The Cotard delusion or Cotard's syndrome, also known as nihilistic or negation delusion, is a rare neuropsychiatric disorder in which a person holds a delusional belief that he or she is dead, does not exist, is putrefying or has lost his/her blood or internal organs. Rarely, it can include delusions of immortality.
It is named after Jules Cotard (1840–1889), a French neurologist who first described the condition, which he called le délire de négation ("negation delirium"), in a lecture in Paris in 1880. He described the syndrome as having various degrees of severity, ranging from mild to severe.
It can arise in the context of neurological illness or mental illness and is particularly associated with depression and derealization. In a mild state, feelings of despair and self-loathing occur, however it is in the severe state that a person with Cotard's syndrome actually starts to deny the very existence of the self.
In this lecture, Cotard described a patient with the pseudonym of Mademoiselle X, who denied the existence of God, the Devil, several parts of her body and denied she needed to eat. Later she believed she was eternally damned and could no longer die a natural death.
Young and Leafhead (1996, p155) describe a modern-day case of Cotard delusion in a patient who suffered brain injury after a motorcycle accident:
The patient's] symptoms occurred in the context of more general feelings of unreality and being dead. In January, 1990, after his discharge from hospital in Edinburgh, his mother took him to South Africa. He was convinced that he had been taken to hell (which was confirmed by the heat), and that he had died of septicaemia (which had been a risk early in his recovery), or perhaps from AIDS (he had read a story in The Scotsman about someone with AIDS who died from septicaemia), or from an overdose of a yellow fever injection. He thought he had "borrowed my mother's spirit to show me round hell", and that he was asleep in Scotland.
Neurologically, Cotard's is thought to be related to Capgras's Syndrome, and both are thought to result from a disconnect between the brain areas that recognize faces (fusiform face areas) and the areas that associate emotions with that recognition (the amygdala and other limbic structures). This disconnection creates a sense that the observed face is not the person's it purports to be, and therefore lacks the familiarity that should be associated with it. If it is a relative's face, it is experienced as an impostor's (Capragas); if the sufferer sees their own face they may feel no association between it and their sense of self, resulting in a sense that they do not exist.
Treatment is difficult, and tricyclic and serotoninergic antidepressant drugs have shown little efficacy. Electroconvulsive therapy has shown greater promise, "curing" Cotard's sufferers in five studies of its efficacy with that treatment.
- In the Scrubs episode My Lucky Charm, a character suffering from Cotard syndrome complains of the hardships of being dead.
- British electronic musician Matt Elliott named a song for the condition on his 2003 album The Mess We Made.
- Chuck Klosterman makes reference to Jules Cotard and Cotard's syndrome in his book, Killing Yourself to Live: 85% of a True Story. The protagonist, Klosterman, feels like he might be a victim of the syndrome, especially when he is in airports.
- American serial killer Richard Chase may have had a mild case of Cotard delusion (blood turning to powder).
- In the 2008 Charlie Kaufman film Synecdoche, New York, the main character's surname is Cotard, reflecting his obsession with death and the deterioration of his body.
- In the fictional book The Echo Maker, by Richard Powers, the main character's brother suffers from Capgras Syndrome, as well as a few other delusions, including Cotard.
- Pearn, J. & Gardner-Thorpe, C. (2002) Jules Cotard (1840-1889) His life and the unique syndrome which bears his name. Neurology, 58, 1400-1403.
- Young, A.W. & Leafhead, K.M. (1996) Betwixt Life and Death: Case Studies of the Cotard Delusion. In P.W. Halligan & J.C. Marshall (eds) Method in Madness: Case studies in Cognitive Neuropsychiatry. Hove: Psychology Press.
- Heffner, G.J. Cotard Delusion. The Autism Home Page.