Cotard delusion

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.

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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.

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:

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.

Cultural references

• On episode 4.14 ("My Lucky Charm") of the television show Scrubs, a character named Jerry (played by Michael Bunin), who suffers from Cotard syndrome, complains of the hardships of being dead.
• British electronic musician Matt Elliott named a song for the condition on his 2003 album The Mess We Made.
• In the April 12, 2007 comic of Dinosaur Comics, T-Rex refers to Cotard syndrome.[1]
• Chuck Klosterman makes reference to Jules Cotard and Cotard's syndrome in his book, Killing Yourself to Live: 85% of a True Story. The protagonist, Klosterman, feels like he might be a victim of the syndrome, especially when he is in airports.
• The characters in Peter Watts' book Blindsight experience Cotard-like symptoms as a result of the intense electromagnetic fields of the Rorschach craft.

See also

• delusion
• delusional disorder
• psychosis

External links and references

• Pearn, J. & Gardner-Thorpe, C. (2002) Jules Cotard (1840-1889) His life and the unique syndrome which bears his name. Neurology, 58, 1400-1403.
• Young, A.W. & Leafhead, K.M. (1996) Betwixt Life and Death: Case Studies of the Cotard Delusion. In P.W. Halligan & J.C. Marshall (eds) Method in Madness: Case studies in Cognitive Neuropsychiatry. Hove: Psychology Press.
• Heffner, G.J. Cotard Delusion. The Autism Home Page.