Acta Psychiatr Scand 2004: 109: 1922 Printed in UK.

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ACTA PSYCHIATRICA SCANDINAVICA

Review article

Lycanthropy psychopathological and psychodynamical aspects

Garlipp P, Go decke-Koch T, Dietrich DE, Haltenhof H. Lycanthropy psychopathological and psychodynamical aspects. Acta Psychiatr Scand 2004: 109: 1922. Blackwell Munksgaard 2004. Objective: The imagination of being transformed into an animal or being an animal is called lycanthropy. The phenomenon is presented and psychodynamical aspects are discussed. Method: A literature review forms the base of this discussion of a psychopathological phenomenon. Results: The lycanthropic symptomatology represents a spectrum of continuity of developmental and culture-dependent normal behaviour via partial forms to the complete picture of lycanthropy. It is observed in dierent mental disorders. Conclusion: Lycanthropy is interpreted by the authors as a delusion in the sense of the self-identity disorder dened by Scharfetter. It is mainly found in aective and schizophrenic disorders but can be a symptom of other psychiatric disorders as well. Psychodynamically this kind of delusion can be interpreted as an attempt to project suppressed aects, especially with aggressive or sexual content, into the gure of an animal. Psychotherapy and/or neuroleptic medication can be eective.
Introduction

P. Garlipp1, T. Gdecke-Koch2, D. E. Dietrich2, H. Haltenhof1

1 Department of Social Psychiatry and Psychotherapy and 2Department of Clinical Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany

Key words: psychotic disorders; schizophrenia; delusions; psychopathology Dr Petra Garlipp, Abt. Sozialpsychiatrie und Psychotherapie, Carl-Neuberg Str. 1, 30625 Hannover, Germany E-mail: garlipp.petra@mh-hannover.de Accepted for publication September 08, 2003

The imagination of being transformed into an animal or being an animal is called lycanthropy (lycos wolf). The transformation must not be verbally reported by the patient. The clinical impression of clear-cut animal-like behaviour is included in the denition. The imagination of the capability of the human being to transform into an animal is a phenomenon that has been described in many cultures since early history lun des syndromes psychiatriques les plus anciens de lhistoire (1) and can be globally found in the early developmental periods. Greek mythology and the bible show examples. In Europe the imagination of being transformed into a wolf or a dog was widespread in the Middle Age. In South-east Asia and Africa animals chosen are the tiger and hyena, the crocodile and shark, common but feared (2) e.g. discussing the strength of animals. Some African rituals, reports of African tribes where the shaman transforms the patient into an animal as an act of healing. The animal cannot suer from the patients human disease, therefore the patient is saved.

Lycanthropy was rst described in medical literature in the second century after Christ by the Greek Marcellus from Side (3). In the 16th and 17th century it was discussed if lycanthropy might be the manifestation of a natural disease, the inuence of Satan or witches or the eect of poison or toxic salves. With the beginning of the Age of Enlightenment in Europe the belief in the demonic inuences was replaced by a rational scientic view of the world. At the beginning of the third millennium, the phenomena of those metamorphoses can still be found as a human pattern of behaviour in traditional and modern societies. In general the denition of lycanthropy as a psychopathological symptom depends on the cultural context. In the Western industrial nations characterized by the principles of rationalism and causality the irrational thought contents were dened as mythology and superstition. Looking at the process of individual development the lycanthropic patterns of behaviour can be seen as psychological varieties of normality. Children do think magical and archaic (4). Speaking animals, magicians, witches, ghosts and magic have their 19

Garlipp et al. place in the fantasy and in the emotional world of children. For them, taking over the role of an animal via identication processes is easily possible. In the adults world the mananimal metamorphoses can be found in literature, in fairy tales and jokes, as well as in art.
Material and methods
Table 1. Case reports of lycanthropy Animal observed Werewolf Werewolf Wolf Dog Dog Bird Dog Horse Wolf Dog Gerbil Cat Bird Rabbit Cat Unspecified Wolf Tiger Dog/Horse/ Cat (serial) Werewolf Bird Tiger Wolf (partial) Dog Dog Unspecified (partial) Dog (in the other) Dog Bee Frog

Authors Surawicz & Banta (8)

Diagnosis

Gender Male Male Female Female Female Female Male Female Male Male (2) Male Male/Female Female Male Male Male Male Male Female Male Male Male Male Male Male Female Male Female Female Female

A Medline research was performed using the key word Lycanthropy for the time span of 19662002. Twenty-one articles, mostly case reports, were found. In addition cross references of the literature lists of the articles found were followed as well. Regarding this article the main review articles and the case reports were chosen.
Results

Drug abuse Brain syndrome Rosenstock & Vincent (7) Schizophrenia Jackson (11) Psychosis Coll et al. (18) Psychot. Depress. Knoll (13) Dementia Schizophrenia Schizophrenia ? Keck et al. (5) Bipolar I Bipolar I Bipolar I Bipolar I Bipolar I Bipolar I Major depress. Schizophrenia Schizophrenia Borderline Dening & West (10) Affective disorder Bnzech et al. (1) Rajna et al. (20) Kulick et al. (19) Verdoux & Bourgeois (9) Rao et al. (16) Moselhy (15) Hysteria/Antisocial PD Schizophrenia Depression Bipolar I Psychotic Depression Depression Mixed affective episode Intermetamorphosis Garlipp et al. (17) Schizophrenia Schizophrenia Schizophrenia

Keck et al. (5) developed operationalized diagnostical criteria for lycanthropy: 1. A patient reports in a moment of clarity or looking back that he sometimes feels as an animal or has felt like one. 2. A patient behaves in a manner that resembles animal behaviour, for example crying, grumbling or creeping. In the current medical literature mananimal metamorphoses were described concerning the following animals: wolf/werewolf (1, 59), dog (5, 1018), gerbil (5), rabbit (5), horse (10, 13), tiger (5, 19), cat (5, 10), bird (5, 13, 20), unspecied animal species (5, 15), frog and bee (17). In Asia, Africa and South America, metamorphoses in tiger, hyena, crocodile and shark were observed (21, 22). The reported cases of metamorphoses into werewolves (1, 8) should not be included in the denition as they represent the transformation into a virtual fairy gure, not an animal. In spite of this, as they were the rst ones to be described, they are also mentioned in Table 1. The symptomatology can be seen as a continuity spectrum of developmental and culture dependent normal behaviour (5, 13) via transitional a fantasy of an artist and partial forms (9, 15) to the whole picture of lycanthropy described by Keck et al. (5). The length of transformation is usually short (5, 10, 11), symptomatology has mostly disappeared in a weeks time. People who live in preindustrial societies and people living on isolated countrysides are predisposed. Other precipitating factors seem to be subconscious sexual conicts. Lycanthropic symptomatology can be seen in dierent mental diseases. Most of the patients suer 20

from an aective disorder (5, 9, 10, 12, 15, 16, 19) or from schizophrenia (5, 7, 11, 13, 15, 17, 20). Furthermore, the mananimal metamorphosis can be seen after the intake of psychotropic substances including cannabinoids (8) as well as alcohol abuse (6, 14). Rarely, lycanthropy is reported in personality disorders (1, 5, 6). Case reports can be found concerning organic psychosyndromes (8), dementia (13) and epilepsy (19). Another dierential diagnosis is hysteria (1, 3, 7). The diagnosis of hysteria was predominant up to the beginning of the last century, especially as the symptomatology sometimes spread epidemically (3).
Discussion

In psychopathological terms the phenomenon of lycanthropy can be understood as depersonalization (8, 16), disorder of the integrity of the self (Jaspers) (12), psychotic symptom (19), overvalued idea (16) or hypochondria. In an earlier paper the authors (17) interpreted lycanthropy as a kind of delusional symptom which is not specic for a disease but mostly seen

Lycanthropy psychopathological and psychodynamical aspects in aective and schizophrenic psychoses. They dened it as a delusional metamorphosis in a sense of a self-identity disorder dened by Scharfetter (23), who does not use the term lycanthropy, but explains the delusional metamorphosis into an animal can be found. Koehler et al. (12) discuss the lycanthropic symptomatology referring to the aspect of possession described by Jaspers (24), who emphasized the determinance of symptoms by the cultural context. He mentioned the aspect of being possessed by the Devil and related it to the phenomenon of hysteria. Koehler et al. (12) state that the lycanthropic experience does not characterize any one specic symptom form. In the literature, psychodynamics of lycanthropy is understood as follows. Verdoux and Bourgeois (9) interpreted the lycanthropy of a patient who failed in his job and was tortured by feelings of guilt and shame as a projected and felt punishment of God. Jackson (11) described a patient who externalized her sexual needs which she experienced as animalistic and loaded with guilt with a hindered aggression by transforming into a dog. Rosenstock and Vincent (7) stated that a bizarre and chaotic sexuality can be externalized by lycanthropy in the sense of projection when the internalized feelings overwhelm the original strategies of defence. They registered a signicant inferiority complex in their patients combined with a high need of aection and attention. Rao et al. (16) interpreted the transformation of two patients into dogs after they had been bitten by dogs as identication with the aggressor. Surawicz and Banta (8) as well as Moselhy and Macmillan (25) hinted at the psychoanalytical interpretation of lycanthropy as a means of expression of primitive id-instincts that can be externalized by splitting mechanisms in an animalistic way, thereby avoiding feelings of guilt. Knoll (26) emphasized the relevance of the aects in the development of delusion and states: () The economy of a () stable gure of delusion in the world of ideas seems to base on a neglect of an extreme ambiguous socially tabooed animalistic aectivity. () Otherwise unbearable tensions on the side of the impulsive aects seem to be bound unidimensionally with the help of a more and more structured delusional idea. Knoll also named the aspect of a lack of communication with the other which might play a symptom-maintaining role. Knoll (13) refers to the problematic phenomena of countertransference which can be induced by lycanthropic behaviour, reecting the taboo of the animalistic part in the professionally psychiatric attitude as well. This could be the reason why these kinds of metamorphoses are rarely described. Lycanthropy is interpreted as a variety of delusional experiences that does not form an own disease entity, but mostly appears in aective and schizophrenic psychoses. Hence the treatment primarily consists out of the diseases treatment, e.g. with neuroleptics. The pharmacological treatment is especially ecient in short-lasting symptomatology that is secondary e.g. to a schizophrenic psychosis, using neuroleptics and in case of an agitation benzodiazepines as well. Lycanthropic symptomatology that is found repeatedly or that is persisting should be treated with a psychotherapeutic approach. As the symptomatology of lycanthropy is very pronounced clinically and seems to happen suddenly at rst sight, it might be possibly judged as a psychotic symptom like others and the meaning that is expressed in the kind of animal and its behaviour will not be interpreted individually. In our view it is a delusional experience in the sense of the self-identity disorder dened by Scharfetter (23). Subconscious conicts of the patients may be symbolized by the choice of animal and the corresponding emotional experience. The symptomatology can be interpreted as a regression in an early childhoods developmental phase. It seems to be plausible that defence mechanisms of aect that are experienced as threatening like aggression and sexuality may fail in a conict situation and a psychotic defence strategy, in this case the lycanthropic symptomatology, may stabilize the patient at rst. In this context, we refer to the case reports mentioned above. The communication aspect of lycanthropy is relevant as well. Especially in those patients who show a therapy-resistant lycanthropy over years, this experience seems to be a self-stabilizing upgraded object replacement. Keck et al. (5) also mentioned examples of patients who faked the lycanthropic symptomatology. The diagnosis of a factitious disease and histrionic elements should therefore be considered as well. A psychodynamic way of interpretation is especially indicated in those constellations. Psychotherapy is often mentioned as a therapeutical element besides pharmacological treatment. Yet, it has to be kept in mind that even a long-lasting psychotherapy sometimes fails in changing the persistence of the symptomatology. To sum up lycanthropy, seeming primarily bizarre and often leading to taboos in the countertransference, is an ancient but current psychopathological phenomenon that can partially be analysed psychodynamically. 21

Garlipp et al.
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