“She was like a zombie,” says psychiatrist Roland Dardennes, describing a patient with Cotard's syndrome. “When I managed to get answers, she was obviously delirious and told me her guts were not functioning anymore.”
Cotard's syndrome — sometimes called “walking corpse syndrome” — causes sufferers to think they are dead or even that they don't exist, oe parts of their body are missing or non-functional.
A denial of the body
Named after French neurologist Jules Cotard, who first identified the symptoms, Cotard’s syndrome is characterized by delusions focused on the individual’s body, including loss of organs, being dead or not existing at all.
In 1880, Cotard drew up a clinical description of physical denial delusion in a melancholia context. Though still not classified as an official mental illness, it’s widely recognized by the scientific community. Throughout his 25-year career treating depression and other mental illnesses, Dardennes only encountered a couple of cases, which tend to be among the elderly.
“In a context of intense depression, it’s a denial of one’s body, when someone believes they have no gut or stomach, or that their organs are rotting. As a consequence, they stop eating because they feel like they can’t digest anymore. To some extent, they can deny their existence,” Dardennes explains.
An extreme state of depression
These types of illnesses are classified as depressive episodes with outbursts of delirium. Depression with delirium is only about 1 percent of total severe depressions, with Cotard syndrome representing a fraction of this percent.
“Patients keep repeating the same words, a litany of the same events and experiences, and they are extremely negative against themselves,” says German Arce Ross, a psychoanalyst also based in Paris.
Signs of hypochondria can also be noted, but to an extent that makes them completely disconnected with reality. “They are deeply delusional – no one can live without their heart, lungs or stomach,” Ross continues. “Because they don’t feel their bodily organs, they can make suicide attempts, and then genuinely feel like they are dead.”
On the other end of the spectrum, sufferers can have a feeling of doomed immortality. “Historically, when the illness used to be more frequent, the patient could feel damned. It used to be associated with a feeling of eternal punishment by God — an endless purgatory,” says Dardennes.
The immortality delirium happens when life feels so hard that they can’t imagine an end to it, and believe their state of suffering will last forever. “I had a patient who said that everyone on the planet was dead but him. They all seemed to be leading a normal life but it was only a lure, and this made them feel extremely lonely,” says Ross.
How it’s cured
“It’s very difficult to treat the patient with only psychotherapy alone – they also need drugs and daily care, preferably from someone outside of the family, because they stop taking care of themselves. They don’t eat, and they don’t clean themselves,” says Ross. To start feeling alive again, the patient needs to reconnect to a time when they could feel emotions.
But because they’re considered a risk to themselves, patients are usually treated with Electroconvulsive Therapy. “In spite of all the research and the advances of science and medicine, electro shock remains the most efficient treatment for depression,” even more than drugs or psychotherapy, says Dardennes.
ECT is fast and efficient: Major improvements can be seen in about two weeks, although it’s not a long-term solution. To avoid relapse, lithium is the standard treatment, but maintenance ECT is also used.