December 8th, 2014
Graham spent his time at the graveyard. His visits would last so long that the local police would find him there, among the gravestones, and bring him back home. He had been suffering from severe depression and several months prior attempted suicide by bringing an electrical appliance into the bath. Graham believed that his brain was dead. He felt he had fried it in the bath. Now living a sort of half-life, stuck between being alive but having a dead brain, Graham’s trips to the cemetery served as the closest connection he could make with death.
Chilling accounts of individuals living with the adamant belief they are dead, like Graham’s, are common among sufferers of a rare and mysterious psychiatric disorder known as Cotard’s syndrome or the Walking Corpse Syndrome.
First described by French neurologist Jules Cotard in 1880, Cotard’s syndrome is a nihilistic delusion characterized by the conviction that one’s own organs, soul, or entire body have been spontaneously destroyed, died, or no longer exist. In denying the existence of the body parts, many patients with Cotard’s will conclude that they are dead and no longer need to eat, sleep, or bathe. Tragically, there have been accounts of people with Cotard’s dying of starvation as a consequence of these delusions.
Currently, Cotard’s syndrome is not recognized as a distinct disorder by the DSM-IV-TR, a manual published by the American Psychiatric Association that outlines the standard criteria for classifying mental disorders; however, the syndrome has been associated with a number of neurological conditions, most commonly appearing with severe depression and/or psychosis.
The prevalence of Cotard’s syndrome is unclear. To date only one study has looked at the question of prevalence. In Hong Kong, case reports of elderly psychiatric patients with diagnoses including major depression, dementia, schizophrenia, and generalized anxiety were retrospectively studied. Of the 349 patients, two individuals, both with major depression, had symptoms congruent with Cotard’s syndrome, suggesting a Cotard’s prevalence of 0.57%. Even without more extensive prevalence studies, it is generally agreed upon that Cotard’s syndrome is a relatively rare condition, making it difficult to study. The available literature on Cotard’s syndrome is largely comprised of single case studies.
A recent case study published in Cortex by Charland-Verville and colleagues is the first of its kind to investigate Cotard’s syndrome using positron emission tomography (PET) imaging and looked at the brain metabolism of Graham himself.
PET imaging allowed researchers to capture 3D images of Graham’s brain and evaluate the relative levels of metabolism across his cerebral cortex. The results of his PET scans were surprising.
PET image of Cotard’s syndrome patient. Regions highlighted in blue indicate lower metabolism. (Charland-Verville et al., 2013)
Extensive low metabolism was observed across several brain regions in the fronal and parietal cortex responsible for conscious awareness and our ability to create a sense of self including the precuneus, adjacent posterior cingulate cortex and mesiofrontal regions. Graham’s brain metabolism was significantly lower and more widespread than what is normally observed in patients with major depression. In fact his brain’s metabolism was so low (a 22% reduction in overall gray matter metabolism compared to normal controls) that it was reminiscent of a brain under anaesthesia, asleep, or otherwise in a vegetative state.
At the time of the PET scan, medication Graham was taking may have factored into why levels of brain metabolism were severely low but it likely does not account for the full extent of the problem. It should be noted that conclusions about Cotard’s syndrome (or any imaging study) should not be drawn from a single patient. With that being said, this data is in and of itself quite interesting. Is reduced metabolism in brain regions critical for consciousness causative of why Graham’s thoughts and perceptions about his brain were altered? Only future studies with additional patients will tell.
Read Graham’s full interview with NewScientist HERE.
Chiu H.F.K. (1995). Cotard’s syndrome in psychogeriatric patients in Hong Kong, General Hospital Psychiatry, 17 (1) 54-55. DOI: 10.1016/0163-8343(94)00066-M
Charland-Verville V, Bruno MA, Bahri MA, Demertzi A, Desseilles M, Chatelle C, Vanhaudenhuyse A, Hustinx R, Bernard C, Tshibanda L, Laureys S, & Zeman A (2013). Brain dead yet mind alive: A positron emission tomography case study of brain metabolism in Cotard’s syndrome. Cortex; a journal devoted to the study of the nervous system and behavior, 49 (7), 1997-9 PMID: 23664000