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Volume 2014, Article ID 946851, 4 pages
http://dx.doi.org/10.1155/2014/946851

Research Article
Visual Perception during Mirror-Gazing at Ones Own Face in
Patients with Depression
Giovanni B. Caputo,1 Marco Bortolomasi,2 Roberta Ferrucci,3 Mario Giacopuzzi,2
Alberto Priori,3 and Stefano Zago3
1

DIPSUM, Universit`a di Urbino, Via Saffi 15, 61029 Urbino, Italy

Unit`a Operativa di Psichiatria Villa Santa Chiara, Via Monte Recamao 7, Quinto di Valpantena, 37142 Verona, Italy
3
Fondazione IRCCS Ca Granda-Ospedale Maggiore Policlinico, Dipartimento di Scienze Neurologiche,
Universit`a degli Studi di Milano, Via F. Sforza 35, 20122 Milano, Italy
2

Correspondence should be addressed to Giovanni B. Caputo; giovanni.caputo@uniurb.it

Received 11 July 2014; Revised 3 November 2014; Accepted 3 November 2014; Published 20 November 2014
Academic Editor: Pietro Pietrini
Copyright 2014 Giovanni B. Caputo et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
In normal observers, gazing at ones own face in the mirror for a few minutes, at a low illumination level, produces the apparition of
strange faces. Observers see distortions of their own faces, but they often see hallucinations like monsters, archetypical faces, faces
of relatives and deceased, and animals. In this research, patients with depression were compared to healthy controls with respect
to strange-face apparitions. The experiment was a 7-minute mirror-gazing test (MGT) under low illumination. When the MGT
ended, the experimenter assessed patients and controls with a specifically designed questionnaire and interviewed them, asking
them to describe strange-face apparitions. Apparitions of strange faces in the mirror were very reduced in depression patients
compared to healthy controls. Depression patients compared to healthy controls showed shorter duration of apparitions; minor
number of strange faces; lower self-evaluation rating of apparition strength; lower self-evaluation rating of provoked emotion. These
decreases in depression may be produced by deficits of facial expression and facial recognition of emotions, which are involved in
the relationship between the patient (or the patients ego) and his face image (or the patients bodily self) that is reflected in the
mirror.

1. Introduction
Strange-face in the mirror illusions [14] are apparitional
experiences that are produced by gazing at ones own face
reflected in a mirror, under low illumination. In a study
set-up, under controlled laboratory conditions, 50 healthy
young adults, after about one minute of mirror-gazing,
began to perceive strange-face apparitions [1]. These included
huge deformations of ones own face (reported by 66% of
individuals), a monstrous face (48%), an unknown person
(28%), an archetypal face (28%), a face of a parent or relative
(18%), and an animal face (18%).
Recently, Caputo et al. [5] showed that some schizophrenic patients perceived much more intense strange-face
apparitions than healthy individuals. In this paper, the scope
of the study was to investigate strange-face illusions in

patients with depression. Depressive subtypes are positioned

to differ functionally by differential contributions by serotoninergic, noradrenergic, and dopaminergic neurotransmitter circuits [6]. The altered cognitive and affective processing
in depression has been associated with disruption of frontotemporal and frontosubcortical networks [7]. Depression
is characterized by maladaptive bottom-up processes that are
generally perpetuated by attenuated cognitive control [8, 9].
Therefore, the main hypothesis of the present study was
that strange-face apparitions, in response to mirror-gazing,
should be different in frequency and intensity in depressed
patients with respect to healthy controls.
Human faces convey important messages, such as identity, age, sex, eye gaze, and emotional expression, which
are relevant to social communication and interpersonal
interaction. In face-to-face interactions between the subject

2
and the other, facial expressions by the other and facial
recognition of the others expressions by the subject are
reciprocally intertwined through mimicry and subject-other
synchronization [10].
Mirror-gazing at ones own face is similar to an interpersonal encounter by the subject (or the subjects ego) with
itself (which is the subjects bodily face that is reflected in
the mirror), as if the subject were an other [11, 12]. In the
case of mirror-gazing, the subjects facial expressions are
reflected in the mirror and then perceived and recognized by
the subject itself. This dynamic self-reflection can produce,
within the subject, recognition-expression or perceptionaction loops. Hence, mirror-gazing can involve, within the
subject, processes of mimicry, synchronization, emotional
connectedness, and so forth, that are all implicated during
face-to-face interactions.
In relationship to faces, patients with depression show
deficits both in facial recognition of emotions and in facial
expression of emotions [1315]. Emotional-processing biases
occur to sad faces presented below the level of conscious
awareness in depression [16, 17]. Depression patients show
deficits in both voluntary and involuntary facial expression
of emotions [13]. By influencing the salience of social stimuli,
mood-congruent processing biases may contribute to dysfunction in conscious recognitions, expressions, and social
interactions in depression [18].
Therefore, a specific hypothesis, which is based on deficits
of facial recognition and facial expression of emotions in
depression, is that strange-face apparitions should be strongly
reduced in patients with depression compared to healthy
controls.
From the clinical viewpoint, it may be noted that no
study has previously investigated mirror-gazing in depressed
patients. Therefore, a simple, standardized test to trigger a
reproducible pattern of strange-face apparitions could help
in completing the standard psychopathological assessment of
patients with depression.

2. Materials and Methods

The study was approved by the hospital ethical committee.
The experiment was conducted in accordance with the Declaration of Helsinki (1964). All participants provided written
informed consent before entry to the study.
2.1. Participants. Our clinical sample consisted of thirteen
hospitalized patients in Villa Santa Chiara Clinic in Verona,
Italy. They were 5 men and 8 women (mean age 50.0 years;
SD 14.2) with depression. Clinicians who have many years of
practice with psychiatric patients did their diagnoses according to DSM-IV-R criteria (American Medical Association,
2004). Controls were 13 individuals recruited from hospital
workers. They were 5 men and 8 women (mean age 40.2
years; SD 13.0) who declared no history of neurological or
psychiatric impairment. Depressed and control individuals
were volunteers; they were nave to the research aim.

The Scientific World Journal

2.2. Procedure. In the experiment, participants were tested
in random order. The experimenter was blind about the
condition of the participant either a patient or a control
individual.
2.3. Mirror-Gazing Test (MGT). MGT was conducted in a
darkened room, 5 m 5 m. The walls of the room were
painted light gray. A mirror (0.5 m 0.5 m) was mounted on
a tripod and placed in the center of the room. The subjects
were seated at a distance of 0.4 m in front of the mirror.
The room was lit only by a halogen light bulb (12 V, 20 W).
The bulb was mounted on a spotlight placed 1.2 m behind
the subjects so that they could not see it. The light bulb
beam was directed toward the floor (about a distance of 5 cm
from bulb to floor), in order to avoid direct lighting. This
indirect illumination provided diffuse lighting over the whole
room. The face was lit relatively uniformly at about 0.2 cd m2
(digital photometer Pantec LM-20 by Carlo Gavazzi, Milano,
Italy). All the fine facial features could be perceived in detail;
colors were attenuated.
With the subject seated in front of the mirror, the
experimenter explained the task: Your task is look at your
face in the mirror. You should keep staring into your eyes. The
task will last seven minutes. During the MGT, the subjects
perceptions were qualitatively and quantitatively assessed.
The number and latency of abnormal perceptions were
evaluated by recording event-related responses to apparitional experiences. Every time subjects had an abnormal
perception, they had to press a button and their responses
were recorded and digitally stored. The experimenter told
participants how to use the button using the following words:
During the seven minutes while you are looking at your face
in the mirror and staring at your eyes you may or may not
notice changes in your face. If you notice a change then press
the button and hold it down for as long as the change lasts. If
you do not notice any changes then do not press the button.
Subjects were then asked if they understood the task, and,
after the experimenter had further clarified and explained
unclear points, the task began. The mirror-gazing session
lasted seven minutes.
When the 7-minute MGT ended, the experimenter
assessed patients and controls with a specifically designed
questionnaireand interviewed them asking them to describe
abnormal perceptions. The interview comprised the following question: What did you see? For both patients and
controls, the experimenter transcribed the answers.
Lastly, after the interview, the participants answered four
five-point Likert-type scale sentences: How often did you
notice anything strange?, How often did it influence you
emotionally?, How often did it seem real?, and How often
did you see another person in the mirror?. Responses given
were scored on a five-point Likert-type scale, ranging from
never (= 0), rarely (= 1), to very often (= 4). The
experimenter transcribed patients and controls answers to
the questionnaire.
2.4. Statistical Analyses. The two groups (patients versus
controls) were matched for gender. Instead, the age of

The Scientific World Journal

participants was not adequately matched between groups,
which were different in mean age ( = 1.8; = 0.08). Therefore, possible effects of age differences between groups were
investigated by including age as covariate variable in statistical analyses.
For event-related responses, the mean onset of the first
apparition was defined as the first time the subject pressed the
button. The frequency of event-related responses was defined
as the number of times subjects pressed the response button,
averaged per minute. The mean duration was the mean
time they held the response button down. The cumulative
duration of apparitions was defined as the sum of durations
of apparitions in MGT, averaged per minute (the cumulative
duration equals the algebraic product of frequency and mean
duration).
The phenomenological descriptions were classified for
content into strange-face categories [1]: deformed traits, relatives, unknown persons, archetypal faces, animal faces, and
monstrous faces. The number of strange faces was calculated
for each subject by counting the number of different types of
strange faces described.
Between-subjects ANOVAs were run with a two-level
factor (patients versus controls). The effect of age differences
between patients and controls was analyzed by inserting age
as covariate variable in ANOVAs. All data are expressed as
means SEM.

3. Results and Discussion

3.1. Event-Related Responses. Five out of 13 patients (38%)
perceived strange-face apparitions; 13 out of 13 healthy controls (100%) perceived strange-face apparitions.
The mean onset of the first apparition (patients 68 23 s
versus controls 175 38 s) did not differ significantly between
patients and controls. The mean frequency of event-related
responses (patients 0.3 0.2 versus controls 0.8 0.2) did
not differ significantly between groups. The mean duration
of apparitions (patients 1.2 0.4 s versus controls 6.1 1.0 s)
was lower in patients than in controls ((1, 23) = 13.9;
< 0.001). Age differences between groups had statistically
nonsignificant effects.
The trade-off between frequency and duration of subjects
responses was verified using the mean cumulative duration
of apparitions per minute of MGT that differed significantly
between groups ((1, 23) = 4.1; = 0.05). The mean cumulative duration of apparitions was shorter in patients than
in controls (patients 1.0 0.6 s min1 versus controls 5.0
1.4 s min1 ). Age differences between groups had statistically
nonsignificant effects.
Results of event-related responses take on more impact
when compared with data from schizophrenic patients [5],
as shown in Figure 1 (the three groups were actually studied
in the same sessions and all participants were tested in blind
design).
3.2. Phenomenological (Qualitative) Descriptions. During the
7-minute MGT, patients perceived a lower number of strange
faces than controls (patients 0.5 0.3 versus controls 1.6 0.3)

3
14
12
10
8
6
4
2
0

Healthy
controls

Depression
patients

Schizophrenic
patients
(Caputo et al., 2012)

Figure 1: Cumulative duration of apparitions per minute of MGT

[s min1 ].

and this difference was statistically significant ((1, 23) = 4.4;

= 0.047). Age differences between groups had statistically
nonsignificant effects.
3.3. Likert-Type Scale Questionnaire. The sentence How
often did you notice anything strange? was rated to be lower
in strength of apparitions by patients than controls (Likerttype scale score of patients 0.5 0.3 versus controls 1.6 0.2).
The difference between groups was statistically significant
((1, 23) = 6.6; = 0.017). Age differences between groups
had a statistically significant effect ((1, 23) = 6.2; = 0.02).
The sentence How often did it influence you emotionally?
was rated as lower by patients than controls (patients 0.3
0.2 versus controls 1.3 0.2). The difference between groups
was statistically significant ((1, 23) = 8.4; = 0.008). Age
differences between groups had statistically nonsignificant
effects.
The sentence How often did it seem real? did not differ
between patients and controls (patients 0.4 0.2 versus
controls 0.7 0.3). The sentence How often did you see
another person in the mirror? did not differ between patients
and controls (patients 0.2 0.2 versus controls 0.7 0.3). Age
differences between groups had statistically nonsignificant
effects.

4. Conclusions
Our study provides first evidence showing that mirrorgazing, at a low illumination level, produces less frequent
strange-face apparitions in depressed patients than in healthy
individuals. Moreover, apparitions were usually of lower
intensity and shorter duration in depressed patients than in
healthy controls. The hypothesis of the present study is therefore supported by the decreased frequency and duration of
event-related responses, decreased number of strange faces,
and lower self-evaluation ratings of apparition strength and
emotions among the patients. Instead, the age of participants
did not influence strange-face apparitions.

4
The experimental finding that depression patients
reported lower ratings of the emotional content of strangeface apparitions than healthy controls can be explained by
the general dampening of emotions in depression [7, 8, 19].
The experimental finding that patients reported fewer
and less frequent strange-face apparitions than controls can
be explained by deficits in emotional facial recognition and
emotional facial expression and by deficit in interpersonal
interactions of patients with depression [1315, 18].
Our phenomenological observation of typical depressed
patients behaviour in front of the mirror gives the compelling
impression that patients saw their own reflected faces similar
to inanimate materials. This behaviour in depression is
opposite to intense strange-face hallucinations that can be
observed in schizophrenia [5]. In fact, depression patients
during mirror-gazing can be described as completely immobile similar to statues of death [20].

Conflict of Interests
The authors declare that there is no conflict of interests
regarding the publication of this paper.

References
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vol. 39, no. 7, pp. 10071008, 2010.
[2] G. B. Caputo, Apparitional experiences of new faces and
dissociation of self-identity during mirror-gazing, Perceptual
and Motor Skills, vol. 110, pp. 11251138, 2010.
[3] C. R. Brewin, B. Y. T. Ma, and J. Colson, Effects of experimentally induced dissociation on attention and memory, Consciousness and Cognition, vol. 22, no. 1, pp. 315323, 2013.
[4] C. R. Brewin and N. Mersaditabari, Experimentally-induced
dissociation impairs visual memory, Consciousness and Cognition, vol. 22, no. 4, pp. 11891194, 2013.
[5] G. B. Caputo, R. Ferrucci, M. Bortolomasi, M. Giacopuzzi, A.
Priori, and S. Zago, Visual perception during mirror gazing at
ones own face in schizophrenia, Schizophrenia Research, vol.
140, no. 13, pp. 4650, 2012.
[6] G. S. Malhi, G. B. Parker, and J. Greenwood, Structural and
functional models of depression: from sub-types to substrates,
Acta Psychiatrica Scandinavica, vol. 111, no. 2, pp. 94105, 2005.
[7] L. Clark, S. R. Chamberlain, and B. J. Sahakian, Neurocognitive
mechanisms in depression: implications for treatment, Annual
Review of Neuroscience, vol. 32, pp. 5774, 2009.
[8] M. L. Phillips, W. C. Drevets, S. L. Rauch, and R. Lane, Neurobiology of emotion perception II: implications for major psychiatric disorders, Biological Psychiatry, vol. 54, no. 5, pp. 515528,
2003.
[9] S. G. Disner, C. G. Beevers, E. A. P. Haigh, and A. T. Beck, Neural mechanisms of the cognitive model of depression, Nature
Reviews Neuroscience, vol. 12, no. 8, pp. 467477, 2011.
[10] T. L. Chartrand and J. L. Lakin, The antecedents and consequences of human behavioral mimicry, Annual Review of
Psychology, vol. 64, pp. 285308, 2013.
[11] M. Merleau-Ponty, The childs relations with others, in The
Primacy of Perception, M. Merleau-Ponty, Ed., pp. 96155,
Northwestern University Press, Evanston, Ill, USA, 1964.

The Scientific World Journal

[12] P. Rochat and D. Zahavi, The uncanny mirror: a re-framing
of mirror self-experience, Consciousness and Cognition, vol. 20,
no. 2, pp. 204213, 2011.
[13] W. Gaebel and W. Wolwer, Facial expression and emotional
face recognition in schizophrenia and depression, European
Archives of Psychiatry and Clinical Neuroscience, vol. 242, no. 1,
pp. 4652, 1992.
[14] D. R. Rubinow and R. M. Post, Impaired recognition of affect
in facial expression in depressed patients, Biological Psychiatry,
vol. 31, no. 9, pp. 947953, 1992.
[15] A. Lembke and T. A. Ketter, Impaired recognition of facial
emotion in mania, The American Journal of Psychiatry, vol. 159,
no. 2, pp. 302304, 2002.
[16] S. Surguladze, M. J. Brammer, P. Keedwell et al., A differential
pattern of neural response toward sad versus happy facial
expressions in major depressive disorder, Biological Psychiatry,
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[17] T. A. Victor, M. L. Furey, S. J. Fromm, A. Ohman, and W. C.
Drevets, Relationship between amygdala responses to masked
faces and mood state and treatment in major depressive disorder, Archives of General Psychiatry, vol. 67, no. 11, pp. 11281138,
2010.
[18] D. A. Clark and A. T. Beck, Cognitive theory and therapy of
anxiety and depression: convergence with neurobiological findings, Trends in Cognitive Sciences, vol. 14, no. 9, pp. 418424,
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Neuropsychoanalysis, vol. 11, no. 1, pp. 751, 2009.
[20] G. B. Caputo, Archetypal-imaging and mirror-gazing, Behavioral Sciences, vol. 4, pp. 113, 2014.

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Perception, 2010, volume 39, pages 1007 ^ 1008

doi:10.1068/p6466

LAST BUT NOT LEAST

Strange-face-in-the-mirror illusion
Giovanni B Caputo

Department of Psychology, University of Urbino, via Saffi 15, 61029 Urbino, Italy;
e-mail: giovanni.caputo@uniurb.it
Received 15 May 2009, in revised form 11 May 2010

I describe a visual illusion which occurs when an observer sees his/her image reflected
in a mirror in a dimly lit room. This illusion can be easily experienced and replicated as
the details of the setting (in particular the room illumination) are not critical. These
observations were made in a quiet room dimly lit by a 25 W incandescent light. The
lamp was placed on the floor behind the observer so that it was not visible either
directly or in the mirror. A relatively large mirror (0.5 m60.5 m) was placed about
0.4 m in front of the observer. Luminance of the reflected face image within the
mirror was about 0.2 cd m2 and this level allowed detailed perception of fine face
traits but attenuated colour perception. The illusion occurred even at higher levels of
illumination of observer's face (from 0.2 to 1.6 cd m2 ). The task of the observer was
to gaze at his/her reflected face within the mirror. Usually, after less than a minute,
the observer began to perceive the strange-face illusion.
Phenomenological descriptions were made by fifty naive individuals (age range
21 ^ 29 years; mean 23 years; SD 2.1 years). At the end of a 10 min session of mirror
gazing, the participant was asked to write what he or she saw in the mirror. The
descriptions differed greatly across individuals and included: (a) huge deformations of
one's own face (reported by 66% of the fifty participants); (b) a parent's face with traits
changed (18%), of whom 8% were still alive and 10% were deceased; (c) an unknown
person (28%); (d) an archetypal face, such as that of an old woman, a child, or a portrait
of an ancestor (28%); (e) an animal face such as that of a cat, pig, or lion (18%);
(f ) fantastical and monstrous beings (48%).
The disappearance or attenuation of face traits could be linked to the Troxler
fading that occurs in the periphery while staring at a central fixation. However, this
explanation would predict that face traits should fade away and eventually disappear
(Wade 2000), whereas the apparitions in the mirror consist of new faces having new
traits. A possibly related `multiple-faces' phenomenon (Simas 2000) has been reported
for photos of faces placed in peripheral vision. In this case, the reported deformations of features include variations of the facial traits and expressions or appearance
of new ones like teeth, or a beard, as well as completely new faces, 3-D distortions,
rotations, upside-down faces, the subject's own face, sometimes younger or older.
Clearly, there are similarities in effects for peripherally viewed photos and centrally
viewed self-reflections in dim light. However, in central viewing, the perception of the
face is more accurate, making the distortion more salient, and, because the distortions
are of one's own face, the effects are amplified from merely intriguing to often unsettling.
The two types of distortion (peripheral versus low-illumination central viewing) can be
compared by viewing one's own face in profile in a mirror in peripheral vision.
From a perceptual viewpoint, the strange-face illusion may be explained by disruption
of the process of binding of traits (eyes, nose, mouth, etc) into the global Gestalt of face
(Thompson 1980). This long-term viewing of face stimuli of marginal strength may
generate a haphazard assembly of face traits that generate deformed faces or scrambled

1008

Last but not least

faces. Frequent apparitions of strange faces of known or unknown people support the
idea that the illusion involves a high-level mechanism that is specific to global face
processing. On the other hand, the frequent apparition of fantastical and monstrous
beings, and of animal faces cannot, in our opinion, be explained by any actual theory
of face processing. Neither constructive approaches nor top ^ down accounts seem to
provide adequate explanations.
The participants reported that apparition of new faces in the mirror caused sensations of otherness when the new face appeared to be that of another, unknown person
or strange `other' looking at him/her from within or beyond the mirror. All fifty participants experienced some form of this dissociative identity effect, at least for some
apparition of strange faces and often reported strong emotional responses in these
instances. For example, some observers felt that the `other' watched them with an
enigmatic expression a situation that they found astonishing. Some participants saw
a malign expression on the `other' face and became anxious. Other participants felt
that the `other' was smiling or cheerful, and experienced positive emotions in response.
The apparition of deceased parents or of archetypal portraits produced feelings of silent
query. Apparition of monstrous beings produced fear or disturbance. Dynamic deformations of new faces (like pulsations or shrinking, smiling or grinding) produced an overall
sense of inquietude for things out of control.
Static face pictures and the distortions seen when they are peripherally viewed (Simas
2000) involve the binding of face traits. In contrast, self-perception in a mirror engages
a far broader set of processes as the image duplicates one's own face perfectly in space
and time, triggering an integration of perceptual, motor, and proprioceptive processes.
It is a dynamic process involving self-motion and autonomous self-exploratory control
of facial pose and expression (Rochat 2002). The construction of our self-identity
includes, among other processes, the capacity to recognise oneself in the mirror, a
competence acquired in childhood between 2 ^ 3 years of age (Zazzo 1981). Another
aspect of the strange-face illusion is the potential breakdown of self-identity that may
take place when gazing at a strange new face that has replaced one's own in the mirror
for a relatively long time.
Acknowledgment. I would like to greatly thank Patrick Cavanagh for his help in revision, advice,
and enthusiastic support.
References
Rochat P, 2002 ``Ego function of early imitation'', in The Imitative Mind Eds A N Meltzoff, W Prinz
(Cambridge: Cambridge University Press) pp 85 ^ 97
Simas M L, 2000 ``The multiple-faces phenomenon: some investigative studies'' Perception 29
1393 ^ 1395
Thompson P, 1980 ``Margaret Thatcher: a new illusion'' Perception 9 483 ^ 484
Wade N J, 2000 A Natural History of Vision (Cambridge, MA: MIT Press)
Zazzo R, 1981 ``Miroir, images, espaces'', in La Reconnaissance de son Image chez l'Enfant et l'Animal
Eds P Mounoud, A Vinter (Paris: Delachaux et Niestle) pp 77 ^ 110

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