The Woman Who Mistook Her Husband for a Stranger: Capgras Syndrome (by Danielle Steinbach)
Nov 20, 2025The 1920s marked a sea of insecurity and instability for many citizens of France, but especially for one woman in particular, a lady we’ll refer to as Marie, who observed something rather disturbing in her personal life. Marie began to suspect something was off within her own home. In fact, she was certain of it. Yes, her husband had been taken and replaced with an imposter.
This was a case that shocked many and still remains a topic of discussion a century later. Although, as it turns out, this was not the sort of case that had to be investigated by detectives. No, this was the sort of case that had to be investigated by psychiatrists.
No one had taken Marie’s husband. He never went missing. The man who came home every day was the same man that had been coming home for years. Marie’s problem was not in fact that her beloved spouse had been abducted, but rather that she suffered with an exceedingly rare neuropsychiatric condition known as Capgras syndrome.
Plagued by paranoia that people around them have been replaced with look-alikes, patients with Capgras syndrome are hypothesized to exhibit marked physiological differences in the emotional and facial recognition centers of their brains. Being the social creatures we are, one of the most important abilities that our brains evolved over centuries is the ability to recognize our loved ones and attach emotions to their faces. Capgras syndrome thus results in a fundamental dissociation between someone and their sense of social stability, leading to feelings of panic and alienation.
Psychiatrists and neuroscientists have considered and researched several possibilities for the root structural causes driving this rare condition. One condition that many psychologists believe shares similar beginnings with Capgras syndrome is schizophrenia – both conditions of the mind that impose a false sense of reality on patients afflicted. In fact, Capgras syndrome and schizophrenia heavily co-occur. It is possible that architectural differences in the frontal lobe are at the root of these two similar syndromes. For example, a case study was conducted with a woman in her mid-60s who suffered from both a tumor in her frontal lobe and Capgras syndrome. Given that brain cancers often result in psychiatric disruptions as well as physical symptoms, it is highly likely that the growth in this woman’s frontal lobe played a role in her development of Capgras syndrome. This would not be surprising taking into account the role of the frontal lobe in social interaction, a skill that depends heavily on facial recognition.
Another possibility for the genesis of Capgras syndrome involves the pituitary gland. Previous case studies have suggested an association between tissue damage in the pituitary gland and delusion-based disorders such as Capgras syndrome. One hypothesis to explain this particular correlation is that pituitary dysfunction could induce aberrant chemical signaling to the temporal and occipital lobes that leads to a disconnect between our visual, memory, and emotional centers. However, the issue for some patients could also be in a region more upstream of the pituitary gland in the hormonal system–the hypothalamus.
To understand the hypothalamus’ potential role in Capgras syndrome, we must first review the system that bridges our emotional and physiological responses. To explain that system, I’ll offer you an illustrative scenario. Let’s say you’re hiking in the woods of Yosemite and you notice your shoelaces untied, so you crouch down to fix them. You look up and suddenly notice a hulking bear in the distance. Luckily, you manage to escape before the bear notices you. A year later, you and your family are sitting around the dinner table deciding where to go for vacation, and someone pulls out a brochure suggesting a camping trip in Yosemite. This suggestion of returning to Yosemite would trigger the memory of the bear encounter stored in neural connections of the hippocampus, which would prompt the amygdala to induce the unpleasant emotional experience of fear. White matter tracts between the amygdala and hypothalamus would then translate that fear response into a physical hormonal response, resulting in the downstream release of stress chemicals such as cortisol.
Why is this important? Our ability to associate emotions with memories (and objects that become familiar to us through memory) rule our behaviors and perception of the world. And so it is possible that Capgras syndrome stems from a key disruption in emotional circuits of the brain.
To understand how a “facial recognition” disorder could arise from dysfunction in emotion-based pathways of the brain, it may be helpful to compare Capgras syndrome to another condition that can result in a loved one’s face becoming unfamiliar: dementia. Dementia, as many know, is a condition that results in general cognitive decline, with a particularly noticeable deterioration of memory. Thus, as would be expected, the hippocampus is one of the regions most heavily impacted and diminished with dementia. However, Capgras syndrome is not an issue with memory. Yes, the face of Marie’s husband felt unfamiliar to her, but Marie knew looking at him that he was supposed to be her husband. Her hippocampus worked fine. Rather, her inability to recognize her husband as her true husband stemmed from an inability to attach the typical feelings of affection to the memory stimulus of his face. Without the strong emotional attachment she usually felt at the sight of her spouse’s face, Marie felt alienated from her husband. She then interpreted this strange feeling as an intuition that her husband must have been replaced by a stranger.
With this more nuanced understanding of the emotional processes that accompany facial recognition, psychiatrists are investigating the potential breakdown of the circuit connecting the hippocampus, amygdala, and hypothalamus.
- Danielle Steinbach
Sources:
https://www.alz.org/alzheimers-dementia/what-is-dementia