Thursday, October 30, 2014

Fright Week: The Stranger in the Mirror

In the mirror we see our physical selves as we truly are, even though the image might not live up to what we want, or what we once were. But we recognize the image as “self”. In rare instances, however, this reality breaks down.

In Black Swan, Natalie Portman plays Nina Sayers, a ballerina who auditions for the lead in Swan Lake. The role requires her to dance the part of the innocent White Swan (for which she is well-suited), as well as her evil twin the Black Swan — which is initially outside the scope of her personality and technical abilities. Another dancer is favored for the role of the Black Swan. Nina's drive to replace her rival, and her desire for perfection, lead to mental instability (and a breathtaking performance). In her hallucinations she has become the Black Swan.1

The symbolic use of mirrors to depict doubling and fractured identity was very apparent in the film:
Perhaps Darren Aronofsky [the director's] intentions for the mirror was its power to reveal hidden identities. If you noticed the scenes where Nina saw herself in the mirror, it reflected the illusion of an evil. The mirror presented to her the darkness within herself that metaphorically depicted the evolution into the black swan.

How can the recognition of self in a mirror break down?

Alterations in mirror self-recognition

There are at least seven main routes to dissolution or distortion of self-image:
  1. psychotic disorders
  2. dementia
  3. right parietal-ish or otherwise right posterior cortical strokes and lesions
  4. the ‘strange-face in the mirror' illusion
  5. hypnosis
  6. dissociative disorders (e.g., depersonalization, dissociative identity disorder
  7. body image issues (e.g., anorexia, body dysmorphic disorder)

Professor Max Coltheart and colleagues have published extensively on the phenomenon of mirrored-self misidentification, defined as “the delusional belief that one’s reflection in the mirror is a stranger.” They have induced this delusion experimentally by hypnotizing highly suggestible participants and planting the suggestion that they would see a stranger in the mirror (Barnier et al., 2011):
Following a hypnotic suggestion to see a stranger in the mirror, high hypnotizable subjects described seeing a stranger with physical characteristics different to their own. Whereas subjects' beliefs about seeing a stranger were clearly false, they had no difficulty generating sensible reasons to explain the stranger's presence. The authors tested the resilience of this belief with clinically inspired challenges. Although visual challenges (e.g., the hypnotist appearing in the mirror alongside the subject) were most likely to breach the delusion, some subjects maintained the delusion across all challenges.

Ad campaign for the Exelon Patch (rivastigmine, a cholinesterase inhibitor) used to treat Alzheimer's disease. Photographer Tom Hussey did a series of 10 award-winning portraits depicting Alzheimer's patients looking at their younger selves in a mirror (commissioned by Novartis).

Mendez et al. (1992) published a retrospective study of 217 patients with Alzheimer's disease. They searched the medical records for caregiver reports of disturbances in person identification of any kind. The most common type was transient confusion about family members that resolved when reminded of the person's identity (found in 33 patients). The charts of five patients contained reports of mirror misidentification, which was always associated with paranoia and delusions. Although not exactly systematic, this fits with other studies reporting that 2–10% of Alzheimer's patients have problems recognizing themselves in a mirror.

A thorough investigation of the topic was actually published 50 years ago, but largely neglected because it was in French. Connors and Coltheart (2011) translated the 1963 paper of Ajuriaguerra, Strejilevitch, & Tissot into English. The Introduction is quite eloquent:
The vision of our image in the mirror is a discovery that is perpetually renewed, one in which our being is isolated from the world, from the objects surrounding it, and assumes, despite the fixed quality of reflected images, the significance of multiple personal and potential expressions. The image reflected by the mirror furnishes us not only with that which is, but also how our real image might be changed. It therefore inextricably combines awareness, indulgence and critique.

They examined how 30 hospitalized dementia interacted with mirrors in terms of (1) recognition of their own reflection; (2) use of reflected space; and (3) identifying body parts. The patients sat in front of a mirror and answered the following questions:
  • What is this?
  • Who is that?
  • How old would you say that person is?
  • How do you think you look?
Then the experimenter stood behind them and asked questions about himself (e.g., “who is that man?”), and showed them objects in the mirror (e.g., an orange or a pipevery funny).

Eight patients did not recognize themselves in the mirror:
  • Three didn't understand the concept of a mirror. They didn't pay attention to any reflections until directed to do so, and then they became transfixed. They also failed to recognize photos of themselves or their caretakers.
  • Another three eventually admitted it might be themselves when prodded several times.
Those six individuals had severe Alzheimer's disease.
  • The final two recognized themselves the second time, and displayed considerably more anxiety. This sounds terribly frightening:
These patients were attentive to their own reflections and those of the researchers, whom they identified. The first patient seemed a bit anxious; she began by touching herself, then laughed, then proclaimed “that is not quite me, it sort of looks like me, but it's not me.” When she was shown her photo head-on and then from the side, she immediately identified herself when the photo was head-on but from the side said “that's not quite me.”
These two individuals were in an earlier state of dissolution and likely had more awareness of what was happening to them.

Other patients with mirrored-self misidentification show greater sparing of cognitive abilities. Chandra and Issac (2014) presented brief case summaries of five mild to moderate dementia patients with “mirror image agnosia, a new observation involving failure to recognize reflected self-images.” This is obviously not a new observation, but the paper includes two videos, one of which is embedded below.
Sixty-two-year-old female was brought to the hospital with features of forgetfulness and getting lost in less familiar environment. ... She was then shown the mirror 45 cm × 45 cm. She could identify it as a mirror. She showed unusual attraction to the mirror and ignored the physician and people around. She would go to the mirror and converse with her own image as if the image is another person but could correctly identify the reflected face of her daughter in law and the resident but she was asking her own reflection for the name and communicated to others saying that ‘here is a woman who does not know her name’.


Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported

LAST BUT NOT LEAST we have the Strange-face-in-the-mirror illusion (Caputo, 2010). When gazing upon one's reflected face in a dimly lit room, after a minute or two...
The participants reported that apparition of new faces in the mirror caused sensations of otherness when the new face appeared to be that of another, unknown person or strange `other' looking at him/her from within or beyond the mirror. All fifty participants experienced some form of this dissociative identity effect, at least for some apparition of strange faces and often reported strong emotional responses in these instances.

try this if you dare, 
on halloween night...

Further Reading

The strange-face-in-the-mirror illusion – Mind Hacks, with 271 comments.

Visual perception during mirror gazing at one's own face in schizophrenia – The strange-face-in-the-mirror illusion with schizophrenics (seems a little mean to me)

Mirrors in film – a list

Reflections and Mirrors in film – discussion board


1 As an aside, Natalie Portman (who has published in NeuroImage) won the 2011 Best Actress Academy Award for this performance. Her male counterpart, Colin Firth (who has published in Current Biology) won the Best Actor Award.


Ajuriaguerra, J. de, Strejilevitch, M., & Tissot, R. (1963). A propos de quelques conduites devant le miroir de sujets atteints de syndromes démentiels du grand âge [On the behaviour of senile dementia patients vis-à-vis the mirror]. Neuropsychologia, 1, 59–73.

Barnier AJ, Cox RE, Connors M, Langdon R, & Coltheart M (2011). A stranger in the looking glass: developing and challenging a hypnotic mirrored-self misidentification delusion. The International journal of clinical and experimental hypnosis, 59 (1), 1-26 PMID: 21104482

Chandra SR, & Issac TG (2014). Mirror image agnosia. Indian journal of psychological medicine, 36 (4), 400-3 PMID: 25336773

Connors MH, & Coltheart M (2011). On the behaviour of senile dementia patients vis-à-vis the mirror: Ajuriaguerra, Strejilevitch and Tissot (1963). Neuropsychologia, 49 (7), 1679-92 PMID: 21356221

Mendez MF, Martin RJ, Smyth KA, & Whitehouse PJ (1992). Disturbances of person identification in Alzheimer's disease. A retrospective study. The Journal of nervous and mental disease, 180 (2), 94-6 PMID: 1737981

- this looks like a strange one -

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At November 01, 2014 5:59 PM, Anonymous Em said...

Thanks for summarizing the film for the post as I have not seen it yet. Something Portman said reminded me of another type of illusion, I heard an actor speaking recently about how to get into character. She claimed no one has really studied how actors do this. It sounds almost similar to being convinced (except deliberately) that you're someone else.


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