Cotard delusion
From The Art and Popular Culture Encyclopedia
|
Related e |
|
Featured: |
The Cotard delusion or Cotard's syndrome, also known as nihilistic or negation delusion, is a rare neuropsychiatric disorder in which a person holds a delusional belief that he or she is dead, does not exist, is putrefying or has lost his/her blood or internal organs. Rarely, it can include delusions of immortality.
It is named after Jules Cotard (1840–1889), a French neurologist who first described the condition, which he called le délire de négation ("negation delirium"), in a lecture in Paris in 1880. He described the syndrome as having various degrees of severity, ranging from mild to severe. In a mild state, feelings of despair and self-loathing occur, however it is in the severe state that a person with Cotards actually starts to deny the very existence of the self¹.
In this lecture, Cotard described a patient with the moniker of Mademoiselle X, who denied the existence of God, the Devil, several parts of her body and denied she needed to eat. Later she believed she was eternally damned and could no longer die a natural death.
Young and Leafhead (1996, p155) describe a modern-day case of Cotard delusion in a patient who suffered brain injury after a motorcycle accident:
- "[The patient's] symptoms occurred in the context of more general feelings of unreality and being dead. In January, 1990, after his discharge from hospital in Edinburgh, his mother took him to South Africa. He was convinced that he had been taken to hell (which was confirmed by the heat), and that he had died of septicaemia (which had been a risk early in his recovery), or perhaps from AIDS (he had read a story in The Scotsman about someone with AIDS who died from septicaemia), or from an overdose of a yellow fever injection. He thought he had "borrowed my mother's spirit to show me round hell", and that he was asleep in Scotland."
It can arise in the context of neurological illness or mental illness and is particularly associated with depression and derealization.
Neurologically, Cotard's is thought to be related to Capgras's Syndrome, and both are thought to result from a disconnect between the brain areas that recognize faces (fusiform face areas) and the areas that associate emotions with that recognition (the amygdala and other limbic structures). This disconnect creates a sense that the face that's seen is not the person's it purports to be because although it is identical with the face it purports to be, it lacks the familiarity it should have. If it is a relative's face, it is experienced as an imposter's (Capgras); if it is mine, I conclude that because I don't have the usual emotional context of self-familiarity associated with the face, I am dead (Cotard).
Treatment is difficult, and tricyclic and serotoninergic antidepressant drugs have shown little efficacy. Electroconvulsive therapy has shown greater promise, "curing" Cotard's sufferers in five studies of its efficacy with that treatment.
