could be responsible for an initial feeling ofunease towards the significant other, which acts as a prelude to the delusional state,but further maintain that this anomalous experience is transformed into a full-blown‘impostor’ experience as and when the patient engages in further, dysfunctionalcognitive processing. The interaction of bottom-up and top-down processes is alsoresponsible, I contend, for the maintenance of the delusional state (for reasons I shallexplain in “The interaction of bottom-up and top-down processes” and “Confirma-tion bias and maintaining the delusion” sections).

Capgras delusion and the phenomenology of everyday experience

In defence of my interactionist two-stage account, I will begin by discussing anargument forwarded by Ratcliffe (2004) who, whilst trying to account for thephenomenology underlying the Capgras delusion, endorses the view that:

“[p]henomenological descriptions of everyday experience can... serve tocommunicate the sense in which someone might be experienced as ‘not mywife.’ It is not a belief that is inferred but something that one is struck by, a waythe world is experienced as being.” (p.37)

Ratcliffe is correct to focus on the phenomenology underlying the Capgras delusion,and in particular the salient nature of the experiential sense of unfamiliarity that ischaracteristic of the disorder. In addition, I agree that the Capgras husband’s belief (that‘this is not my wife’) is not something that is inferred but something he is struck by.However, I consider Ratcliffe’s claim, that descriptions of everyday experiences can beused to communicate a sense of the phenomenology underlying the Capgras delusion, tobe flawed, at least based on the examples he presents.2 Nevertheless, I believe that a

2 In rejecting Ratcliffe’s examples, I am not ruling out altogether the possibility that there may be othereveryday examples that are equivalent to the phenomenal experience of the Capgras patient. I thank theanonymous referee for drawing my attention to this point.

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detailed discussion and analysis of his examples, and in particular his example of an‘everyday experience,’ will highlight the importance of the interaction betweenbottom-up and top-down processes to the initiation and maintenance of the Capgrasdelusion, and support the claim for a specific ‘impostor’ experience.

Ratcliffe begins by drawing a comparison between the experience of a husbandexpecting to see his wife and Sartre’s (1969) example of a friend waiting for Pierreto enter the café. His point is this: whether you enter a café expecting to meet Pierre,or your home expecting to be met by your wife, the experience is structured aroundthe possibility that these people will appear. On failing to do so, “the experienceincorporates an absence into its structure” (p.38), be it in the form of ‘Pierre is nothere’ (if one is in the café) or ‘my wife is not here’ (if one is at home). This absenceis salient and, according to Ratcliffe, cannot be reduced to the mere propositionalnegation of an individual’s presence.

Thus, upon entering his house at time t1, the husband has an experience of afamily home in which his wife is absent (let us call this his ‘absent-wife’experience). At time t2, somebody appears (that ‘somebody’ being his wife) andsays “Good evening darling!” Nevertheless, the husband’s absent-wife experiencepersists. What Ratcliffe seems to be suggesting is that this is equivalent to Pierre’sfriend continuing to experience the café as a place where Pierre is not each timesomeone other than Pierre enters. There is, however, an important differencebetween the respective experiences of Pierre’s friend and the husband. In the caféexample, Pierre is experienced as absent because he is absent. This is not, of course,the case with the wife who continues to be experienced as absent even when sheenters the room.

That issue aside, more in keeping with the Capgras delusion, Ratcliffe modifiesthe husband’s experience so that instead of experiencing the usual sense offamiliarity when in the presence of his wife, he now experiences her as just another“anonymous person” toward which “the buzz of recognition that is part of theexperience ‘this is my spouse’ does not occur” (p.38). Here, rather than experiencinghis wife as merely absent, the husband now has an ‘X is not my wife’ experienceapproaching that of the Capgras patient.

To further emphasise the salient nature of this sense of unfamiliarity, Ratcliffeintroduces an example of “everyday experience” (p.39) that, in part at least, isphenomenologically equivalent to the unfamiliarity experienced by the Capgraspatient. To reiterate, whilst I do not agree that this ‘everyday example’ is equivalentto phenomenology underlying the Capgras patient’s delusion, even in part, I doconcede that a detailed analysis of it will provide useful discussion points in supportof my interactionist two-stage account. Consider, then, Ratcliffe’s everyday exampleof a man entering a pub.

I enter a pub in England not expecting to see a certain friend, who I believe tobe in Ireland. As I sit down, I see someone waving at me. Even though Iperceive him clearly, it is not initially obvious ‘who’ he is. And then there is thefeeling of familiarity. The face transforms, the whole experiential structurechanges and takes on an air of familiarity as the face’s significance is registered;‘It’s him!’ Without that sudden experiential reorientation, perhaps he wouldremain unfamiliar, unrecognised. Imagine an experience that hovers perma-

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nently in the state prior to re-orientation. Unfamiliarity is something thatexperientially strikes one. No inference will circumvent the persistent feelingthat ‘he is not known to me.’ (39)

Most people, at some time in their lives, have probably had a similar experienceto the one Ratcliffe describes here. However, if we are to compare this moreeveryday occurrence to the much rarer condition of the Capgras delusion, then anumber of phrases within the passage need to be examined. What is meant, forexample, when Ratcliffe states that he perceives the man ‘clearly,’ and also by thephrase “then there is a feeling of familiarity”? In addition, we need to discuss therelationship between being unfamiliar and being unrecognised which apparently gotogether in the absence of experiential reorientation, for as Ratcliffe states: “Withoutthat sudden experiential reorientation, perhaps he would remain unfamiliar,unrecognised.”

Let us allow that by perceiving the man clearly Ratcliffe is aware of his friend.Importantly, what he lacks, at this stage at least, is the awareness that it is his friend. Inother words, in perceiving the man clearly, a man who happens to be his friend,Ratcliffe is aware of the man and therefore of his friend. What he lacks, however, isthe awareness that the man he is aware of is his friend.3 It might be tempting toequate being aware that x with a sense of familiarity towards x – that they aresomehow synonymous. However, at present, I wish to reserve judgement on anysuch claim, although I will return to this point later.

So, although Ratcliffe perceives his friend clearly, he does not, as yet, know whothe man is: he is not aware that it is his friend waving at him. A clear perception, quaawareness of x, is not, it would seem, sufficient for recognition. Ratcliffe indicatesthat a further event must coincide with his identification of the man – that is, with anawareness that it is his friend. As he states: “then there is a feeling of familiarity”(p.39, my italic). This feeling (of familiarity) is the result of experientialreorientation, and is marked by the fact that Ratcliffe is no longer simply aware ofhis friend; he is now aware that it is his friend. In short, after experientialreorientation, the experience is transformed, as is the face of the man, into that of hisfriend. He now knows (is aware) that the man waving at him is his friend:knowledge that coincides with the experience of him as such. He has an ‘It’s him’ ora ‘My friend’ experience (or some such thing). Importantly, though, if one is unableto progress from a state of perceiving clearly to that of experiential reorientation –and merely hovers between the two in a state prior to reorientation – then anindividual, no matter how clearly they are perceived (one supposes), will remainunfamiliar to the perceiver, and unrecognised by him. The subject will be struck bythe salient experience ‘he is not known to me.’

Part of what Ratcliffe’s example is trying to illustrate is that experientialreorientation brings with it a sense of familiarity that is absent pre-reorientation.However, more than this, Ratcliffe wants the absence of familiarity to be salient.When Ratcliffe initially perceives the man waving at him from across the room yetfails to realise that it is his friend, it is not simply that he does not experience the

3 For a detailed discussion on this difference, see Dretske (1995, 2000).

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man as his friend but, instead, that he experiences the man as not his friend. In otherwords, his failure to recognise the man does not constitute simply a lack of ‘this ismy friend’ experience; rather, it is a consequence of what he does experience, themuch more salient ‘this is not my friend.’ As he states: “Unfamiliarity is somethingthat experientially strikes one.” Ratcliffe, in his example, is struck by the negation offamiliarity, and it is the salience of this experience that we are told equates to thephenomenology underpinning the Capgras delusion.

Distinguishing between a lack and loss of familiarity

Prior to experiential reorientation, Ratcliffe does not recognise and is thereforeunfamiliar with his friend – let us call him Bob. What we need to consider is therelationship between familiarity and recognition. Judging by what Ratcliffe says, hebelieves that the two are closely related. There appears to be something-it-is-like torecognise x and, for Ratcliffe, this something is a sense of familiarity. Whilstaccepting that there is some truth to this, I would nevertheless like to draw adistinction between recognising x and having a sense of familiarity with regard to x.

To illustrate: suppose that I experience a sense of familiarity whenever I am in thepresence of Bob, but have no awareness that the man in front of me is Bob. I amaware of Bob and, equally, I am aware that I experience a sense of familiarity whenin his presence. What I do not do is recognise the man as Bob. Let us say that in aroom full of people I might say something like “you look familiar,” or even “Irecognise you, but can’t quite place you.” Here, if we are to use the word ‘recognise’it is in a weaker form, when perhaps what we mean to say is I feel as though I shouldrecognise you.4 It would seem that there exists a sense of familiarity in the absenceof full-blown recognition. Let us examine this independence further.

Allow me to develop Ratcliffe’s example beyond that which he intended.Consider this possibility. Bob approaches me, waving his arms so as to attract myattention. Prior to reorientation I experience a lack of familiarity and recognition.Not only do I fail to recognise the man as my friend, I also lack any sense offamiliarity in relation to him. This should not be particularly troubling to me,however, for as far as I am concerned the man is a stranger, and hence myexperience is appropriate to that of a stranger. If the man insists that he is my friend,and I am still in a state of pre-reorientation, then I may have a salient ‘this is not myfriend’ experience, but it would not be, I suggest, an anomalous experience. It mightbe a slightly uncomfortable situation in which to find oneself, but it is not equivalentto the troubling phenomenology experienced by the Capgras patient.

The Capgras patient, in contrast, does not experience a lack of familiarity, as Iwould do in the example just described; rather, he or she experiences a loss offamiliarity. The experiential background against which this loss is made salient isone in which the Capgras husband, for example, expects to meet his wife. It istherefore because of this context (this experiential background) that the husbandrecognises the woman in front of him as his wife. And it is because he recognises her

4 I am grateful to Matthew Ratcliffe for this example.

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as his wife, and therefore as someone he should feel a (strong) sense of familiaritytowards but does not, that the absence he does feel is experienced as a loss ratherthan a lack of familiarity. The origin, then, of the anomalous experience thatunderpins the Capgras delusion (neurophysiology aside, for the moment) is rooted inthe fact that the Capgras husband does and yet does not recognise his wife. Now,clearly, this statement is ambiguous. A fuller explanation will draw upon theneurophysiology underpinning recognition (to be discussed in “Is an affective deficitsufficient to explain the anomalous experience?” section). However, for now, recallthat it is possible to have a sense of familiarity towards someone without recognisingthem; so it is possible to recognise someone without having a sense of familiaritytowards them. This dissociation is, of course, an integral part of the mirror-imagemodel. However, my interest, as stated from the beginning, is not in the fact that thedissociation exists but in the (neglected) nature of the phenomenal experience itproduces.

To reiterate, it is not that there is no or very little feeling associated with thepresence of the wife, as would be the case with a stranger, or if one were in a state ofpre-reorientation (to use Ratcliffe’s terminology), it is that there is a very strongfeeling that something is wrong, precisely because the husband both recognises andyet do not recognise the person in front of him; and it is this discrepancy, against anexperiential background in which the husband expects to see his wife, that makessalient the loss of familiarity.5 This incongruence creates an unusual and evendisturbing experience, which makes the husband reluctant to accept that his wife isstood before him. His reluctance stems from the fact that he does not have a ‘this ismy wife’ experience. What he does experience, initially at least, may be ill-definedand troubling to him. However, as salient as it is, it should not yet be described as an‘impostor’ experience. What is required for this will be discussed in “The interactionof bottom-up and top-down processes” section.

Is an affective deficit sufficient to explain the anomalous experience?

As stated above, the dissociation between a sense of familiarity and recognition iscompatible with Ellis and Young’s (1990) mirror-image model which posits that theinability to consciously recognise familiar faces, characteristic of prosopagnosia, issaid to be the result of damage to that part of the brain (ventral route) whichsubserves conscious visual recognition. Conversely, in the case of the Capgrasdelusion, the underlying aetiology of delusional beliefs – the anomalous phenomenalexperience – is believed to stem from damage to the ventral limbic structure.6 AsEllis and Lewis (2001) state:

[I]f prosopagnosia is the result of damage to the system responsible forgenerating conscious face recognition, sometimes leaving an unconscious or

5 In Young (in press) I try to clarify further what I mean by recognising and yet not recognising someone,as well as the role familiarity plays in this distinction. In the discussion, I contrast recognition-familiaritywith estrangement.6 See Breen, Caine and Coltheart (2000) for a more detailed discussion on this, and also Haxby, Hoffmanand Gobbini (2000) and Haxby et al. (2001).

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covert mechanism intact, then the Capgras delusion might arise when thereverse occurs, that is, an intact overt system, coupled with a malfunctioningcovert system. (149)

Ellis and Young thus hypothesised that if damage to the ventral limbic structurehad occurred in those suffering from the Capgras delusion then, unlike patients withprosopagnosia, Capgras patients should experience no increase in skin conductanceresponse (SCR) when presented with a familiar face.7 As predicted, when presentedwith such faces, despite conscious recognition, Capgras patients failed to exhibit anyincrease in autonomic response (see Ellis, Young, Quayle, & de Pauw, 1997, andHirstein & Ramachandran, 1997). However, it would appear that this affectivedeficit cannot, by itself, account for the Capgras delusion. Research by Tranel et al.,(1995), for example, found the same inhibited autonomic response (to familiar faces)in patients with brain damage, but also noted that they lacked any subsequentdelusional beliefs. Davies and Coltheart (2000) describe such a patient:

[H]is experience of loved ones is strange, flat, not quite right,... as if these werenot really his loved ones... In an imaginative spirit, he might entertain andexplore that hypothesis [that they are not his loved ones]. But he could still stopshort of actually adopting and maintaining the explanatory hypothesis as abelief. (11)

An inhibited autonomic response (SCR) is equated with a lack of a sense offamiliarity. However, this cannot be what makes the anomalous experienceanomalous in the case of the Capgras patient. The same low level of SCR occurswhen in the presence of strangers, yet this is not experienced as unusual, odd orbizarre.8 The reason why the experience for Capgras and Tranel patients feels sostrange is because, as already mentioned, it amounts to a loss of familiarity notsimply a lack of it. Such an experience cannot be fully accounted for, then, byreduced SCR, although it is strongly correlated with its occurrence.

The comparison made between Capgras and Tranel patients usually centres on thelatter’s lack of delusional belief. Tranel patients make analogous claims to the effectthat it is as if the other person is an impostor. In contrast, the Capgras husband’sclaim is categorical: “That woman is an impostor.” This is often taken to beevidence for some kind of second-stage cognitive disruption in the Capgras patient,be it in the form of an attributional bias, or a conflict between conservatism andobservational adequacy in belief formation (Davies & Coltheart, 2000), or adisruption in episodic rather than procedural rationality (Bermúdez, 2001), or a lackof inhibition of the pre-potent doxastic response (Hohwy & Rosenberg, 2005)

7 When prosopagnosic patients are presented with a familiar rather than an unfamiliar face, despite theirlack of conscious recognition, there is an increase in SCR. This difference is often interpreted as a measureof unconscious recognition and has been associated with one’s sense of familiarity (see Bauer, 1984, andTranel & Damasio, 1985).8 Actually, Young (1999) noted that, when questioned more closely, Capgras patients report a generalsense of oddness and unfamiliarity, and of things ‘not quite being right.’ This is what one might expect ifthe patient is less able to establish affective links with those around him, or even elicit emotionalsignificance from certain places or objects. However, this general, and much milder, sense of ‘oddness’does not lead to delusional belief.

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(amongst other things). However, what seems to be suggested in terms of thephenomenology underlying both patient groups is that they are basically the same.Each has the same anomalous experience, but only the Capgras patient considers itto be sufficient evidence to support his ‘impostor’ hypothesis.9 Now, whilst I acceptthat some form of cognitive disruption is necessary (although it is beyond the scopeof this paper to discuss its exact nature), and is that which distinguishes the twopatient groups, I nevertheless maintain that the respective experiences of the Capgrasand Tranel patients are different, or certainly become different; and are differentbecause of the cognitive disruption.10 In short, the Capgras husband makes thecategorical claim that his wife is an impostor because he has an ‘impostor’experience. Likewise, the Tranel patient makes the analogous claim that it is as if hiswife (or whoever) is an impostor because it is perhaps the best or only way he canarticulate his experience (of a loss of a sense of familiarity). The two distinctiveclaims are based, then, on two distinct experiences, and not on an inference madeabout the same experience which is either reasonable or unreasonable.

The interaction of bottom-up and top-down processes

In the Introduction I claimed that two-stage models tend to neglect thephenomenology underlying the Capgras delusion. Often it is described simply asan anomalous experience that stems from some form of neural pathology. This isbelieved to cause a lack of a sense of familiarity which is correlated with decreasedSCR. The causal chain seems to be unidirectional – from anomalous experience tothe formation and maintenance of delusional beliefs.11 What I am proposing, instead,is that the formation of the delusional belief impacts on the nature of the experience,which then helps maintain the belief because it re-confirms it experientially (see“Confirmation bias and maintaining the delusion” section for a discussion on beliefmaintenance). There is an interaction between the neuropathology underpinning theexperience and the top-down cognitive disruption at the second-stage.

This interaction is not restricted to pathologies; rather, it forms the basis for muchof our understanding of perception as an active process (see Churchland,Ramachandran, & Sejnowski, 1994 and Noë, 2004). By way of an illustration,consider the ambiguous duck-rabbit image. The image is such that it can beperceived either as a duck or a rabbit depending on context. When the context ismanipulated so that, for example, the image is placed amongst other pictures ofrabbits, the ambiguous image is more likely to be perceived as a rabbit (or vice-versain the context of ducks). After prolonged exposure to the ambiguous image (in the

9 Although it could be argued that differences in the underlying neuropathology produce differentexperiences. Something in this difference leads one group to form delusional beliefs and another group notto.10 I appreciate that this statement is difficult to prove (to say the least), and problematic because of it.However, I hope that the argument presented throughout this paper provides some support at least for thepossibility of the claim being true.11 See Davies and Coltheart (2000) for a more detailed example of this. Their EHBC account proposes aprogression from experience to hypothesis to belief to circumscription.

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context of rabbits), the perceiver is likely to form the belief that it is an image of arabbit and therefore perceive it as such in more ambiguous contexts. If one believesthat the image represents a rabbit then that is what one experiences.12

Of course, most people are still able to flit between the two possible images (duckor rabbit) if they wish. In the context of the Capgras delusion, things are morecomplex. The patient can consider a number of different hypotheses, or entertain anumber of different beliefs, and flit between these; what he cannot do is change theunderlying sense of unfamiliarity he experiences, which is fixed by the neuraldamage incurred. He is never able to remove himself from the experiential context of‘something is not right here’ unless he believes that the woman is an impostor. Toexplain: if, due to some form of attribution/reasoning bias, the Capgras husbandadopts the belief that his wife is an impostor, then his experience will changeaccordingly. His belief will shape his experience, and an impostor is what he willsee. If he believes that the woman in front of him is an impostor he will recogniseher as an impostor. Why? Because his recognition and the absence of a sense offamiliarity are now congruent. This is how he should feel when in the presence of animpostor. When faced with someone he believes to be an impostor his experiencechanges from a loss of familiarity to a lack of it. Ironically perhaps, what has nowbecome a congruence in recognition is the means by which the Capgras husbandidentifies the putative wife as an impostor. He accepts that she is an impostorbecause he experiences, and re-experiences, her as such (see also Hohwy &Rosenberg, 2005), and so his belief is confirmed and re-confirmed by his experience.

Confirmation bias and maintaining the delusion

Finally, a question often raised in relation to the Capgras delusion is: Why does thedelusional belief persist despite overwhelming evidence to the contrary? Attribu-tional bias or reasoning style, for example, may be used to explain the formation ofthe belief, but not its maintenance. Again, I believe, my interactionist approachoffers insight into why the delusional belief is maintained. Interestingly, it has beenreported that the delusional belief is strongest when the putative impostor is present(Breen, Caine, & Coltheart, 2000, and Bermúdez 2001). It is also generally acceptedthat the Capgras patient does not suffer from a global breakdown in rationality – heis often aware that his belief is implausible, and even accepts that if someone elsewas trying to convince him that their wife was an impostor, he probably would notbelieve them. Yet the delusional belief persists.

I have argued that the ‘impostor’ experience stems from an initially anomalousexperience that is perhaps best articulated as ‘something is not quite right here’which is based upon an incongruence between recognition and the absence offamiliarity where there should not be, producing the experience of a loss offamiliarity. Due to some form of cognitive disruption, the Capgras patient forms thebelief that his wife is an impostor. The individual’s experience is then organised

12 I am not trying to endorse the view that Capgras patients would be much more susceptible to all formsof visual illusion. Instead, I am simply trying to draw a parallel between our normal and active perceptualprocessing and that of the Capgras patient.

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around this belief such that what is experienced – what is perceived – is congruentwith it. As a result the wife is transformed into an impostor-wife. Now, every timethe putative impostor is perceived, she is perceived as an impostor because nothingwithin the experience will have changed, and the experience matches the belief. So,even if the patient starts to succumb to the overwhelming evidence against thelikelihood of his wife being an impostor, his belief is re-confirmed (and thereforemaintained) as soon as he sees her again, because what he experiences is animpostor.

Confirmation bias is the idea that, when solving problems, we “often form wronghypotheses by looking only at the most salient factors and by ignoring contraryevidence” (Silverman, 1992, 972). The Capgras patient attends to that which,initially at least, was simply anomalous – the loss of familiarity – but which nowconfirms his belief that his wife is an impostor, because it is congruent with it, andhence is experienced as a lack of familiarity. Now a lack of familiarity may beconsidered slim evidence upon which to maintain a belief, especially in light of themass of evidence one imagines being accrued against it. However, due to thepatient’s cognitive dysfunction, which some research suggests may be a willingnessto accept minimal evidence to confirm a hypothesis,13 one might speculate that suchminimal evidence is therefore considered equally sufficient to re-confirm it. At thesame time, one could argue that none of the evidence stacked against the delusionalbelief is able to change the experience of a lack of familiarity; only the Capgrashusband’s belief that his wife is an impostor appears to be congruent with it. And, ofcourse, once the belief is accepted, it structures the experience such that it counts aspowerful evidence in favour of there being an impostor present.

Finally, even if the Capgras husband is able to flit between other possibleexplanations which may lead him to revise his belief – a bit like being able to flitbetween the belief that the ambiguous image is of a rabbit rather than a duck (orvice-versa) – he cannot experience a sense of familiarity towards the putativeimpostor. What he can experience is either a loss of familiarity, if he entertains thebelief that it is his wife (but then he is back facing the question: Why do I feel a lossof familiarity towards my wife?), or he can experience a lack of familiarity if hecontinues to belief she is an impostor (which succeeds in reinforcing his belief). Theloss of familiarity simply leads him away from the belief that it is his wife; the lackof familiarity confirms that it is not his wife. Someone whom I recognises as just likemy wife, but who is unfamiliar to me, must be an impostor. The reinforced beliefmaintains the ‘impostor’ experience.

Conclusion

What I hope to have highlighted in this paper is the importance of thephenomenology underlying the Capgras delusion. I have deliberately not engagedin much discussion regarding the exact nature of the cognitive disruption that is

13 Huq, Garety and Hemsley (1988) and Garety, Hemsley and Wessely (1991) noted that people withdelusions tend to request less information before drawing a conclusion about the likely outcome of anevent, preferring instead to jump to conclusions.

Restating the role of phenomenal experience 187

believed to occur at the second-stage. This is not because I believe it to beunimportant, but simply because there has already been much written about thisaspect of the disorder to the detriment, in my view, of its phenomenology. Plus, I donot anticipate that any variation in the details or the extent of the cognitive deficitwill impact greatly on the essential thrust of my argument.

In conclusion, by using Ratcliffe’s example of everyday experience as the basisfor discussion, my aim has been to stress the importance of the phenomenalexperience underlying the Capgras delusion, and therefore to bring to the fore theimportance of the interaction between top-down and bottom-up processes in theinitiation and maintenance of the delusional belief. The underlying phenomenologyof the Capgras delusion is not simply a unidirectional process from experience tobelief but, rather, a dynamic interaction between the two that creates fluidity withinthe experience. This fluidity, I believe, better explains why the delusional belief isformed and, importantly, why it is maintained.

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