An earlier illusory death

For such an obscure corner of the medical literature, Cotard’s delusion is remarkably well known as the delusion that you’re dead. This was supposedly first described by Jules Cotard in 1880 but I seem to have found a description from 1576.

It’s worth noting that although Cotard’s delusion has come to represent ‘the delusion that you’re dead’, Jules Cotard’s original description was not actually that – it was a delusion of negation where the patient believed, as noted by Berrios and Luque, that she had “no brain, nerves, chest, or entrails, and was just skin and bone”, that “neither God or the devil existed”, and that she did not need food for “she was eternal and would live forever”.

In its modern use, Cotard’s delusion typically refer to the belief that you’re dead, you don’t exist, or that your body is rotting or absent. It is rare but can occur in severe psychosis.

While spending my weekend reading Basil Clarke’s book Mental Disorder in Earlier Britain (yes kids, I’m like Snoop Dogg but for out of print history of psychiatry books), I found a mention of not one but possibly two cases of Cotard delusion.

They were apparently described Levinus Lemnius’s 1576 book The Touchstone of Complexions, as Clarke recounts:

A ‘Hypochondriake person’ was unshakeably convinced that frogs and toads were eating his entrails. This was accepted, and he was given purges and enemas, the doctor slipping ‘crawlynge vermyne’ into the pot to satisfy him. A case of a man who thought his buttocks were made of glass was incomplete. Another patient had fallen into ‘such an agonie, & fooles paradise’ that he thought he was dead and gave up eating. After a week, friends came into the dark parlour in shrouds and settled down for a meal. The ‘Passioned Party’, on asking, was told that they were dead and that dead men ate and drank. ‘Straightwayes skipped this Pacient out of his Bedde and joined them.’ After supper he was given a sleeping draught.

The mention of the man who believed he had glass buttocks is also interesting as this is the glass delusion, the belief that you are made of glass and might shatter.

This was apparently common in cases of madness during the Late Middle Ages but is now virtually non-existent. Famously, it affected Charles VI of France.

7 thoughts on “An earlier illusory death”

  1. I really like what the Cotard’s patient’s friends did for him, it’s bizarre but such a caring gesture. I don’t know if the ‘Passioned Party’ is the best treatment in all cases, but here at least it seems to have gotten the ill man to eat.

  2. Well this is utterly fascinating to me. I have never heard of this syndrome, but I’ve suffered from both forms of it at times in my life. When I was 22, after failing to get into any graduate schools, I had my first nervous breakdown, and for a time I woke up every morning feeling that I had no skin. I would stay in bed hugging the covers close to me, suspecting that they were the only thing keeping my organs from spilling out. I eventually recovered, met a wonderful woman, got married, finally got into graduate school, and graduated with the beginnings of a promising career in 2008. I was high on life: loving my success, loving the election of Obama, and (in equal measure) loving the TV show “Lost”. Then I found out I had stage 4B Hodgkin’s Lymphoma and had to be rushed into eight months of intensive chemo. When I emerged, I was cancer-free, but I discovered that, while I was semi-comatose, the economy had died, my newfound career had died, I was now facing crushing student loan debt, Obama had lurched to the right, and “Lost” had ended terribly (which as almost as bad, in my mind). I proceeded to have nervous breakdown #2 at age 35, but this time I became occasionally convinced that I had actually died from the cancer, and my wife and friends were too polite to mention it to me, allowing me to continue my delusion of being alive until I finally caught on. This time I saw a therapist, where I got diagnosed with bipolar disorder and heavily medicated. Once again, I came out of it and had two wonderful kids, who have cheered me up quite a bit. Anyway, thanks for giving a name to my troubles.

  3. I don’t doubt that all of this is true but how much of these illnesses or how many delusions could be caused by the environment? I mean, they used antimony and lead in their paint for god’s sake.

    1. I suppose it’s possible that SOME cases of Cotard delusion could be caused by heavy metal poisoning, but most cases of it are caused by bipolar disorder, schizophrenia, psychotic depression, or epilepsy. They don’t use antimony or lead in paint anybody, but people still experience this phenomenon.

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