Ganser syndrome is a rare psychiatric disorder described in 1897 by Sigbert Ganser in incarcerated people. This German psychiatrist observed that some prisoners gave erroneous – but approximate – answers to simple questions (for example, “two plus two equals six”). This way of acting would have the purpose of achieving release from prison due to mental illness, but it occurs unconsciously.
It is included within dissociative disorders, which suppose a disconnection between thoughts, memories, actions and identity. They constitute an involuntary escape from reality.
“It is a very rare disorder that is diagnosed and treated, above all, by prison doctors “to date, there is little theoretical basis and research to clarify the nature of the syndrome.”
It is “a set of symptoms (that is the definition of the syndrome ) striking because it resembles dementia or a psychotic disorder, without being one”. It is not easily diagnosed “due to the confusion that its origin and classification produce among mental health professionals.”
the prevalence of this disorder “is very low and is more common in men (75% or more) and incarcerated people.” The average age of people with this syndrome “is 32 years and ranges from 15 to 62 years.”
There are four hypotheses about its causes, according to Jiménez. “I adhere to the dissociative origin hypothesis “, adds the psychiatrist. In Ganser’s words, this syndrome is “the result of an unconscious effort to escape from an intolerable situation .” This hypothesis is reinforced by “the fact that the onset and end are usually abrupt and that patients sometimes do not remember what they did without worrying about their striking symptomatology, always being a reaction to an environmental stressor”.
The second hypothesis is that it is secondary to organic damage because cases have been described where it was attributed to head injuries, tumours or previous encephalopathies. It is believed that organic damage would make it easier to react in this way to environmental stressors.
The third hypothesis is that it is a psychotic condition due to the similarity in the clinical presentation and because cases that later evolved into schizophrenia have been diagnosed.
The last hypothesis is that it is a simulation box. “It is said that the simulation (or conscious production of disorders) would induce the production (this time unconscious and amnesic) of other disorders of dissociative origin.
The most characteristic symptom of Ganser syndrome is giving approximate or ridiculous answers to simple questions. It is a fictitious and non-fictitious disorder, the difference being that saying something fictitious means inventing it on purpose and being fully aware of it. On the other hand, the artificial has an unconscious character: it is done looking for a gain (in this case, acquiring the role of a patient), but without the intention of doing so.
These are other possible manifestations of this psychiatric disorder:
- Clouding of consciousness.
- Memory loss.
- Somatic conversion symptoms ( disequilibrium, pseudo amnesia and other neurological symptoms).
- Visual and auditory hallucinations.
- Echolalia (involuntarily repeating a word or phrase that has just been heard or pronounced).
- Echopraxia (involuntary imitation of another person’s movements).
- Distortion or loss of personal identity.
- Fugue and regression to stages of infantile behaviour.
The duration of the symptoms “is usually variable -days or weeks- or, in the case of a psychotic or neurological disorder, it can become chronic .”
The exceptional nature of this psychiatric syndrome and the lack of knowledge of its ultimate causes constitute the most relevant barriers to developing specific prevention strategies.
The diagnosis of Ganser syndrome is fundamentally based on the psychiatric evaluation of the patient, questioning him about his personal and family history, family and work situation, etc. “In any case, a neurological evaluation is advisable to rule out an organic cause.
In some cases, it may be indicated to administer psychotropic drugs to patients with Ganser syndrome. Still, Arango emphasises that it is generally treated “with a psychotherapy oriented towards focusing on reality .” In certain cases, hypnosis can be useful.
the goal of psychotherapeutic treatment is “to integrate the emotional content with the content of the possible trauma that may have occurred.” In exceptional cases, “hospitalisation may be necessary during the acute phase of symptoms if the patient represents a danger to himself or others.”
Ganser syndrome is also known by other names, such as prison psychosis, hysterical pseudodementia, factitious obtundation, nonsensical responses, Ganser’s twilight state, or nonsensical response symptom complex.
Sometimes it is related to other psychiatric illnesses, especially when its possible psychotic origin is considered. Based on this criterion, it would be linked to schizophrenia, substance abuse, and severe depressive disorders.
Jiménez asserts that the prognosis “is good because it disappears completely, although if the poor basic emotional management capacity that these patients present is not worked on, it is easy for similar pictures to appear.” However, the specialist insists that it is important “to make sure that it is not a psychotic condition and that there is no underlying organic cause.”