Psychiatry
Interpersonal and Biological Processes
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Abducted by Aliens: A Case Study
Adriana D. Neagoe
To cite this article: Adriana D. Neagoe (2000) Abducted by Aliens: A Case Study, Psychiatry,
63:2, 202-207, DOI: 10.1080/00332747.2000.11024911
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Psychiatry 63(2) Summer 2000
202
Abducted by Aliens: A Case Study
ADRIANA
D.
NEAGOE
THIS article describes a case of Shared Psychotic Disorder in a married couple.
Because only one of the partners of the pair (the inducer) was alive, at the time of
the research, the other partner (the recipient) is presented by using a "psychological
autopsy" based both on 19 tape recordings containing her delusional recollections
and on a history provided by the husband. The content of their delusion, shaped
by a fantasy theme of contemporary Western culture, is unique among cases of
Shared Psychotic Disorder published in the last 30 years. The discussion following
the case presentation draws attention to the potential risk of this type of case
leading to a homicide-suicide pact. Additionally, comments are made about both
the pathogenesis, with emphasis on psychodynamic hypothesis, and a consideration
of the prognosis, which seems modulated by cultural factors.
Shared Psychotic Disorder (SPD) exerts a fascination based on its element of contagiousness, which uses a psychological rather
than physical means of infection. Contagion
of the imagination was first described by
Digby in 1658, although priority is often attributed to Lasegue and Falret (1877). The
case described below satisfies the DSM-IV
(American Psychiatric Association 1994) criteria and underscores both the difficulty of
obtaining access to a partner (once one member of the dyad is treated) and the social isolation in presentations of this rarely reported,
though perhaps not uncommon phenomenon
(Howard 1994; Silveira and Seeman 1995).
Adriana D. Neagoe, MD, is a senior Resident
at Boston University Medical Center, Psychiatry
Residency Training Program, 850 Harrison Avenue, Dowling 7 South, Boston, MA 02118; e-mail:
adneagoe @bmc.org.
The author thanks Mr. Peter Reich, Drs
Donald S. Gair, Padraic Burns, Douglas H.
Hughes, Frances Frankenburg, Albert Gaw, Lawrence Herz, and Charles Lewis for their assistance.
CASE PRESENTATION
The Inducer
Mr. J, a 46-year-old Catholic widower
who self referred to the Emergency Department in the middle of a night, was voluntarily
hospitalized because he was suicidally depressed. He was a salesman at a local grocery
and was living in a public shelter. He had a
plan to jump off a high building that night.
Following admission, he indicated that his anguish was associated with the first anniversary
of the death of his second wife, whom I will
call Cathy.
Previous depressive events included an
episode at age 17, a110ther in his twenties,
and a hospitalization for severe depression ano
attempted suicide at age 37 on the first anniversary of the death ot his first wife, whom 1
will call Linda. At that time, he attempted
suicide for the first time in his life by taking
an overdose of insulin, which he used to control his Type I diabetes. He had never come
to psychiatric attention before. The discharge
summary referred to his stories of gambling
and overspending, for which he was prescribed
Lithium in addition to Amoxapine for depres-
ABDUCTED BY ALIENS
sion; it did not mention any psychotic features
accompanying this depressive episode, despite
the fact Mr. ] was treated with an antidepressant with antipsychotic qualities. After a 6month period of outpatient stability, Mr. ]
stopped treatment on his own.
Mr. ] had no known family history of
psychiatric illness. He grew up in a rural area
and was proud that he was the only one in the
family able to obtain a college education; he
had a degree in mathematics. He mentioned
a longstanding conflict with his whole family
because of "their low level of education." Surprisingly, Mr. ] had only nonintellectual jobs
(e.g., taxi driver, management staff at a store,
flower delivery, bagel baker). He had always
had the desire to share with people ideas about
fundamental existential issues. His vocation as
a young adult was to become a priest, but he
was not able to pursue the theological courses
because he was too depressed about being
away from home. For the last few years he
had lost his belief in God and considered himself an atheist and only nominally a Catholic.
He met his first wife, Linda, in high
school and married her while in college. After
15 years of marriage, Linda died from a postsurgery embolism. His father-in-law blamed
Mr. ] for the death of his only child because
Mr. ] had not advised Linda to go see a surgeon sooner. Mr. ]'S guilt, aroused by this
accusation, led to his suicide attempt at age
37 and to his first psychiatric admission, as
noted above.
Soon after that hospitalization, Mr. ]
met his second wife, Cathy. They were married two years later, and for the next 6 years
until her death, she was bedridden with condiLions associaLed with juvenile rheumatoid arthritis. Dnring this time he provided 24-hour
care. It was during this enforced isolation that
a shared delusion developed. Interviews with
Mr.] and information from 19 tape recordings
that he made of his wife's "recollections" prior
to her death document a delusion involving
UFOs and aliens on the part of Cathy and
Mr.], whose interest in UFOs dated back to
his high school years. Mr. ] claimed to have
seen a UFO with his first wife, although she
203
did not share this belief or his idea of a possible
"reunion through UFOs" after death. He reported that he had lost interest in UFOs after
his first wife's death and resumed the study
of them 4 years into his marriage with Cathy.
Following Cathy's death, he moved to another
state where he found an hourly job at a grocery
as a salesman while living in a shelter. He
planned to save money to afford psychiatric
sessions with a local expert, author of a popular and controversial book about abduction
and aliens.
Mental Status Examination. Mr.] was a
well-nourished and well-dressed gentleman,
who looked older than his stated age. He
maintained good eye contact. He was cooperative, alert, and fully oriented. Speech was
normal in rate, volume, amount, and spontaneity. He was circumstantial in his thought
process and intact cognitively on screening
tests. His mood was depressed with appropriate emotional reactivity; he was unable to
speak about his second wife without tears during the admission exam. No abnormal perceptions were elicited. He gave his well-structured delusional material without insight, but
he was aware that his depression was an illness.
He had a suicidal plan on that night of his
admission, believing there would be a "50%
possibility of joining her [his second wife] on
a UFO or another planet" if he jumped off a
high building. He remained firmly fixed in his
belief about aliens, whom he viewed not as
persecutors but rather as beings that try to
make us aware of their existence.
Psychological Test. In summary, the
"Minnesota Multiphasic Personality Inventory 2" was valid and showed particular elevation on scales measuring mania, tendency to
somatization, and histrionic traits. l\11r. ] obtained one of the lowest scores for depression.
Pertinent Medical Findings. Mr.]' s active
problems were a Diabetes Mellitus Type I, of
which he had been aware since his early 3Os,
and a 1O-year history of impotence, likely secondary to the diabetes.
Mr. J's Hospital Course and Disposition.
During his hospital stay, when he and I listened to the tapes of Cathy, he spoke about
204
ADRIANA
the terminal period of his wife's life with considerable detachment. When presented in
rounds, he appeared like a scientist; he repeatedly returned to his haunting UFO topic. He
felt an obligation to share with professionals
his and his wife's extraordinary experience.
Letting people know of the possibility of being
abducted by aliens gave a purpose to the rest
of his life. As he explained his goal of spreading
the couple's extraordinary experience, he
found his suicidal idea contradicted. He appeared enthusiastic when visited by one of his
six friends, all alien believers. He was started
on valproic acid, up to 500 mg B.I.D. He also
had a trial of risperidone, which he could not
tolerate because of orthostatic hypotension.
He refused another trial of neuroleptics thereafter. His wish to stabilize his affect made him
compliant with his hospitalization, exams, and
valproic acid. His depression with suicidal
plan quickly went into remission, but his fIxed
beliefs in aliens remained. He was discharged
after 11 days of voluntary hospitalization, with
a plan to continue treatment as an outpatient,
which it was recommended to address his grief
and help him structure reality in psychotherapy, continue depakote and fInd acceptance
from the patient to use atypical neuroleptics,
and assist him in maintaining his work.
The Recipient and the Delusion
Data from her husband and 19 tapes
containing her recollections made possible a
"psychological autopsy" of Cathy.
Cathy grew up the only child of a middle-class family and graduated college with a
major in psychology. She was a social worker
ill her hUIIlt: city rnr lllany years and was 39
years old, single, amI living alune when she
111et 1v11'. J, whu was twu year!5 yuunger. 1'.,.1r.
J described his second wife as both educated
and intelligent.
Cathy was diagnosed with juvenile
rheumatoid arthritis when still a teenager. Mr.
J denied that she had any psychiatric problems
or that she had a family history of any psychiatric illnesses or other serious medical disorders. Mr. J did mention, however, that she
D.
NEAGOE
had a long-standing fear "of birds in general
and of owls in particular."
After two years of friendship, they decided to marry despite the grave prognosis of
her illness. Mr. J described their marriage as
"perfect," as they never argued and Cathy
never opposed him. He said they shared the
same enjoyment of reading. Neither the wife
nor the husband had ever used alcohol or
drugs. Cathy used to take over-the-counter
nonsteroidal anti-inflammatory drugs for her
chronic arthritis. She was bedridden for the
last 6 years of her life before she died in hospital from an infection, subsequent to her advanced juvenile rheumatoid arthritis. Two
years before she died, Mr. J began to show
her pictures of aliens who resembled owls and
discovered that she was very afraid of owls.
She began to experience a "nightmare" in
which she screamed out her "memories" of an
alien abduction. Mr. J asked her interviewlike questions to elicit more information about
her experience. He was able to record 19 tapes
with their dialogue while she was "sleeping"
and speaking loudly with wide-open eyes. She
would not remember anything in the morning, but when confronted with the tapes, Cathy and Mr. J elaborated the conviction that
she was an alien, born 3,000 years ago, and
that Mr. J had met and married her because
aliens induced him to do so, as he was the
right person to help her "remember." The
couple came to believe that they were in contact with aliens. During the day, nothing happened by chance; for example if they could
not fInd an object in the house, it was a sign
"They" exist. Mrs. and Mr. J saw objects disappearing' and reappearing in their house. Mr.
J said that one d<1Y 'In <lid" h<ld <1skcd C'lthy
Lu !Jl'Ove she was in contact with aliel'1s. IIe
elaillleJ LhaL Lwo objects Spolltl111eou51y t1nd
simultaneously dropped off the wife's bed in
front of everyone, which shocked them. Later,
Mr. J came to believe that he might also have
been abducted thousands of years ago and
might currently be an alien himself.
Cathy asked her husband to help her
die if she were ever in extreme pain and signed
a will to attest to this. Mr. J had a plan to press
205
ABDUCTED BY ALIENS
a pillow against her face when that moment of
extreme suffering came and then to kill himself by jumping off the building. This did not
happen because Cathy died peacefully in the
hospital.
Six months after his discharge from the
hospital, I saw Mr. ] again. After he gave his
consent for this report, he said he was not
seeing any therapist and had stopped taking
Depakote because he did not notice any difference. His mood seemed to have remained stable since his discharge. I told him that his
chart, which I needed for this article, was missing from the Record Department. He suggested that some day the chart would reappear, making reference to the aliens' manner
of becoming noticed on Earth. He was somehow right: the chart "miraculously" reappeared in a few days, returned from the outpatient clinic where he had had a follow-up visit
for his diabetes.
DISCUSSION
The Delusion
The partners shared the same content
of the delusion, but it had bizarre, persecutory,
ego-dystonic qualities in Cathy's case, whereas,
for Mr.], itis a pure delusion of reference with
a flavor of grandiosity and ego-syntonicity.
The belief that Cathy was a child abducted 3,000 years ago and later came to Earth
as an alien with human appearance is similar
to Capgras syndrome in that there is the same
delusional denial of the authenticity of the
identity of a clearly recognized person. In this
case, however, the two Identities of a single
physical appearance are not concomitant.
The cosmic content of the delusion
seems shaped by a theme from popular culture
of alienation and "Spirit Possession" common
in culturc-bound syndromcs like the Puerto
Rican espiritismo, the Cuban Santeria, the
Mexican curanderismo (Alonso and ] effrey
1988), or perhaps the Romanian Zburatorul.
Shared religious delusions described in
the literature pose a high fatal risk in suicide
p:lrts h~tw~f'.n f:lmily m~mhers (Kraya and
Patrick 1997). Here the similarity with the
religious types of delusion is worrisome: the
aliens replace God and a UFO or a mysterious
planet replaces Heaven (a place of rest when
one dies).
Hypothetical Pathogenic Mechanisms
Schmidt (1949) developed a behaviorist
model to explain SPD. The recipient learns
the abnormal beh~vior from the inducing
dominant partner and subsequently begins to
think and behave psychotically. From this
learning theory perspective, Cathy could not
ignore certain habitual behaviors of her husband, such as his interest in literature about
aliens, his fascination while looking at strange
pictures of aliens whose faces resembled owls,
and his wondering about her own fear of owls.
From wondering about her "owl phobia" to
constructing a false belief about aliens was
probably only one step. When no corrections
to these fantasies were forthcoming from outside herself because of her seclusion, the borders between reality and imagination could
have become increasingly blurred.
From a psychodynamic point of view,
picturing Cathy in her submissive bedridden
position accepting and building upon the delusion of her husband to preserve their gratifying relationship is not difficult. Her childish
screams on the tapes provide evidence of the
regression she might have experienced as a
result to her physical disability, her psychological isolation, and her possible depression.
We can observe how in fantasy Cathy
achieves her wish for attachment; however,
the result is a pathological one, that is, she
follows Mr. J'fl delufliCln and C()l1ttlhlltes to its
elaboration from her own repertory of childhood events. Here, separation-individuation
theory comes into play in the loss of differentiation and object-seeking quality of sharing the
other person's belief (Pine 1979).
The circular character of SPD described in the literature (Mentjox, van
Houten, and Koiman 1993) applies in our case
too, so that the term "Shared Psychotic Disorder" introduced by DSM-IV is indeed more
correct than the previous "Induced Psychotic
206
ADRIANA
Disorder." The circular causality of the phenomenon makes the terms "inducer" and "inductee" somehow blurred, and the delusion
itself becomes elaborated by both partners until it is owned by them as a believable symbiotic creation. Mr. J, who on his own had never
before thought he might be an alien, came to
believe it through the couple's mutual delusion.
Sharing his delusion with six peers kept
Mr. J united with those involved, saving him
from total withdrawal. We do not know the
degree to which the six friends shared and
accepted his belief: a wide range exists from
people manifesting a simple interest in UFOs
(as we can see on the Internet every day),
to people claiming to have been abducted by
aliens and experiencing psychotic symptoms.
But the bond was strong enough for one of
the six to visit him in a locked psychiatric unit.
D.
NEAGOE
important for the recipient (who in this case
is dead), but recognizing the role reversal phenomenon and the circular cau~ality, we realize
it is equally important for the treatment of
the inducer. In the case ofMr.J, the separation
may have happened physically, but in his
fantasy, the mutual delusional bond may remain psychologically strong. On theoretical
grounds, we may hope thatMr.J could benefit
from individual psychotherapy. However, in
practice, the cultural factors (i.e., association
with other alien believers) to which he continues to be exposed, strongly interferes with the
work of achieving the psychological separation. The prognosis is further guarded because
we have to take into account the difficulties
that the process of psychotherapy could encounter because of another of Mr.]'s belief:
his non-compliance with the medication.
The Safety Risk
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The current endeavor of Mr. J to make
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once shared with his wife seems to be the sole
meaning of his life. The narrow focus of his
preoccupation prevents him from forming
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fit into this unique purpose and fosters a devaluation of many things formerly dear to him:
his parents and siblings are almost non-existent for him, and his belief in God now has
no meaning for the former good Catholic who
wanted to become a priest. From the perspective of Presuicidal Syndrome, a concept introduced by Ringel (1976), this progressive limitation in so many areas leads to a deprecation
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