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Notes
It is debated whether Cotard’s original description comprises a discrete pathology or a syndrome that is symptomatic of other mental disorders (Enoch and Ball 2001, p. 169). Note also that Cotard himself did not name the eponymous syndrome. In 1893 Emile Régis introduced the label “The Cotard Syndrome” which was later popularized by Jules Séglas (1987) in Le Délire de Négation (See, Berrios and Luque 1995a; Enoch and Ball 2001).
“[…] she was an elderly lady who insisted on being dressed in her shroud and placed in a coffin. She stayed in it for weeks until the feeling (though not the lady herself) passed away (Förstl and Beats, 1992)” (Enoch and Ball 2001, p. 158).
See for instance Moreau (1973, p. 49). Moreau’s description is of particular interest since it includes a self-experienced episode of the delusion of being dead. The case is discussed below.
Symptoms of depersonalization are typically expressed in terms of a characteristic as-if prefix. Patients tend to say that it feels as-if they are dead, detached, or mechanical and so on, whereas deluded subjects frankly declare with rigid conviction that they are, for instance, dead. The as-if phrase is commonly interpreted as a mark of a non-delusional state.
The numbered order of the listed case reports is arbitrary.
Note in particular nihilistic attitudes toward religion, which are commonly expressed in terms of there being no God. Cotard noted that, “religious beliefs, and especially belief in God, often disappear, sometimes very early in the illness” (Cotard 1882, p. 359).
Reports that highlight an ambiguity between life and death may tell us something important. For instance, that patients do not consider either “being dead” or “being alive” to describe aptly the state they are in, or perhaps that there remains a rudimentary form of insight.
Some cases include a prominent sense of absent feeling (not to be confused with the absence of phenomenal feel as such). Jaspers observes this phenomenon: “This feeling of having no feeling is a remarkable phenomenon. It appears in certain personality disorders (psychopaths), in depressive and in the initial stages of all processes. It is not exactly apathy but a distressful feeling of not having any feeling. Patients complain that they no longer feel gladness or pain, they no longer love their relatives, they feel indifferent to everything. Food does not gratify: if food is bad they do not notice. They feel empty, devastated, dead” (Jaspers 1963, p. 111). Cf. Ramachandran, who argues that the patient’s lack of emotion is one of the chief characteristics of the condition. He writes: “I would predict that Cotard’s syndrome patients will have a complete loss of GSR for all external stimuli—not just faces—and this leaves them stranded on an island of emotional desolation, as close as anyone can come to experiencing death” (Ramachandran and Blakeslee 1998, p. 167).
See, for instance, Fuchs (2005a) for an elaborated account of this conception of corporealisation (or bodily reification) as well as the opposite state, not being able to sense one’s own body. As regards corporealisation, he writes: “Hence, depressed people are preoccupied with bodily malfunctions or possible diseases; hypochondriacal delusions mostly relate to a restriction, constipation, or shrinking of the body, which is experienced as decaying from within or even dying. However, this decay also affects the self in its core: The depressive person cannot retain a position outside of her body, but is dragged into its ruin and destruction. She herself feels shrinking, decaying, and rotting” (Fuchs 2005a, p. 99–100). And further, concerning the loss of bodily sensations, he writes: “It may be understood as a separation of the ‘pure’, unaffected consciousness from the corporealized body, whose depressive heaviness now changes into the opposite, namely, a feeling of lightness or even a complete loss of bodily sensations: proprioception, taste, smell, and even the sense or warmth or pain are missing. At the same time, the environment looks dead; persons and objects seem hollow and unreal, the whole world is emptied. The patients may conclude that they have already died and ought to be buried” (Fuchs 2005, p. 100).
The link between disturbances of embodiment and depersonalisation seems fairly strong. Oliver Sacks (1985) describes a case in which a patient loses the sense of proprioception and as a consequence suffers from depersonalisation. The patient feels like a ghost trapped inside an uncontrollable body. However, not all states including an altered sense of disembodiment give rise to depersonalisation symptoms. For instance, in cases of so-called out-of-body experiences, the subject may feel an enhanced sense of being alive. Moreover, out-of-body experiences are commonly accompanied by a subtle kind of body awareness even if there also is a distinct sense of being out of one’s physical body (See Blackmore 1982). Even if the relation between feelings of deadness and various types of disembodiment is somewhat obscure, an ordinary everyday sense of embodiment seems to be a vital condition for a genuine sense of being alive.
This particular tradition of vampire lore seems to go along with the common assumptions of Doppelgänger dualism, namely, that the soul makes a person properly alive. Cf. Frazier (1922).
Epicurus writes: “Become accustomed to the belief that death is nothing to us. For all good and evil consists in sensation, but death is deprivation of sensation (Epicurus 1926, p. 85). Epicurus’ view is echoed in 20th-century literature by Ludwig Wittgenstein [1922]. He writes: “As in death, too, the world does not change, but ceases” (Tractatus, 6.431). “Death is not an event in life. Death is not lived through” (Tractatus, 6.4311).
Note especially case 7 where the patient says, “I speak, breathe and eat but I am dead”.
Roughly, there are two interpretations of Descartes’ cogito. First, the empiricist interpretation, in which the cogito is a first-order awareness of phenomenal and subjective experiences. By the rationalist interpretation, in contrast, the cogito requires self-reflexive propositional attitudes. Cf. Young and Leafhead, who write: “Returning to Descartes, we can see that these delusions are interesting with respect to his question of what it means to say that one exists. At first sight, the patients are bad philosophers, because even though they say that they are dead or do not exist, they maintain that they can think. This looks like cogito without ergo sum. However, the contradiction may be more apparent than real. What the patients often give as evidence of their non-existence or death is that they don’t have proper feelings. But according to Russell (1961), this is actually close to what Descartes had intended, that is, cogito should be interpreted not just as ‘I think’ but as ‘I think and feel’: […]” (Young and Leafhead 1996, p. 149). I accept the empiricist interpretation for what is required in order to have a psychologically convincing feeling of being alive. I suspend my judgment on whether this is a plausible interpretation of Descartes’ cogito. See Billon (2014a) for a discussion of empiricist and rationalist versions of the cogito in relation to the reasons why we are certain that we exist.
Consider the distinction between experiences of fake kinds (e.g. flowers or toasters and so forth), opposed to fake individual items (specific persons or particulars like the Mona Lisa etc.). In depersonalisation and derealisation both types of experience seem to be common. Abed and Fewtrell (1990) present a study that demonstrates misidentification of familiar inanimate objects. A patient believed that particular items of clothing and a painting on the wall were duplicates of allegedly absent originals. The patient claimed that the real items would be identifiable if present, and subtle differences in the observed objects were confabulated. Note that illusory experiences of fake kinds and fake individuals do not necessarily overlap. For instance, imagine that you perceive something that merely looks like your favourite shirt, a duplicate of the real thing as it were. In such a case, the perceived shirt may still be apprehended as a real shirt, albeit not the particular one that you usually wear.
It is notable that some patients deny their humanity. See in particular case 4, but also cases 7 and 14.
Note the logical difference between a negation of “life”, on the one hand, and the negation of a particular identity in connection with a perceived individual, on the other. If “life” is negated, “death” seems to be the accurate term in so far as “death” is the opposite of life (provided that the item can be alive). On the other hand, the negation of the proposition “this is my father” does not specify who the perceived individual is. So, the expression “my father” has no obvious opposite whereas “being alive” has. Thus, the negation of “life” comes out seemingly more definite than the negation of “this is my father”. Of course, if the individual in front of me is not my father it has to be somebody else, but who it is, is left undetermined.
See for instance, Enoch and Ball who observe that: “It is significant how often the patients themselves use the word ‘doubles’ and ‘impostors’ to describe the misidentified person. One patient categorically affirmed ‘She is her double’” (Enoch and Ball 2001, p. 7–8).
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Acknowledgments
I wish to thank the two anonymous reviewers for helpful comments and suggestions. I also want to thank Börje Bydén, Felix Larsson and Susanna Radovic for valuable criticism. This work was sponsored by the Swedish Research Council (SE–421-2010-1780).
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Radovic, F. The sense of death and non-existence in nihilistic delusions. Phenom Cogn Sci 16, 679–699 (2017). https://doi.org/10.1007/s11097-016-9467-x
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DOI: https://doi.org/10.1007/s11097-016-9467-x