On Misidentification: A Clinical Note

Misidentification is one of the most common symptoms of the psychoses. It occurs frequently in toxic states when patients misidentify relatives and friends and just as frequently in the so called functional psychoses. With an otherwise clear sensorium, patients refuse to recognize their immediate relatives and call them by names of other people whom they do not necessarily resemble or by names of people long dead. The tendency to misidentify people and especially the tendency to identify living people with the dead has attracted my curiosity for a long time, but I was never able to find a satisfactory explanation because I never saw a case in which misidentification was an isolated symptom. Usually, misidentification is associated with other symptoms such as delusions and hallucinations which obscure it. Recently I studied a case in which misidentification was the only presenting symptom.

Misidentification is the counterpart of identification and one cannot discuss one without the other. For all practical purposes, identification is the same thing as introjection although Knight1 in a recent paper points out that identification includes both introjective and projective mechanisms. The presence of projection in identification remains, however, a debatable question. In Mourning and Melancholia, Freud2 described melancholia as consisting largely of a process of ejection of the love object whom the person had introjected in the course of libidinal attachment to the object. Clinical experience, especially in the psychoses, has convinced me that this is a fundamental mechanism especially in reactive depressions. I am not at all