October 20, 2016 • 42 mins
Consider Cotard’s Delusion, also known as Cotard’s Syndrome, that rare mental illness in which the patient comes to believe themselves a corpse. In this episode of Stuff to Blow Your Mind, Robert and Joe investigate tales of the deathly deluded.
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Speaker 1 (00:03):
Welcome to Stuff to Blow your Mind from housetop work
dot com. What seems to be the problem. Well, so
(00:25):
the thing is, dr I am dead? Mm hmm, you're dead?
Well can you explain I'm I'm dead. My organs have
stopped working, They've ceased to function, my heart, my intestines,
my brain. That you're speaking to me right now, well,
(00:45):
I agree, I don't know how to explain that. I
guess I should be quiet, but I need to be
put in a grave. I'm registering a heartbeat, a pulse.
You're certainly breathing now. I think you're just getting the
sound of air moving through the empty skin, empty, I guess,
except for the bones. Everything else feels like it's gone.
(01:06):
It's rotten, melted away. Well, if this were the case,
you wouldn't be able to think, or reason or or
even travel to my office and tell me these things.
Something isn't letting me die. Something not God, I mean,
not not God, but something. Anyway, doctor, I need you
(01:28):
to destroy my body, if that's possible. Hey, welcome to
stuff to blow your mind. My name is Robert Lamb
and my name is Joe McCormick. And that is an
(01:49):
odd scenario that most doctors probably would never find themselves in.
But it is actually not not just a fictional contrivance.
There have been scenarios where a doctor has had someone
show up at their office claiming not that they're dying,
but that they are dead. Yes, yeah, and it would
I mean, it would be comedic if the examples of it,
(02:12):
the actual case studies, weren't so depressing and heartbreaking. And
then the condition itself we're not so real. Yeah. Um,
so this is going to be the subject of today's episode.
What it looks, What it's like to experience being dead
while still being alive. Yes, it is sometimes referred to
(02:32):
as Quatard's syndrome, also Qutard's delusion, and I think delusion
is more accurate based on the commentaries we've been reading
the idea that this is not a a specific affliction
so much as kind of an array of symptoms that
emerges from a few different conditions that can occur neurologically.
(02:53):
So let's go back into history where do we first
see this emerging? That the concept of someone who presents
to a doctor claiming to be dead yet from the
outside there obviously alive. Well, it's an interesting question, and
and some of the individuals who have tackled it have
certainly pointed to examples in myth and legend and saying, well,
this could possibly explain these scenarios. Um. However, it seems
(03:18):
to be that the earliest case of Qatar's delusion, even
though it was not known as Guitar's delusion yet, possibly
goes back to seventy sev UM. And this is when
Geneva naturalist and philosophical writer Charles Bonnet encountered what might
be the early example, earliest example the condition. Uh. And
(03:39):
this was a seventy year old, otherwise healthy woman who
upon experiencing something like a stroke. And this was after
a draft of air hit hit her in the neck,
according to the the studies. I read the same thing
there and she reported a draft of air hit her
in the neck and then she felt like a paralysis
across half her body and uh. And then she was
(04:01):
silent as a corpse for four days. And then when
she opened her mouth finally she demanded burial. That is
a strange thing to demand. Yeah. Yeah, Like I said,
it would be comedic if it weren't so serious. Um.
But yeah, so she seemed to be under the real
persistent idea that she was no longer alive even while
(04:21):
she was alive to tell people this. Yeah, yeah, she so,
she she apparently, it's just very insistent of it, Like
it was very much like a delusion, like something again
that the individual that's believing it is it in completely
invested in it, completely convinced of its of this reality,
no matter how ridiculous it might seem to anyone on
(04:41):
the outside. It's like she became agitated, and she was
scolding her friends for for not for not doing it.
She she asked, she said, I'm not alive anymore. I
need to be buried. Um, you know. They they ended
up calling a doctor, and eventually everybody thought it was
necessary to dress her like a co warps and layer
layer out to calm her down, and they actually had
(05:05):
a sort of funeral for her, like they essentially had
to indulge in her delusion a bit just to to
calm her down, and and she eventually fell asleep and
was undressed and put to bed. But but yeah, how
do you even treat something like this? Certainly well, uh,
Bennet arrived on the scene and he treated her with quote,
(05:27):
a powder of precious stones mixed with opium. And I
guess it worked because he reported that she emerged from
her death delusion. But while she she gave up the
notion that she was dead. She then became became convinced
that she was in Norway with her daughter while she
was actually in Copenhagen the whole time, and insisted that
she needed to return to Copenhagen from Norway. Um And
(05:50):
during this time she was otherwise normal, but she could
not sweep without the opium, So sadly, she ended up
suffering the same condition every three months thereafter. So mean
a reprisal of the idea that she had already died, right,
the idea that she she had died would return, she'd
have to be talked out of it, and then she
would register surprise when she finally learned that she was
(06:12):
in fact alive. Now, I wonder what it's like, um, Like,
what what is the behavior of a person who truly
believes themselves to be dead? Like? What does that entail
for how they act? Well? It seems to vary from
case to case as we look at it, I mean
a lot of it seems to boil down to just
(06:33):
an essential breakdown in conception of self and identity. Instead
of like the like, we all walk around through our
lives with a de facto statement, I am alive. And
you know, maybe being alive is fantastic, maybe it's not,
but we at least begin the sentence with I am alive.
It's sort of an axiom. Yeah, like you, you don't
(06:54):
need to debate this point. But for them, the accident
axiom is vacant. It's it's absent, and in its place
I am dead. I'm clearly not alive. I must be dead,
and then therefore x sometimes that excess clearly I must
be buried, or my body must be destroyed. Or in
some cases it's uh, I'm not alive and yet I exist.
(07:15):
Perhaps I have entered some deathless state, perhaps some afterlife,
some afterlife, etcetera. So it kind of varies depending on
what's going. The underlying conditions that are causing these symptoms
come into play as well, is presumably the the exact,
you know, worldview of the individual afflicted. Yeah. Another thing
that I've read about in many of the cases here
(07:37):
is a sort of denial of life sustaining activities like
the person seems to in many cases lose interest in
eating and going about their business as one normally would
and doing any of the things that would constitute a
life going on. Yeah, sleeping, it's etcetera. Um. Authors Hands
(07:57):
Forstal and Barbara Beats wrote about the the Benet case
for the British Journal of Psychiatry, and they theorized that
the idea of imminent death played a role in this too. Uh,
the the idea of imminent death during the old woman's
stroke overpowered her thoughts at least, and so she regained
full consciousness. Um So, so like while she was having
(08:21):
a stroke, she had the idea that she was dying,
and then in some sort of liminal state following the stroke,
she had not yet overcome the conclusion of that assumption. Yeah,
I mean, because like if the last, if the last
experience you have with like a full consciousness and a
full conception of self is that of oh crap, I'm
(08:43):
about to die. Oh crap, something horrible is happening to
my body. And then when the then then the next
phase you exist in is this altered phase in which
some of your normal neural processes are adjusted. That maybe
the explanation you've all back on that at least is
one one theory. Here's a quote from what they had
(09:05):
to say. The most exceptional and strange ideas can gain
such acceptance if the mind is suddenly thrown from its
ordinary reasoning and forced into a new main idea. A
sudden physical disorder in the brain or a sudden violent
excitement can cause such a change there that we are
pushed beyond insight into its unreasonable nature, because we assume
(09:26):
to notice a correct functioning of our imagination, even in delusion,
which I love that because it I think one of
the things that's fascinating about delusions such as this with
other neurological conditions is that it not It not only
illustrates what is possible in terms of human perception of reality,
but also how ultimately ephemeral the quote unquote normal perception
(09:50):
of reality actually is. Well. Yeah, and it also I
think underlies our our inherent predisposition for a completely a
rational thinking um like Obviously, I don't mean this as
an indictment of people suffering from Catard's delusion. I'm not.
I'm not trying to impugne their rationality, but this seems
(10:11):
to be a thing that's it's latent in the human brain. Uh,
the ability to hold thoughts that are impossible, because in
a strange way, this this is perhaps the most delusional
possible thought, like from a Cartesian point of view. And
what I mean by that is, you know, so Renee
Decartes was trying to come up with an axiom that
(10:33):
he could start his deductive philosophy with, right, um, And
so he could start with like, well, I observe that
I'm in a room. But then you can't actually start
with observations, according to him, because there's no way you
can be certain you're not hallucinating every aspect of your surroundings.
But Decarter eventually said, you know what, I can start
with cogito ergo some I think, therefore I exist, because
(10:58):
I mean, it's pretty much that is true by definition,
it cannot be false. So this syndrome is kind of
some form of the denial of the Cartesian axiom. It's
denying the thing that could not by definition be false.
I think, but I do not exist. Yeah, in this
it would be the ultimate denial, the ultimate nihilism, right yeah.
(11:21):
And indeed this is uh, this is some of the
thinking that the namesake of French neurologist Jewels Qatard had
as well. So again this is this is where we
get the name. Obviously. Uh, the year was eighteen eighty,
so it's about a hundred years after the original KI. Yeah,
and it wasn't ye until later people piece that together. Um.
(11:43):
He received a most curious patient, okay, a forty three
year old woman who believed she had no brain, nerves, chest,
or entrails. She believed she was merely skin and bones
and it quote neither God nor the devil existed, and
that she no longer required food as she was quote
eternal and would live forever. So she requested to be
(12:04):
burned alive and attempted suicide several times thereafter, and then
eventually died of starvation. So this is a pretty pretty
severe and grim case. Well, so what did Quatard make
of this? Well, he initially saw it as an extreme
form of hypochondriasis, you know, hypochondriacts, and he he thought
that this is a this would occur during a severe
(12:26):
psychotic depression. And in many cases this delusion has been
linked strongly to depression, not not in every case, because
there are a lot of different scenarios that seem to
produce similar effects and delusions, but we do see that
as a recurring factor along with like near death or
some traumatic experience. But it has been often linked to
(12:46):
severe types of depression. And he He indeed is a
one that mentioned that tales of the wandering Jew might
be related to bits of myth that extend from such abouts.
So so he's thinking that cultural ideas like not not
just the hardware of the brain malfunctioning, but that software
running on the brain, you know, received ideas or informing
(13:08):
this syndrome or sorry, you shouldn't say syndrome the delusion. Well,
or at least that like these ideas of saying that
they're being an immortal, depressed wanderer out there in the
world might have some ties to this condition, that this
might be the nugget of truth behind such a concept, right,
if you're not familiar, the concept of the wandering Jew
is the idea that, of course uh in in the
(13:30):
New Testament, the Christ predicts that he will return to
Earth before everyone standing before him has passed away. Obviously
a lot of time has passed, and so one solution
to this textual problem is that people assumed that at
least one person standing there listening to Jesus was actually
essentially immortal and had continued to wander the earth since then. Yeah,
(13:51):
essentially cursed because some tellings the wandering Jew laughed at
Christ on the cross. Oh, I don't think i'd heard that.
That's that's the version I ran across recently. So it's
kind of like Highlander, except more anti Semitic. So Inquitard's
later writings on the condition, he he described it as
(14:11):
a nihilistic delusion, a negation of everything, God, food, life
itself quote, a marked tendency to deny everything. Well, then
in this case, it would seem that the way that
we originally characterized it as the belief that one is
dead is actually not the not the overarching nature of this,
but it's sort of like one expression of it. Ultimately,
(14:33):
as Qutard conceived it, it's just a denial of everything,
and the denial of one's own continuing life is one
facet of that. Right. Yeah, if if this absolute denial
enters your consciousness, then even if it's an altered consciousness,
then how do you make sense of it? Um? So
I assume he didn't name this this delusion after himself. No, No,
(14:54):
that wasn't until three uh Emil Regius coined the term
Qatard's syndrome, and it was made famous by Jules Sieglass,
who himself thought that it was all a severe anxious
melancholia rather than a distinct clinical condition. Now, of course,
if it were just two cases, that wouldn't be much
(15:15):
to go on. But of course there have been other
cases of Cotard's delusion, which we'll get to right after
this break. All right, we're back, alright, So, uh, there
have been more than just these two historical cases we
talked about. But it also is not an extremely common condition. Yeah,
(15:37):
it's exceedingly rare um and perhaps even more so in
the modern age, since swift treatment of the underlying psychotic
disorder uh typically occurs. And most studies related to Qatar's
delusion are, of course about a single patient. This is
not the kind of thing where a doctor is going
to encounter multiple Qatard's delusion patients, say with him, you know,
(15:59):
within the core of an entire lifetime, right Like here,
here's this one clinical encounter, Not like I recruited a
group of a hundred people suffering from Qatard's delusion, right, Yeah,
it's that this is, you know, one of those conditions.
It's super rare, probably, but it gets more attention because
it is so alarming. Um. In fact, some of you,
I know we have some Hannibal fans out there. There
(16:20):
was actually an episode of Hannibal where we had the
the sort of killer or character of the week with
somebody with quitards syndrome. Um. But I don't have a
clear enough memory of the episode two to do any
kind of critiquing of it of how they presented it. Well, so,
now that we've seen more cases showing up throughout history,
what are the most common symptoms, Like, how does this
(16:44):
delusion present itself most frequently? Claims of being dead obviously,
of organs missing or having rotten or melted away. Claims
of a missing brain. Oh yeah, I saw that one
with the guy who said I don't have a brain.
I don't know how to explain this, but I just
don't have one. Claims of course of being I didn't
see any encounter where someone actually said hey, I'm a
(17:06):
zombie or I am a litch or something. But that
is they basically explained undeadness. Yeah, they basically are like
I'm not alive, I'm dead. But I'm also in some
sort of protected state, as if in some cases it's
there are a few cases will look at where that
where the individual is saying like, God won't let me die.
But then other times they're just they're just totally negating
(17:28):
God or the devil as well. So, yeah, there's this
sense of what, you know, what what a a Dungeons
and dragons um A fan might term litch um, the
idea that you're not dead, you're not alive, but somehow
death is given you a either a cursed or elevated status. Well,
let's look at some more modern examples of what this
(17:50):
actually looks like in people who present with it. Okay, well,
one interesting case, and we're not going to touch on
all of them, because even though it is rare, there
have been multiple cases. Some of them just aren't particularly
noteworthy or or provide much illumination for our purposes here.
But in two thousand four, there was a case of
an individual by the name of Graham Harrison, and he
(18:10):
attempted suicide by empty entering a bathtub with an electrical appliance.
And the next thing he knew is he awoke in
the hospital and he thought he was dead. So in
this we see we definitely see elements of the traumatic
like occurrence, the near death event, and then waking up
with this condition. And he was indeed diagnosed with Guitard's delusion.
(18:34):
But most interestingly, given the time in which this took
place in the hostile environment, it allowed doctors an unprecedented
uh PET scan peek into the brain of the deathly
deluded here. Oh, so they could get some imaging results
see how the brain of a person experiencing this delusion
looks compared to someone who's not. Yeah, at least in
this particular patient. Yeah, And they found that his brain
(18:55):
wave patterns were were vegetative despite his being awake, so
he had very low metabolic activity across large areas of
the frontal and parietal brain regions. Some of his this
expanse related to the default mode network, which we've covered before.
This is the you know, the constant chatter in your
your head that's uh, you know, questions about the and
(19:17):
worries about the past in future, that sort of thing.
But also the regions afflicted here uh were involved in
formulating theory of mind. Now, one of the researchers who
worked on this case, who was interviewed in an article
and New Scientists about it. Stephen Lori's of the University
of Louisian, Belgium said that the pet scan results were
essentially what you'd expect to see in someone who is
(19:40):
asleep or under general anesthesia. Like you know, so you
mentioned the low metabolism. It was as if the brain
had sort of been shut down. And however, the researchers
also cautioned that this scan could be affected by the
antidepressants he was taking, So you know, we shouldn't draw
too many conclusions from one case, right, but apparently something
(20:01):
had happened to his sense of self. Yes, inde, that's
what's really interesting here, and that's that's what we're going
to see reflected in some of the other cases. We're
gonna look at this idea that that the brain's ability
to conceive self, uh, and and and and indeed to
conceive the identity of others is what is afflicted here. Um. Now, Luckily,
(20:21):
in the case of Harrison here, thanks to psychotherapy and
drug treatment, he was eventually able to overcome these symptoms
and return to something of a normal life. And there's
actually an interview with him in New scientists from a
few years back. You can find it Mindscapes First Interview
with a dead Man. Yeah, and I was just gonna
say that it's an interesting read worth checking out. Now.
(20:45):
In some of these papers, I found reference to an
individual who wanted to erase their body with acid, but
I wasn't able to track down a particular study on
that one. But there were some other interesting cases that
came up, But one of which was a two thousand
five I ran i in case covered in the article.
This is a telling title covered in the study coexistence
(21:08):
of lacanthropy and Qtard syndrome in a single case. Wait, lacanthropy,
that's werewolf syndrome andn't indeed, Yeah, something you don't really
expect to pop up in a in a serious psychological paper. Now,
in the clinical definition, I think like canthropy is what
the belief that one has been transformed into an animal
or behaviors indicating such a belief, right, Yeah, so we're
(21:29):
not talking about actual transformation into a wolf for a
dog or what have you. Uh. This individual is a
thirty two thirty two year old man who arrived at
the hospital and complained a that he was dead and
be that he had turned into a dog both yea,
and that the same was true of his wife and daughters.
Well that I think. He claimed that his wife had
been turned into a dog and that his daughters had
(21:51):
been turned into sheep. That's right, So his delusion of
zoological transformation extended to his family, but not necessary really
the same animal. Now. I claimed that his relatives had
tried to poison him as well. Yeah, I think by
putting cyanide in his tea. Well, that's one tactic to employ.
(22:11):
And he also claimed that God protected him even in
this undead form, which which is interesting. It ties back
into this this theme we see again and again that
they're they're dead, but somehow undying. So what did the
study conclude about this patient? Well, here's the here's the quote.
A patient meeting a d s M for criteria for
bipolar mood disorder mixed type with psychotic feature had the
(22:35):
delusion of being transformed into a dog. He was also
deluded that he was dead. He was restless, and had
a serious sense of guilt about a previous sexual contact
with a sheep. Coexistence of lecanthropy and Cotard syndrome has
not been reported before and this patient, zoophilic orientation assorted
associated with a sense of guilt were concluded to be
important factors causing his delusions. So he had also like
(22:59):
some guilt going on about a zoophilic encounter. Essentially, yes,
that's that's what the paper is getting at. So a
rather disturbing case all around. I think everyone will agree.
But it's interesting because we're seeing this delusion here. In
this case, perhaps have causes that are less tied to
(23:19):
physical trauma and more to just like severe guilts of
your psychological trauma over over a past incident. Uh. Matt
Soniac has a great blog post about this at Matt
Sonia soni Act. That's m A T T s O
in I A k dot com uh, and he adds
that quote in Persian folklore, the dog is both the
(23:42):
symbol of loyalty and a symbol of impureeness. The man's
sexual history was sheep, coupled with his desire to protect
his sheep daughters and many dogs roles as herders and
protectors of flocks, adds another layer of paradox. So this
is another thing perhaps comparable to whether this is sumption
was correct or not. The The original assumption of Qatar that,
(24:04):
like the Wandering Jew, mythology could figure into the presentation
of this delusion. Here, it's saying like cultural ideas or
beliefs or sort of received associations can also play a
role in how this delusion is manifest because you have
a condition that is causing these symptoms, and then the
mind has to somehow make sense of the symptoms that
(24:26):
it's working with, and for that you often need to
be able to you have to call on cultural motifs
or some some bit of mythology, or some some at
least vague concept of what it means to not be yourself,
what it means to not be alive. Yeah, So a
lot of the the cases we've talked about so far,
cases where the information we have comes from uh well
(24:47):
and in one case at least an interview, but mostly
from sort of clinical observation. So researchers are looking at
these patients and at the symptoms they're presenting and trying
to describe them for for the scientific literat sure, but
I think it's also important to try to get a
picture from people's own first person perspective. So, first of all,
(25:08):
there's an article in the Washington Post in November about
card guitard syndrome and one of the people that tells
the story of in the article is is this this
woman as Mayway Jun Wang and Uh and in thirteen
she came to the conclusion that she was dead. According
to the article, Wang lost consciousness during a long flight
(25:29):
from London to San Francisco, and her doctor has never
found any explanation for the incident. But afterward she began
to experience increasingly strange symptoms of of distress and disorientation psychosis,
losing her sense of reality, and about a month later,
she woke up one morning with a new consciousness of
her situation. And I'm going to quote from the article
(25:52):
uh quote she gives to them quote. I was convinced
that I had died on that flight, that I was
in the afterlife, and hadn't realized it until that moment,
said Wang, now thirty two, who has convinced her husband
and their dog Daphne, were dead as well. And then
her quote continues, that was the beginning of when I
was convinced that I was dead, But I wasn't upset
(26:12):
about it because I thought I could do things in
my life over and do them better. But her condition
did worsen from there. So Whang wrote an essay called
Perdition Days that she posted online about her experience. And
I read this and I really recommend reading it because
it's a really interesting um and I would say, very
(26:33):
well written description of of what it's like first person
to have this kind of experience. So in the essay,
she describes how when she first discovered she was dead
and living in some sort of afterlife, she felt happy,
but this soon decayed into a state of misery where
she began to believe that she was living in a
form of perdition, which is a state of punishment or hell.
(26:57):
And she writes quote, during the perdition days, which had
no rhythm to them, I could not summon the motivation
to do anything. I would not eat, I often would
not move. I would not attempt to read or answer
an email or have a conversation because there is no
point in doing anything when in perdition. Instead, there is
only horror and a physical agitation that refuses to manifest
(27:19):
physically for a lack of motivation. But it does line
up with these other examples. We've looked at this sense
that it's it's not nearly waking up and saying, oh,
I think I'm dead. It's this you feel it odds
with everything in your world, like again, kind of getting
into that negation of everything, that ultimate nihilism though that
(27:40):
almost puts to defined, uh a definition on it, you know,
like it seems like it's it's basically again, it comes
down to your left with this just in human feeling
and you have to make something human out of it
or attempt to with with what you had to work with. Yeah,
so it's obvious that these these cases. And by the way,
(28:01):
I do recommend that the listeners read this essay Perdition Days,
because I think it's really good. Will include a link
to that as well as the other interview on the
landing page for this uh this episode is stuff to
buy your mind dot com. But also I think we
should be asking the question of, well, wait a minute, if,
if what you're just saying is true, Robert, you know
there's this problem with UM, this collection of symptoms being
(28:23):
kind of only very vague and loosely associated while certainly
very real. Um, are are we talking about one coherent
thing when we talk about Guitard's delusion, or instead, are
we sort of are are we fabricating the connective tissue
that's holding all these cases together? Yeah? So this is
(28:44):
this is something that really throughout the history of Guitard's
delusion or Guitard syndrome, you see time and time again.
Is it a true syndrome or is it just a
delutional state that emerges from various other conditions. Now we're
certainly not questioning the reality of the experiences of the
individual people how having this, uh these experiences, But what
are we saying is essentially is it one thing or
(29:07):
are these different things that we're trying to group together
under the same heading. Right, So it's kind of like,
in a broad sense, you have hallucinations, but there are
various forms of hallucinations, and there are myriad reasons for
why one would experience a hallucination. So is this the
case where Guitard's delusion is simply something that emerges due
(29:29):
to various causes? Well, one thing, and I think there's
a strong case to be made for them. Okay, Yeah, Well,
one thing we could do to sort of sort of
help unify or understanding of it is to look at
the cause and effect situation. It has there been a
cause isolated by the researchers who work on this. Uh,
is there something they can point to to say, yeah,
we think when we see coutar this is the most
(29:50):
likely cause. Well, based on the resources I was looking
at there a number of researchers seemed to think that
it boils down to to misfiring in the fusiform face
areas of the brain. Now what is that? So these
are areas involved in facial recognition as well, and also
misfirings in the amigola, which matches emotional response to all
(30:12):
those faces. So again we're getting back to that idea
of the brain's ability to deal with self, to deal
with identities, and to then attribute appropriate emotional responses to
those identifications. Um so how how would this be man
So if you're if you're having trouble recognizing faces and
feeling the correct emotional reactions to them. Um, how would
(30:37):
this manifest as a belief that one was dead or
had lost your existence or identity? Well, you can think
of like one way to think of it is to
think of use of a mirror. And again, this is
not saying that that Cotard's delusion depends on an individual
visual looking in a mirror. But if you have if
you're having, if you're experiencing a lack of emotion and
viewing faces UH and a resulting attachment, and then you
(31:01):
view your own face in a mirror, well then that
could lead to this startling detachment between your sense of
self and the project itself in the mirror. So, in short,
you cease to see yourself as you you end up
you do not exist. It's kind of like the Medusa
staring into the being confronted with a mirror. Do you
just feel that you have turned to stone? Yeah? Yeah, exactly. So.
(31:22):
One thing I came across when reading about this is
that there seemed to be a wide range of different
treatment options that have been tried. The Washington Post article
I mentioned earlier spoke with a psychiatrist named Jesus Ramirez
Bermudez at the National Institute of Neurology and Neurosurgery in Mexico,
and he says he's treated at least fourteen patients with
(31:43):
UH with the Coutard's delusion using a combination of medication
and psychotherapy. Yeah, and that that seems to be UM
the situation you run across that UM, it's coming back
around to the to the the idea that Cotard syndrome
again has not it's it's a it's a battery of
symptoms that emerge from a from different causes, and so
(32:07):
you know, you can't really treat the symptoms. You can
try and control the symptoms, but it's going to vary,
you know, depending on what is actually causing them and
and whether that's being addressed or not. So you see
anti depressants, anty psychotics, and even electro convulsive therapy uh
resulting in some benefits from time to time. Now, when
(32:28):
we mentioned disorders of the recognition of faces, this does
seem related to another type of delusion I've read about before,
the cap Graw delusion. Yeah, yeah, and this is one
that I've at least written about in the past. I
can't remember if I've done any podcast content on it.
I think maybe Josh and Chuck have. But it's it's
a delusional identification syndrome, which generally involves right brain anomalies
(32:52):
linked to a number of illnesses and neurological disorders, ranging
from schizo effective disorder and Alzheimer's disease to severe head injuries,
pituitary tumors, and migraines. Even alcoholism can play a role,
but it basically entails the experience of doppelgangers, thinking that basically,
you encounter individuals in your life, maybe they're even family members,
(33:14):
but suddenly you see them, but there's this mix up
in identity. So you see them, but you think they
are not themselves. You think that, and then if you
try and make sense of that, while they have been replaced,
these are replis. That's how I've heard it explain, is
that you you recognize the person, but you don't think
they're really them. Yeah, you know, my family has been
replaced by impostors. Yeah, so they're there. Definitely seems to
(33:37):
be some strong connective tissue between these two scenarios, again
getting back to that idea that it's a disruption of
the ability to process self and identity. Now, in researchers
ge Barrios and are A Luke presented three different possible
categorizations for Cadard's solusion uh and this was following their
(33:58):
analysis of two d public cations um uh you know,
concerning Guitard's syndrome or delusion. So they they said one
their psychotic depression and this includes patients where uh where
where there's this overhanging sense of melancholy and in this
uh in these nihilistic delusions emerge. And then there's Guitard
(34:20):
type one, they said, which includes patients that represent a
clear case of Guitard syndrome, but more specifically, the delusion
is is prominent in comparison to the depressive picture um
that we already mentioned. And then there's a Gutard type two,
a mixed group, and this is where they patients of
demonstrate anxiety, depression, and even auditory allusions as well. So
(34:43):
even so, basically the take home here is that if
you if you start breaking it down, it's it's not
even that that Qutard's delusion of Quatard syndrome is like
one set of thing, you know, it maybe three different things.
It's a it's kind of depending on it's a battery
of symptoms, and that exact battery of symptoms will differ
from one page into another. Seems like it might be
(35:04):
kind of a what what a working theory, like a
working categorization technique. Yeah, yeah, I think so, because overall
the delusion has been reported as a symptom or or again,
a battery of symptoms, in a number of different underlying conditions,
including migraine, uh neoplasms of the parietal cortex uh serbovascular disease,
(35:30):
and epilepsy, trauma, acute toxic phase of typhoid fever, multiple sclerosis. Wow. Yeah,
again with with such a range of causes and such
a range of different specific presentations, it makes me wonder,
yet again, is this really one thing? Yeah? And and
I think I think that the case is very strong
(35:50):
that it is not that it is that this is
this is something emerges from various conditions. One thing that
makes me think about, and I mentioned it a couple
of times so far, is the role of beliefs in
the four Nation of delusions. We mentioned it with the
Wandering Jew and with the the idea of permit perdition. Um.
So there's sort of like the hardware versus software formulations
(36:10):
of brain function. Right, So if you imagine hardware is
the physical and chemical activity of the brain and the
software or your thoughts and beliefs. Um. When I read
literature about um mental conditions or any disorder of the brain,
it often seems theorized in terms of hardware malfunction, and
(36:33):
there is some kind of malfunctioning of the hardware of
the brain that is producing negative effects in the software.
But I keep thinking about the way the software feeds
back into how the hardware works. Like again, um that
the things we mentioned so far. One thing I thought
was interesting in Wine's essay, she mentions that she came
(36:54):
to believe that she was living in perdition even though
she had never been a Christian, but that was still apparently,
I mean, that was still obviously a script that was
available to her. It's kind of like individuals who who
experience some sort of supernatural occurrence um, paranormal event, and
(37:14):
then there they have to make sense of it. So
they have a few different scripts they can go to
if if they if they want. Yeah. Another experience that
I think is interesting here in terms of how this
reads on beliefs is the reports of people sort of
recognizing the illogical nature of what they're being told and
(37:36):
yet being unable to stop believing it. Like when people
say I'm dead and someone says to them, but you're
walking around and you're talking dead. People can't do that. Uh.
It seems that some of these people who who experience
Guitard's delusion, they recognize that they're like, oh, yeah, you know,
I that's true that dead people can't walk around and stuff,
(37:57):
But yet it is a fact that I'm dead, Like
that is a primary, uh you know, prima facie conclusion. Yeah,
I mean, it's not just a situation where you can
talk somebody out of it and therefore it Yeah, it's
it is interesting to think of it in terms of
the hardware software, because there are these these clear cases
where it's like, all right, clearly there's there's damage to
the brains, some sort of trauma occurred, stroke like scenario, etcetera,
(38:20):
and then that messed up the software. But in other
cases it seems like it might be pure software, such
as the case of the the the Iranian um um
man who thought he was both you know, I mean
not to say there's not some potential physical trauma going
on there as well, that was either uh, you know,
underreported or not reported. But still, you know, one of
(38:43):
the scariest and most troubling things about this delusion is
that in some forms of it, it seems like medical
science is having difficulty helping people. In other cases, people
do seem to have been able to get treatment that
achieved a positive conclusion. In Wayne's essay again, she she
talks about meeting with her doctors and feeling to spare
(39:05):
at the idea that they really didn't have any way
that they could cure this. They were just talking about, like, well,
how much of her life would she have to live, Uh,
feeling these heightened states of psychosis as opposed to relatively
milder periods, And uh, that's just such a horrible thing
(39:25):
to have to be told. I mean, not like it's
the doctor's fault, um, but I would hope that this
is something that we can make progress on. You know,
when people talk about about curing diseases, about medical progressing
curing diseases, they're almost always talking about somatic illnesses, people
having you know, cancer or other problems, And of course
(39:46):
those are worth addressing too, But I but I think
it's really important to help keep up hope for the
for the alleviation and curing of mental illnesses. I agree,
I agree. So, hey, that's it for this episode. But
we know that this probably stirred a number of thoughts
from our listeners, and hey, it's not it's not impossible
(40:07):
that somebody out there listening to this has second or
even firsthand experience with with the Qatar's delusions. So if
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(40:27):
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(40:48):
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(41:08):
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(41:28):
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(42:03):
Joy to pot the potto prop
Welcome to Stuff to Blow your Mind from housetop work
dot com. What seems to be the problem. Well, so
(00:25):
the thing is, dr I am dead? Mm hmm, you're dead?
Well can you explain I'm I'm dead. My organs have
stopped working, They've ceased to function, my heart, my intestines,
my brain. That you're speaking to me right now, well,
(00:45):
I agree, I don't know how to explain that. I
guess I should be quiet, but I need to be
put in a grave. I'm registering a heartbeat, a pulse.
You're certainly breathing now. I think you're just getting the
sound of air moving through the empty skin, empty, I guess,
except for the bones. Everything else feels like it's gone.
(01:06):
It's rotten, melted away. Well, if this were the case,
you wouldn't be able to think, or reason or or
even travel to my office and tell me these things.
Something isn't letting me die. Something not God, I mean,
not not God, but something. Anyway, doctor, I need you
(01:28):
to destroy my body, if that's possible. Hey, welcome to
stuff to blow your mind. My name is Robert Lamb
and my name is Joe McCormick. And that is an
(01:49):
odd scenario that most doctors probably would never find themselves in.
But it is actually not not just a fictional contrivance.
There have been scenarios where a doctor has had someone
show up at their office claiming not that they're dying,
but that they are dead. Yes, yeah, and it would
I mean, it would be comedic if the examples of it,
(02:12):
the actual case studies, weren't so depressing and heartbreaking. And
then the condition itself we're not so real. Yeah. Um,
so this is going to be the subject of today's episode.
What it looks, What it's like to experience being dead
while still being alive. Yes, it is sometimes referred to
(02:32):
as Quatard's syndrome, also Qutard's delusion, and I think delusion
is more accurate based on the commentaries we've been reading
the idea that this is not a a specific affliction
so much as kind of an array of symptoms that
emerges from a few different conditions that can occur neurologically.
(02:53):
So let's go back into history where do we first
see this emerging? That the concept of someone who presents
to a doctor claiming to be dead yet from the
outside there obviously alive. Well, it's an interesting question, and
and some of the individuals who have tackled it have
certainly pointed to examples in myth and legend and saying, well,
this could possibly explain these scenarios. Um. However, it seems
(03:18):
to be that the earliest case of Qatar's delusion, even
though it was not known as Guitar's delusion yet, possibly
goes back to seventy sev UM. And this is when
Geneva naturalist and philosophical writer Charles Bonnet encountered what might
be the early example, earliest example the condition. Uh. And
(03:39):
this was a seventy year old, otherwise healthy woman who
upon experiencing something like a stroke. And this was after
a draft of air hit hit her in the neck,
according to the the studies. I read the same thing
there and she reported a draft of air hit her
in the neck and then she felt like a paralysis
across half her body and uh. And then she was
(04:01):
silent as a corpse for four days. And then when
she opened her mouth finally she demanded burial. That is
a strange thing to demand. Yeah. Yeah, Like I said,
it would be comedic if it weren't so serious. Um.
But yeah, so she seemed to be under the real
persistent idea that she was no longer alive even while
(04:21):
she was alive to tell people this. Yeah, yeah, she so,
she she apparently, it's just very insistent of it, Like
it was very much like a delusion, like something again
that the individual that's believing it is it in completely
invested in it, completely convinced of its of this reality,
no matter how ridiculous it might seem to anyone on
(04:41):
the outside. It's like she became agitated, and she was
scolding her friends for for not for not doing it.
She she asked, she said, I'm not alive anymore. I
need to be buried. Um, you know. They they ended
up calling a doctor, and eventually everybody thought it was
necessary to dress her like a co warps and layer
layer out to calm her down, and they actually had
(05:05):
a sort of funeral for her, like they essentially had
to indulge in her delusion a bit just to to
calm her down, and and she eventually fell asleep and
was undressed and put to bed. But but yeah, how
do you even treat something like this? Certainly well, uh,
Bennet arrived on the scene and he treated her with quote,
(05:27):
a powder of precious stones mixed with opium. And I
guess it worked because he reported that she emerged from
her death delusion. But while she she gave up the
notion that she was dead. She then became became convinced
that she was in Norway with her daughter while she
was actually in Copenhagen the whole time, and insisted that
she needed to return to Copenhagen from Norway. Um And
(05:50):
during this time she was otherwise normal, but she could
not sweep without the opium, So sadly, she ended up
suffering the same condition every three months thereafter. So mean
a reprisal of the idea that she had already died, right,
the idea that she she had died would return, she'd
have to be talked out of it, and then she
would register surprise when she finally learned that she was
(06:12):
in fact alive. Now, I wonder what it's like, um, Like,
what what is the behavior of a person who truly
believes themselves to be dead? Like? What does that entail
for how they act? Well? It seems to vary from
case to case as we look at it, I mean
a lot of it seems to boil down to just
(06:33):
an essential breakdown in conception of self and identity. Instead
of like the like, we all walk around through our
lives with a de facto statement, I am alive. And
you know, maybe being alive is fantastic, maybe it's not,
but we at least begin the sentence with I am alive.
It's sort of an axiom. Yeah, like you, you don't
(06:54):
need to debate this point. But for them, the accident
axiom is vacant. It's it's absent, and in its place
I am dead. I'm clearly not alive. I must be dead,
and then therefore x sometimes that excess clearly I must
be buried, or my body must be destroyed. Or in
some cases it's uh, I'm not alive and yet I exist.
(07:15):
Perhaps I have entered some deathless state, perhaps some afterlife,
some afterlife, etcetera. So it kind of varies depending on
what's going. The underlying conditions that are causing these symptoms
come into play as well, is presumably the the exact,
you know, worldview of the individual afflicted. Yeah. Another thing
that I've read about in many of the cases here
(07:37):
is a sort of denial of life sustaining activities like
the person seems to in many cases lose interest in
eating and going about their business as one normally would
and doing any of the things that would constitute a
life going on. Yeah, sleeping, it's etcetera. Um. Authors Hands
(07:57):
Forstal and Barbara Beats wrote about the the Benet case
for the British Journal of Psychiatry, and they theorized that
the idea of imminent death played a role in this too. Uh,
the the idea of imminent death during the old woman's
stroke overpowered her thoughts at least, and so she regained
full consciousness. Um So, so like while she was having
(08:21):
a stroke, she had the idea that she was dying,
and then in some sort of liminal state following the stroke,
she had not yet overcome the conclusion of that assumption. Yeah,
I mean, because like if the last, if the last
experience you have with like a full consciousness and a
full conception of self is that of oh crap, I'm
(08:43):
about to die. Oh crap, something horrible is happening to
my body. And then when the then then the next
phase you exist in is this altered phase in which
some of your normal neural processes are adjusted. That maybe
the explanation you've all back on that at least is
one one theory. Here's a quote from what they had
(09:05):
to say. The most exceptional and strange ideas can gain
such acceptance if the mind is suddenly thrown from its
ordinary reasoning and forced into a new main idea. A
sudden physical disorder in the brain or a sudden violent
excitement can cause such a change there that we are
pushed beyond insight into its unreasonable nature, because we assume
(09:26):
to notice a correct functioning of our imagination, even in delusion,
which I love that because it I think one of
the things that's fascinating about delusions such as this with
other neurological conditions is that it not It not only
illustrates what is possible in terms of human perception of reality,
but also how ultimately ephemeral the quote unquote normal perception
(09:50):
of reality actually is. Well. Yeah, and it also I
think underlies our our inherent predisposition for a completely a
rational thinking um like Obviously, I don't mean this as
an indictment of people suffering from Catard's delusion. I'm not.
I'm not trying to impugne their rationality, but this seems
(10:11):
to be a thing that's it's latent in the human brain. Uh,
the ability to hold thoughts that are impossible, because in
a strange way, this this is perhaps the most delusional
possible thought, like from a Cartesian point of view. And
what I mean by that is, you know, so Renee
Decartes was trying to come up with an axiom that
(10:33):
he could start his deductive philosophy with, right, um, And
so he could start with like, well, I observe that
I'm in a room. But then you can't actually start
with observations, according to him, because there's no way you
can be certain you're not hallucinating every aspect of your surroundings.
But Decarter eventually said, you know what, I can start
with cogito ergo some I think, therefore I exist, because
(10:58):
I mean, it's pretty much that is true by definition,
it cannot be false. So this syndrome is kind of
some form of the denial of the Cartesian axiom. It's
denying the thing that could not by definition be false.
I think, but I do not exist. Yeah, in this
it would be the ultimate denial, the ultimate nihilism, right yeah.
(11:21):
And indeed this is uh, this is some of the
thinking that the namesake of French neurologist Jewels Qatard had
as well. So again this is this is where we
get the name. Obviously. Uh, the year was eighteen eighty,
so it's about a hundred years after the original KI. Yeah,
and it wasn't ye until later people piece that together. Um.
(11:43):
He received a most curious patient, okay, a forty three
year old woman who believed she had no brain, nerves, chest,
or entrails. She believed she was merely skin and bones
and it quote neither God nor the devil existed, and
that she no longer required food as she was quote
eternal and would live forever. So she requested to be
(12:04):
burned alive and attempted suicide several times thereafter, and then
eventually died of starvation. So this is a pretty pretty
severe and grim case. Well, so what did Quatard make
of this? Well, he initially saw it as an extreme
form of hypochondriasis, you know, hypochondriacts, and he he thought
that this is a this would occur during a severe
(12:26):
psychotic depression. And in many cases this delusion has been
linked strongly to depression, not not in every case, because
there are a lot of different scenarios that seem to
produce similar effects and delusions, but we do see that
as a recurring factor along with like near death or
some traumatic experience. But it has been often linked to
(12:46):
severe types of depression. And he He indeed is a
one that mentioned that tales of the wandering Jew might
be related to bits of myth that extend from such abouts.
So so he's thinking that cultural ideas like not not
just the hardware of the brain malfunctioning, but that software
running on the brain, you know, received ideas or informing
(13:08):
this syndrome or sorry, you shouldn't say syndrome the delusion. Well,
or at least that like these ideas of saying that
they're being an immortal, depressed wanderer out there in the
world might have some ties to this condition, that this
might be the nugget of truth behind such a concept, right,
if you're not familiar, the concept of the wandering Jew
is the idea that, of course uh in in the
(13:30):
New Testament, the Christ predicts that he will return to
Earth before everyone standing before him has passed away. Obviously
a lot of time has passed, and so one solution
to this textual problem is that people assumed that at
least one person standing there listening to Jesus was actually
essentially immortal and had continued to wander the earth since then. Yeah,
(13:51):
essentially cursed because some tellings the wandering Jew laughed at
Christ on the cross. Oh, I don't think i'd heard that.
That's that's the version I ran across recently. So it's
kind of like Highlander, except more anti Semitic. So Inquitard's
later writings on the condition, he he described it as
(14:11):
a nihilistic delusion, a negation of everything, God, food, life
itself quote, a marked tendency to deny everything. Well, then
in this case, it would seem that the way that
we originally characterized it as the belief that one is
dead is actually not the not the overarching nature of this,
but it's sort of like one expression of it. Ultimately,
(14:33):
as Qutard conceived it, it's just a denial of everything,
and the denial of one's own continuing life is one
facet of that. Right. Yeah, if if this absolute denial
enters your consciousness, then even if it's an altered consciousness,
then how do you make sense of it? Um? So
I assume he didn't name this this delusion after himself. No, No,
(14:54):
that wasn't until three uh Emil Regius coined the term
Qatard's syndrome, and it was made famous by Jules Sieglass,
who himself thought that it was all a severe anxious
melancholia rather than a distinct clinical condition. Now, of course,
if it were just two cases, that wouldn't be much
(15:15):
to go on. But of course there have been other
cases of Cotard's delusion, which we'll get to right after
this break. All right, we're back, alright, So, uh, there
have been more than just these two historical cases we
talked about. But it also is not an extremely common condition. Yeah,
(15:37):
it's exceedingly rare um and perhaps even more so in
the modern age, since swift treatment of the underlying psychotic
disorder uh typically occurs. And most studies related to Qatar's
delusion are, of course about a single patient. This is
not the kind of thing where a doctor is going
to encounter multiple Qatard's delusion patients, say with him, you know,
(15:59):
within the core of an entire lifetime, right Like here,
here's this one clinical encounter, Not like I recruited a
group of a hundred people suffering from Qatard's delusion, right, Yeah,
it's that this is, you know, one of those conditions.
It's super rare, probably, but it gets more attention because
it is so alarming. Um. In fact, some of you,
I know we have some Hannibal fans out there. There
(16:20):
was actually an episode of Hannibal where we had the
the sort of killer or character of the week with
somebody with quitards syndrome. Um. But I don't have a
clear enough memory of the episode two to do any
kind of critiquing of it of how they presented it. Well, so,
now that we've seen more cases showing up throughout history,
what are the most common symptoms, Like, how does this
(16:44):
delusion present itself most frequently? Claims of being dead obviously,
of organs missing or having rotten or melted away. Claims
of a missing brain. Oh yeah, I saw that one
with the guy who said I don't have a brain.
I don't know how to explain this, but I just
don't have one. Claims of course of being I didn't
see any encounter where someone actually said hey, I'm a
(17:06):
zombie or I am a litch or something. But that
is they basically explained undeadness. Yeah, they basically are like
I'm not alive, I'm dead. But I'm also in some
sort of protected state, as if in some cases it's
there are a few cases will look at where that
where the individual is saying like, God won't let me die.
But then other times they're just they're just totally negating
(17:28):
God or the devil as well. So, yeah, there's this
sense of what, you know, what what a a Dungeons
and dragons um A fan might term litch um, the
idea that you're not dead, you're not alive, but somehow
death is given you a either a cursed or elevated status. Well,
let's look at some more modern examples of what this
(17:50):
actually looks like in people who present with it. Okay, well,
one interesting case, and we're not going to touch on
all of them, because even though it is rare, there
have been multiple cases. Some of them just aren't particularly
noteworthy or or provide much illumination for our purposes here.
But in two thousand four, there was a case of
an individual by the name of Graham Harrison, and he
(18:10):
attempted suicide by empty entering a bathtub with an electrical appliance.
And the next thing he knew is he awoke in
the hospital and he thought he was dead. So in
this we see we definitely see elements of the traumatic
like occurrence, the near death event, and then waking up
with this condition. And he was indeed diagnosed with Guitard's delusion.
(18:34):
But most interestingly, given the time in which this took
place in the hostile environment, it allowed doctors an unprecedented
uh PET scan peek into the brain of the deathly
deluded here. Oh, so they could get some imaging results
see how the brain of a person experiencing this delusion
looks compared to someone who's not. Yeah, at least in
this particular patient. Yeah, And they found that his brain
(18:55):
wave patterns were were vegetative despite his being awake, so
he had very low metabolic activity across large areas of
the frontal and parietal brain regions. Some of his this
expanse related to the default mode network, which we've covered before.
This is the you know, the constant chatter in your
your head that's uh, you know, questions about the and
(19:17):
worries about the past in future, that sort of thing.
But also the regions afflicted here uh were involved in
formulating theory of mind. Now, one of the researchers who
worked on this case, who was interviewed in an article
and New Scientists about it. Stephen Lori's of the University
of Louisian, Belgium said that the pet scan results were
essentially what you'd expect to see in someone who is
(19:40):
asleep or under general anesthesia. Like you know, so you
mentioned the low metabolism. It was as if the brain
had sort of been shut down. And however, the researchers
also cautioned that this scan could be affected by the
antidepressants he was taking, So you know, we shouldn't draw
too many conclusions from one case, right, but apparently something
(20:01):
had happened to his sense of self. Yes, inde, that's
what's really interesting here, and that's that's what we're going
to see reflected in some of the other cases. We're
gonna look at this idea that that the brain's ability
to conceive self, uh, and and and and indeed to
conceive the identity of others is what is afflicted here. Um. Now, Luckily,
(20:21):
in the case of Harrison here, thanks to psychotherapy and
drug treatment, he was eventually able to overcome these symptoms
and return to something of a normal life. And there's
actually an interview with him in New scientists from a
few years back. You can find it Mindscapes First Interview
with a dead Man. Yeah, and I was just gonna
say that it's an interesting read worth checking out. Now.
(20:45):
In some of these papers, I found reference to an
individual who wanted to erase their body with acid, but
I wasn't able to track down a particular study on
that one. But there were some other interesting cases that
came up, But one of which was a two thousand
five I ran i in case covered in the article.
This is a telling title covered in the study coexistence
(21:08):
of lacanthropy and Qtard syndrome in a single case. Wait, lacanthropy,
that's werewolf syndrome andn't indeed, Yeah, something you don't really
expect to pop up in a in a serious psychological paper. Now,
in the clinical definition, I think like canthropy is what
the belief that one has been transformed into an animal
or behaviors indicating such a belief, right, Yeah, so we're
(21:29):
not talking about actual transformation into a wolf for a
dog or what have you. Uh. This individual is a
thirty two thirty two year old man who arrived at
the hospital and complained a that he was dead and
be that he had turned into a dog both yea,
and that the same was true of his wife and daughters.
Well that I think. He claimed that his wife had
been turned into a dog and that his daughters had
(21:51):
been turned into sheep. That's right, So his delusion of
zoological transformation extended to his family, but not necessary really
the same animal. Now. I claimed that his relatives had
tried to poison him as well. Yeah, I think by
putting cyanide in his tea. Well, that's one tactic to employ.
(22:11):
And he also claimed that God protected him even in
this undead form, which which is interesting. It ties back
into this this theme we see again and again that
they're they're dead, but somehow undying. So what did the
study conclude about this patient? Well, here's the here's the quote.
A patient meeting a d s M for criteria for
bipolar mood disorder mixed type with psychotic feature had the
(22:35):
delusion of being transformed into a dog. He was also
deluded that he was dead. He was restless, and had
a serious sense of guilt about a previous sexual contact
with a sheep. Coexistence of lecanthropy and Cotard syndrome has
not been reported before and this patient, zoophilic orientation assorted
associated with a sense of guilt were concluded to be
important factors causing his delusions. So he had also like
(22:59):
some guilt going on about a zoophilic encounter. Essentially, yes,
that's that's what the paper is getting at. So a
rather disturbing case all around. I think everyone will agree.
But it's interesting because we're seeing this delusion here. In
this case, perhaps have causes that are less tied to
(23:19):
physical trauma and more to just like severe guilts of
your psychological trauma over over a past incident. Uh. Matt
Soniac has a great blog post about this at Matt
Sonia soni Act. That's m A T T s O
in I A k dot com uh, and he adds
that quote in Persian folklore, the dog is both the
(23:42):
symbol of loyalty and a symbol of impureeness. The man's
sexual history was sheep, coupled with his desire to protect
his sheep daughters and many dogs roles as herders and
protectors of flocks, adds another layer of paradox. So this
is another thing perhaps comparable to whether this is sumption
was correct or not. The The original assumption of Qatar that,
(24:04):
like the Wandering Jew, mythology could figure into the presentation
of this delusion. Here, it's saying like cultural ideas or
beliefs or sort of received associations can also play a
role in how this delusion is manifest because you have
a condition that is causing these symptoms, and then the
mind has to somehow make sense of the symptoms that
(24:26):
it's working with, and for that you often need to
be able to you have to call on cultural motifs
or some some bit of mythology, or some some at
least vague concept of what it means to not be yourself,
what it means to not be alive. Yeah, So a
lot of the the cases we've talked about so far,
cases where the information we have comes from uh well
(24:47):
and in one case at least an interview, but mostly
from sort of clinical observation. So researchers are looking at
these patients and at the symptoms they're presenting and trying
to describe them for for the scientific literat sure, but
I think it's also important to try to get a
picture from people's own first person perspective. So, first of all,
(25:08):
there's an article in the Washington Post in November about
card guitard syndrome and one of the people that tells
the story of in the article is is this this
woman as Mayway Jun Wang and Uh and in thirteen
she came to the conclusion that she was dead. According
to the article, Wang lost consciousness during a long flight
(25:29):
from London to San Francisco, and her doctor has never
found any explanation for the incident. But afterward she began
to experience increasingly strange symptoms of of distress and disorientation psychosis,
losing her sense of reality, and about a month later,
she woke up one morning with a new consciousness of
her situation. And I'm going to quote from the article
(25:52):
uh quote she gives to them quote. I was convinced
that I had died on that flight, that I was
in the afterlife, and hadn't realized it until that moment,
said Wang, now thirty two, who has convinced her husband
and their dog Daphne, were dead as well. And then
her quote continues, that was the beginning of when I
was convinced that I was dead, But I wasn't upset
(26:12):
about it because I thought I could do things in
my life over and do them better. But her condition
did worsen from there. So Whang wrote an essay called
Perdition Days that she posted online about her experience. And
I read this and I really recommend reading it because
it's a really interesting um and I would say, very
(26:33):
well written description of of what it's like first person
to have this kind of experience. So in the essay,
she describes how when she first discovered she was dead
and living in some sort of afterlife, she felt happy,
but this soon decayed into a state of misery where
she began to believe that she was living in a
form of perdition, which is a state of punishment or hell.
(26:57):
And she writes quote, during the perdition days, which had
no rhythm to them, I could not summon the motivation
to do anything. I would not eat, I often would
not move. I would not attempt to read or answer
an email or have a conversation because there is no
point in doing anything when in perdition. Instead, there is
only horror and a physical agitation that refuses to manifest
(27:19):
physically for a lack of motivation. But it does line
up with these other examples. We've looked at this sense
that it's it's not nearly waking up and saying, oh,
I think I'm dead. It's this you feel it odds
with everything in your world, like again, kind of getting
into that negation of everything, that ultimate nihilism though that
(27:40):
almost puts to defined, uh a definition on it, you know,
like it seems like it's it's basically again, it comes
down to your left with this just in human feeling
and you have to make something human out of it
or attempt to with with what you had to work with. Yeah,
so it's obvious that these these cases. And by the way,
(28:01):
I do recommend that the listeners read this essay Perdition Days,
because I think it's really good. Will include a link
to that as well as the other interview on the
landing page for this uh this episode is stuff to
buy your mind dot com. But also I think we
should be asking the question of, well, wait a minute, if,
if what you're just saying is true, Robert, you know
there's this problem with UM, this collection of symptoms being
(28:23):
kind of only very vague and loosely associated while certainly
very real. Um, are are we talking about one coherent
thing when we talk about Guitard's delusion, or instead, are
we sort of are are we fabricating the connective tissue
that's holding all these cases together? Yeah? So this is
(28:44):
this is something that really throughout the history of Guitard's
delusion or Guitard syndrome, you see time and time again.
Is it a true syndrome or is it just a
delutional state that emerges from various other conditions. Now we're
certainly not questioning the reality of the experiences of the
individual people how having this, uh these experiences, But what
are we saying is essentially is it one thing or
(29:07):
are these different things that we're trying to group together
under the same heading. Right, So it's kind of like,
in a broad sense, you have hallucinations, but there are
various forms of hallucinations, and there are myriad reasons for
why one would experience a hallucination. So is this the
case where Guitard's delusion is simply something that emerges due
(29:29):
to various causes? Well, one thing, and I think there's
a strong case to be made for them. Okay, Yeah, Well,
one thing we could do to sort of sort of
help unify or understanding of it is to look at
the cause and effect situation. It has there been a
cause isolated by the researchers who work on this. Uh,
is there something they can point to to say, yeah,
we think when we see coutar this is the most
(29:50):
likely cause. Well, based on the resources I was looking
at there a number of researchers seemed to think that
it boils down to to misfiring in the fusiform face
areas of the brain. Now what is that? So these
are areas involved in facial recognition as well, and also
misfirings in the amigola, which matches emotional response to all
(30:12):
those faces. So again we're getting back to that idea
of the brain's ability to deal with self, to deal
with identities, and to then attribute appropriate emotional responses to
those identifications. Um so how how would this be man
So if you're if you're having trouble recognizing faces and
feeling the correct emotional reactions to them. Um, how would
(30:37):
this manifest as a belief that one was dead or
had lost your existence or identity? Well, you can think
of like one way to think of it is to
think of use of a mirror. And again, this is
not saying that that Cotard's delusion depends on an individual
visual looking in a mirror. But if you have if
you're having, if you're experiencing a lack of emotion and
viewing faces UH and a resulting attachment, and then you
(31:01):
view your own face in a mirror, well then that
could lead to this startling detachment between your sense of
self and the project itself in the mirror. So, in short,
you cease to see yourself as you you end up
you do not exist. It's kind of like the Medusa
staring into the being confronted with a mirror. Do you
just feel that you have turned to stone? Yeah? Yeah, exactly. So.
(31:22):
One thing I came across when reading about this is
that there seemed to be a wide range of different
treatment options that have been tried. The Washington Post article
I mentioned earlier spoke with a psychiatrist named Jesus Ramirez
Bermudez at the National Institute of Neurology and Neurosurgery in Mexico,
and he says he's treated at least fourteen patients with
(31:43):
UH with the Coutard's delusion using a combination of medication
and psychotherapy. Yeah, and that that seems to be UM
the situation you run across that UM, it's coming back
around to the to the the idea that Cotard syndrome
again has not it's it's a it's a battery of
symptoms that emerge from a from different causes, and so
(32:07):
you know, you can't really treat the symptoms. You can
try and control the symptoms, but it's going to vary,
you know, depending on what is actually causing them and
and whether that's being addressed or not. So you see
anti depressants, anty psychotics, and even electro convulsive therapy uh
resulting in some benefits from time to time. Now, when
(32:28):
we mentioned disorders of the recognition of faces, this does
seem related to another type of delusion I've read about before,
the cap Graw delusion. Yeah, yeah, and this is one
that I've at least written about in the past. I
can't remember if I've done any podcast content on it.
I think maybe Josh and Chuck have. But it's it's
a delusional identification syndrome, which generally involves right brain anomalies
(32:52):
linked to a number of illnesses and neurological disorders, ranging
from schizo effective disorder and Alzheimer's disease to severe head injuries,
pituitary tumors, and migraines. Even alcoholism can play a role,
but it basically entails the experience of doppelgangers, thinking that basically,
you encounter individuals in your life, maybe they're even family members,
(33:14):
but suddenly you see them, but there's this mix up
in identity. So you see them, but you think they
are not themselves. You think that, and then if you
try and make sense of that, while they have been replaced,
these are replis. That's how I've heard it explain, is
that you you recognize the person, but you don't think
they're really them. Yeah, you know, my family has been
replaced by impostors. Yeah, so they're there. Definitely seems to
(33:37):
be some strong connective tissue between these two scenarios, again
getting back to that idea that it's a disruption of
the ability to process self and identity. Now, in researchers
ge Barrios and are A Luke presented three different possible
categorizations for Cadard's solusion uh and this was following their
(33:58):
analysis of two d public cations um uh you know,
concerning Guitard's syndrome or delusion. So they they said one
their psychotic depression and this includes patients where uh where
where there's this overhanging sense of melancholy and in this
uh in these nihilistic delusions emerge. And then there's Guitard
(34:20):
type one, they said, which includes patients that represent a
clear case of Guitard syndrome, but more specifically, the delusion
is is prominent in comparison to the depressive picture um
that we already mentioned. And then there's a Gutard type two,
a mixed group, and this is where they patients of
demonstrate anxiety, depression, and even auditory allusions as well. So
(34:43):
even so, basically the take home here is that if
you if you start breaking it down, it's it's not
even that that Qutard's delusion of Quatard syndrome is like
one set of thing, you know, it maybe three different things.
It's a it's kind of depending on it's a battery
of symptoms, and that exact battery of symptoms will differ
from one page into another. Seems like it might be
(35:04):
kind of a what what a working theory, like a
working categorization technique. Yeah, yeah, I think so, because overall
the delusion has been reported as a symptom or or again,
a battery of symptoms, in a number of different underlying conditions,
including migraine, uh neoplasms of the parietal cortex uh serbovascular disease,
(35:30):
and epilepsy, trauma, acute toxic phase of typhoid fever, multiple sclerosis. Wow. Yeah,
again with with such a range of causes and such
a range of different specific presentations, it makes me wonder,
yet again, is this really one thing? Yeah? And and
I think I think that the case is very strong
(35:50):
that it is not that it is that this is
this is something emerges from various conditions. One thing that
makes me think about, and I mentioned it a couple
of times so far, is the role of beliefs in
the four Nation of delusions. We mentioned it with the
Wandering Jew and with the the idea of permit perdition. Um.
So there's sort of like the hardware versus software formulations
(36:10):
of brain function. Right, So if you imagine hardware is
the physical and chemical activity of the brain and the
software or your thoughts and beliefs. Um. When I read
literature about um mental conditions or any disorder of the brain,
it often seems theorized in terms of hardware malfunction, and
(36:33):
there is some kind of malfunctioning of the hardware of
the brain that is producing negative effects in the software.
But I keep thinking about the way the software feeds
back into how the hardware works. Like again, um that
the things we mentioned so far. One thing I thought
was interesting in Wine's essay, she mentions that she came
(36:54):
to believe that she was living in perdition even though
she had never been a Christian, but that was still apparently,
I mean, that was still obviously a script that was
available to her. It's kind of like individuals who who
experience some sort of supernatural occurrence um, paranormal event, and
(37:14):
then there they have to make sense of it. So
they have a few different scripts they can go to
if if they if they want. Yeah. Another experience that
I think is interesting here in terms of how this
reads on beliefs is the reports of people sort of
recognizing the illogical nature of what they're being told and
(37:36):
yet being unable to stop believing it. Like when people
say I'm dead and someone says to them, but you're
walking around and you're talking dead. People can't do that. Uh.
It seems that some of these people who who experience
Guitard's delusion, they recognize that they're like, oh, yeah, you know,
I that's true that dead people can't walk around and stuff,
(37:57):
But yet it is a fact that I'm dead, Like
that is a primary, uh you know, prima facie conclusion. Yeah,
I mean, it's not just a situation where you can
talk somebody out of it and therefore it Yeah, it's
it is interesting to think of it in terms of
the hardware software, because there are these these clear cases
where it's like, all right, clearly there's there's damage to
the brains, some sort of trauma occurred, stroke like scenario, etcetera,
(38:20):
and then that messed up the software. But in other
cases it seems like it might be pure software, such
as the case of the the the Iranian um um
man who thought he was both you know, I mean
not to say there's not some potential physical trauma going
on there as well, that was either uh, you know,
underreported or not reported. But still, you know, one of
(38:43):
the scariest and most troubling things about this delusion is
that in some forms of it, it seems like medical
science is having difficulty helping people. In other cases, people
do seem to have been able to get treatment that
achieved a positive conclusion. In Wayne's essay again, she she
talks about meeting with her doctors and feeling to spare
(39:05):
at the idea that they really didn't have any way
that they could cure this. They were just talking about, like, well,
how much of her life would she have to live, Uh,
feeling these heightened states of psychosis as opposed to relatively
milder periods, And uh, that's just such a horrible thing
(39:25):
to have to be told. I mean, not like it's
the doctor's fault, um, but I would hope that this
is something that we can make progress on. You know,
when people talk about about curing diseases, about medical progressing
curing diseases, they're almost always talking about somatic illnesses, people
having you know, cancer or other problems, And of course
(39:46):
those are worth addressing too, But I but I think
it's really important to help keep up hope for the
for the alleviation and curing of mental illnesses. I agree,
I agree. So, hey, that's it for this episode. But
we know that this probably stirred a number of thoughts
from our listeners, and hey, it's not it's not impossible
(40:07):
that somebody out there listening to this has second or
even firsthand experience with with the Qatar's delusions. So if
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(40:27):
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