If You Did Not Care, You Would Not Notice: Recognition and Estrangement in Psychopathology

Young's paper (2007) identifies fundamental differences in the use of the concept of familiarity in the description of the experience of patients affected by the Capgras delusion and by prosopagnosia. Moreover, he suggests a way of disambiguating "familiarity" and proposes that the experience of Capgras patients is accounted for in terms of estrangement. Although we share the concern that the concept of familiarity might be used too broadly, we find his proposed solution problematic with respect to the Capgras delusion.

In this brief commentary, we address two interrelated issues. (1) Can estrangement from an object of experience be coherently distinguished from the failure of re-identification of that object? (2) Given that the delusional belief is what essentially characterizes the Capgras syndrome, can the experience of Capgras patients be accounted for independently of a reference to their delusional beliefs?

Recognition and Estrangement

There are at least three cases in which an object of experience can turn out to be unfamiliar to the subject of experience. (a) One can fail to re-identify the object and sees it as novel—as if one had not experienced it before. A typical reaction to this failure, when acknowledged, would be to say: "I've never seen this before." (b) One can fail to re-identify the object because one sees it as if it were different from how one experienced it before or from how one would have expected it to be. A typical reaction to this failure, when acknowledged, would be to say: "It is not x, because it looks different from x." The element of comparison is important in this case. It signals that a similarity or continuity with a previously known object of experience is detected but that the similarity or continuity is not sufficient for the re-identification to succeed. (c) One can re-identify the object but fail to have the emotional response toward it that usually accompanied one's previous experiences of it. In this case, one would say something like: "I feel differently toward this object." (This is what Young calls "estrangement").

Young claims that we cannot describe the experience of Capgras patients in terms of (a) or (b), because "The Capgras patient recognizes the familiar face as a familiar face; he experiences, then, the what-it-is-likeness of recognition" (31). Although we can see the reasons why he is making this claim, namely that the Capgras patient would not be accusing someone to be an imposter if she found that person entirely new and unfamiliar, there are difficulties in asserting that the patient recognizes the person. The Capgras patient does not recognize that person as the person dear to her, so the recognition that is taking place is just a partial one and its cognitive and affective components cannot be entirely made independent of one another.

Moreover, the experience of Capgras patients cannot be characterized purely as (c). Their reaction to the abnormal experience is not consistent with their feeling estranged from the object of experience. If they had an awareness that their emotional reactions or feelings toward the object of experience had changed, but no problem in recognizing the person as the dear one, they would not fail to re-identify the person as their loved one, but would attempt to find an explanation for the radical change in their emotional response. But Capgras patients do offer explanations such as those mentioned in (b), where they claim that the person (as they currently experience her) does not entirely correspond to the person they know. Some reports by Capgras patients (e.g., the imposter's eyes are too small or that she is too tall) indicate that they do make a comparison between two objects of experience (Campbell 2001). One could argue that these reports by Capgras patients should not be taken as evidence for the quality of their experiences, because they might be the effect of post hoc justification (Bortolotti 2005).

The claim would be that the reports that...