The neural correlates of person familiarity. More interesting and powerful findings from functional MRI. Comparing the brain activation patterns of people seeing familiar vs. unfamiliar faces, and listening to familiar vs. unfamiliar voices, reveals the neural correlates of familiarity or recognition — areas of the posterior cingulate gyrus of the cortex, for those who know neuroanatomy. I have long been interested in the dramatic psychotic symptom called Capgras’ delusion, which involves the belief that familiar others have been replaced by nearly — but not quite — identical duplicates. Extreme cases in which the patient was convinced that their entire city was replaced by a near-duplicate have been described. The deep resonances of this terrifying experience are reflected in such classic films as Invaders from Mars and Invasion of the Body Snatchers, in which the panic-stricken protagonists cannot convince others that people around them are being replaced or controlled.(Of course, on another level, films of this ilk are talked about in the context of our Cold War societal complex about Communist brainwashing and takeover — which may be coming back into fashion — but that’s a different story; I think they speak to something far more primal.) It has long been observed that the Capgras delusion occurs both in “functional” psychoses (e.g. schizophrenia) and a variety of “organic” conditions (e.g. carbon monoxide poisoning). Back in psychiatry’s dark ages of either/or, this was one of the early suggestions that functional mental illnesses were diseases of the brain as much as of the mind.
I have been suggesting for a long time that the Capgras symptom arises from a disorder of the machinery underlying the sense of familiarity in the brain, and that it might have some similarity to other so-to-speak delusions of unfamiliarity. For example, there is a class of paranoid patients whose concerns revolve around the conviction that people come into their homes while the patient is asleep or out, rearranging or absconding with things there. I suspect that the failure of these patients to retain a sense of familiarity about the arrangement or placement of the objects in their environment is the basis of their belief that things have been meddled with. There is also a particular set of paranoid fears that arises as memory and familiarity fade with the progression of Alzheimer’s and other dementias. There is also a symptom called derealization, in which people have a strange sense that the world around them is not real but a caricature or cartoon version of itself; they cannot articulate percisely what is different, but they know it is. This often occurs in temporal lobe epilepsy, which can involve the cingulate gyrus, and is related to frequent deja vu experiences, clearly a disorder of the sense of familiarity. Now, with the demonstration of neural correlates of the experience of familiarity, even if no new treatment interventions arise, a convincing explanation may at least some of the time be a comfort to the patients so afflicted, or their families. As an aside, I’m curious to see whether the more disembodied familiarity of media celebrities is subsumed by the same machinery as the more intimate experience of the familiarity of our associates, friends and family. Brain