Disturbing Disorders: Cotard’s Delusion (Walking Corpse Syndrome)

C4In 1880, a middle-aged woman paid a visit to the French neurologist, Jules Cotard (pictured below), complaining of an unusual predicament. She believed she had ‘no brain, no nerves, no chest, no stomach, no intestines’. Mademoiselle X, as Cotard dubbed her in his notes, told the physician she was ‘nothing more than a decomposing body’. She believed neither God nor Satan existed, and that she had no soul. As she could not die a natural death, she had ‘no need to eat’.

Mademoiselle X later died of starvation. [1]

Although this peculiar condition eventually became known as ‘Cotard’s Delusion’ the French neurologist was not the first to describe it. In 1788—nearly 100 years earlier—Charles Bonnet reported the case of an elderly woman who was preparing a meal in her kitchen when a draught ‘struck her forcefully on the neck’ paralyzing her one side ‘as if hit by a stroke’. When she regained the ability to speak, she demanded that her daughters ‘dress her in a shroud and place her in her coffin’ since she was, in fact, dead.

[T]he ‘dead woman’ became agitated and began to scold her friends vigorously for their negligence in not offering her this last service; and as they hesitated even longer, she became extremely impatient, and began to press her maid with threats to dress her as a dead person. Eventually everybody thought it was necessary to dress her like a corpse and to lay her out in order to calm her down. The old lady tried to make herself look as neat as possible, rearranging tucks and pins, inspecting the seam of her shroud, and was expressing dissatisfaction with the whiteness of her linen. In the end she fell asleep, and was then undressed and put into bed.

_1Hoping to break her spell, a physician attended her bedside and administered a ‘powder of precious stones mixed with opium’. Eventually, the woman did awake from her delusional state; however, she continuously redeveloped her paroxysm every three months for the rest of her life. During the periods when she thought that she was dead ‘she talked to people who had long been dead, preparing dinners for them and hosting the occasion somberly and constantly’. [2]

Today, the condition is sometimes referred to as ‘Walking Corpse Syndrome’. Although rare, people are still diagnosed as suffering from nihilistic delusional beliefs that they are dead and no longer exist. Occasionally, the condition is characterized by a belief that one is missing essential body parts or organs, as in the a case of a 28-year-old pregnant woman who thought her liver was ‘putrefying’ and that her heart was ‘altogether missing.’

In 2013, New Scientist interviewed a man named Graham Harrison, who had attempted suicide 9 years earlier by taking an electrical appliance with him into the bath, and awoke in the hospital believing he was dead. He said:

When I was in hospital I kept on telling them that the tablets weren’t going to do me any good ’cause my brain was dead. I lost my sense of smell and taste. I didn’t need to eat, or speak, or do anything. I ended up spending time in the graveyard because that was the closest I could get to death.

It was his brain which had died. He had fried it, or so he thought. Doctors tried to rationalize with him, but to no avail. Eventually, Graham was referred to Dr Adam Zeman, a neurologist at the University of Exeter, and Dr Steven Laureys, a neurologist at University of Liège. They used positron emission tomography (PET) to monitor his metabolism. What they found was unsettling.

‘Graham’s brain function resembles that of someone during anaesthesia or sleep. Seeing this pattern in someone who is awake is quite unique to my knowledge’, Dr Laureys told New Scientist. ‘I’ve been analysing PET 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’. The below image shows the areas of Graham’s brain which are underactive (coloured in blue) in comparison with a healthy person.


Graham is the only patient with Cotard’s Delusion to have undergone a PET scan, and therefore scientists can draw few conclusions about the results since they have no basis for comparison. The condition has been tentatively linked to bipolar disorder in young people, as well as severe depression and schizophrenia in older patients. Treatment of the condition is varied. Typically, those suffering from it are put on a combination of anti-depressants and anti-psychotic drugs, although electroconvulsive therapy has also been known to be successful.

For Graham, psychotherapy and drug treatment has helped ebbed the symptoms of Cotard’s Delusion, though it’s been a long, hard journey. Over the past decade, he could often be found sitting in local graveyards in an attempt to get closer to death. ‘The police would come and get me, though, and take me home’, he said. [3]

Graham is one of the lucky ones. Many who have suffered from the condition in the past have died from starvation, and some have even resorted to pouring acid on themselves in an effort to stop being one of the ‘walking dead’. One thing is for certain: Cotard’s Delusion, or ‘Walking Corpse Syndrome,’ illustrates just how little we still know about the human brain in the 21st century.

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1. Berrios G.E & Luque R, ‘Cotard’s Delusion or Syndrome: A Conceptual History’, Comprehensive Psychiatry, 36:3 (May/June, 1995), p. 218.
2. Hans Forstl and Barbara Beats, ‘Charles Bonnet’s Description of Cotard’s Delusion and Reduplicative Paramnesia in an Elderly Patient (1788)’, British Journal of Psychiatry (1992), p. 417.
3. Helen Thomson, ‘Mindscapes: First Interview with a Dead Man’, New Scientist (23 May 2013).

26 comments on “Disturbing Disorders: Cotard’s Delusion (Walking Corpse Syndrome)

  1. […] 1880, a middle aged woman paid a visit to the French Neurologist, Jules Cotard, complaining of an unusual predicament. She believed she had ”no brain, no nerves, no chest, no stomach and no intestine” […]

  2. […] 1880, a middle-aged woman paid a visit to the French neurologist, Jules Cotard, complaining of an unusual predicament. She believed she had ‘no brain, no nerves, no chest, no stomach, no intestines’. Mademoiselle […]

  3. […] No seriously, I’m dead. Living With Being Dead Disturbing Disorders: Cotard’s Delusion […]

  4. […] 1880, a middle-aged woman paid a visit to the French neurologist, Jules Cotard, complaining of an unusual predicament. She believed she had ‘no brain, no nerves, no chest, no stomach, no intestines’. Mademoiselle […]

  5. Suko says:

    I have paranoid schizophrenia and I sometimes believe I am dead. I don’t think I should go to work or do anything at all as I’m dead. I have to believe other people when they tell me I’m still alive and should go to work.

  6. masterminds5 says:

    How many documented cases of Walking Corpse Syndrome have there been if Harrison is only the first one to undergo a PET scan?

  7. Hat says:

    “Has helped ebbed”? Shome mishtake shurely?

  8. Christine says:

    A friend of mine who suffers from paranoid schizofenia, is also utterly convinced that a large part of his brain is missing, and this belief is constant, both during psychotic and normally functioning phases/episodes.
    He is highly intelligent otherwise but for him this a physical fact not even worth discussing.
    It just is.
    From what I’ve been able to gather from his own account, the belief that specific parts of his brain were gone predates the onset of schizofrenia by years.

    It would be interesting to see a PET scan of his brain though he probably would refuse – no need to investigate what he knows for a fact…
    But then, as fascinating Cotard’s Delusion is, it probably woulnd’t go far as a reason to spend public money on a scan in the Danish healthcare system.

  9. […] 1880, a middle-aged woman paid a visit to the French neurologist, Jules Cotard (pictured below), complaining of an unusual predicament. She believed she had ‘no brain, no nerves, no chest, no […]

  10. […] The Chirurgeon’s Apprentice: Disturbing Disorders: Cotard’s Delusion (Walking Corpse Syndrome) […]

  11. […] There are a lot of seriously strange neurological disorders out there. The brain is a barely understood piece of wet ware that can get all freaky and out of balance with disturbing ease. There’s the Palinopsia Disorder where the after image left in the eye after seeing bright images won’t go away sometimes for days afterwards. Or folks who suffer from Dysmimia who can only not comprehend or even realize what’s happened with hand signals. Or even the famous Stendahl Syndrome (there’s even a movie about it) where one can experience vivid hallucinations when being exposed to good art. But the weirdest, and most disturbing neurological disorder I’ve yet encountered, has to be Cotard’s Delusion, often referred to as “The Walking Corpse Syndrome”. […]

  12. […] del siglo XIX, no es frecuente, pero existen bastantes casos en la literatura médica. La conocemos gracias a The Chirurgeon’s Apprentice, donde nos cuentan que suele encontrarse asociada a la hipocondría (el miedo a las enfermedades), […]

  13. […] More at The Chirurgeons Apprentice […]

  14. julieallyn says:

    Reblogged this on A Sawyer's Daughter and commented:
    The Chirurgeon’s Apprentice is one of my favorite blogs. Her posts are always fascinating. Our brains: The Next Frontier?

  15. I agree with Dr Smith re: possible ECT for the affective component of the disease. However, I don’t think any sort of psychotherapy is ever indicated in true cases of Cotard’s, for the simple reason that no amount of rational discussion can overcome an ingrained delusion. I’d go straight to neuroleptic Rx and titrate aggressively and as tolerated. But I know, from my one case of Cotard’s years back, that the outcome, regardless of intervention, is always guarded at best.

  16. I have seen with such severe depression that they claim that their brain is rotting or that parasites are eating their organs, Nosology is difficult but most have a family history of depression or bipolar disorder. Treatment is difficult as cognitive or psychotherapy often does not work alone. Medications, therapy and perhaps ECT in combination seem to work the best….in my experience.

    William Alton Smith, Jr., M.D., F.A.C.P.

  17. The ABC television show (rather unfortunately cancelled) “Black Box” had an episode built around a man suffering this syndrome. It was fascinating!

  18. As I understand it, Cotard’s Delusion (or Syndrome, as it is sometimes called) is the result of the misfiring of impulses between the fusiform face area, which is mainly associated with the recognition of faces and the amigdala, which is the seat of emotions. The individual cannot emotionally connect with his/herself and in order to compensate for the concomitant cognitive dissonance the brain creates the narrative that the individual is dead or that organs are rotting/missing or that he/she is immortal.

    Is this correct?

  19. Kate says:

    Reblogged this on BitterSuites and commented:
    This is absolutely fascinating to me.

    I have to wonder if it might be connected to some of the zombie situations in the islands as well. A combination of drugs and a delusional belief.

    Wow. Now I have something to research. At the very least it would make an intriguing short story.

  20. carolynloyel says:

    They did an episode about this on Black Box with Kelly Reilly. I thought it was pretty interesting!

  21. I’ve read about this disorder before and it just never fails to fascinate me. Also, it makes me really happy to know they’ve at least gotten a few steps closer to curing it. I can’t help but to wonder how people viewed Cotard’s Delusion before they understood it was an actual disorder though. Did they think it was magic/the devil/god/etcetc?


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