Ilvolo in concert Saturday November 21st TD Colosseum experience an unforgettable evening of soaring arias classic Italian melodies and beloved crossover hits join Ilvolo on a musical journey filled with sensational harmonies you won't forget Visit ticketmaster.com today and experience Ilvolo in concert presented by GELP Productions This episode was suggested by a listener Lou if you'd like to suggest a topic You can do so on Facebook and Instagram at morbid curiosity podcast on Twitter at morbid podcast and on our website www.morbid curiosity podcast calm this episode contains discussions of depression delusions hallucinations self-harm suicide war and trauma If these aren't things you want to hear about this may be a good episode to skip Also, if you think you have experienced any of the symptoms discussed in this episode, please consult a mental health professional right away Humans are fascinated by gore and violence, but even more so the mysterious and unsolved Interest in these disturbing and unpleasant subjects is called morbid curiosity and it has gripped millions of people throughout the ages I am one of those people my name is hally and this is the morbid curiosity podcast Psychosis or the loss of contact with reality has long captured the fascination of both psychiatrists and the public at large It terrifies and intrigues us, especially if we've never experienced the hallucinations and delusions. It causes ourselves We can't imagine being unable to identify what's real and what's not Unfortunately around 100,000 us teens and young adults newly discover exactly what that's like every year one of the more rare delusions Is the firm belief that one is dead or doesn't exist this delusion is called walking corpse syndrome also known as cotard's delusion or cotard's syndrome To date only around 200 cases have been reported worldwide and while it seems like an extreme state of psychosis most people do recover with treatment Before we get into the details some context is in order a delusion is a belief that is clearly false And that indicates an abnormality in the affected person's content of thought the false belief is not accounted for by the person's cultural or religious Background or level of intelligence a person with a delusion will hold firmly to the belief regardless of evidence to the contrary Absolutely convinced that the delusion is real delusions are a symptom of either a medical neurological or mental disorder The ancient Greeks used the term paranoia to describe any mental abnormality similar to how we use the word insanity during the Renaissance The insane were thought to hold specialized knowledge of the limits of the world However near the end of the Renaissance intellectualism began to develop and reason and unreason became more defined the term insanity reappeared in the 17th century And it was largely used as a generic name for mental illness also in the 17th century the so-called great confinement began in Europe Those deemed insane were segregated to the margins of society and then physically confined in institutions such as prisons and workhouses with other people who were considered Anti-social such as prostitutes vagrants and blasphemers this confinement made insane people easily available to medical doctors Which soon led to the study of insanity and the idea that it could be cured like a disease The study of the brain or neurology is actually quite ancient ancient Egyptians described the brain as did ancient Greek Roman era of the Chinese physicians the academic study of the brain and its pathologies began in the 16th century CE with the anatomical texts of the Renaissance Modern psychiatry or the study and treatment of mental illness developed in the late 18th early 19th centuries many of the most influential Psychiatrists which at the time were sometimes known as alienists came from France until the 1880s French schools held a preeminent position in the development of Psychiatric concepts the humanitarian reform of the silums had been introduced in the early 1800s in which the old ways of restraining and imprisoning the insane Were replaced with humane treatment nutritious food wide outdoor spaces and activities state run as silums became more common where patients with mental illnesses were housed and treated as well as studied However by the turn of the century the idea that mental illness could be cured this way was falling out of favor The average number of patients in a silums kept on growing and the funding couldn't keep up a silums quickly reverted to their previous state almost indistinguishable from prisons Jan Goldstein's book console and classify gives an excellent overview of the history of psychiatry in France She suggests that the major popularity of French psychiatrists in the early 1800s lay in their ability to create diagnostic labels Their extensive terminology which included labels like monomania and hysteria disguised the fact that they couldn't actually do anything for their patients except comfort and console them between the 1880s and the 1930s French psychiatry schools developed these diagnostic categories that set them apart They were the first to describe the three most famous delusional disorders cop-grad illusion folia due which has recently been Returned shared psychotic disorder and cotard syndrome as we've already done episodes on cop-grad illusion and folia due Let's talk about cotard syndrome The first clinical report of cotard syndrome also called CS or walking corpse syndrome was presented during a meeting of the psychological Medical Society in Paris on June 28th, 1880 the syndrome was described by jewel cotard a French neurologist who worked under Jean-Martine Charco Known as the father of modern neurology at the renowned Paris asylum la pizzier Cotard originally called the condition hypochondriac delusion, but changed it to de la de negacion in 1882 The collection of signs and symptoms became known as cotard syndrome in 1893 after his death at the 1880 meeting Cotard described the symptoms of one of his patients a 43-year-old woman He referred to as Mademoiselle X the woman believed she had no brain nerves chest stomach or intestines only skin and bones She also felt that her body was decomposing cotard described her condition thus She said she had no soul for her God nor the devil existed and affirmed that she was no more than a decomposition She had no need to eat to live that she would not die of natural causes and that she would exist eternally Cotard reported that the woman asked to be burned alive and had made several attempts to take her own life already Unfortunately, the woman eventually starved to death Cotard categorized the syndrome as a type of depression characterized by symptoms such as anxious malancholia ideas of Domination or rejection in sensitivity to pain delusions of non-existence concerning one's own body and delusions of immortality Today cotard syndrome is described as a nihilistic delusional syndrome nihilism being the philosophy that life is meaningless Nihilistic delusions include delusions about the patient's own body such as believing that they are dead or don't exist or that certain organs are missing or decomposing Patients who believe they don't exist also often believe they have no name age or family They may not remember anything from their past those who believe they are dead might describe how they died Some extreme cases deny the existence of the external world these delusions are often accompanied by depression anxiety Hypochondria feelings of guilt uselessness and of being the source of unhappiness infection or bad luck for those around them as well as Insensitivity to pain and thoughts of suicide one of the common consequences of this syndrome is self starvation due to the belief that food is not required by the dead Cotard syndrome usually affects middle-aged people and is more common in females 89% of cases suffer from severe depression Presentation in younger people is often associated with increased risk of bipolar disorder CS is not mentioned in either the diagnostic and statistical manual of mental disorders fifth edition also known as the DSM-5 or the International classification of disease 10th revision also known as the ICD-10 both of which are considered to be authoritative when it comes to mental health classification However, nihilistic delusions are mentioned in both despite not being included in either manual CS has been divided into several types Psychotic depression is considered to be prerequisite to see us Psychotic depression is severe depression that includes hallucinations and delusional thinking usually featuring persecution and inadequacy Cotards type one is characterized by hypochondriacal delusions or believing that you're seriously ill when you're not nihilistic delusions of the body such as Parts of it are missing or decomposing and nihilistic delusions of existence such as that you don't exist or are dead However, these delusions occur without any behavioral responses to them Cotard type two is characterized by delusions of immortality anxiety Auditory hallucinations and nihilistic delusions of existence unlike type one type two includes emotional and behavioral responses to delusions such as suicidal behavior Self-harm and self-servation three stages of development of the condition have also been proposed The first stage is germination, which is characterized by psychotic depression and hypochondria The second stage is blooming which features full symptoms of nihilistic delusions The final stage known as the chronic stage involves chronic changes in mood and continued severe delusions, which include suicidal thoughts Doctors GE Barrios and R. Luke of the University of Cambridge analyzed 100 reported cases of CS in scientific literature between 1880 and 1995. They found that 89% of those affected presented depressive symptoms 65% presented with anxiety and 63% had feelings of guilt within the nihilistic delusions Those pertaining to the body were found in 86% of patients.
Those contesting their own existence were found in 69% Hypochondriacal delusions were present in 58% and delusions of immortality were present in 55% Within the hallucination spectrum 22% referred to auditory hallucinations and 19% visual hallucinations Nihilistic delusions sometimes occur as part of other mood disorders, psychotic disorders, schizophrenia, dissociative disorders, postpartum depression, and post-traumatic stress disorder, or PTSD Patients with conditions like these can sometimes feel disconnected from the world around them This can manifest as delusions which seem logical to the patient even if they appear bizarre to bystanders A patient may develop nihilistic delusions after being ignored or silenced as an expression of the feelings associated with those experiences The patient has no control over these delusions They occur because the brain is doing something that the patient is not conscious of And if they are conscious of it, they can't control it without help from professionals Similar to CS, our depersonalization and derealization Depersonalization or DP is a feeling of being disconnected from oneself You may feel like an automaton or that you're watching your body from a distance Many people experiencing depersonalization feel as if they're dead but don't believe that they are Derealization or DR is when one feels disconnected from reality as if they're in a dream Things seem to move in slow motion around them Both depersonalization and derealization are forms of dissociation and feature in skitsotypal and borderline personality disorders as well as PTSD It's also its own disorder called depersonalization derealization disorder or DPRD when experienced chronically DP and DR can also happen to neurotypical people usually in times of stress or extreme fatigue But it's not long lasting While CS usually develops psychologically, it can also develop as a result of physical issues Such as central nervous system infections, cerebrovascular disease, central nervous system neoplasms, or traumatic brain injuries I'll get into the causes of cotard syndrome after the break While the delusion itself is quite extreme, most of the behaviors associated with CS might be subtle People suffering from CS may be socially isolated Visit the doctor often, neglect their hygiene, stop speaking, suffer from insomnia, and stop eating Some may have the desire to go to or hang around in or near cemeteries or morgues Because they feel that they belong there, they might stop moving around completely Chronic sufferers of CS however may engage in extreme and irrational behavior There was a case reported of an elderly woman who demanded to be dressed in a shroud and placed in a coffin She later wanted to be buried One patient was reported to have stabbed himself multiple times in an attempt to prove that he had no blood because he was dead Chronic patients may try to end their own lives or go to extremely dangerous lengths to prove they can't die because they're already dead One patient attempted to cut her own head off with a chainsaw There are several schools of thought about what causes cotard syndrome, but before we get into that, let's pause for a word from our sponsors If you like this podcast, why not sponsor the MCP yourself by becoming a patron on Patreon? Over 45,000 people download this podcast every month, but only around 140 people are supporting us on Patreon For a mere dollar in episode that's $2 a month, you can get ad-free episodes, bonus behind the scenes info, give your opinion by answering polls, have access to all the horror story readings, and get updates on past episodes For $3 an episode, you get monthly outtake reels For $5 you get a monthly quiz episode where I quiz my husband on past episodes For $10 you get a detailed bibliography of all the resources I've used while researching an episode And for $20 you get a bit of miscellaneous morbidity, a short essay on a random morbid topic every month Previously we have reviewed horror video games and television shows, discussed the plague pits of London, and tried out historic recipes from previous episodes All of these rewards aside, your patronage supports the podcast and keeps new episodes coming I can't keep doing this podcast without you, so go to bit.ly slash morbidpatreon, that's b-i-t.ly slash morbidpatreon, to choose your rewards and support the MCP You'll have my eternal gratitude, and now back to the podcast One theory as to the cause of cotard syndrome is that it's a delusional misidentification syndrome, or DMS The patient can identify people, places and things, but doesn't recognize them, or find them familiar For example, when you see a loved one, you recognize them and feel warm emotions toward them, usually subconsciously With a misidentification syndrome, you can identify that that's your loved one, but there's no feeling associated with them They seem off, strange, unfamiliar The mind tries to make sense of this abnormal perception, bringing about delusions Researchers, young and leaf head, suggest that, as the brain tries to make sense of the abnormal perceptual experience, the pre-existing depression of the patient Exaggerates the negative effects of this feeling, whilst correctly attributing the change to the patient themselves The lack of emotional response, feeling of emptiness, derealization and depersonalization, leads the patient to believe they themselves are soulless, empty, and dead This theory also proposes that cotard delusion is a different interpretation of a similar anomalous experience However, the patient attributes the change to others instead of themselves In a patient without severe depression, the patient assumes that something is wrong externally, with whoever they are seeing and not reacting to normally The patient knows the subject looks the same, but they don't elicit the feelings of familiarity, therefore they must be imposters In summary, this theory proposes that both syndromes are due to abnormal perception, most likely due to lesions or dysfunctions in the brain areas, that are involved in processing emotional recognition But whether this develops into cotards or cocross delusion depends on the patient's attribution style, either internal depressed for cotards or external paranoid for cocross Dr. Philip Gerens has suggested that cotards and cocross can be differentiated in another way He suggests that the patient's entire emotional processing is destroyed or suppressed, resulting in feelings of disembodiment When that combines with psychotic depression, cotard's delusion develops as a response to the feelings of disembodiment and depression Cocross doesn't often include depression, and when it does, it soon develops into cotard syndrome However, these theories don't explain why some patients experience nihilistic delusions about only parts of their body, or deny the existence of objects or people outside of themselves It also doesn't explain cases in which cotard syndrome and cocross syndrome occur at the same time in one patient Also, despite believing they are dead, many patients do express emotions, such as anxiety, fear, guilt, distress, and even sometimes euphoria So it's unlikely that the absence of emotions is central to the condition There is some evidence that cotard syndrome is associated with lesions on parts of the brain and brain atrophy Many CS patients exhibit abnormal changes, most commonly vascular lesions, or abnormal tangles of flood vessels, on the right or sometimes both sides of the brain No part of the brain works completely alone, but the right side of the brain, sometimes called the non-dominant side, is associated with visual and intuitive processing While the left is more involved in verbal and analytical processing Each side has several areas called lobes that specialize in certain functions I won't go into detail because the brain is a very complicated organ and its function is far beyond the scope of this podcast Studies have demonstrated that increased cerebral atrophy on both sides of the brain and right middle frontal lobe atrophy are particularly common in patients diagnosed with CS The frontal lobe contains the premotor cortex, which is deeply involved in memory, concentration, and personality It also contains the cingulate cortex, which is involved with emotion formation and processing, learning, and memory Disruption of right fronto-parietal temporal networks, as well as temporal parietal dysfunction, has been implicated in disorders such as schizophrenia and bipolar disorder In these conditions, corporeal awareness, which is the integration of information from both outside and inside the body to form a coherent and accurate mental experience of the state of the body, functions abnormally The affected areas of the brain, the frontal parietal and temporal lobes, are associated with processing sensory information, recognition, and visual memory If the left brain is functioning properly, while the right brain, especially the frontal, isn't, this may cause false nihilistic beliefs You see people you know are familiar, but they don't feel familiar, or you yourself feel emotionless, hollow, and dead A positron emission tomography, or PET scan, which measures the metabolic or biochemical function of tissues and organs, was done on one quatard syndrome patient The results showed that metabolic activity across large areas of the frontal and parietal lobes of the brain was so low that it resembled someone in a vegetative state These areas of the brain are very important for memory and core consciousness, as in its thoughts about the self, knowing we are the agents of our actions and our sense of self Because this is the only scan done on a person experiencing cratard syndrome, we can't draw too many conclusions, as we have nothing to compare it to Still, it's interesting, and seems to support the theory of frontal and parietal brain involvement in the delusion Trauma is also thought to be part of the development of cartards delusion Physical trauma refers to bodily injury, in the case of cartards delusion, this is usually a head injury, or perhaps the infection of a head injury, in the parts of the brain that we just discussed Psychological trauma is an emotional response to a deeply distressing or disturbing experience The experiences that can cause trauma are different for everyone, meaning one incident may not cause trauma in one person, but can hugely affect another General nihilistic delusions are primarily due to profound stress and trauma Patients may create an alternate reality where people, places and things no longer exist as they once did, usually in reaction to a traumatic event that causes a disconnect or break with reality Brain areas involved in memory, including the hippocampus amygdala and prefrontal cortex, are usually the most affected by psychological trauma While CS is rare, it does appear more often in people with other forms of psychosis, such as schizophrenia, which are often due to changes in the brain brought on by psychological trauma An example of a whole population of people who seem to have developed a condition very similar to CS due to trauma are the Tamil people of Sri Lanka This culturally dependent version of walking corpse delusion shares some symptoms with the western version of the condition, but it's specific to this population A bloody 26-year war erupted in Sri Lanka between the Senalese ethnic majority and the Tamil ethnic minority in 1983 Until 2009, Tamil people experienced indiscriminate shelling, massacres, civilian displacement, abductions, disappearances, torture, and extrajudicial killing of Tamil civilians Four distinct waves of Tamil refugees migrated out of the country in 1984, 1999, 2006, and 2009 Currently an estimated 1 million Tamil people, around a quarter of the Sri Lankan Tamil population in total, live outside of Sri Lanka A unique pattern of psychological complaints developed in war traumatized Tamil men during a study conducted in Toronto The words the patients used were floppy or flaccid mind, it's seen at first like a new category of mental illness, but it's now thought to be part of a larger culturally specific condition called nebipinam or walking corpse Patients described feeling like a zombie, basic body functions are happening, but they are unaware, not consciously in control of or able to remember their actions, thoughts or emotions, which are often muted or not present at all Worries and memories of trauma usually trigger acute attacks, but the patient can't remember what triggered it The cause is most likely psychological trauma due to prolonged exposure to war The Tamil people most affected are married men with children or mothers with young children The patients believe they have failed in their duties to protect their family, which is a version of traumatic guilt nebipinam is not the same as Cotard syndrome, but there are many similarities in the symptoms Tamil psychiatrists in Sri Lanka compare it to early onset dementia with depression Different communities and cultures explain and exhibit mental health symptoms in different ways It's important for clinicians to be aware of relevant cultural context in order to properly diagnose and help Culturally specific syndromes can't be treated without knowledge of the culture Under specific conditions, Cotard syndrome can occur as a reaction to certain medications Anti-viral medications, acyclovir and valasyclovir has caused Cotard syndrome to develop in patients with weakened kidneys In one case study, a 25-year-old woman with a failing kidney transplant was given valasyclovir to treat a viral infection By her third day on the medication, she described her body as unfamiliar and began suffering from visual and auditory hallucinations On day four, she could barely walk and cried out in terror She began dialysis and within 45 minutes, she stopped screaming and could speak After an hour, she was able to explain that she was convinced she was dead After two hours, she had calmed down, but her body still felt unfamiliar After dialysis was complete, she still had difficulty walking and was afraid that she was dead Once she was taken completely off valasyclovir, her symptoms disappeared overnight This drug reaction supports the theory that CS is neuropsychiatric in origin Meaning it can occur due to both neurological and psychiatric causes Cotard syndrome has also been associated with other brain disorders such as Parkinson's disease, chronic migraines, brain tumors, and multiple sclerosis Recently, Cotard syndrome has been found in association with the COVID-19 virus The COVID-19 pandemic has had a significant impact on mental health globally Prolonged psychological and psychosocial stressors such as fear of disease and or death, unexpected losses, the imposed isolation, and insecurity about the future Combined with inadequate coping mechanisms can lead to psychiatric symptoms The most common COVID crisis-related mental health problems are insomnia, anxiety, and depression However, there have been rare cases of COVID-related reactive psychosis in COVID-negative individuals, including healthcare workers The COVID-19 infection itself is thought to cause various neuropsychiatric symptoms Around 34% of patients are diagnosed with a neuropsychiatric disorder in the following six months after recovery from COVID-19 These psychiatric symptoms range from delirium to long-term fatigue with the most common diagnosis being mood or anxiety disorders The estimates for the incidence of psychotic disorders after COVID-19 infection are relatively low 1.4% for all psychotic disorders and 0.42% for the first onset of a psychotic disorder However, the rare reports of first onset psychosis do include homicidal and suicidal behavior One case was especially extreme A middle-aged man had a mild to moderate case of COVID-19 pneumonia He had no psychiatric symptoms during the hospital stay and was discharged once his symptoms cleared up and he tested negative for the virus Once home, however, he couldn't sleep Then he believed the virus had caused permanent damage and that he wasn't cured He accused the doctors of faking negative results On the third day after his hospital discharge, he became highly agitated and smashed the walls and doors of his home He acted physically aggressive towards his relatives, saying that he wanted to save them from their misery Once admitted to a psychiatric unit, his mental state began to fluctuate He was suspicious, disoriented, and suddenly aggressive He said he was dying or that he was already dead and refused all medications, food, and liquid He had hypochondriac, denialistic delusions that he was still infected with the virus He was sure that he had died and that his organs were rotten No physiological cause of his symptoms could be determined, but his psychiatric symptoms were definitely fixated on COVID-19 As I said earlier, while the symptoms are often extreme, Cotard syndrome usually has a good prognosis Recovery may occur suddenly and seemingly spontaneously, even when the case is severe and chronic Treatments have included psychotherapy, behavioral therapy, and medications such as antidepressants, antipsychotics, anti-convulsants, sedatives, and in the case of the acyclovir removal of the offending drugs Generally, treatment of the underlying condition usually alleviates the delusion Currently, the most effective treatment for Cotard syndrome is electroconvulsive therapy ECT historically has a bad reputation due to overuse in the mid-20th century Before anesthesia and muscle relaxants, the ECT procedure was quite dramatic for the patient, causing a full-scale seizure with the rare but serious side effects of bone fracture and dislocation It was also quite disturbing for those who witnessed the treatment In the 1950s, better-regulated muscle relaxants and anesthesia were used in combination with the ECT, making it both safer and less painful However, the use of ECT soon dropped dramatically in favor of antidepressants The negative depictions of ECT in the media, such as the 1962 book One Flew Over the Cuckoo's Nest by Ken Casey, also made it unpopular This negative association still exists today, and ECT remains controversial due to the memory loss and other side effects associated with it However, when used in combination with the right anesthesia and muscle relaxants and shorter births of electricity at smaller amplitudes that are standard today, ECT is effective for a narrow range of severe psychiatric disorders, including Cotard syndrome Psychosis is both terrifying and fascinating Millions of people experience it and yet it still seems to be a taboo subject in Western society There's stigma surrounding psychosis as well, such as the prevalent fear that those who suffer from it are dangerous While some cases do include violent behavior, the person suffering from psychosis is far more likely to hurt themselves than someone else This is especially true of Cotard syndrome Thankfully, we are in an era of medicine where there are treatment options and while Cotard syndrome seems extreme, most people do recover from their delusions of death Still, the cause of the condition and its fixation on death is mysterious, which is why walking corpse syndrome ignites our curiosity The Morbid Curiosity Podcast was produced by H. Lloyd If you'd like to get in touch or suggest a morbid topic for me to talk about, you can tweet the show at Morbid Podcast or find us on Facebook and Instagram at Morbid Curiosity Podcast If you like the show, please share us on social media and please give us a rating on Apple Podcasts or whatever podcast app you use Your shares and ratings help us expand this wonderfully creepy community Thank you to everyone who liked, commented, followed and shared the MCP on social media Crystalline S and Morgan S both have my eternal gratitude for becoming patrons Thank you so much Because of you, the listeners, our creepy community is growing, especially on Facebook, so head over there to engage with other listeners, discuss episodes, suggest topics, and share your own morbid curiosities The MCP has joined the Straight Up Strange Podcast Network, which hosts true crime, paranormal, history, science, folklore, and other enigmatic podcasts Nothing is off-limits when you enter the world of Straight Up Strange The MCP is also part of a wider creepy community known as the Belfry Podcast Network Check out other shows on the Belfry Network at www.thebelfry.rip If you want to support the MCP but would rather not become a patron on Patreon, you can give one-time donations by going to our website, www.morbidcuriositypodcast.com And clicking the donate button Also on our website, you'll find links to all our social media, a list of episodes, and other ways to contact us, including our mailing address Another way to help the show is by visiting our Amazon Wishlist at bit.ly slash Morbid Wishlist That's B-I-T dot L-Y slash Morbid Wishlist Any purchases from this list are greatly appreciated We are eternally grateful for your support My name is Halley, and until next time, thanks for listening Beatboxing actually has hidden health benefits, it can help strengthen and protect Your voice from injury, see healthy living differently with Manulike, visit manulike.ca slash health