Kandinsky-Clerambault syndrome: what is it and can it be cured?

Kandinsky-Clerambault syndrome, or mental automatism syndrome, is a mental disorder characterized by the development of hallucinations and paranoia. Patients suffering from this type of disorder are susceptible to the development of obsessive states, in which a person is confident that there is an outside influence on his psyche. Patients complain that their thoughts are controlled by a certain entity to whom they must obey unquestioningly. Ultimately, the patient gains confidence in the automaticity of his own actions, which leads to alienation of the individual.

"Hunters" and victims

The first comprehensive description of the symptoms of this disorder belongs to the Russian psychiatrist Viktor Khrisanfovich Kandinsky (1849–1889), who in 1880 published a chronicle of his own illness, “On the Doctrine of Hallucinations,” where he gave a detailed description of the observed mental disorders. In 1881, a German translation of the book was published, which quickly received responses in Germany and France.

Almost 40 years later, Gaëtan Henri Alfred Eduouard Léon Marie Gatian de Clérambault (1872–1934), a French psychiatrist, compiled a classification of the symptoms identified by Kandinsky and combined them into a syndrome, which he received name: Kandinsky-Clerambault syndrome.

Thus, Kandinsky and Clerambault independently described the syndrome of mental automatism. It is noteworthy that both psychiatrists analyzed and described their own painful experiences. They were both sick, and both eventually led to suicide.

History

The syndrome is named after Viktor Kandinsky, the second cousin of the artist Wassily Kandinsky. In 1876-1877 Victor served in the navy as a ship’s doctor, participated in the Russian-Turkish War and suddenly felt that he had been “subjected” to the mental attack of the Tsarist secret police. But he seized control in time and went to psychiatry himself, where he was able to describe his experiences in the critical-clinical study “On Pseudohallucinations,” which was highly praised in his works by the luminary of psychiatry, Jaspers. In addition, he is considered the father of Russian forensic psychiatry.

To stop external “influence” on his brain, he committed suicide in the name of conspiracy at the peak of one of the attacks in 1889. through overload with substances.

There is not much interesting about the second half of the syndrome, about Clerambault: he was a similar schizophrenic psychiatrist-schizophrenic from France, “controlled” by Surte (this is a French FSO) and, independently of Kandinsky, described his symptoms of mental automatism.

He also came up with erotic delusions (Clerambault syndrome), the law of his name, and then fell into depression with delusions of guilt and shot himself.

Symptoms of Kandinsky-Clerambault syndrome

This is a feeling of alienation from one’s own mental processes, of mastery by someone from the outside. Arises as a result of delusional ideas about the imaginary impact on the patient (for example, radiation or ultrasound).

Ideatorial, or associative, automatisms are the result of an imaginary influence on thinking processes and other forms of mental activity.

These include:

Mentism is a violent influx of thoughts and images beyond the patient's control.

A symptom of openness of thoughts is the feeling that thoughts are known to others.

“Thought withdrawal,” in which the patient’s thoughts “disappear” from the head.

“Made thoughts” is the belief that his thoughts belong to strangers, most often his persecutors, and are put into the patient’s head.

“Unwinding of memories”: patients, against their will and desire, as if under the influence of an outside force, are forced to remember certain events of their life; Often, at the same time, the patient is “showed pictures” illustrating memories.

The phenomenon of “made moods, feelings, dreams”: patients claim that their moods, feelings, likes and dislikes are the result of external influences. For example, there is a feeling that emotions do not arise independently, but under the influence of an outside force (“they laugh at me,” “they cry at me”).

Sensory or sensory automatisms usually include unpleasant sensations that also arise as a result of the imaginary influence of an outside force. They manifest themselves as a feeling of sudden heat or cold, painful sensations in the internal organs, head, and limbs. Most often they are unusual, pretentious: patients talk about extremely peculiar sensations in the form of twisting, pulsation, bursting of internal organs and body parts. For example, I heard from patients that “from radiation, the heart swells and buzzes like a bell” or “a plasticity has formed in the head... the brain has frozen, hardened...”; “My intestines are tied in knots - this is causing constipation...” The intestines were turned off, the brain was preserved, stopped - violence! In this case, there may be no real problems from the authorities at all.

Motor, or motor, automatisms include the feeling of external imposition of the movements performed by the patient. Patients believe that their actions are controlled, they move their limbs, tongue, cause a feeling of immobility, numbness, and deprive them of the ability to voluntarily move. Motor automatisms also include speech motor automatisms: patients claim that their language is spoken; the words they utter belong to strangers. So, a patient who has just scolded the doctor with the last words sharply begins to apologize: “Sorry, it’s not me... You are a good doctor, but your tongue moves in your mouth by itself...

Forms of the disease

Clerambault syndrome can occur in two phases:

• Acute (from several days to 3 months). The symptoms are pronounced. A person suffers from pseudohallucinations with the manifestation of delusional thoughts. He is active, talkative, aggressive and often gets irritated over trifles. Sometimes there is an unjustified feeling of fear. In some cases, the patient is so emotionally unstable that he completely falls out of normal functioning in society.
• Chronic (up to several years).
  Symptoms increase gradually. They cannot be diagnosed at an early stage of the disease, so they often go unnoticed. First, signs of associative automatism appear, then sensory symptoms appear, and in severe cases, motor symptoms.

Pseudohallucinations

These phenomena are characteristic specifically of Kandinsky-Clerambault syndrome. These are visual, auditory, olfactory, gustatory and other deceptions of perception, distinguished by patients from real objects (i.e., the patient seems to “see them with his inner eye” or “hears them inside his body”) and have the nature of being made, artificial.

For example, the patient “sees” “made images”: faces, entire panoramas (similar to watching a movie), which are “showed” to the patient by his “persecutors” with the help of certain “apparatuses”. Auditory pseudohallucinations - noises, words, phrases “transmitted” by radio, through various equipment; they are most often localized in the head and body; have an imperative and commentary nature, belong to familiar and unfamiliar persons; can be men's, women's, children's.

For example, one of the patients very colorfully (at the peak of an acute condition) described to me “pictures of the future” that “alien angels” were “transmitting” into his brain. It looked, he said, like a filmstrip or slides that were shown to his inner “brain” eye. He described the contents of the “pictures” in detail, but due to other thinking disorders, he could not complete the description to the end, slipping into other topics.

We also constantly have to ask patients - where exactly do they hear “voices”? If a person reports that orders or swearing are heard inside the head, even in complete silence around, this is a serious sign of our syndrome.

Delusions of influence or persecution

The patient can explain his painful sensations by influencing him using a variety of methods - from witchcraft and hypnosis to modern means (electricity, UHF waves, radio waves, radiation, atomic energy, laser beams). The influence is carried out by both individuals and organizations, often with the goal of causing harm to the patient. For example, in my practice, which began in the late 90s of the last century, the most common complaints were about the “mafia or racketeers” (everyone remembers the dashing 90s !), as well as aliens from other planets and psychic sorcerers (remember the craze for parapsychology and ufology in the 80s and 90s!).

It is Kandinsky syndrome within schizophrenia that is characterized by delusions of persecution, interpretation, and influence. Other types of delusions are also inherent in other mental illnesses.

It is possible to develop an inverted version of Kandinsky-Clerambault syndrome: the patient himself supposedly has the ability to influence others, recognize their thoughts, influence their mood, feelings, and actions. These phenomena are usually combined with ideas of overestimation of one's personality or delusions of grandeur.

One of my regular patients, a fairly young girl, at the height of a schizophrenic attack, believed in “enormous magical power” emanating from her. She felt like “an all-powerful healer, connected by energy fields to the entire world,” and was unstoppable in her attempt to heal literally everyone who came into her sight. I must disappoint lovers of mysticism and energy therapy. The patient only seemed to be “guessing” the diagnosis, and she could not help anyone. But she made an excellent recovery and is now practically healthy.

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• What's next

Flow

Hallucinatory-paranoid syndrome within the framework of schizophrenia can develop acutely or become chronic. The acute form develops quickly, is characterized by a paroxysmal course, vivid, figurative, but poorly systematized delusions; variability, inconsistency of symptoms, intensity of emotions (not only fear, suspicion, hostility, but also high spirits), severity of mental automatisms.

The chronic form develops gradually, sometimes unnoticeably; can last for years. Usually the clinical picture becomes more complicated due to the accumulation of various automatisms. Delusional ideas are often systematized and directed. The patients’ sensations and imaginary sources of influence take on fantastic content (for example, their stomach was taken out, their intestines were blocked: they are being influenced from other continents with the participation of CIA employees, aliens).

Diagnostics

The presence of Kandinsky-Clerambault syndrome is determined by signs of the unconscious emergence and development of mental disorders with an ever-increasing feeling of alienation and awareness of their violence.

In addition, as part of the diagnosis of schizophrenia, we pay attention to other mental disorders that are characteristic of the disease itself. Indeed, with schizophrenia, specific disorders of the emotional-volitional sphere, behavioral disorders, memory and intellectual disorders occur. Of great importance is the history of the development of the disease process, its stages, the role of heredity and the premorbid personality of the patient.

All this allows the psychiatrist to separate Kandinsky syndrome from other externally similar mental phenomena.

Why does the disease occur?

Kandinsky syndrome is a pathology that occurs as a result of other serious diseases. These include:

• various psychoses (alcoholic, infectious, vascular);
• schizophrenia;
• obsessive-compulsive disorder.

Less commonly, this pathology can be caused by the following reasons:

• head injuries;
• drug use;
• brain tumors;
• intoxication with chemicals.

These conditions have a very strong impact on the psyche, which leads to the activation of the body’s defense mechanism, which appears in the form of automatisms.

The most common manifestation is sensory automatism, which justifies traumatic events and interprets them as a consequence of external influences.

Treatment and prevention of mental automatism syndrome

To prevent the development of Kandinsky-Clerambault syndrome, timely treatment is necessary, usually in a psychiatric hospital. Complex therapy, as part of the treatment of the underlying disease - schizophrenia:

• medicinal (neuroleptics: haloperidol, trifluoperazine, clozapine, olanzapine, risperidone and other drugs);
• biological therapy - electroconvulsive, insulin comatose;
• psychotherapy (with the positive effect of psychotropic drugs) followed by social rehabilitation (at the stage of recovery and awareness of the disease).