Psychotic false recognition syndromes
Several years ago I discovered a second source for Lacan’s notion of foreclosure. The latter term is his translation of Freud’s Verwerfung. He is very voluble about the Freud source which relies on two case histories, namely, the Schreber case  and the Wolf Man case.  A number of years ago my attention was drawn to this second source by Thibierge.  It led me to what is called the delusional misidentification syndromes and especially to a case history published in 1923 by Capgras, entitled ‘L’illusion des sosies dans un delire systematise chronique’.  We can call the phenomenon of doubles the delusion of doubles, a delire d’interpretation or the Capgras syndrome. It is a singular psychotic phenomenon within a wider context of paranoia, and that is equivalent to a chronic systematic delusion. It must have been the patient who found the name of her own delusion in Molière’s play called Amphitryon. It must have been her who called it an illusion.
Capgras was a psychiatrist of stature, whose most important contributions were made in the first third of the last century. Lacan acknowledges in his MD thesis his indebtedness to the works of Sérieux and Capgras as well as expressing his gratitude to them for the sympathetic reception of his views.  Capgras was not a psychoanalyst, but he was acquainted with some of Freud’s writings. Whether he was acquainted with Freud’s theory of psychosis, I am unable to say. When Capgras read his case at a meeting of the Society of Psychological Medicine in 1923, de Clérambault was in the audience. I add for anyone who might find it of interest that of Lacan’s teachers the latter was the only one he nominated as his mentor in psychiatry.
The phenomenon under discussion, L’illusion des sosies, is now called the delusion of doubles or the Capgras syndrome. It is defined in the Oxford Textbook of Psychiatry  as a patient who believes that a person closely related to him has been replaced by a double. He believes that the double is an exact replica of the original person but is not the original person. In Capgras’ paper it is not necessarily a person closely related to the patient that is replaced by a double. There are sosies of the housekeeper and of the tenants. Recognition is intact since the double is an exact replica of the original person. Identification is flawed because it is not the original person. Substitution by a double forces the subject to make the deduction that the original person has been abducted. This is for Capgras the structure of the delusion, based on recognition and misidentification. Lacan a:grees with him.  However, this patient’s problems go well beyond the delusion of doubles. Her identifications in general are unstable.
The following year Capgras with another co-author developed a hypothesis concerning the cause which he called méconnaissance systématique. It’s a concept similar to foreclosure. Capgras’ translator, a British psychiatrist, Coleman, evidently grasped what was at stake in the concept. He translated it as systematic misidentification.  The original and the translation both indicate an awareness of a flaw in the subject’s identifications. It would be amusing to take a leaf out of the DSM style and call it an identification disorder. Delusional identification would be more descriptive. I will remain loyal to Coleman’s translation. It also avoids the frequent translation of méconnaissance as misrecognition. The latter translation may be preferable in other situations than the one we are going to be dealing with.
Capgras’ case history is one of three clinical structures that were classified later as l’illusion de fausses reconnaissances des aliénés, psychotic false recognition syndromes. It includes two other syndromes, the Frégoli and the intermetamorphosis syndromes. Capgras’ case is not based on false recognition and, strictly speaking, should not be classified under this rubrique. False recognition also describes a phenomenon of an organic, dementing state, for instance, of Alzheimer’s disease. In the clinical structures in question a disordered identification is the crucial problem, not false recognition. We should follow what is in any case current use that these structures be grouped together as the delusional misidentification syndromes. The following abridged version of Capgras’ case focuses on the delusion of doubles and a few other delusional problems with identification.
The patient’s proper name is symbolically adrift; it is no longer tied to an image. She has to invent the name Madame de Rio Branco for herself. She names herself. She invents her own family tree, and a royal one at that. She is the granddaughter of a Princess, and her mother is called de Rio Branco which is also the name of the children of Henri IV of whom she is a descendant. She is the daughter of the Duc de Broglie. Her name indicates that she has holdings in the city of Rio in Brazil. Whether there ever was a time when the patient used her ‘proper’ name, I am unable to say. The representations are foreclosed, foreclosed from her own history. She is forced to make a name for herself- and with that a new history.  By how much are these names being imposed on her? There would be a real dimension to these names. She experiences a lot of things as being imposed on her. One can take this sort of imposition as a category Lacan calls the real. The proper names that the patient constructs would be an imaginary use of symbolic fragments transformed to a real status by foreclosure. They are having grandiose effects. Identifications with noble personages provide her body with good form and are imaginary. The father’s name returning in the family tree is pluralised. Lacan calls them the names-of-the-father, not the Name-of-the-Father. They can be prosthetic devices used for making a name for oneself as well as a body for oneself. These are prosthetic devices that hold RSI together. The names-of-the-father are flexible in that they can have real, symbolic and imaginary effects. As prosthetic devices they are too grandiose to allow the subject to construct a social bond to the larger community.  There is enjoyment in the grandiose effects of this delusional family tree, an enjoyment she can use to libidinally reinvest objects. She only reinvests herself. No social bond will hold in that sort of situation.
In another passage she is attempting to use some dregs of a symbolic bureaucracy to make up for a symbolico-imaginary that is not functioning very well: “For a long time I have been putting myself in order, equipped with certificates, stamped papers, certificates of identity, so that it will be of no use taking me for another, that is, for a sosie.”  She needs a legal signifier to make up for the law of the Father to stop a drift at the level of the imaginary. This other she does not want to be taken for is her double with which she cannot identify. It has ceased having a specular function or never did have one. The double is non-ego. If there ever was such a function, she has passed from the specular image to the double of the object a. 
Madame de Rio Branco in a delusional retrospective says that she herself began life as a double. She was abducted from her parents and lived with a M. M, substituted for his daughter. She is also a sosie. The abduction from her parents subverts her own proper name, and sets it adrift. She must not be called M but Louise C, the name of her husband, or, even better, Mathilde de Rio Branco, the name of her true family, delusionally true, that is. “M. Pierre-Paul M,” she says, “who died at home with me, certified before his death that I was not his daughter and that he had acted criminally in hiding me from my parents and that I was fifteen months old when the crime was committed.”  In a retrospective consideration of her position she is creating her own history which happens to be delusional. It’s called a delusional retrospective. She is replacing her memory with a delusional memory. Delusional retrospection is the psychotic equivalent to retrospective signification of a ‘normal’ signifying chain that Lacan called après-coup. Her proper name- perhaps, this requires some tautological support- her own proper name becomes detached from her own image which is in itself an effect of a foreclosure. There is a nameless object in the delusion of doubles.
Nonetheless she cannot escape being taken for another. In the hospital she was taken for another, a woman who had committed offences and indiscretions. “The captivity I am suffering belongs to another, one of my sosies. I know very well that one person left in my place, resembling me, dressing like me, occupying my apartment in my absence.” 
Her husband was replaced eighty times by sosies. As far as she is concerned, he has not existed for ten years. She recognises his image, but it hasn’t got a name. She cannot identify him as her husband and wants a divorce. She wants to divorce the sosie and not her husband. Her husband has no symbolic value; il est plus que méconnaissable, to use her expression that Capgras is probably doing. “He is more than misrecognisable” doesn’t work as a translation. She recognises his image, although it is strange and foreign. We can associate strange and foreign with misidentifiable. The delusion includes her one surviving daughter who has been substituted two thousand times by sosies. The delusion of doubles cannot become established without the function of recognition being intact and without a foreclosure that leaves the image nameless. Between image and identity there is no link. 
Madame de Rio Branco’s body is always on the verge of disappearing. Her identifications are so unstable that they vary: “I was blond but they have made me auburn. My eyes protruded at first but are flattened out. I was busty but that’s flat now as well. That’s why I am not recognised.”  She strains to compensate for the fault in identification: “I never had any other colour than that of correctness. . . me, a woman without stain. . . I am a creature outside any doubt, who not only has her reason but wanted to save the genuine administration. . . My signature is valuable; my particulars are those of an honest woman. My good antecedents are attractive to people who are seeking to appropriate them, using the papers identifying me.” She is experiencing being robbed of a sense of self. Her body in the mirror keeps changing. She is no doubt wavering in her belief in the image in front of her which forces her to make exaggerated claims as to her virtue. Madame de Rio Branco is desperate to snatch at what identifications in the mirror she can, but her specular image perseveres in becoming the foreign and invasive image of the double. 
The phenomenon of the double allows one to define the real as something always returning to the same place which conforms to Lacan’s early definition of it. An image or a signifier becomes real when foreclosed. Her husband was replaced 80 times and her daughter 2000 times by sosies. These objects are in a constant return to the same place and cannot be lost. Madame de Rio Branco is in a constant encounter with the real. One function of language in relation to the real is expressed very early in Lacan’s teaching. The word is the murder of the thing, where the thing is another word for the real. The word is the death of the real. Language evacuates enjoyment. Language does not function like that for Madame de Rio Branco. The word does not kill the thing, and the image is indelible. It would be difficult to find evidence of object-loss in this case. The Thing is operating still. There is a lack of the lack. One can take that as another way of defining the real. There is another translation of lacking the lack in that it points to a pure presence.
Lacan takes delusion to be the fundamental psychotic phenomenon. This is why we all agree that a madman is a madman, he says.  The definition of delusion includes a subject who cannot be deterred from his belief in an idea incompatible with his social group. Delusional belief always has the character of certainty. The certainty attached to delusional phenomena for the subject suffering from them can be explained by their character of pure presence. There is no loss in psychotic structure. It’s the indelibility of the image of Madame de Rio Bronco’s daughter and husband. This presence without an absence is the fundamental characteristic of the real which has an effect of certainty.
Capgras explains the structure of the delusion of doubles in two steps. He and his collaborator in 1923 explain it with the expression agnosie d’identification or identification-agnosia.  Agnosia as such is a neurological condition in which the patient fails to recognise objects. It’s usually due to brain damage and to illnesses which lead to brain damage. Her daughter has been substituted two thousand times, but the image has remained constant and recognisable. The function of recognition is intact in the delusion of doubles. Our attention is shifted to the second term of the expression, namely, identification. My supposition is that agnosia is being used here to qualify identification as faulty rather than to indicate misrecognition. A psychiatrist writing in the British Journal of Psychiatry might support it. He calls it a delusional hypoidentification.  I think the term is quite apt. There is a weakness in identification, not in recognition. In the following year, 1924, with another collaborator, Capgras calls it méconnaissance systématique which has been translated as systematic misidentification.  It is meant to replace the earlier explanatory attempt with agnosie d’identification. There is a flaw in identification making it a misidentification to be considered at the level of structure. That it is systematic points to a certain logic in the delusion and, perhaps, it also points to the field of causality, by which is meant it is not necessarily the cause but is associated with the cause.
Lacan introduces Capgras’ notion of systematic misidentification as a question about the character of delusional belief in general without mentioning what delusion is at stake, namely, the delusion of doubles. Presumably, his psychiatric audience would have recognised the case immediately. He says that what is denied is in some way recognised. To put it in the terms being offered, one can say that what is systematically misidentified is in some way recognised. There is one possible problem associated with the latter statement. ‘To misidentify presupposes recognition’ can be interpreted as recognition being primary and misidentification secondary to it. Then recognition becomes crucial and not misidentification.  In the delusion of doubles misidentification is crucial. The image has the support of perception with the effect of recognition but recognition hasn’t got the support of the signifier because the latter is hypoidentificatory and the image is systematically misidentified. 
There are two further clinical syndromes collected together along with the Capgras syndrome under l’illusion de fausses reconnaissance des aliénés or psychotic false recognition syndromes: the Frégoli syndrome and the intermetamorphosis syndrome. These syndromes do not all have the same structure. The delusion of doubles is structured on recognition and misidentification. The misidentification in this case is a delusional hypoidentification. The Frégoli and intermetamorphosis syndromes are structured on false recognition and misidentification. The misidentification here is a delusional hyperidentification.  In each case there is a disorder of identification that Capgras sees as the effect of méconnaissance systématique. The delusional misidentification syndromes seem to suit the classification of these phenomena.
The Frégoli syndrome consists in the delusional belief that the persecutor returns as the body of someone else. The individual who is transporting the persecutor in this manner is, of course, entirely innocent except from the point of view of the patient. Courbon and Fail describe a twenty-seven year old woman who is convinced that her persecutors are the actresses Robine and Sarah Bernhardt. The patient herself who spent all her free time at the theatre called her persecutor a Frégoli, an Italian actor capable of changing appearances several times in the same scene. Robine and Sarah Bernhardt frégolise other persons for the purpose of torturing her, of looking at her in the act of masturbation which they oblige her to do, and it is destroying her body. She is diagnosed as schizophrenic. The psychoanalytical parameters of the clinical condition are present: an object that cannot be lost, namely the gaze; under the gaze she is being looked at masturbating; the destruction of her body under this gaze by the return of enjoyment to it; the detachment of her proper name from the image.
She experienced being influenced by an unknown woman passing her in the street whom she attacked. In that moment this woman became Robine who is living in another body. Robine and the fregolised women undergo a disconnection between name and image. The misidentification here is a hyperidentification between Robine and the unknown woman, the effect of which is false recognition. We don’t know what happened to the victim of the attack, but the patient was hospitalised. The problem is always at the level of identification. 
The intermetamorphosis syndrome was discovered by Courbon and Tusques in a 49 year old, melancholic woman with persecutory ideas. Neighbours became her husband who consequently became older or younger, taller or shorter, according to the neighbour in question. It was like being at the cinema, according to the patient. The husband retained certain traits in the course of the metamorphosis, for instance, an amputated finger and his grey eyes. The subject believed that people around her were changing into each other with the effect of false recognition. Again this would be secondary to a delusional hyperidentification. 
Courbon and Tusques consider like Capgras that the fundamental disorder in these syndromes is a problem at the level of identification. They establish three categories of identification: hyperbolic, amnesiac and delusional. In hyperbolic identification the patient is expressing in an excess of language a resemblance perceived between people. Memory is intact. It corresponds to what Christodoulou calls hyperidentification, amnesiac identification to hypoidentification, but they would all be delusional identifications. False recognition is secondary to delusional identification. 
It’s probably not too far out to think that Lacan’s trek to the concept of foreclosure begins with Madame de Rio Branco.
Lacan in his post war papers also uses the term méconnaissance as a neurotic mechanism in the same moment he is using méconnaissance systématique as a concept in psychosis. He translates Freud’s Verneinung variously as denial, negation, denegation as well as méconnaissance. This latter term becomes a principle of ego defence. Lacan uses the expression désaveu d’appartenance to indicate that neurotic méconnaissance is not a disavowal of membership by which is meant that the psychical representations are not destroyed as they are when attacked by systematic misidentification. The phenomenon in question, namely, Verneinung, reveals one of the subject’s tendencies in the very moment in which he denies it. 
Freud illustrates it in the short paper called “Verneinung” or “Negation” in English. The patient says to the analyst: “Now you’ll think I mean to say something insulting, but really I’ve no such intention.” Or: “You ask who this person in the dream can be. It’s not my mother.” It does not involve a disavowal of belonging, according to Lacan. By belonging he means that the negated material can be found amongst the subject’s representations. The desire to insult the analyst belongs to the subject, and he can eventually own up to it. The psychotic refuses ownership of the phenomena in which he is nevertheless entangled in his delusions of reference, and he is persecuted by insults. They are not included in the subject’s representations and it would be an uphill task to get him to admit that it’s he who desires to insult people.
Why does Lacan make the Freudian Verneinung a principle of ego-defence? When applied to an action it cancels it. A very common obsessional defence is doing and undoing. The obsessional is compelled to touch something that makes him anxious, and he has to touch something else which he considers the opposite and cancelling action. Likewise, a reaction-formation is a particular use of negation. A filthy child beginning to develop habits of neatness and cleanliness could be applying negation. The representations persist nevertheless.
Richard Klein, Finsbury Park, London
About the author:
Richard Klein is a practising analyst living and working in London. The following papers issue from clinical experience, textual labour and his characteristic commitment to the transmission of psychoanalysis in the Lacanian orientation.
-  Freud, ‘Psychoanalytical Notes on an Autobiographical Account of a case of Paranoia’ (1911), SE 12.
-  Freud, ‘From the History of an Infantile Neurosis’ (1918), SE 17.
-  Thibierge, S., Pathologies de l’image du corps, PUF, Paris, 1999.
-  Capgras, J and Reboul-Lachaux, J., “L’illusion des ‘sosies’ dans un delire systematique chronique”, Bull. Soc. Clin. Med. Ment., 11, 1923.
-  Lacan, J., De la psychose paranoiaque dans ses rapports avec la personnalité (1932), Editions du Seuil, Paris, 1975, p. 16.
-  Gelder et al, Oxford Textbook of Psychiatry, third edition, OUP, 1996, p.304.
-  Lacan, ‘Presentation on Psychical Causality’ (1946), Ecrits, W. W. Norton & Co., 2006, p. 135.
-  Coleman, S. M., Misidentification and Non-Recognition, Journal of Mental Science, 79, 1933.
-  Lacan, J., Le Séminaire, book XXIII, Le sinthome (1975-6), Editions du Seuil, Paris, 2005, p. 94. Capgras’ patient wants to make a name for herself. That’s obvious, and it has grandiose effects. To make a name for oneself is one way, according to Lacan, that the psychotic has of compensating for the total absence of the Name-of-the-Father due to a foreclosure. Lacan calls this compensatory name le sinthome. Joyce’s sinthome keeps RSI together.
-  Joyce made himself a name, and it compensated for a paternal absence. Lacan centres his thinking around the proper name on p. 94 of his S23. Here he also makes the distinction between symptom and sinthome. Joyce’s art is something so particular, according to Lacan, that it has to be a sinthome and not symptom. Symptoms (psychotic or neurotic) are shared by all subjects afflicted by one of a few clinical structures. The sinthome does not necessarily belong to a clinical structure. It is particular to the subject and keeps RSI holding together. The use of the sinthome becomes a way of doing without the Name-of-the-Father.
-  Capgras et al (1923)
-  Lacan, Le Séminaire, livre X, L’angoisse (1962-3), Editions du Seuil, Paris, 2004, p. 104.
-  Capgras et al (1923), op. cit.
-  Ibid.
-  Thibierge, S., Pathologies de l’image du corps, PUF, Paris, 1999, p.89 n1.
-  Capgras et al (1923)
-  Lacan (1962-3), op. cit., pp. 104, 116.
-  Lacan (1946), p.135. The sufferer of a delusion is what we call a madman. Or a psychotic? Perhaps we can trace Lacan’s somewhat eccentric use of the term psychosis back to the delusion. His title of S3 is Les Psychoses. In a book entitled Psychoses he speaks only about paranoia. Psychosis having become somewhat of a generic term these days, Lacan seems to be pinning it down to one category.
-  Capgras et al (1923), op. cit.
-  Christodoulou, G.N., “The Syndrome of Capgras”, British Journal of Psychiatry (1977), 130.
-  Capgras, J., et Carrette, P., “Illusion des Sosies et Complex d’Oedipe”, Ann Med.-psych., avril, 1924.
-  Lacan (1946), op. cit., p. 135.
-  In some textbooks of psychiatry one might find agnosia under disorders of perception, but in so far as it is also defined as a perception associated with a loss of meaning, the hypoidentificatory signifier becomes crucial. The subject cannot extract a meaning out of such a signifier.
-  Christodoulou (1977), op. cit.
-  Courbon et Fail, “Syndrome d’illusion de Frégoli et de schizophrénie”, Bull. Soc. Clin. Med. Ment., 1927, 5-6-7, p. 121-125.
-  Courbon et Tusques, “Illusion d’intermétamorphose et de charme”, Ann. Med.-Psych., 1932, 1, p. 401-406.
-  Courbon et Tusques, “Identification délirante et fausse reconnaissance”, Ann. Med.-Psych., 1932, 2, p. 1-12.
-  Lacan (1946), op. cit., p. 146.