The Ganser Syndrome

Abstract

In 1897 Ganser delivered a paper entitled “Concerning an Unusual Hysterical Confusional State” in which he described three prisoners who developed transitory symptoms of mental illness. The main features were disturbances of consciousness with subsequent amnesia for the episode, prominent hallucinations, sensory changes of an hysterical kind and, on questioning, peculiar verbal responses which have come to be regarded as the hallmark of the Ganser state. The illness terminated abruptly with full restoration of normal mental function. Despite Ganser's designation of the condition as hysterical, controversy over its precise nosological status has persisted over the past sixty-odd years. Is it in fact a form of hysteria, or is it a psychotic illness of brief duration? Is the hysterical pseudo-dementia described by Wernicke (1906) identical with or distinct from the Ganser syndrome? What is the relationship, if any, of the symptomatology of the Ganser state—the often-described “vorbeireden” and “approximate answers”—to the disordered thought of the schizophrenic and the dysphasia of the patient suffering from organic brain disease? Is it a fact that the Ganser syndrome occurs most frequently in patients in military or civil prisons and is rare in the non-delinquent population? To these and other problems the standard textbooks of psychiatry return conflicting answers.