Jules Cotard and the Syndrome Named After Him

Jules Cotard was the first psychiatrist to write about the cluster of symptoms that would come to be called “Walking Corpse Syndrome.” But his work was unfinished, and left a great deal of room for debate about it among his colleagues.

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Episode Transcript

Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class from how
Stuff Works dot com. Hello, and welcome to the podcast.
I'm Holly Frying and I'm Tracy B. Wilson, A Tracy.
We work on a podcast. We do. We also listen

(00:22):
to podcasts, sure do. And uh. One thing that's going
on this March is that podcasts in general are all
trying to get people interested in podcasting as a general thing.
So all this month we are asking you to tell
somebody that you love about a podcast you think they'll
love that doesn't have to be our podcast. Um, I

(00:45):
love my big podcast love right now is How to
Be Amazing with Michael ian Black. I have said it
amongst friends, I will say it here. I think he
has the best interviewer in any medium right now. Awesome,
He's amazing. And I'm sure that there is someone out
there that you know or love, like our your best friend,
or someone in your family that you think, oh, this

(01:06):
podcast would be perfect for them, something like how to
Be Amazing or some other podcast and recommend it. Uh
So go tell them about these things because everybody should
be listening to podcasts. It's a medium that has something
truly for everyone. And we want you to also share
with us in the world what you recommended to that
friend by posting on social media and using the hashtag

(01:28):
tripod which is t r y p o D. So
spread the word about some podcasts. Uh. It will only
make us all smarter and more interested in the world.
So thanks for that, and now we're gonna hop into
our topic for today, which is another question to Tracy. Tracy,
you have heard of Qatard's delusion or Guitard syndrome before, right,
and usually probably if you've seen it. It comes up

(01:48):
on frequently online on like lists of you know, world
strangest maladies or or you know, lists of of sort
of disturbing or un settling mental disorders. Because in those
lists it's usually just characterized as a patient believing themselves
to be deceased. It is sometimes called walking corpse syndrome

(02:09):
because of that, and while that can certainly be part
of it, it is a lot more complex than that,
so Catard syndrome is quite rare. It involves both a
negation delusion, so the individual feels a major change in
their body or they deny the existence of one or
several parts of their organs or bodies like they will
sometimes think that they no longer have this era, or

(02:30):
that their blood is gone, or some other variation on
that theme. And it also has a nehalistic delusion element,
so in that in that part of it, the individual
also believes that they are are all people are dead,
that they are somehow comporting themselves around the earth in
a state of non living nous. Uh. So it is
it's very complex. And additionally, the work of Jules Quatard

(02:53):
is much debated even today, and part of that is
because it was unfinished, which we're going to talk about.
So really, the story of this syndrome that's named for him,
in many ways is the story of psychiatry and how
ideas are challenged and then shift and change through interpretation
as well as accumulation of data through the passage of time.
So we're gonna talk about Jules Guitard his work in

(03:15):
this area, and then sort of how things played out
later on in terms of using his work to address
issues patients for having Jules Quatard was born on June one,
eight forty, in East Tudan in central France. As a
young man, he became a medical student in Paris, where

(03:36):
he studied under several prominent and trailblazing physicians of the day.
These included Pierre Paul Broca, who has a portion of
the frontal lobe in the brain named after him because
of his work studying that area and then also establishing
the concept of brain function being associated with specific areas.
There's also Alfred Vulpian who is credited with the dicovery

(04:00):
of adrenaline being made by the adrenal gland, and Jean
Martin Charkoal who's considered the father of modern neurology and
has more than a dozen medical conditions or discoveries named
for him and short as kind of an incredible time
to be studying medicine in Paris, it really was. There
was also a lot going on, of course in Vienna

(04:21):
and Germany at the time that Paris had some really
interesting neurological and psychiatric culture growing up around it, so
initially Qatard was on the same path as the neurologist
that he had been studying under. His first significant paper
was titled Physiological and Pathological Studies on Cerebral Softening, exploring
how inflammation and hemorrhaging damage his brain tissue, and then

(04:46):
his doctorate paper in eighteen sixty eight, was titled Study
on Partial Atrophy of the Brain. One event though, would
really significantly change the course of Cotard's career. He witnessed
the psychiatrist Charles Les Sig interviewing a patient and he
was enthralled. Based on watching this man at work, Uh

(05:06):
Coutard began to shift his focus away from neurology and
into psychiatry. The two men would eventually become colleagues, and
I feel like we should say that this was It
was not uncommon for people going into psychiatry at this
time to have started out in neurology. A lot of
people did. In eighteen seventy four, l Sega introduced Jews

(05:28):
Coutar to Jews Falcli, and the two jewels Is would
go on to become research partners, working side by side
in the Mazon de Sante that's the asylum at von
Zes in Paris, UH in the southwestern suburbs. And incidentally,
Fare's father actually owned that asylum. What Tired gave a
presentation to Paris's Medical Psychological Society on June eighty. He

(05:54):
read a case report he and fall I had assembled
titled of the Hypochondriact arium in a severe form of
anxious melancholy. In this case, the patient was a woman
who was forty three. She had a unique set of symptoms.
So this woman, who is referred to in the paper
as Madame X, thought that she was made of nothing

(06:14):
but skin and bone, and that she had no brain, nerves,
chest or entrols. Additionally, she had come to the conclusion
that God did not exist, nor did the devil, and
that she would live forever. She had made several attempts
on her own life and requested of her doctors and
others that she be burned alive. As Coutard presented, he

(06:36):
referenced similar cases that had been on the record going
as far back as twenty years. He specifically mentioned similar
cases handled by doctor Juel by Rs as some of
the oldest. These were considered part of a diagnosis of
general paralysis, and in this context the paralysis referred to
as a failure of the brain characterized by a loss

(06:57):
of inhibitions and the exhibition of delusional thinking. So not
a lack of physical movement or an inability to move
your body right. When we think of paralysis, that's usually
what comes to mind, but that's not the application of
the word here. So yeah, this these similar um cases
that had been studied two decades earlier had kind of
gotten lumped in as general paralysis, but Qatard felt like

(07:20):
there was something a little more specific about them, and
he thought that what his patient was exhibiting was actually
a form of what was at the time called lipomania
or lipomania, and that term eventually was supplanted by melancholy. Basically,
he thought he had identified a specific form of melancholia,
and this was, in his opinion, and anxious melancholia, with

(07:42):
delusions that could include religious misbeliefs of damnation or demon possession,
the perception that some or all of the body had
ceased to exist, inability to perceive physical pain, immortality delusions,
and suicidal behavior. Jules Cotard also drew possible connections and

(08:02):
this presentation from the symptoms he had observed in the
patient two similar historical events, including various cases of reported
demon obsession. He suggested that the idea of the wandering
Jew legend, which was a man who had taunted Christ
on the cross and then was doomed to wander earth
until the world ended, He thought that may have had

(08:24):
roots in the observation of a person with a similarly
delusional state. Yeah, he was kind of making this case
that it could be that that whole legend grew out
of someone speaking with a person who actually had this
delusion that he was trying to identify. And Guitar continued
to develop his research on this topic. In two he

(08:46):
expanded on it by introducing the term deligions and that's
neolistic delusions in an article that he published in the
Archives den Patients with such delusions, he said, had a
tendency to deny everything, leading in extreme cases to denial
of the self. He separated the delusions of negation clinically

(09:08):
from delusions of persecution. In that article, he characterized persecution
delusions as exhibiting mistrust, paranoia of poisoning, delusions of grandeur,
and acoustic verbal hallucinations that would sometimes be homicidal. In contrast,
he listed anxious monologue, deep melancholic depression, refusal to eat,

(09:30):
visual hallucinations, and suicidal behavior as characteristics of the delusion
of negation. Four years after Qatar's initial presentation on the
symptoms of madam X, he wrote about another patient, this
one an adult man who said that he could no
longer see his children's features. In eighty four, Qatar, still

(09:52):
trying to build up a unified theory of what he
believed to be related symptoms, came to the conclusion that
this was a loss of mental vision, and that this
was actually the root of the problem. When patients exhibited
nehalistic delusions, the mind, in his estimation, was simply unable
to process visual representation of objects. He would later refine

(10:13):
this concept by describing the problem as a loss of
quote psychomotor energy, causing the patient to lose visual representation
and to experience psychomotor impairment. It's entirely likely that Cotard
would have continued to refine his work on the topic
had he not met an untimely end. In eighteen eighty nine,

(10:33):
at just forty nine years old, he contracted He contracted diphtheria,
which he caught from his daughter. He never recovered, and
he died on our August nineteen of that year. At
his funeral, his partner for I spoke calling him quote
a profound and original thinker, given to paradox but guided
by a robust sense of reality. And next up, we're

(10:55):
gonna talk about what the rest of Paris's psychiatric community
did with Qatard's work after his death. But first we're
going to pause and have a word from one of
our sponsors. Almost immediately after Jules Quatard's death, debate began
about his work and where he had been headed with

(11:17):
it and what his intentions actually were. One of the
ongoing themes of Qatard's work was this struggle to develop
terminology for psychiatric ailments, and he had also championed this
idea of using symptomatic classification for psychiatry. So, of course,
with his work in this state of arrested development, I
mean he had been writing updates to his ideas just

(11:38):
days before his death, there was a lot of room
for interpretation. While some of his contemporaries thought he had
been cataloging an entirely new disease, others thought his work
had always been focused on exploring a severe and specific
form of melancholia. Others thought that he merely sought to

(11:59):
catalog and described a symptom cluster that could be found
in other diseases in addition to melancholia. In August of
eight two, the issue was hotly debated at the Mental
Medicine Congress in Bois France, Coutard's partner Falclay, advocated for
the idea that his friend had identified a new disease,

(12:20):
and to argue his case, he claimed that there was
an essential form of Qutard's delio de negusion which stood
on its own and also in a secondary form of
it that could be part of other melancholia and even
non melancolia disorders. Others and attendants argued that the specific
cluster that Fare was advocating as part of Coltard's newly

(12:42):
identified disorder included elements that were so rare, specifically those
relating to religion based concepts of demonic possession, damnation, and
eternal life, but there was no validity to calling it
its own singular syndrome. To support this view, was pointed
out the verse really, all patients with melancholia had a

(13:02):
tendency toward negation and guilt, so the cases in Cotard's
writings were just extreme examples of this. Additional arguments against
this being a standalone disorder or disease identification included claims
that Qatard was merely listing a random assortment of symptoms
that could be found in any number of mental disorders,

(13:24):
so grouping them together was essentially meaningless aside from anyone's
specific patient having them. Cases were also brought into the
discussion to illustrate the rather common occurrence of nehalistic delusions
in cases of chronic melancholia. While the Mental Health Congress
came to no clear conclusion as to whether Cotard's work
was describing a specific syndrome or common elements of multiple

(13:49):
mental disorders, there was some agreement on how to define
realistic delusion syndrome, and that was that it included two
specific elements, anxious melancholia and systematized ideas of negation. So
as an assign to clarify what that means, uh systematized
delusion indicates that a patient has developed a consistent, complex

(14:12):
system of beliefs associated with their condition, which often fit
together perfectly in a really elaborate narrative. So, for example,
if you think that you died in an accident where
you did not die, all of the strange things that
may happen to you you will put together into a
puzzle to support that conclusion, like I'm clearly dead. That
is why that person never calls me back. It's because

(14:34):
I'm dead and they're not getting my call. That's a
very simplified and and basic way, and I'm sure any
doctor would be like hallad no. But that's just to
kind of give you an idea of what this systematized
aspect of it means. One year after that Congress and
four years after Cotard's death, the term Cotard syndrome was

(14:55):
first introduced. That was a by Emil Resis name the
depressive disorder that Coutard had studied and described that then
became cemented in the lexicon through its use by another
of Coutard's contemporaries, who was psychiatrist Jules Sigla. Although there
were some differences in how Sigla and Coutard viewed this condition.

(15:20):
While many believed that Cotard's work had led him to
the conclusion that neilistic delusion was a separate and unique condition,
Segla felt that it was an expression of an extreme
state of anxious melancholia. So the case in which Sigla
first used the term Qatar's syndrome to describe a patient

(15:41):
featured a man who, much like Coutard's patient, Madam X,
believed himself to be immortal, damned, and without his internal Organs,
and despite his different view of whether the syndrome was
a unique disorder or a way to identify extreme cases,
Sigla's diagnosis of a patient as having Gutarge syndrome really

(16:01):
popularized the terms usage. With the dawn of the twentieth
century came many changes in the way mental health was
discussed and treated, and Coutard's work had to be examined
in new ways as a consequence. So first you probably
noted that leading up to this point we exclusively used
the term melancholia. That's because depression and manic depressive illness

(16:24):
as diagnostic terms didn't exist until the twentieth century, and
those have continued to be refined. Now people generally say
bipolar disorder and not manic depressive illness. Once they were introduced, though,
these terms really impacted a lot of disorders and illnesses,
including Coutard syndrome. So in the early nineteen hundreds, Cotard

(16:45):
syndrome was invoked as a symptomatic analysis of patients who
were being treated for general paralysis and senile dementia, as
it had been towards the end of the nineteenth century
been used in both of those, but now it was
also associated with the newer terms depression and at that
point manic depressive illness. And so this wider range of

(17:06):
use also came with the development of a subdivision of
the syndrome by some doctors into two types, the melancholic
type of Catard syndrome and the hypochondriacal type of Catard syndrome.
The melancholic type was considered secondary and a patient with
effective disorder. It's a mood disorder such as depression by
polar disorder or anxiety disorder, characterized by nihilistic delusions and

(17:30):
the patient's subjectivity. The hypochondriacal type was considered a primary
manifestation of the syndrome, where the patient's symptoms were focused
around incorrect and paranoid feelings about that body, like that
it was missing viscera or that it was no longer alive.
And again we should make clear that this was not

(17:51):
a universally accepted approach to to dividing this UH. In
nineteen oh four, Leonardo Bianchi and James hog McDonald wrote
a tech Book of Psychiatry for physicians and students, and
in it they wrote, quote Qatard and others have assigned
undue importance to the delirium of negation, attributing to its
certain clinical characters, many of which, as a matter of fact,

(18:14):
are common to the majority of cases of depressive delirium,
such as self accusation and hypochondria, of which it represents
a more advanced stage of evolution. It was just as
a decade earlier, a time when some of the medical
mental health community believed that Qatard had wrongly associated a
series of fairly common symptoms into one unique cluster. Another

(18:36):
idea developed during this period was a way to identify
analyistic delusions as true Guitard syndrome. This particular approach required
that a patient exhibit a combination of an effective or
mood component like anxiety, and an intellectual component, which is
the idea of negation. This approach meant that these delusions

(19:00):
could be recognized and acknowledged in a variety of scenarios
without the identification of Qatard syndrome, And to make things
even more nebulous, some positions also suggested breaking down the
syndrome into complete and incomplete versions based on variations in
the patient's symptoms. This is one of those things where

(19:20):
the more I read, the more I was like how
do any doctors or clinicians ever agree on anything, because
because it is so hotly debated, and I know this
isn't just unique to Catard syndrome. Yet others suggested that
Catard syndrome is really a result of institutionalization, and in fact,
that first patient that Qatard described back in eighty was

(19:43):
a woman who had been confined at the Van Vis
Asylum for a number of years. So to wrap things up,
we're going to talk a bit about the discussion and
handling of Quatard syndrome after World War Two. But first
we're gonna take one last quick break for a word
from a sponsor. During World War two, Paris was of

(20:07):
course occupied by the Nazis, and so work on psychiatry
they're certainly slowed. But after the war, Catard's work was
once again examined, and in some ways history repeated itself,
as various clinicians offered their interpretations based on their work
with patients that had similar or related symptoms. In the
book Uncommon Psychiatric Syndromes, writers Morgan Enoch and William Trethowen wrote,

(20:32):
it is quote justifiable to regard Cotard's syndrome as a
specific clinical entity, because it may exist in a pure
and complete form even when symptomatic of another mental illness.
Analyistic delusions dominate the clinical picture and today, of course,
classification of mental disorders continues to be debated, and in

(20:54):
the eighties many of the concepts that were being introduced
were in their infancy, so things were constantly in flux.
There was ongoing debate about what various disorders should be called,
and even how to arrange the known disorders into a
larger classification system. Because the very juvenile stage of many
of the concepts that Gatard was writing about, and the

(21:14):
fact that he was writing in French, there have been
additional debates through the years about the interpretations of his
work and how translation has affected it. For example, in
a paper written in by G. E. Barrios and R. Luke,
there is some discussion about the use of the French
word dellier, which has more complex and nuanced meaning than

(21:36):
it's usual translation to delirium or delusion. The two writers
of that paper explain that the word is more inclusive
than that and can be used to describe a syndrome
with lots of different symptoms, not just delusions, and this
syndrome now has three distinct developmental stages recognized within it
UH In the work of some doctors, the German Nation

(21:58):
stage is characterized by depression and often a fear or
worry about illness. And in the second stage, called the
Blooming stage, patients exhibit anxiety and negativism and the delusions
of death and immortality appear. This is what most people
are describing if you ever read like a very quick
blurb about what Gutard's is UH, and then the third
chronic stage of Quatard syndrome manifests in severe depression. Gutard's

(22:23):
syndrome is not listed in the Diagnostic and Statistical Manual
of Mental Disorders or in the International Classification of Diseases
as an independent disorder. Instead, it is listed as a
nihilistic delusion, which is an effective delusion within an oppressive
episode with psychotic features and Guitards. Syndrome can be treated

(22:45):
with antidepressants, antipsychotics, and mood stabilizers, either by themselves or
in some combination, depending on the tests that have been
run and what the doctor and and patient determined to
be the best course of action. Sometimes UH these still
controversial electro convulsive therapy is also used. That is very
different than it used to be. F y. I. Uh.

(23:06):
The greatest risks in terms of the syndrome today when
speaking about potential mortality are starvation and patients that refuse
to eat or suicide. So patients undergoing treatment do you
have to be watched very carefully. But there is treatment
and there are many cases of people who come out
of this and uh treat it and no longer have it.
So that's guitar syndrome, which fascinates me. Yeah. Do you

(23:30):
also have some listener mail? I do, and it's not
about psychiatric weirdness at all. Um. This is from our
listener whose name is genevra I. Hope I am pronouncing
that correctly. She says, Hi, guys, I love your show.
I'm an illustrator and love listening to it when I'm working.
I made a hardcore Heroines of History Cards series last year,

(23:51):
and a few of the women I had heard of
because of your show and the others I found through research.
I recently saw that you did an episode on Edmonia Lewis,
and I was so excited since I found her last
year and was blown away by what she accomplished in
her lifetime. Also, here is the archaeology badger that came
to mind from the Unearthed episode. I laughed so hard
and loved your tagline. At any rate, here's a pack

(24:12):
of cards for fun. I've included my artist animal pun
series since I know cats and are are also a
love of uh one of yours. Thanks for being superstellar, Geneva.
And she also writes, PS, this is my first fan
mail I've ever sent. Of course, a history podcast moved
me to embarrass myself. I love it and I love
the shows. These are the cutest things. So now I

(24:34):
will describe these adorable cards which she has sent, and
I'll have to take pictures and share them. So one
is a hardcore history of heroines, no hardcore heroines of
history that you've probably never heard of. And basically she
has incorporated animals into these portraits. So for example, there
is um Caroline Herschel that we did an episode on
as a bird, and she's lovely. Uh sojourn her truth

(24:59):
uh is I think that is a ferret, but I'm
not a certain. They're all very, very adorable and this
new pack, which includes artists, has some of the best
things ever including Marcel du Chimp, Mark Chagal, Leonardo duck Vinci,
and Beatrix Otter. UH have to take picture of the
pictures of these and share them because they are so cute.

(25:20):
So thank you, thank you, thank you. Shanever, these are
just the most darling things I have maybe ever seen.
I love them. UH. If you would like to write
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(25:42):
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(26:04):
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