Monday, June 8, 2015

Cotard's Delusion: Walking Corpse Syndrome

In 1880, French neurologist Jules Cotard treated a middle-aged woman now known only as Mademoiselle X.  She claimed she was missing several vital body parts.  No brain, no nerves, no chest, no stomach, and no intestines, she said.  She didn't believe there was a God or a Devil, and yet believed she was condemned to eternal damnation - and thus couldn't die a 'natural' death.  She also claimed she was "eternal and would live forever."  As such, Mademoiselle X didn't see the point in eating and soon starved to death.

Cotard published his description of this delire des negations, and it was widely circulated, eventually leading to the disorder being named after him.  However, delusions of missing organs and immortality are only two of the ways in which Cotard's delusion may manifest itself.

Patients suffering from Cotard's delusion may believe:
-They are already dead, do not exist, or self-identify as a dead body or zombie.
-That they are missing any number of organs or body parts (or deny the existence of those parts).
-That the things around them are dead (animals or trees).
-That the world will soon be destroyed.
-That they have been taken to Hell.
-Patients may have an increased fascination with death and the macabre, frequently wishing to visit graveyards so they do not feel so alone.
-That doctors or other medical professionals are deceiving them with regard to their non-existent parts.  (A woman who didn't believe she possessed blood, would accuse her doctors of this when they took blood samples or checked her blood pressure.)

 Cotard's delusion often presents alongside migraines, psychotic depression, hypochondria, and sometimes schizophrenia.

Unfortunately, Cotard's delusion is so rare that there has not been a large amount of study devoted to its pathophysiology.  However, the current theory is that it is caused by a misfiring in the fusiform gyrus and amygdalae.  The fusiform gyrus is thought to be responsible for facial recognition; the amygdalae, the emotions related to those faces.  When damaged or impaired, this can lead to not recognizing the people in one's life, oneself, and a sense of derealization about the world in general.  Capgras delusion (the notion that everybody in your life has been replaced by an exact replica) is another disorder associated with damage to these areas of the brain.  There is also some study that suggests Cotard's delusion is linked to lesions of the median frontal lobe.

As observed, Cotard's delusion goes through three stages.  The "Germination stage", where the patient first observes the feelings of the self-negating delusion, depression, or hypochondria; the "Blooming stage" wherein the disorder develops fully; and the "Chronic stage", characterized by ongoing delusions and depression.

These stages might be better described via examining the case of Haley Smith, an Alabama teen, who was diagnosed with Cotard's Delusion and found treatment through therapy and Disney movies.  According to Smith, she was having a hard time dealing with her parents' divorce, and in English class one day, she was struck with the sensation that she was dead.  The school nurse was unable to find anything wrong with her, and sent her home.  On her way, she wanted very much to stop by a graveyard, but was unable and continued home to sleep the feeling off.  It worked.  The sensation went away for several days.

Then, as Smith entered the Blooming stage, the sensation was not solved with sleep.  One day when out shopping, her whole body went numb and she ran home, reeling under the severity of the feeling.  It didn't go away this time.  It took her two years of coping with the syndrome before seeing a psychiatrist, who quickly diagnosed her.

Thankfully, with the help of her therapist, her boyfriend, and classic Disney movies, Haley's condition improved.  As she put it: "Watching Disney films gave me a warm, fuzzy feeling...  I asked my boyfriend, Jeremy, 'How can I be dead when Disney movies make me feel this good?'"  Thus, Smith was able to stave off the third stage: Chronic Cotard's delusion.

Certainly, not everyone gets such a happy ending.  Don't forget about poor Mlle. X.  But, compared to many other extremely rare disorders, those with Cotard's tend to respond very well to treatment.  However, this doesn't undo the creepiness of the experience.  With no markers for predisposition, anyone could be struck with Cotard's delusion.


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