Cotard's Syndrome or Cotard delusion
is a very rare disease, one of the rarest in the world. According to New Scientist
, a 1995 study
of 349 elderly psychiatric patients in Hong Kong found two with symptoms similar to Cotard's. However, it is believed that only a few hundred people suffer with the condition at any time.
Experts have linked the condition with depression. It presents with varieties of delusions that range from the conviction that one has ceased to exist totally or simply that one is dead or that some part of the body or vital organ, such as the brain or stomach or heart, is either missing, dead, does not exist, not functioning or rotting.
reports that the condition was first described in a patient, Mademoiselle X, whom Jules Cotard presented in a lecture in Paris in 1880. The woman presented with "self-loathing manifested as denial of the existence of god or the devil and several parts of her body... she believed herself to be eternally damned and incapable of dying a natural death and so no longer needed to eat. She later died of starvation..."
reports that Graham woke up nine years ago with the sudden conviction that he was no longer alive. The conviction came soon after a suicide attempt during a bout of depression in which he went into the bathroom with an electrical appliance and tried to electrocute himself.
After that, he developed the belief that he had died and lost interest in all his favorite activities, including smoking. He hardly spoke and refused to eat because "no point because I was dead."
His condition became so bad that his family had to look after him to ensure that he washed himself and ate. He said
: "I didn't want to face people. There was no point. I didn't feel pleasure in anything. I used to idolize my car, but I didn't go near it. All the things I was interested in went away. I lost my sense of smell and my sense of taste. There was no point in eating because I was dead. It was a waste of time speaking as I never had anything to say. I didn't even really have any thoughts. Everything was meaningless."
He felt an irresistible urge to hang out at graveyards, among the dead with whom he felt a special kinship, being, as he believed, dead. He said: "I just felt I might as well stay there. It was the closest I could get to death. The police would come and get me, though, and take me back home."
Doctors tried to convince him he had not died. Their efforts only annoyed him for it seemed evident that he was missing his brain. He insisted that his brain had died after he fried it with the electrical appliance. He said: "I just got annoyed. I didn't know how I could speak or do anything with no brain, but as far as I was concerned I hadn't got one."
: "When I was in hospital I kept on telling them that the pills weren't going to do me any good 'cause my brain was dead."
: "It's really hard to explain. I just felt like my brain didn't exist any more. I kept on telling the doctors that the tablets weren't going to do me any good because I didn't have a brain. I'd fried it in the bath."
Thoroughly baffled, doctors referred him to neurologists Adam Zeman at the University of Exeter and Steven Laureys at the University of Liege in Belgium.
The doctors diagnosed him with Cotard's Syndrome, also known as Cotard's delusion or "Walking Corpse Syndrome" because people with the condition have the firm conviction that they are "zombies," literally.
: "It's the first and only time my secretary has said to me: 'It's really important for you to come and speak to this patient because he's telling me he's dead."
According to Zeman: "He was a really unusual patient." Zeman felt that the patient's belief was a metaphor of how he felt about life.
Zeman and Laureys ordered a positron emission tomograph (PET)
to monitor metabolism across his brain. According to New Scientist
, that was the first PET scan ever taken of a person with Cotard's.
The doctors found such a profound level of depression of metabolic activity across large sections of the patient's frontal and parietal brain regions that it appeared to be in a vegetative state. The affected areas, according to New Scientist
, are those related to sustenance of a sense of self and related core consciousness functions.
Laureys said: "I've been analyzing (brain) scans for 15 years and I've never seen anyone who was on his feet, who was interacting with people, with such an abnormal scan result. Graham's brain function resembles that of someone during anesthesia or sleep. Seeing this pattern in someone who is awake is quite unique to my knowledge."
reports that some scientists believe that a cause of the condition could be malfunction in the fusiform areas of the brain, which help us to recognize faces, and the amygdala linked to emotions. According to Scientific American
: "The result is a lack of emotion when viewing familiar faces and the result disconnection can result in complete detachment. Viewing ones own face in this condition can lead to a lack of association between their reflections or projected self and their own sense of self, leading to a belief that one doesn't exist."
Graham is recovering after several months of therapy, drugs and other treatment. Scientific American
reports that the condition is treated using anti-depressants and anti-psychotics. Electroconvulsive therapy is also used, but very little is known about the illness and its treatment.
Graham says that although he is not back to what he used to be completely, he is feeling much better and can now live independently. He said: "I don't feel that brain-dead any more. Things just feel a bit bizarre sometimes. I'm not afraid of death. But that's not to do with what happened – we're all going to die sometime. I'm just lucky to be alive now."