A werewolf in the 1960s TV show Dark Shadows. (Photo: Public Domain)

About five years ago, a smart, college-educated 26-year-old Moroccan man began sensing that his body was undergoing a radical physical transformation. When he met with Jan Dirk Blom, a Dutch psychiatrist based at the Parnassia Psychiatry Institute in The Hague, he "complained of increased hair growth on the arms (as visually perceived by him, not by [the doctors]), 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)."

After a few Internet queries, he had become absolutely convinced that he was shape-shifting into a wolf. Despite his own doubts about the compatibility of his self-diagnosis with scientific rationality and reminders from the medical experts he met with, "he could not be persuaded to accept any other explanation."

In the psychiatric literature, the werewolf hallucinations and delusions the patient was experiencing are broadly classified as clinical lycanthropy, or lycomania. Because the "extremely rare" disorder has not received much academic scrutiny and is "poorly understood," Blom recently took it upon himself to perform a rigorous multi-lingual search of historical documents and medical databases for any references to or extant case records on the condition between 1850 and May 2012.

Though the resulting analysis, published this month in the History of Psychiatry, only unearthed 13 case descriptions that satisfied the definition of "clinical lycanthropy proper," the paper traces the evolution of the illness and provides a detailed description of symptoms, treatments, and divergent theories about its causes.

Derived from ancient legends in which the gods shape-shifted into animals, actual lycanthropy, or the notion that humans can physically transform into wolfish beasts after exposure to "lunar influences" or through the more deliberate means of "potions, charms, rituals ... or by drinking water from a wolf’s foot print," was in much greater vogue during the medieval ages and early modern period. According to the paper, France identified a high of 30,000 werewolf cases during the Inquisition "between 1520 and 1630, many of which ended under extremely cruel circumstances at the hands of the Inquisitor’s executioner." Of course, these strong beliefs increase the chances of conflating actual clinical cases ("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") with misrepresentations due to religious pressures.

But even in the Early and Middle Ages, however, there's some evidence that doctors were treating it as a natural disease with a cure, rather than a damning demonic spell. Primitive health care recommended "dietary measures, complex galenical drugs, hot baths, purgation, vomiting, and bloodletting to the point of fainting" and many doctors labeled it "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." Surprisingly, the 7th century Greek Byzantine physician Paul of Aegina linked it to brain disorders, "notably epilepsy, humoral pathology and the use of hallucinogenic drugs."

By the 1800s, physicians had finally more broadly and formally defined it "as a delusional belief." Blom discovered a couple detailed patient reports from around this time, one of which described a patient who entered a French asylum in 1852, insisting he was already living as 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.

But what, specifically, drives this strange delusion? There are a number of theories.

In psychoanalysis, the wolf delusion is seen as a sort of "unresolved intrapsychic conflict or an actual trauma" that leads to an "expression of primitive id instincts" in order "to avoid feelings of guilt."

Some psychologists suspect it has to do with difficulty and confusion in adjusting to puberty (an actual physical transformation that sometimes seems werewolf-like), which breeds "a primitive expression of sexual and aggressive urges."

Other experts see it "as a severe form of depersonalization," a major psychological disturbance in which someone enters a "dreamlike" state in which they are outside observers of their own body, which they feel powerless over.

Perhaps the most fascinating and far-fetched explanation for the phenomenon is evolutionary history. Given the werewolf's relative decline in terms of cultural and fictional cache, this might explain why it has survived into more contemporary times:

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.

As with most contemporary psychiatric illnesses, the treatment answer is usually a cocktail of psychotropic drugs, not the more dramatic induced vomiting and hot baths of yore. "Currently best practice would seem to be 'treatment as usual,' that is to say antipsychotics in cases that fulfill the criteria of psychotic disorder, mood stabilizers in [cases] that fulfill the criteria of bipolar disorder, and so on," Blom told Pacific Standard in an email. "But if and when more specific aberrations can be found, such as parietal lesions or dysfunctions, those should be treated accordingly."

However, drug treatments are usually not enough to achieve "full – or even incomplete – remission" from the challenging disorder, as the paper notes. Though Blom's own patient was released after about six months of treatment, he later returned to the hospital. "The second time it took no more than a few weeks [to release him]," Blom told Pacific Standard. "He has been stable since then, and is functioning more or less independently although I do not believe that he is currently [employed]."

Because the delusions frequently occur alongside "signs and symptoms that allow for more conventional diagnoses such as schizophrenia, bipolar disorder, and so on," Blom notes that there's a strong potential that physicians are under-reporting clinical lycanthropy, both now and historically.

Though it may seem like there would be no advantage to differentiating lycanthropy from the more broad-based mental illnesses, Blom believes it can be especially beneficial when dealing with patients, like his, who are suffering from bodily hallucinations that cause them to lose touch with their physical sense of self. That kind of dysfunction is linked to "more specific brain areas and/or functions" than the more general delusion, allowing for a more targeted treatment plan. As he concludes in his review, these cases "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."