February 22, 2014
The Mysterious Brain: The Walking Corpse Syndrome
The human brain is a strange and wonderful thing and, like any other major organ, when it goes wrong the results can be devastating. But brain malfunction is different in that it can change a sufferer’s perception of reality. The victim lives in a world that is far removed from “consensus reality,” which is the world that the rest of us see and accept. Some of these malfunctions have bizarre and disastrous manifestations and one of them, Cotard’s Delusion, also known as the Walking Corpse Syndrome, is among the rarest but most distressing of all but recent discoveries about this condition may lead to improved knowledge of more common mental health problems and the working of the mind in general.
People with this illness believe that they or parts of their body, like internal organs or their blood, no longer exist, are putrefying, or are in fact dead. Typically, a patient with Cotard’s Delusion will have previously presented with depressive, psychotic, and hypochondriacal symptoms and, unsurprisingly, when the illness becomes full blown they often find it impossible to lead normal lives leading to self-neglect as their distorted view of the world drives them further and further away from normality.
In one case, a young Scottish man who experienced brain injury after a motorcycle accident came to believe that he was dead. When his mother took him to South Africa he believed that he had gone to Hell and the intense heat there reinforced his “reality” of being a walking corpse in Hell. He had, he thought, died as a result of septicaemia, AIDS, or an overdose from a Yellow Fever injection. He also believed that he had “borrowed my mother’s spirit to show me round Hell” and that she was back home asleep in Scotland.
Cotard’s Delusion is an extreme form of derealization and, clinically, patients have been found to exhibit abnormally high brain atrophy as well as lesions in the parietal area of the brain. It was first described by a French neurologist, Jules Cotard, in a lecture he delivered in 1880 in Paris. He described his experience of one patient – Mademoiselle X – who began to deny that parts of her body existed. She believed that, because of this, she no longer needed to feed herself and she eventually died of starvation after refusing to eat. Her case is sadly typical as other sufferers often resort to this kind of extreme self-harm and have been known to starve themselves like Mademoiselle X or even try to dispose of the body with acid as they believe it has become useless.
New light has been shed on this condition by neurologists who have used positron emission topography to scan the brain of a patient suffering from Cotard’s. Their findings were shocking. In large areas of the frontal and parietal brain metabolic activity was as low as in a patient in a “vegetative state.” It was like observing the brain of a person who is anesthetized or asleep and yet the patient was able to move and interact with the world around him. What seems to be happening is that there is a deficit in the brain’s default mode network – the complex neurological system which controls our consciousness, our awareness and sense of self – in effect our interaction with and perception of reality. These discoveries will hopefully lead to better understanding and treatment of Cotard’s but, perhaps more importantly, the way neurologists comprehend how the brain creates self-awareness and how it can be impaired.