Tue, Aug 11, 2009 - Page 16 News List

When loved ones become imposters

Several recent experiments suggest that people recovering from severe brain injury are helped by contact with a familiar social environment. Their progress provides insights into how identity is formed, scientists say

By Benedict Carey  /  NY TIMES NEWS SERVICE , WEEDSPORT, NEW YORK

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Adam Lepak looked over at his mother and said, “You’re fake.”

It was a Tuesday late last month, and Cindy Lepak could see that her 19-year-old son was exhausted. Long days like this one, with hours of physical therapy and memory drills — I had a motorcycle accident, I hit my head and have trouble remembering new things, I had a motorcycle accident — often left him making these accusations.

“What do you mean ‘fake,’ Adam?” she said.

He hung his head. “You’re not my real mom,” he said. His voice changed. “I feel sorry for you, Cindy Lepak. You live in this world. You don’t live in the real world.”

Doctors have known for nearly 100 years that a small number of psychiatric patients become profoundly suspicious of their closest relationships, often cutting themselves off from those who love them and care for them. They may insist that their spouse is an impostor; that their grown children are body-doubles; that a caregiver, a close friend, even their entire family is fake, a duplicate version.

Such delusions are often symptoms of schizophrenia. But in the last decade or so, researchers have documented similar delusions in hundreds of people who are not schizophrenic but have neurological problems including dementia, brain surgery and traumatic blows to the head.

A small group of brain scientists is now investigating misidentification syndromes, as the delusions are called, for clues to one of most confounding problems in brain science: identity. How and where does the brain maintain the “self”?

What researchers are finding is that there is no single “identity spot” in the brain. Instead, the brain uses several different neural regions, working closely together, to sustain and update the identities of self and others. Learning what makes identity, researchers say, will help doctors understand how some people preserve their identities in the face of creeping dementia, and how others, battling injuries like Adam’s, are sometimes able to reconstitute one.

“When I wrote up my first case like this back in 1987, no one was much interested; it was a curiosity,” said Todd Feinberg, a neurologist and psychiatrist at the Albert Einstein College of Medicine and Beth Israel Medical Center, who has just published a book on the topic, From Axons to Identity. (Axons are nerve fibers.)

“Now there’s an explosion of interest in these cases,” Feinberg said, “because of their relation to the self, to the neurobiology of identity — to what it means to be human.”

WHO IS THAT?

“Who is that, Adam?” a physical therapist named Mike said on a recent morning, supporting the young man’s lean frame in front of a full-length mirror; a nurse supported him from the other side. “Who do you see there?”

“Mike.”

“That’s right,” said Pat Taisey, the nurse, who spends most days with him at home when the Lepaks are at work. “But who else do you see in the mirror, Adam?”

“You. Pat.”

“Yes, but who else?” she said.

An uncertain smile creased Adam’s face.

Two years ago it was not a hard question to answer. He was a first-year college student with a girlfriend, a tight group of buddies. A vegetarian, a fitness nut, a master of sarcasm, of the lunatic prank. He was the drummer for Sacred Pledge, a “straight edge” band (no drugs, no alcohol, no promiscuous sex) that was breaking into the hard-core scene in the Syracuse area.

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