Cotard's syndrome or Delirium of Cotard is a rather rare mental disorder caused by nihilistic-hypochondriacal depressive delusions. Most people with this disease have the same symptoms, they are sure that they are already dead. They will convince you to the last that they are missing or have rotted some organs, that they no longer need to eat or drink. These people will increasingly become depressed, lose interest in something, stop caring for themselves, or even try to harm themselves.
There are 2 main forms of the syndrome: moderate and extremely severe. The average form of the disease is expressed in self-loathing, self-torture and attempts to leave life, justifying this by the fact that their existence brings only harm to others. Severe degrees occur with serious mental disorders, in the form of hallucinations and delusions. A 53-year-old woman told a psychiatrist that she smelled of rot because she had already died. She insisted that her family come to take her to the morgue. In another case, the woman denied not only her own life, but also the lives of everyone around her. She was sure that everyone on the planet had died, including her.
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Quite often, these patients test this out on their own experience, taking something very risky or trying to commit suicide. Either way, they are overly consumed with thoughts of their own death and often demand to be killed. For example, one person, day and night, heard a voice reading him a death sentence and describing the torture that was being prepared for him.
Cotard's syndrome is often associated with depression, hallucinations, and memory loss. Sometimes it also occurs in schizophrenia.
The disease is named after the French psychiatrist Jules Cotard, who first described patients with this syndrome at the Parisian meeting of psychiatrists (Societe Medico-Psychologique) in 1880, and later, in 1891, published a book about them. He described conditions of varying severity, from moderate to extremely severe. Patients of moderate severity experience feelings of despair and self-loathing. But if the disorder takes on more complex forms, patients imagine changes taking place both within themselves and outside. Kotard believed that the denial of one's own existence occurs in the most serious cases.
Although people can suffer from Cotard syndrome at almost any age, the condition usually manifests itself by midlife. It is much more common in women than in men, although no satisfactory explanation has yet been found for this. Patients often have a completely normal childhood (as far as can be judged). The attacks come on suddenly, without prior mental disturbances. However, there is usually a period of initial anxiety before symptoms appear, which can last from several weeks to several years. Outwardly, this anxiety often manifests itself only in irritability.
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Denying the existence of different parts of the body, one patient stated the following:
I used to have a heart. Now something else beats in his place … I have no stomach and I never want to eat. When I eat, I taste the food, but after it has passed through the esophagus, I do not feel anything. It seems that the food is falling into the void.
According to Drs. M. D. Enoch and W. G. Tretowen, … [a patient with Cotard syndrome] may not even use the personal pronoun "I". One patient referred to herself as "Madame Zero," emphasizing her absence. Another … said about herself: “This is no use. Wrap it up and throw it in the trash."
Enoch and Tretowen mention that although patients with Cotard syndrome may become so desperate that they declare a desire not to exist,
… paradoxically, the probability of death seems impossible to them and leads to the development of ideas about immortality. This causes them the strongest despair - to thirst for death, but to be doomed to eternal existence in a state of nihilism, reminiscent of the lifetime hell of Kierkegaard {75}.
Enoch and Tretowen add that some patients with this disease are prone to self-injury.
Hallucinations that haunt patients may be gustatory or olfactory. In these cases, patients are convinced that they
… they rot, that their food has gone bad, they are offered [for food] dirt, feces or human flesh. This is another paradox, because, despite their belief in their own death or immortality, they try to destroy themselves.
Since 1880, psychiatrists have been deciding whether this disease can be classified as a syndrome. Some say that clinical observations do not support this, and attribute Cotard syndrome to a subtype of depression or delusions of a special kind.
The cause of the disease is seen in many things. Presumable causes include structural brain problems, toxic and metabolic pathologies. These include various diffuse brain diseases, atrophy of the basal ganglion (located at its base) and damage to the parietal lobe (middle and upper parts of the posterior part of the brain).
However, computed tomography shows that patients with Cotard syndrome do not have problems with the parietal lobe, but there is “multifocal atrophy of the brain and disease of the middle frontal lobe,” in which the grooves of the brain are expanded.
Japanese researchers argue that problems with beta-endorphins, which play a large role in pain perception, in the regulation of behavior and hormonal secretion, play a significant role in the onset of Cotar syndrome.
There is a detailed case study of a 27-year-old man who presented with Cotard syndrome as a result of typhoid fever {78}.
This syndrome is believed to be rare. In a study of scientists from Hong Kong, among 349 psychiatric patients, only 0.57% of patients with this disease were identified {79}.
In a study by the University of Cambridge of 100 cases of the disease, it turned out that almost all patients with this syndrome were diagnosed with psychotic depression. Interestingly, 86% of them had nihilistic ideas about their bodies, 69 - denied their own existence, and 55% considered themselves immortal. The condition of all patients was accompanied by a heightened sense of anxiety and guilt {80}.
However, one thing is clear for sure: Cotard syndrome is an extreme form of self-denial.
Neil's case
The story of 26-year-old Neil is a classic example of Cotard syndrome.
Neil's childhood, the only child in the family, was quite normal. When he turned twenty, his parents were killed in a plane crash in a small plane. Neal was deeply religious, and this tragedy shocked and embittered him. Blaming himself for the death of his parents, Neil became a recluse, cut off all relationships with people and connections with the outside world. He dropped out of university, began to use hard drugs and practically did not do anything, living off the inheritance from his wealthy parents. For some time, Neal was interested in spiritualism, and especially the topic of reincarnation.
In the end, the family doctor convinced Neil to seek psychiatric help. The young man was obsessed with the delirium of no body. Neal refused to admit that he had a head, torso, legs and arms - any body parts at all. He denied that he was eating, drinking, urinating, defecating, and could not explain why he was getting dressed if he went outside. At one of the stages of therapy, Neil was asked to drink a glass of water. After that, he was asked to explain where the water had gone. The young man replied that she had "evaporated." When the doctor demanded to explain these and other inconsistencies, Neal either did not answer, or simply said, "I don't know." Apparently, he did not notice any inconsistency or contradiction in his answers.
And why did I raise this topic then. Just recently, the first part of the sixth season of The Walking Dead - 8 episodes - was released. Another 8 episodes will be released from February this year.
In general, I like the series from the very beginning and the continuation is quite active and interesting. I understand that the topic is fantastic, but several points have already accumulated that could somehow be explained or thought out differently:
1. In the first seasons, it was explained that ghouls infect a healthy person with their saliva. Precisely explained that not even with blood (yes, the living are almost always from head to toe in the blood of a ghoul). And what for then you show how decayed skeletons without tissues at all bite? How will they infect that?
2. For some reason, more and more began to show almost naked rotten skeletons - but how do they move? Okay, their brain was preserved there by some miracle, but the muscles are gone for a long time. They would show normal zombie bodies as expected.
3. And hence the question: ok at the beginning of the disaster - there were many normal monsters. And now, after a lapse of more than one year, they all had to fucking decay and fall apart. They should not have the ability to move or infect. How did they acquire the ability to preserve their DEAD tissue? Time would have killed them all and the epidemic would have ended.
How do you like the serial?