Ganser Syndrome

GANSER SYNDROME (Ganser), characterized, according to Ganser's own definition, by the fact that patients are unable to answer correctly even the simplest questions, although from the character of their answers it is evident that they understand the meaning of the questions proposed to them; in their answers they exhibit surprising ignorance and the disappearance of knowledge which they certainly possessed and possess...”. Patients deliberately give incorrect answers to the questions and demands presented to them. They answer incorrectly questions about their name, age, occupation, place of residence, about their relatives, about their former conditions of life; they deny certain facts from their past and, on the contrary, report events that never took place; they exhibit ignorance of the most elementary things and relationships; they perform incorrect even the simplest calculations, name the objects presented to them by another name and handle them not in accordance with their purpose, but systematically do the opposite, for example, insert the key into the door with the bit upward or the handle forward, try to light a match with the back side, read the time on the watch as the opposite of the actual time; they do not recognize close persons, but greet people whom they see for the first time as acquaintances; they deny what they have just said, and so on. An illustration can be provided by the example of a conversation. - “How many noses do you have?” - “I don't know.” - “Do you have a nose?” - “I don't know.” - “Do you have eyes?” - “I do not have eyes.” - “How many fingers do you have?” - “Eleven.” “How many legs does a horse have?” - “Three.” - “And an elephant?” - “Five,” and so on. This symptom occurs in its most typical and vivid form in the syndrome described by Ganser, the hysterical twilight state, and also enters the picture of states related to this syndrome (pseudodementia, puerilism); it may also occur in schizophrenia as a manifestation of negativism and absurd wit.

P. Zinoviev. Ganser's twilight state, or Ganser syndrome, is a form of hysterical twilight states described for the first time in 1897 by the Dresden psychiatrist Ganser. In the etiology of this syndrome, mental shocks, fear, trauma, and prison sentences play a large role (it is very often observed in accused prisoners). The picture of the disease is characterized by the presence of Ganser's symptom; alongside it, other phenomena are observed: the patient's general appearance is timid and bewildered, depressed; hallucinations and delusional fantasies occur; his behavior reveals a state of complete theatrical emphasis on meaninglessness; the patient often behaves somewhat childishly: sometimes he laughs absurdly, sometimes as if in fear demonstratively hides under a table or bed, sometimes there are sharp phenomena of mental and motor delay (Raecke's hysterical stupor of prisoners): the patient lies motionless in bed, looks completely indifferently at the surroundings and answers questions with great delays, sometimes complaining of a headache. There are present various hysterical stigmata. Ganser's symptom usually holds for a short time at the height of the twilight state and with the clarification of consciousness usually disappears, but in individual cases it can also take a protracted course. The absurd answers of the patient to simple questions force one to assume at first glance a deep loss of elementary knowledge, which is not observed in any form of acquired dementia: they exhibit, however, characteristic features that distinguish them from other incorrect answers of mentally ill people and facilitate their recognition and correct assessment. Despite the obvious incongruity of the answers, the latter always relate to the questions and remain within the limits of representations related to the question. Through systematic observation and indirect questions it is possible to convince oneself that the patient possesses the knowledge whose loss his answers force one to assume, and that outside of direct examination he exhibits a correct understanding of things and relationships. This peculiarity, in connection with the frequent manner of speaking slowly, as if thinking and searching for an answer, creates the impression of intentionality and involuntarily suggests the thought of simulation. In accordance with modern views on the essence of hysterical reactions and psychogenic disorders, in Ganser syndrome one has to see primarily phenomena of 'repression' and 'flight into psychosis'. Arising usually under conditions of unbearable situation, Ganser syndrome is, on the one hand, an expression of the unconscious desire to appear or be sick and thereby create a more favorable position, and on the other hand, a manifestation of the usual prejudice that mental disease must be expressed in absurd speech and loss of elementary knowledge. At the same time, severe experiences (imprisonment, fear of responsibility, military danger), shaking often already insufficient and unstable psyche, create in patients a state of bewilderment, helplessness, inability to concentrate, and questions about the simplest things may suggest the thought of impossibility to answer, analogously to the hypnotically suggested inability to count to 10. The forensic-medical significance of Ganser syndrome is very great both because it most often occurs in accused prisoners and is often the subject of psychiatric expertise, and because of its proximity to simulation, since, being a peculiar defensive reaction, it represents an unconsciously conducted simulation. In individual cases, drawing a sharp line between Ganser syndrome and conscious feigning, especially outside of stationary observation, seems quite difficult, and this obliges the expert to great caution.