Cotard’s Syndrome patients claim they’re dead or parts of their bodies are dead, rotten. Credit: Max Pixel.

There are literally thousands of mental and personality disorders, some more peculiar than others. Perhaps one of the rarest and oddest mental disorder is Cotard’s syndrome. Patients who suffer from Cotard’s syndrome literally feel like zombies since they’re absolutely convinced that their brain, and possibly other organs, are dead, destroyed or non-existing. The patients also believe they do not need to do activities to keep themselves alive (drink, eat, basic hygiene etc.).

The condition was initially known as “the delirium of negation” and was first described in 1882 by psychiatrist Jules Cotard. In one of his papers, Cotard described the curious case of a patient who claimed she had “no brain, nerves, chest, or entrails, and was just skin and bone” and maintained “that neither God or the devil existed, and she did not need food, for she was eternal and would life forever.”

Not surprisingly, bearing all of this in mind, Cotard’s syndrome is often known as ‘Walking Corpse syndrome’. The rare disorder isn’t classed under the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) but it the International Classification of Diseases recognizes it as a “disease of human health” like with “psychosis, clinical depression, and schizophrenia.”

Meet some zombies

There aren’t many cases of Cotard’s syndrome but the few reported instances are all absolutely mindblowing.

One Scottish man who suffered a serious injury to his head following a motorcycle accident in 1996 told his doctors he had died because of complications during his recovery. He later moved from Edinburgh to South Africa with his mother. There he found in the scorching heat all the evidence he needed to confirm he was, in fact, dead. Only Hell could be that hot, the patient concluded.

In 2008, doctors published a paper detailing the case of a 53-year-old Filipino woman who “was admitted to the psychiatric unit when her family called 911 because the patient was complaining that she was dead, smelled like rotting flesh, and wanted to be taken to a morgue so that she could be with dead people.”

Belgian psychiatrists reported in 2009 that an 88-year-old man walked into the hospital claiming he was dead. He felt anxious and concerned because no one had buried him yet. The same doctors treated a 46-year-old-woman who said she had not eaten or gone to the toilet for moths. She also claimed she hadn’t slept in years. The woman explained to the doctors that she was devoid of blood. When doctors showed the woman her blood pressure and put her in front of a monitor that recorded her heart beats, she casually dismissed them. The woman accused the doctors they were deceiving her — after all, she could no longer hear the heart beating anymore.

Perhaps, the oddest case is that of an Iranian 32-year-old man who told doctors in 2005 that he was not only dead but he had turned into a dog. That’s not all — his wife suffered the same fate and his three daughters, he claimed, also died but turned into sheep this time. According to the patient, he was poisoned by his neighbors but nevertheless felt vindicated since God offered him protection even in death.

Some of these patients were able to recover following treatment. Medication doesn’t seem to work too well but symptoms seem to subside following electroconvulsive treatment (ECT). As for what causes Cotard’s syndrome, things aren’t settled yet. According to clinical psychologist Peter Kinderman, the condition may arise after the patient goes through intense periods of distress and confusion. These beliefs can combine to evoke feelings which compel patients to not recognize themselves anymore. The only conclusion that remains for the patient that might explain what they’re going through is that they’re dead. Oddly enough, almost in all cases the patient suffering from Cotard’s waves away any logical explanation that might convince him otherwise, like X-rays of his still intact brain or tissue.

Picking the brain of the ‘dead’


What most patients seem to have in common are symptoms of severe depression. New Scientist’s interview with a Cotard’s syndrome patient named Graham is most enlightening in this respect.
“It’s really hard to explain,” he says. “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.”
“I didn’t need to eat, or speak, or do anything.”
“I just felt really damn low,” he said.
“I had no other option other than to accept the fact that I had no way to actually die. It was a nightmare.”
His severe angst compelled him on numerous occasions to visit the local graveyard.
“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.”
“He was a really unusual patient,” said neurologist Adam Zeman at the University of Exeter, UK, who studied the patient. Graham’s belief “was a metaphor for how he felt about the world – his experiences no longer moved him. He felt he was in a limbo state caught between life and death”.
Graham was the first ever Cotard’s syndrome patient who received a PET scan, and the research proved very valuable in demystifying the condition. The PET scan revealed that Graham had cortical hypometabolism in the medium and dorsolateral regions. This sort of activity can pop up in patients with major depressive disorder but nothing like the patterns seen in Graham’s brain.
These brain regions are thought to be part of what neurologists refer to as the ‘default mode network’, which is a complex neural system though to be critical to consciousness. It’s through this network that scientists believe we’re able to piece together the past, think about ourselves and create a sense of self. When this network becomes faulty, patients may risk losing touch with their self — they no longer feel like agents responsible for their own actions.

“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,” said Steven Laureys at the University of Liège in Belgium.. “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.”

No other PET scans have been made since so it would be rather speculative to draw definite conclusion from the study of a single individual. What Cotard’s syndrome, and other disorders like it, show us, however, is that we still don’t know much about consciousness. And scary as it may be to read about such peculiar cases, these stories should make us grateful not only for still being alive but also for being able to feel alive.