False Reconnaissance
False reconnaissance is the false recognition, or misidentification, of the people around oneself. In its positive form, strangers are mistaken for people the individual actually knows; in its negative form, people who are genuinely known are insisted to be strangers, sometimes elaborated into a belief that they are doubles or impostors standing in for the real person.
This has traditionally been noted to vary in extent by context: in acute confusional states and acute schizophrenia, only a few people tend to be misidentified at most, whereas some individuals with chronic schizophrenia may assign a false identity to essentially everyone they encounter.
Also known as
- Positive misidentification
- Strangers are wrongly recognised as friends, relatives, or other familiar people.
- Negative misidentification
- Genuinely familiar people, such as friends or relatives, are insisted to be strangers or impostors in disguise.
Recognition features
- Strangers are confidently identified as known people (positive misidentification), or genuinely known people are insisted to be strangers (negative misidentification)
- Extent varies from a handful of misidentified individuals in acute states to a pervasive pattern affecting nearly everyone encountered in some chronic presentations
- Occurs in the context of organic psychoses as well as acute and chronic schizophrenia
- Negative misidentification may be elaborated further into a belief that the person is a double or impostor rather than simply unfamiliar
Eliciting it at interview
- Ask directly about experiences of recognising people who turn out to be strangers, or of familiar people seeming to have become strangers
- Where negative misidentification is present, explore carefully whether it has been elaborated into a specific belief that the person is a double, impostor, or otherwise not who they claim to be
- Assess the overall extent of the pattern, since this — from an isolated instance to a pervasive pattern affecting nearly everyone — carries clinical significance
Distinguishing features
- Differs from déjà vu and its relatives in applying specifically to the identity of people, rather than to the general felt familiarity of a place, event, sound, or thought
- Negative misidentification, when elaborated into a fixed belief that a specific person has been replaced by an identical double, becomes the more specific and severe presentation known as Capgras syndrome
- The overall extent of misidentification (isolated versus pervasive) helps distinguish an acute, transient confusional presentation from a more chronic psychotic one
Common misconceptions
- That false reconnaissance is the same as ordinary forgetting a person's name or face; it involves an active, confident (mis)identification, not simply a failure to recognise someone
- That negative misidentification and Capgras syndrome are the same thing; Capgras syndrome specifically involves the further, elaborated belief in a substituted double, which is not present in every instance of negative misidentification
Related phenomena
Distortion of Recognition · Déjà Vu · Capgras Syndrome
Related syndromes
Fregoli Syndrome · Syndrome of Intermetamorphosis · Syndrome of Subjective Doubles · Reduplicative Paramnesia
Practice this
A patient in an acute confusional state repeatedly greets several strangers on the ward as though they were old friends, while also occasionally insisting that his own genuinely familiar nurse is actually a stranger he has never met. What is this? · A patient firmly and repeatedly insists that his wife, whom he acknowledges looks and sounds identical to his real wife in every way, is actually an impostor who has secretly replaced her, becoming suspicious and hostile toward her as a result. Before revealing the answer: is this false reconnaissance? · A patient fails to recognise someone they genuinely know. Before revealing the answer, decide what distinguishes false reconnaissance from Capgras syndrome. · You suspect a patient shows false reconnaissance. Before revealing the answer, decide how you would assess for this. · Explain why the overall extent of misidentification is described as a useful clue to whether an acute or a chronic process is at work.
Illustration
On a busy hospital ward, a 68-year-old man in an acute confusional state repeatedly and confidently greets an unfamiliar nurse as his late wife, while a woman with chronic schizophrenia on the same ward insists that every single member of staff, including several she has known for years, are strangers she has never met before today.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 5, 'Disorders of Memory'.