Cotard's syndrome: Living without the brain

Psychiatrists call Cotard's syndrome a delusion of grandeur turned inside out. The disease is a mania of self-denigration. Patients state that they are dead, decayed and are walking dead, or that they are criminals and murderers. Recently an interview was published with a person suffering from Cotard's syndrome who considered himself dead for ten years.

In scientific terms, Cotard's syndrome or delusion is defined as a nihilistic, hypochondriac depressive delusion, combined with the ideas of vastness. Patients believe that they turned into walking dead, great criminals and other "dark lords." Those suffering from Cotard's syndrome are characterized by denigrating themselves to the point of absurdity, and the size comparable with delusions of grandeur. For example, a person may claim that they poisoned the entire world with their poisonous breath or infected the entire world population with AIDS. Often, patients think that they are dead, and their existence is an illusion and that they are an empty shell.

Cotard's syndrome is also called "delusional denial." This was the name used by a French neurologist Cotard in 1880.  

Patients may argue that they have no brain, heart or lungs. It also happens that "delusional denial" applies to the intellectual and moral qualities. Patients complain about the complete lack of intelligence, conscience and knowledge. Sometimes patients deny the existence of the external world; complain that the earth is empty, that living people have no souls and just empty shells, etc. Despite the fact that these symptoms taken separately may appear to some as witty observations of the reality, people with Cotard's syndrome experience real suffering.
 
It is not easy to feel like a walking dead for years. It is assumed that this mental illness is an extreme form of depression. Cotard's syndrome occurs as a side effect of schizoaffective disorders and may accompany senile dementia and other brain malfunctions.

It is not known how common this condition is. Modern drugs successfully treat depression, and experts suspect that this state is exceedingly rare today. However, patients who feel that they are dead exist to this day. Because of the pathological belief that they are dead, the patients may attempt suicide to get rid of the "useless shell" - their body. They die of starvation, assuming that they no longer need to eat, or pour acid on themselves to stop being a "walking dead".

Recently, New Scientist magazine published a unique story of a man who considered himself dead for a decade. This case is surprising because the patient's delusions of "dead brain" turned out to be true to some extent.

Ten years ago, Graham woke up and felt dead. For a long time before that Graham had suffered from a severe depression. He even tried to commit suicide by throwing an electric appliance into a bath filled with water. That morning, Graham realized that during a suicide attempt he killed his brain. He reported that he felt that he simply did not have brain any longer. When hospitalized, he assured doctors that pills would not help because he had no brain as he burned it in the bathtub.

The doctors' reasoning had little effect on Graham. They could not convince him that if he could speak, breathe, eat and move his body was alive and his brain actually worked. He said he was just annoyed with the doctors' words because he did not know how he could say or do something without a brain. 

Graham did show some signs of brain damage. For example, he assured that he has lost his sense of smell. However, theoretically it could have been another component of his depressive delusions. The man lost interest in the activities he previously enjoyed. He did not want to see people as it made no sense to him. He did not enjoy anything. He used to love his car but then lost any interest in it. Even his bad habits lost their appeal, for example, Graham quit smoking. He no longer felt the taste of cigarettes or found this activity pleasant.

Doctors at the local hospital did not know what to do and sent Graham directly to two world-famous neurologists, Adam Zeman of the University of Exeter (UK), and Stephen Laureys from the University of Liege (Belgium). The scientists were astonished to find out through positron emission tomography (PET) that in some way Graham was right. Metabolic activity in significant parts of the frontal and parietal regions of his brain was abnormally low, in fact, so low that it looked like a snapshot of a person in a vegetative state.

"I have been administering PET for 15 years and have never met a person who would be on his feet, able to communicate, but had this anomaly," Laureys confessed.

In a sense, part of Graham's brain was indeed nearly dead, the scientist added: "His brain worked as if he was under anesthesia or sleeping. As far as I know, this is quite a unique phenomenon for the brain of a person who is awake."

His colleague Zeman who also worked with Graham believes that the reduced metabolism caused pathological changes in the patient's perception of the world. Interestingly, the patient's delirium in some way proved to be prophetic. "We still do not know very much about the mind," Laureys said.

First the news of the results of the scan did not have any effect on Graham. He still felt dead, and considered any treatment of his "empty shell" a misery bordering on torture. He had to make peace with the fact that he would not be able to die for real 

The man used to go to the cemetery, and the police would bring him back every time. According to Graham, he belonged with the dead. By that time his teeth were black because he refused to brush them. For some reason, he lost all the hair on his legs, and the doctors were not able to explain why.

Gradually, however, Graham's condition improved. After the brain scan he was prescribed an appropriate treatment based on medication and psychotherapy. Before his brothers and a nurse had to look after him, but now he is able to live independently and cope with household chores on his own. 

"I cannot say that I completely returned to normal, but now I feel much better," he said. "I can run errands and leave the house."

Graham added that he no longer believed that his brain was dead, but sometimes the world around him seemed strange. He is not afraid of death but feels lucky that he is still alive.
 
Yana Filimonova   

Pravda.Ru 

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