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research-article2013

HPY25110.1177/0957154X13512192History of PsychiatryBlom

Article

When doctors cry wolf: a systematic
review of the literature on clinical
lycanthropy

History of Psychiatry
2014, Vol. 25(1) 87­–102
© The Author(s) 2013
Reprints and permissions:
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DOI: 10.1177/0957154X13512192
hpy.sagepub.com

Jan Dirk Blom

Parnassia Psychiatric Institute, The Hague, and Groningen University

Abstract
This paper provides an overview and critical reassessment of the cases of clinical lycanthropy reported in
the medical literature from 1850 onwards. Out of 56 original case descriptions of metamorphosis into an
animal, only 13 fulfilled the criteria of clinical lycanthropy proper. The remaining cases constituted variants
of the overarching class of clinical zoanthropy. Forty-seven cases involved primary delusions, and nine
secondary delusions on the basis of somatic and/or visual hallucinations which may well have affected the
patients’ sense of physical existence, also known as coenaesthesis. Cases of secondary delusions in particular
warrant proper somatic and auxiliary investigations to rule out any underlying organic pathology, notably in
somatosensory areas and those representing the body scheme.

Keywords
Coenaesthesiopathy, lycomania, monothematic delusion, therianthropy, zoanthropy

Introduction
Clinical lycanthropy is also known as lycomania. The adjective ‘clinical’ is used to distinguish the
condition from actual lycanthropy, or the ability to metamorphize physically into a wolf (i.e. a
lycanthrope or werewolf) and back again into a human shape, as depicted in classical mythology
and demonology (Blom, 2010: 101). The term partial lycanthropy is used when delusional beliefs
about excessive hair growth are accompanied by a wolf-like appearance, but not by delusional
concerns about wolf or werewolf transformations (Silva et al., 2000; Verdoux and Bourgeois,
1993). In ancient Greece the related term kynanthropy was used to denote a person’s
transformation into a dog (Nejad and Toofani, 2005). Likewise, the term boanthropy is used to
denote the bovine variant of this classical condition, ailuranthropy or galeanthropy to denote the
feline variant, and zoanthropy to denote the general class of transformations into an animal form.
Lycanthropy has been known and described since ancient times, and has remained an evocative
theme up to the present day, judging by the many and varied references to it in the popular media.
Corresponding author:
Jan Dirk Blom, Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH The Hague, The Netherlands.
Email: jd.blom@parnassia.nl

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88

History of Psychiatry 25(1)

Clinical lycanthropy, however, has received relatively little attention. Although many psychiatric
textbooks mention this monothematic delusion in passing, original case descriptions have always
been rare. Since the 1970s a modest rise in the number of published cases can be discerned, but
although the condition is still considered extremely rare, and certainly poorly understood, it may
well be even rarer than the literature suggests.
The present paper provides an overview of published cases of clinical lycanthropy and zoanthropy. It aims to assess the clinical characteristics of these conditions, and to re-examine their
pathophysiological underpinnings as well as implications for nosology, classification and
treatment.

Methods
A search was carried out in the historical scientific literature from 1850 onwards, as well as in
Embase, PubMed and Ovid, up to May 2012, using the search terms lycanthropy, lycomania,
therianthropy, zoanthropy and werewolf delusion, including their German, French, Spanish and
Dutch equivalents. All cases were carefully re-examined, and the delusions involved were rated as
clinical lycanthropy, kynanthropy, ailuranthropy, boanthropy or zoanthropy (i.e. involving a different or an unspecified animal). Whenever rendered in the original reports, the clinical diagnosis,
type of treatment and outcome were also assessed.

Results
A search in the international scientific literature from 1850 through May 2012 yielded 52 papers
on the delusional metamorphosis into an animal (i.e. clinical zoanthropy), and 56 original case
descriptions, five of which derived from textbooks; for an overview, see Table 1. Included were all
cases in which the authors had either rendered their patients’ delusional conviction of having turned
into an animal, or had inferred the likelihood of that conviction on the basis of animal-like behaviour (see below for the criteria by Keck et al., 1988). Excluded were those cases in which patients
seemed to imitate animals more or less deliberately, such as a woman who barked like a dog and
imitated the crowing of a rooster, as described by Binswanger (1904), and a barking woman who
was cured with the aid of psychoanalysis (Chalewsky, 1909). In all the latter cases the authors’ own
decisions to refrain from a diagnosis of clinical zoanthropy or any of its variants were taken as
decisive.
As the focus of the present paper is on clinical lycanthropy proper, the initial results were narrowed down to cases of werewolf delusions, thus yielding a modest number of 13 cases of clinical
lycanthropy and two of partial lycanthropy. Among the excluded cases, for example, were Jung’s
(1928: 55) case involving a woman who ‘in her insanity would exhibit a sort of lycanthropy in
which she crawled about on all fours and imitated the grunting of pigs, the barking of dogs, and the
growling of bears’ – without any reference to delusions of being a lycanthrope; and a case reported
by Coll et al. (1985), who described a woman who ‘had full recollection of her animal-like behaviour and said she had thought she was a dog’. Some other cases in point are reports of patients who
thought they had turned into a frog or a bee (Gödecke-Koch et al., 2001). A large and admittedly
striking case series was collected by Younis and Moselhy (2009) in Babylon governorate, Iraq
(where King Nebuchadnezzar once succumbed to madness), comprising seven patients who had
the delusional conviction of having changed into a dog, and one into an ox. As noted above, the
proper generic term for such delusions of animal metamorphosis and/or accompanying behaviour
is clinical therianthropy or clinical zoanthropy (Blom, 2010: 101; Garlipp, 2005). Although it falls
outside the historical scope of the present paper, it should be noted that Nebuchadnezzar II

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Ailuranthropy
Zoanthropy (multiple:
i.e., dog, bull)
Kynanthropy

F
F

F

F
F
M

M
M

M

F

F

 5
 6

 7

 8
 9
10

11
12

13

14

15

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Schizophrenia

Lycanthropy

Kynanthropy

Schizophrenia

Lycanthropy



Psychotic disorder NOS

Hysteria

Hysteria
Coenaesthesiopathy

Psychotic depression

Psychopathy

Alcohol intoxication
Psychotic disorder due
to multiple drug use,
Schizophrenia
Chronic brain syndrome

Kynanthropy
Lycanthropy

Zoanthropy (unspecified)
Lycanthropy
Zoanthropy (rhinoceros)

Zoanthropy (unspecified)

M

Lycanthropy

Lycanthropy

Lycanthropy

 4

M

 2

Psychotic depression

Diagnosis

Zoanthropy (unspecified)

M

M

 1

Delusion type

 3

Sex

Case no.

Antipsychotics

Antipsychotics

Antipsychotics



Sedatives
(unspecified)

Antipsychotics

Morphine












Treatment

Incomplete
remission
Incomplete
remission
Incomplete
remission


Incomplete
remission

Incomplete
remission


Full remission

Death due to
suicide
Death due to
starvation
Death by
garrote
(execution)
Death due to
pulmonary
tuberculosis



Outcome

(continued)

Surawicz and Banta,
1975
Rosenstock and
Vincent, 1977
Jackson, 1978

Lange, 1970
Surawicz and Banta,
1975

Jung, 1928
Fodor, 1945
Laing, 1967

Guinon, 1891
Deny and Camus,
1905
Schneider, 1920

Stahl, 1875

Rúa Figueroa, 1859

Morel, 1852

Bariod, 1850

Reference

Table 1.  Cases of clinical lycanthropy and other types of clinical zoanthropy in the scientific literature, 1850–2012 (M = male; F = female; ECT =
electroconvulsive treatment; – indicates unknown).

Blom
89

Sex

F

F
M
F

M

M

M

M

M

F

F

M

M
M

Case no.

16

17
18
19

20

21

22

23

24

25

26

27

28
29

Table 1 (continued)

Kynanthropy
Lycanthropy

Ailuranthropy

Ailuranthropy

Zoanthropy (bird)

Zoanthropy (unspecified)

Kynanthropy

Zoanthropy (unspecified)

Depressive disorder, Psychotic
disorder NOS, Alcohol abuse
in remission
Bipolar disorder
Schizophrenia

Bipolar disorder

Bipolar disorder, Obsessivecompulsive disorder
Bipolar disorder, Obsessivecompulsive disorder
Bipolar disorder

Schizophrenia

Bipolar disorder, Cannabis
abuse
Bipolar disorder

Lycanthropy

Zoanthropy (gerbil)

Senile dementia
Schizophrenia
Schizophrenia

Psychotic depression

Diagnosis

Zoanthropy (bird)
Kynanthropy
Zoanthropy (horse)

Kynanthropy

Delusion type

Antipsychotics,
lithium
Antipsychotics,
antidepressants
Antipsychotics,
antidepressants,
antiepileptics
Antipsychotics
Antipsychotics

Antipsychotics

Antipsychotics

Antidepressants,
ECT


Antipsychotics,
ECT
Antipsychotics,
lithium
Antipsychotics,
antidepressants
Antipsychotics

Treatment

Full remission
Incomplete
remission

Treatment
refractory

Full remission

Incomplete
remission
Full remission

Treatment
refractory
Full remission

Full remission

Incomplete
remission


Death due to
suicide
Full remission

Outcome

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(continued)

Keck et al., 1988
Keck et al., 1988

Keck et al., 1988

Keck et al., 1988

Keck et al., 1988

Keck et al., 1988

Keck et al., 1988

Keck et al., 1988

Keck et al., 1988

Keck et al., 1988

Knoll, 1986
Knoll, 1986
Knoll, 1986

Coll et al., 1985

Reference

90
History of Psychiatry 25(1)

F

M

M
M

M

M

M

M

M

M
F

32

33
34

35

36

37

38

39

40
41

M

30

31

Sex

Case no.

Table 1 (continued)

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Schizophrenia, Personality
disorder, Psychopathic
disorder
Psychotic disorder NOS
Psychotic disorder NOS

Lycanthropy

Partial lycanthropy
Zoanthropy (unspecified)

Psychotic depression

Psychotic depression

Kynanthropy

Kynanthropy

Schizophrenia

Bipolar disorder, Obsessivecompulsive disorder

Partial lycanthropy

Kynanthropy

Bipolar disorder
Psychotic depression

Kynanthropy
Lycanthropy

Schizophrenia

Depersonalization disorder,
Alcohol dependence,
Antisocial personality disorder,
Borderline personality
disorder
Psychotic depression

Lycanthropy

Zoanthropy (multiple:
i.e., dog, cat, horse, wolf)
Zoanthropy (goose)

Diagnosis

Delusion type


Antipsychotics,
benzodiazepines

Antipsychotics,
antidepressants,
benzodiazepines
Antipsychotics
Antidepressants,
antipsychotics
Lithium,
antipsychotics,
ECT
Antipsychotics,
ECT
Antidepressants,
lithium,
antipsychotics
Antidepressants,
antipsychotics


Antipsychotics



Treatment


Incomplete
remission

Incomplete
remission


Incomplete
remission
Full remission

Incomplete
remission

Full remission
Full remission

Incomplete
remission

Full remission



Outcome

(continued)

Silva et al., 2000
Garlipp et al., 2001

Moselhy, 1999

Rao et al., 1999

Moselhy and
Macmillan, 1994
Rao et al., 1999

Koehler et al., 1990
Rojo Moreno et al.,
1990
Verdoux and
Bourgeois, 1993

Dening and West,
1989
Rajna et al., 1990

Bénézech et al.,
1989a, 1989b

Reference

Blom
91

F

M

M

M

F
F
F
F
M
F
M

M

M

F

44

45

46

47
48
49
50
51
52
53

54

55

56

F

42

43

Sex

Case no.

Table 1 (continued)

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Zoanthropy (snake)

Lycanthropy

Zoanthropy (wild boar)

Kynanthropy
Kynanthropy
Kynanthropy
Kynanthropy
Kynanthropy
Kynanthropy
Boanthropy

Kynanthropy

Psychotic depression

Alcohol intoxication, Bipolar
disorder
Schizophrenia

Psychotic depression
Psychotic depression
Psychotic depression
Psychotic disorder NOS
Psychotic depression
Schizoaffective disorder
Schizophrenia

Psychotic depression

Bipolar disorder

Psychotic depression

Lycanthropy

Kynanthropy

Schizophrenia

Schizophrenia

Diagnosis

Zoanthropy (bee)

Zoanthropy (frog)

Delusion type

Antipsychotics,
antidepressants,
antiepileptics
Antidepressants,
antipsychotics









Antipsychotics

Antipsychotics,
antidepressants
Antipsychotics,
antiepileptics,
ECT




Antipsychotics

Treatment

Full remission

Incomplete
remission







Incomplete
remission
Full remission



Incomplete
remission
Full remission

Incomplete
remission

Incomplete
remission

Outcome

Bou Khalil et al.,
2012

Blom et al., 2010

Garlipp et al., 2009

Younis and Moselhy,
2009
As above
As above
As above
As above
As above
As above
As above

Garlipp et al., 2001;
Gödecke-Koch et al.,
2001
Garlipp et al., 2001;
Gödecke-Koch et al.,
2001
Moghaddas and
Nasseri, 2004
Nejad and Toofani,
2005

Reference

92
History of Psychiatry 25(1)

93

Blom

(c.630–562 bc), King of the Neo-Babylonian Empire, is often referred to as one of the oldest
recorded cases of clinical lycanthropy, whereas we know little more about the King’s seven-year
episode in the wild than that he behaved like an animal, and ate grass ‘as oxen’. Other notable cases
I chose to exclude are those of Moselhy (1999), who described a woman with severe depression
and suicidal ideation who was convinced that ‘claws were growing in her feet’ and that ‘she was
going lunatic’; also the case described by Grover et al. (2010) of a woman who was convinced that
her bones had been replaced by a pig’s. Both these were presented as examples of ‘partial lycanthropy’ even though any further comments or behaviour suggesting an animal-like appearance or
identity were lacking. A final example involves two patients from the otherwise impressive collection provided by Keck et al. (1988), who both admitted that they had never actually believed that
they had turned into an animal, and indicated that their animal-like behaviour (one mimicking a
Bengal tiger and the other a rabbit) had been under their voluntary control.
Taking these deliberations into consideration, and apart from the 15 cases of (partial) clinical
lycanthropy, the present literature search yielded 19 cases of clinical kynanthropy, one of clinical
boanthropy, three of clinical ailuranthropy, and 18 of clinical zoanthropy. Animals mentioned in
the latter category were bee, bird (twice), frog, gerbil, goose, horse, rhinoceros, snake, wild boar,
and six unspecified animals. Finally, there were two cases of multiple clinical zoanthropy (i.e. one
involving dog as well as bull, and one involving wolf, dog, cat and horse). With 34 male and 22
female patients, the sex ratio was almost 1.5:1. As noted in previous reviews by Moselhy and Nasr
(1999) and Verdoux et al. (1989), the duration of the symptoms varied from a single hour to decades. The clinical diagnoses were equally variable (see Table 1), although there was a marked
overrepresentation of schizophrenia spectrum disorder (25%), psychotic depression (23.2%), bipolar disorder (19.6%) and psychotic disorder NOS (12.5%). The type of treatment, described in
58.9% of the cases, mostly involved pharmacological intervention in accordance with the established clinical diagnoses and contemporary treatment guidelines. In five cases (i.e. 15.2%) pharmacotherapy was augmented with electroconvulsive treatment (ECT). The outcome, reported in
69.6% of the cases, was full remission (35.9%), incomplete remission (46.2%), no remission
(5.1%), and death (12.8%); death was due to marasmus, pulmonary tuberculosis, suicide (twice)
and execution (see below).

Discussion
Traditional metaphysical explanations
Wahl (1923) aptly portrayed clinical lycanthropy as an ‘archaic delusion’, in the sense that it
involves an ancient belief that is on the wane, and may well be on the verge of disappearing altogether. The belief in werewolves and other were-animals was indeed much more prevalent in the
past. It has its roots in primeval legend, wherein Odin is depicted as turning into an eagle, Jupiter
into a bull, Hecuba into a bitch, Actaeon into a stag, and Ulysses’ comrades into swine, to mention
a few examples (Baring-Gould, 1865: 5–8). Lycanthropy used to be conceptualized as an actual
conversion of humans into wolves and vice versa, linked with such wide-ranging themes as lunar
influences (hence the term lunacy), witchcraft, demonology, and the wolf children theme, depending on geographic and culturo-religious variables (Bénézech and Chapenoire, 2005). In France its
peak incidence appears to have coincided with the heyday of the Inquisition and the advent of
scientific thinking, with the huge number of 30,000 recorded cases between 1520 and 1630 (Farson
and Hall, 1975: 49), many of which ended under extremely cruel circumstances at the hands of the
Inquisitor’s executioner. Although the application of present-day diagnostic categories to historical
cases is always a knotty issue, some of these cases may well have been connected with severe

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History of Psychiatry 25(1)

forms of hirsutism, Ambras syndrome (i.e. hypertrichosis, also known as ‘werewolf syndrome’) or
severe congenital erythropoietic porphyria, i.e. a rare inborn error of porphyrine-heme synthesis
characterized by reddish-brown urine, reddish-brown teeth, red eyes, a pale, excoriated and ulcerated skin, anatomical malformations due to damage to the cartilage and bones, hyperpigmentation
of photosensitive areas, hyperpilosity, and abnormal behaviour with an inclination towards nocturnal strolls (Bénézech, 1990; Illis, 1964). However, judging by the rarity of the syndromes it would
seem unlikely that they accounted for more than a minority of the historical cases. Moreover, they
may well have prompted others to believe that they were dealing with a werewolf, whereas the
victims themselves did not necessarily have to share that conviction. We should carefully distinguish the once widespread belief that others may turn into a wolf or other animal from a person’s
conviction that this applies to himself, especially when there are no objectifiable changes in that
person’s physical appearance that might justify a case of ‘partial lycanthropy’ (Moselhy and Nasr,
1999).
Yet even during endemic outbreaks of lycanthropy (as defined by the Inquisition and other
authorities) there may well have been a substantial proportion of – what we would call – cases of
clinical lycanthropy. As suggested by Emminghaus (1878: 54), ointments prescribed by witches
may well have caused paraesthesias, which may have been interpreted as proof of hair growing on
the inside of the skin (a condition known as versipellis in the medieval literature), and thus of proof
of the person turning into a werewolf. Moreover, it is possible that the oral ingestion of alkaloids
(derived, for example, from Papaver somniferum, Atropa belladonna or Mandragora officinarum)
has been responsible for at least some of the cases described in the older literature (Baring-Gould,
1865: 82–3; Kulick et al., 1990). Ensuing hallucinatory metamorphoses into leopard, crocodile,
snake and myriad other indigenous and mythological animals have been described extensively by
contemporary anthropologists and ethnopharmacologists studying the effects of hallucinogens and
entheogens (Rätsch, 2005: 14), and were known to the Pope’s physicians as early as 1545 (Russell
and Russell, 1989) and probably even earlier. But the majority of the cases of lycanthropy in the
classical and medieval literature seem to be connected with the culturally and (sometimes also)
religiously sanctioned notion that people may either deliberately seek to turn themselves into a
wolf (with the aid of potions, charms, rituals or a magic belt, for example, or by drinking water
from a wolf’s foot print) or may fall victim to magical and/or diabolical forces.

Early medical explanations
Metaphysical explanations for lycanthropy appear to have prevailed for millennia (for overviews, see: Baring-Gould, 1865; Eisler, 1969), but historical explanations of a more rational
nature can also be found. The Dutch physician Johannes Wier (c.1515–88) has been lauded for
being the first to designate lycanthropy as a natural rather than a supernatural affliction (Zilboorg
and Henry, 1941: 261), and yet Galen (ad 129–217) and Marcellus of Side (ad c.117–c.161)
appear to have preceded him by some 1400 years (Surawicz and Banta, 1975). Unfortunately
only fragments of Marcellus’s long medical tract have survived, but according to Illis (1964)
they give reason to believe that this Greek physician considered lycanthropy a disease rather
than a manifestation of evil possession. Throughout the Early and Middle Ages detailed accounts
of medical cures for lycanthropy – involving dietary measures, complex galenical drugs, hot
baths, purgation, vomiting, and bloodletting to the point of fainting – were provided by GreekByzantine physicians such as Oribasius (c.320–400), Aëtius of Amida (mid-fifth to mid-sixth
century), Paul of Aegina (c.625–c.690), Michael Psellos (c.1017–c.1078) and Johannes Actuarius
(c.1275–c.1328); they all classified the condition as a type of melancholia (i.e. a disease due to
an excess of black bile), whereas Paul of Nicaea classified it as a type of mania (Metzger, 2006;

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Blom

Poulakou-Rebelakou et al., 2009). In Paul of Aegina’s seven-volume medical encyclopedia,
lycanthropy is attributed to diseases of the brain, notably epilepsy, humoral pathology and the
use of hallucinogenic drugs (Drake, 1992).
In 1584 the English country gentleman Reginald Scot (c.1538–99) famously stated that lycanthropy was caused by a ‘melancholike humor’, and in 1586 the Italian writer Tommaso Garzoni
(1549–89) drew a similar conclusion in his text on ‘incurable fooles’ (Drake, 1992). The case of
Jean Grenier, a 14-year-old, self-confessed lycanthrope from Les Landes in France, who boasted
that he had eaten more than 50 children, illustrates that it may not have been unusual for legal
courts to consider natural causes of lycanthropy (Farson and Hall, 1975: 50–2). As recounted by
Robbins (1959: 234): ‘The local Parlement … sent two physicians to examine Jean Grenier; they
decided that the boy was suffering from “a malady called lycanthropy,” induced (and here the doctors slipped back into superstition) by an evil spirit which deceived men’s eyes into imagining such
things.’ Although a former court had sentenced him to be hanged and his body burned, the Parlement
of Bordeaux instead sent him to a monastery for lifelong imprisonment and education. Likewise,
Jacques Roulot, an alleged lycanthrope caught while apparently devouring human flesh in the
vicinity of Angers, France, in 1598, was sent to a madhouse (Farson and Hall, 1975: 43–4).
Accounts such as these may well be considered isolated instances of proto-scientific thought,
but they indicate that throughout the past 2000 years lycanthropy was not invariably explained in
metaphysical terms. But discarding the belief in werewolves as a myth was not always a matter of
sophisticated reasoning. In seventeenth-century England, for example, lycanthropes were generally considered victims of delusion due to excessive melancholy – not because English doctors
were so far ahead of their Continental colleagues at the time, but rather because wolves were then
already extinct in their country, and the werewolf theme had been supplanted by similar myths
involving the cat and hare (Baring-Gould, 1865: 56).
The scientific revolution brought about a shift towards the mundane, and yielded a general
atmosphere in which biomedical interpretations of lycanthropy eventually became paradigmatic –
alongside the traditional, metaphysical ones, which apparently never entirely lost their appeal
(Melton, 1996: 782–4). In the nineteenth century Western physicians described the condition as a
delusional belief in metamorphosis to animal form, referred to as imitative monomania (Dendy,
1847), insania zooanthropica (Fahy, 1989) or delirium of metamorphosis (Bianchi, 1906), but
many of them noted that the number of cases was on the wane (see, for example: Bianchi, 1906;
Bourquelot, 1849; Dendy, 1847; Tanzi, 1909).
The oldest known case report on zoanthropy in the modern medical literature stems from Bariod
(1850), who described a patient who grunted like a pig and clawed around, thus prompting the
author to suspect a case of lycanthropy (Vedie et al., 1993). But the first case report on clinical
lycanthropy proper we owe to Morel (1852), who described a man admitted to the Asile d’Aliénés
de Maréville in Nancy, France, convinced that he had turned into a wolf. To demonstrate this, he
parted his lips with his fingers to show his alleged wolf’s teeth, and complained that he had cloven
feet and a body covered with long hair. He said that he only wanted to eat raw meat, but when it
was given to him he refused it because it was not rotten enough. He also demanded to be sent to
the forest and shot, but eventually he died in the asylum in a state of agony and marasmus. Another
early case involves Manuel Blanco Romasanta, a Spaniard who was accused of multiple homicide
in 1852, and who claimed to have committed his crimes while his body had taken the shape of a
werewolf (Rúa Figueroa, 1859). As recounted by Pérez Hervada (1972), Blanco was diagnosed
with psychopathy rather than psychosis, and therefore held accountable for his deeds by the court
of Allariz, and accordingly sentenced to death.
During the twentieth century only a few new cases were described (see Table 1), although cases
of zoanthropy appear to have remained prevalent in various non-Western cultures. Thus, members

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History of Psychiatry 25(1)

of the Toraja tribe in Middle Celebes – a well-documented example – ritually executed various
alleged werewolves every year throughout the nineteenth century and possibly well into the twentieth (Kruijt, 1899). In 1967 a thesis on the subject was published in Germany (Hackenbroch,
1967), and shortly afterwards clinical lycanthropy caught the attention of various physicians
(Jackson, 1978; Lange, 1970; Rosenstock and Vincent, 1977; Surawicz and Banta, 1975).

Operational definition, diagnosis and classification
As noted by Surawicz and Banta (1975), ‘The definition of lycanthropy through the ages is fairly
universal, namely that once a man is changed into a wolf, he acquires its characteristics, roaming
around at night, howling in cemeteries and attacking man and beast in search of raw flesh’. This
rather narrow definition was stretched somewhat by Keck et al. (1988), who observed that ‘Strictly
speaking, “lycanthropy” refers to transformation into a wolf, whereas the term “therianthropy”
describes transformation into animals in general. However, the term “lycanthropy” has now come
to embrace other species.’ (Keck et al., 1988). Since then, many authors appear to have felt at liberty to adopt this somewhat broader definition, applying the term ‘lycanthropy’ where they actually
mean ‘therianthropy’ or ‘zoanthropy’.
That being said, a strict clinical diagnosis of clinical lycanthropy hinges on the patient’s verbal
report of having turned (or being able to turn) into a wolf, whereas a somewhat looser diagnosis
may depend either on verbal reports of turning into a different species of animal or on animal-like
behaviour. As regards nosology and classification, the historical literature would seem to give little
reason to designate clinical lycanthropy – or zoanthropy – as a separate nosological entity. Although
it is definitely striking in nature, and may have far-reaching consequences (to the extent of homicide, see for example: Rúa Figueroa, 1859; Bénézech et al., 1989a,1989b), this peculiar delusion
tends to co-occur with clusters of signs and symptoms that allow for more conventional diagnoses
such as schizophrenia, bipolar disorder and so on. Yet there are numerous hypotheses regarding the
mediation of this specific type of delusion.

Aetiological and pathophysiological considerations
As noted by Pigeaud (2006), clinical lycanthropy has historically been interpreted by physicians
either in a metaphorical sense (i.e. as a symbolic departure from one’s identity as a human, a
setting-apart of oneself as ‘non-human’) or as imitation (i.e. acting as if one were a wolf), with the
ensuing risk of being lured into believing that one has actually become a wolf (i.e. delusion).
Starting with Bariod (1850) and Morel (1852), all modern authors reporting on clinical lycanthropy label the condition as a type of delusion. Psychoanalytical models tend to trace the origin of
this delusion to an unresolved intrapsychic conflict or an actual trauma, and designate it, for example, as a concretistic expression of primitive id instincts by means of a splitting mechanism that
serves to avoid feelings of guilt (Garlipp et al., 2004; Surawicz and Banta, 1975). Likewise, various psychologically-oriented authors have suggested a possible link with concerns regarding the
development of secondary sexual characteristics or heterosexual relations (Rao et al., 1999), and
labelled the condition accordingly as a primitive expression of sexual and aggressive urges
(Rosenstock and Vincent, 1977). Nejad and Toofani (2005) report the case of a man who had had
a sexual relationship with a sheep during adolescence, and later developed the delusion of being
transformed into a dog, and being paradoxically dead as well as immortal (i.e. Cotard’s syndrome).
Another case connected with such an irresistible zoophilic drive was described by Rosenstock and
Vincent (1977).

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Clinical lycanthropy has also been conceptualized as a severe form of depersonalization (Rao
et al., 1999). As noted by Binswanger (1904), this model may be especially apt to explain the condition’s erstwhile endemic occurrence. Schneider (1920) distinguished two types of clinical lycanthropy/zoanthropy, i.e. one with respiratory spasms which he considered indicative of hysteria, and
one accompanied by clouding of consciousness, indicative of a twilight state. A possible relation
with delusional misidentification has also been suggested (Silva and Leong, 2005), whereas Moselhy
and Nasr (1999) hint at the possibility of a reverse type of intermetamorphosis, in the sense of an
intermetamorphosis syndrome which focuses on the self rather than on another person, and which
involves the transformation of a person into a wolf rather than a person into a different person.
Eisler (1969) offers an evolutionary explanation by pointing out certain parallels with our
herbivorous ancestors, who, once forced to add meat to their diet, may have sought to imitate the
wolf or invoke its spirit by dressing in furs and painting their faces with lupine markings. As suggested by Younis and Moselhy (2009), primitive Man may well have disguised himself in the body
or body parts of an animal during moments of danger, and perhaps this focus idea (or archetype, as
the authors call it with reference to Jung) has survived into the modern human mind, where it lies
dormant until it is awakened by life-threatening circumstances.
If we may designate cases with a psychological or uncertain aetiopathophysiology as primary
clinical lycanthropy, cases of secondary clinical lycanthropy would be those that evolve out of
somatic hallucinations and/or alterations in one’s sense of physical identity. Such alterations have
historically been known as coenaesthesiopathies. In the literature, at least nine cases stand out
which were accompanied by – and possibly based upon – somatic hallucinations, body schema
illusions and/or perceived changes in physical appearance (see Table 2). For example, the patient
my colleagues and I described in a previous paper (Blom et al., 2010) complained of increased hair
growth on the arms (as visually perceived by him, not by us), a ‘hardening’ of the jaws and facial
musculature, nondescript changes within the oral cavity, and tiny wounds in the corners of the
mouth which he attributed to the presence of fangs (which he, incidentally, did not perceive during
the time of investigation). Our patient was an intelligent, 26-year-old Moroccan man who had gone
to college, and who – contrary to our expectations – did not attribute his symptoms to the influence
of a djinn, as is quite customary among psychotic patients with an Islamic background, but who
had searched the internet for possible causes, and had concluded that his was definitely a case of
lycanthropy. Even though he himself initiated a discussion with us on the condition’s incommensurability with the natural science paradigm, he could not be persuaded to accept any other
explanation.
Our patient was diagnosed in accordance with the DSM-IV-TR criteria with schizophrenia,
paranoid type, but we framed his secondary lycanthropic delusion as a specific type of coenaesthesiopathy, as conceptualized by Deny and Camus (1905); see also Table 3. This forgotten diagnostic
category was designed by these French pioneers to cover various aberrations of coenaesthesis, i.e.
of the sense of one’s physical existence, as produced by the sum of all bodily sensations (Blom and
Sommer, 2012: 163–5). The importance of such internally mediated bodily sensations for our sense
of physical identity has been neglected for almost a century, but was eventually reappraised by
Damasio (1999), and throughout the past decade various imaging studies have pinpointed specific
brain areas that appear to be of crucial importance for the mediation of this basic existential sensation. Among them are premotor and motor cortex (Arzy et al., 2006), the precuneus and somatosensory association cortex (Bär et al., 2002), and primary and secondary somatosensory cortex (Bär et
al., 2002; Shergill et al., 2001). The coenaesthesiopathies do not feature in any current psychiatric
classifications (although the ICD-10 does include a preliminary diagnostic category called ‘cenesthopathic schizophrenia’; WHO, 1992), and the modern literature on this topic is rather limited,
but this classical nosological category appears to constitute a fertile starting point for a

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Table 2.  Some examples of somatic hallucinations and perceived changes in physical appearance, as
described in the medical literature on clinical lycanthropy/zoanthropy.
Perceived alteration

Reference

Altered mouth and teeth
Long hair covering the whole body
Cloven feet

Morel, 1852

Feeling like an animal with claws, teeth, fangs, and hair
Seeing the eye of a wolf and (later) the head of a wolf in the
mirror (i.e. mirrored self-misidentification)

Rosenstock and Vincent, 1977

Increased facial hair

Rojo Moreno et al., 1990

Increased hair growth, all over the body (as visually and tactically
perceived)
Seeing the face of a wolf in the mirror (i.e. mirrored selfmisidentification)

Verdoux and Bourgeois, 1993

A broadening and swelling of the chest (as somatosensorily
perceived)
Feeling that the ribs on the right side had changed into a dogs’ ribs

Rao et al., 1999

Feeling of claws growing into the feet

Moselhy, 1999

Feeling of body becoming smaller (i.e., whole-body
microsomatognosia) and turning into a bee
A burning sensation in the thighs and belly

Garlipp et al., 2001; GödeckeKoch et al., 2001

A sensation like an electric shock
A feeling that the whole body has changed

Nejad and Toofani, 2005

Increased hair growth on arms (as visually perceived)
A ‘hardening’ of the jaws and facial muscles
Nondescript changes within the oral cavity
Tiny wounds in the corners of the mouth

Blom et al., 2010

Table 3.  Classification of the coenaesthesiopathies (adapted from Blom et al., 2010).
Type of coenaesthesiopathy

Characterization

Coenaesthesiopathy (cenesthopathy)

A pathological alteration in the sense of bodily
existence, caused by aberrant bodily sensations
A total absence of the sense of bodily existence

Acoenaesthesiopathy (acenesthesia,
total asomatognosia)
Hypercoenaesthesiopathy
Hypocoenaesthesiopathy
Paracoenaesthesiopathy

A hypertrophic alteration in the sense of bodily
existence, caused by aberrant bodily sensations
A hypotrophic alteration in the sense of bodily
existence, caused by aberrant bodily sensations
A qualitative alteration in the sense of bodily
existence, caused by aberrant bodily sensations

reconceptualization of secondary forms of clinical lycanthropy. If it is true that lycanthropic and
other zoanthropic delusions may have their roots in somatosensory aberrations that affect the body
scheme, and that the latter may in turn cause fundamental changes in one’s sense of physical

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identity – somewhat comparable, perhaps, to the process underlying total asomatognosia – we
may well be on our way to shedding new light on the neurobiological substrates of the condition.

Treatment
It is apparent from the majority of the published cases that, irrespective of the established
psychiatric diagnosis, pharmacological monotherapy is seldom sufficient to obtain full – or
even incomplete – remission (see Table 1 for details). However, judging by the fate of the older
cases, notably those described between 1850 and 1875, we may consider our current treatment
programmes quite beneficial. Laing (1967: 120–37) was the first to claim a full remission in a
patient suffering from zoanthropy (who, by the way, refused to take any of the major pharmacological agents), but from the 1980s onwards a trend can be discerned towards improved medication results. As the EEG of our own patient showed increased paroxysmal activity which was
considered different from the diffuse, non-epileptiform activity that may accompany the use of
antipsychotics, he was treated with valproic acid (in addition to quetiapine and, later, imipramine), and after seven months he had recovered sufficiently to allow discharge from the hospital
(Blom et al., 2010).

Conclusions
On the basis of the present review, and adhering to the time-hallowed, albeit somewhat strict definition of clinical lycanthropy as the delusion of having turned into a wolf, this monothematic delusion would appear to be even less prevalent than previously suggested. With 13 cases reported over
a time span of 162 years, we should take heed not to cry wolf too often. On the other hand, surveys
such as those by Keck et al. (1988) and Younis and Moselhy (2009) indicate that clinical lycanthropy may well be severely underreported. As the condition tends to occur in the context of major
psychiatric disorders such as schizophrenia, psychotic depression, bipolar disorder or psychotic
disorder NOS, there seems to be little practical use in classifying the condition as a separate
nosological entity. However, cases of secondary clinical lycanthropy in particular warrant proper
somatic and auxiliary investigations to rule out any underlying organic pathology, notably in cerebral somatosensory areas and those representing the body scheme and sense of self. As regards
treatment, it should be obvious that systematic studies are as yet unavailable, and that for now
pharmacotherapy in accordance with the guidelines for the treatment of any underlying disorder
may be considered ‘best practice’.
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